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Methow Valley

Health & Wellness 2012/2013

A supplement to the Methow Valley News

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Methow Valley

Health & Wellness 2012/2013 Don Nelson, publisher/editor Sue Misao, design Robin Doggett, advertising manager Callie Fink, advertising Dana Sphar, ad design/production Linda Day, ad design Marilyn Bardin, office manager Janet Mehus, office assistant

Contributors Mike Maltais Ann McCreary Joanna Smith Marcy Stamper Laurelle Walsh A publication of the Methow Valley News PO Box 97, Twisp, WA 98856 509.997.7011 • Fax 509.997.3277 editor@methowvalleynews.com www.methowvalleynews.com

Making good

choices

The uncertainties about individual health care have never been more challenging. Who’s going to provide it? How convenient will it be? What will it cost? How will we pay for it? How will we make good choices from among complicated options? Those questions are more pressing for those of us who live at some distance from major medical centers and the concentration of health care providers they attract. We look to our local providers for not only primary care, but also advice and direction for living healthy lives and attending to health issues as they arise. That’s part of the lifestyle choice we’ve made, but it doesn’t need to be limiting when it comes to taking good care of ourselves and our loved ones. Our annual Health & Wellness special publication is intended to help with those challenging health care questions, through the topical articles we provide and by connecting you with our advertisers: local medical services, alternative care providers who tend to body, soul and mind, and related businesses. All of these taken together provide the Methow Valley with a variety of options and philosophies for overall well-being. We hope Health & Wellness will help you learn more about them. –Don Nelson

Table of Contents Women and children first Prenatal, postnatal and pediatric services.....................p. 4 Rethinking the rural hospital Mid-Valley, Three Rivers diagnose the future..........................p. 6 Emergency help is close by Valley’s responders are there when you need them........................p. 8 Seniors face special challenges Finding the best health care, living arrangements......................p. 10 It’s all about prevention Dental health requires personal commitment...................................p. 12 Directory of advertisers Supporters of this guide................p. 15 Cover photo: Hula hooper Nancy Daniels at The Studio in Twisp. Photo by Sue Misao

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Women and children first: a guide to Methow Valley resources By Joanna Smith With its blue skies, clear streams and organic farms, the Methow Valley is a healthy place to raise and nurture children. The Methow Midwifery & Women’s Health clinic in Twisp works closely with Three Rivers Hospital in Brewster to provide a full range of health care services and education for pregnant women and their partners.

Prenatal & postnatal care

There are three family practice clinics in the Methow Valley which offer pregnancy screenings and pediatric care. But for prenatal visits, women are directed to Methow Midwifery & Women’s Health in the North Glover Healing Center in Twisp. To prepare for your initial visit, Methow Midwifery & Women’s Health has an informative website, www. methowmidwifery.com, complete

4 HEALTH & WELLNESS

with forms that you can fill out prior to the first visit. Methow Midwifery & Women’s Health is operated by Blue Bradley, a Certified NurseMidwife (CNM), Advanced Registered Nurse Practitioner (ARNP). Services include prenatal care, home and hospital births, postpartum home visits, newborn care, well-woman exams and holistic health care for women of all ages. Bradley performs the same schedule of prenatal visits as a doctor and schedules her visits for one hour. She provides, on average, more education and discussion on what to anticipate than a traditional 15- to 30-minute doctor consultation. At her clinic in Twisp, Bradley performs routine blood draws for a standard OB panel and offers both home and hospital births. Bradley most often works with Three Rivers Hospital (formerly Okanogan-

Photo by Sue Misao

The Methow Valley is a healthy place to raise and nurture children. Douglas District Hospital) in Brewster. Three Rivers, www.threerivershospital.net, has newly remodeled birthing suites and is one of only 125 hospitals in the United States to be certified “Baby Friendly” for its world-class standard of

maternity care. The North Glover Healing Center offers other prenatal and postnatal services such as pregnancy massage and Jin Shin Jyutsu. Tracy Bocarde Sprauer is certified in pregnancy massage, used to relieve tension and strain on the body during pregnancy. Massage brings the body into optimal alignment, resulting in easier labor with fewer complications, says Sprauer. One of the main benefits is “the increased awareness of what is happening … [Massage is] a wonderful adjunct to the primary care women receive.” Christine Schlotzhauer offers Jin Shin Jyutsu prenatal care at the North Glover Healing Center and also works with post partum babies. Jin Shin Jyutsu is an ancient practice of harmonizing the life energy in the body. Similar to acupressure, this gentle art focuses on the needs of the mother and

the developing systems in the baby during the “nine months of creation.” A variety of discomforts can be treated with Jin Shin Jyutsu: morning sickness, backaches, blood pressure and other concerns. After delivery, Jin Shin Jyutsu can assist the baby with digestive distress, nursing, sleep problems and more. Self help is at the core of this art, says Schlotzhauer, who teaches parents different ways to hold their baby that enable them to support the baby’s well being. For postnatal care, Elaine Marquez – also at North Glover Healing Center – offers cranio sacral therapy. After babies come through the birth canal, their cranium and mouths may not be aligned, making it difficult to breastfeed. If babies are having difficulty gaining weight, Marquez uses gentle natural movements to realign the cranium and mouth.

vigorous activity like walking or yoga. The Methow Valley is home to the largest interconnected trail system in the United States, with more than 120 miles of groomed trails accessible year-round, courtesy of the hard working people at the nonprofit Methow Valley Sports Trail Association. The website www.SkiTheMethow. com is updated daily with weather forecasts and trailhead information about the routes that include suspension bridges along the picturesque Methow River, majestic views of the North Cascades, shaded forests, wildflower meadows and local cafes in downtown Winthrop, where you can satisfy your prenatal cravings for sweet ice cream and salty pickles. Group workouts are fun and excellent ways to meet other moms. Becky Studen offers both prenatal and postnatal yoga classes at The Studio in Twisp. For more information see www.thestudiomethow.com/ classes/yoga.

Structured classes help prepare you and your partner for the rigors of labor and delivery. Going together can decrease anxiety while getting both partners involved in the early stages.

Stay fit

Regular exercise can alleviate some of the aches and pains of pregnancy and will help you develop the strength and endurance you’ll need both during your pregnancy and after. Choose a safe, moderately

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Education available

Methow Midwifery & Women’s Health offers childbirth education classes for new parents. Relaxation exercises, birth videos and many different tools are incorporated into the sessions to help couples cope with labor, newborn and early postpartum basics, breastfeeding and more. If you’re planning to breastfeed your baby, learn as much as you can before the baby comes! Talk with other mothers and your practitioner to learn what to expect. Methow Midwifery and Three Rivers Hospital offer assistance in helping both you and your baby learn how to nurse. Room One offers a Mothering Group for moms and a Parenting Group for dads that offer support and educational meetings.

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Room One in Twisp offers a multitude of resources for expectant parents (www. roomone.org). The Baby Goods Exchange Room is filled with maternity clothes, infant and toddler clothing, cribs, breast pumps, car seats and more. The Baby Goods Exchange Room is an active recycling program that is open to all Methow Valley residents. To help people connect with services and resources, including pregnancy medical insurance, Room One has an online portal to Washington Connections at www. washingtonconnection.org, and offers assistance in filling out applications. Hosted programs at Room One offer resources for families, including family planning, WIC and wellness checks.

Choose a pediatrician for your baby by asking for recommendations from your pregnancy caregiver, friends, coworkers and neighbors. Make sure the doctor accepts your health insurance, keeps hours that work with your schedule and has an office that’s convenient for you. These valley clinics offer pediatric services:

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Finding a pediatrician

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Regular exercise helps builds strength that is needed during pregnancy and after.

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HEALTH & WELLNESS 5

Rethinking the rural hospital By Ann McCreary Problems confronting the nation’s health care system are magnified for rural hospitals such as Mid-Valley Hospital in Omak and Three Rivers Hospital in Brewster. The two 25-bed hospitals are struggling to remain financially viable and to continue providing high-quality care in the face of challenges presented by their remote location, small size, limited work force and constrained financial resources. Looking toward the future, administrators for Mid-Valley and Three Rivers say that the only thing that’s certain for rural hospitals is that things are going to change. “We believe that between now and 2017, there will be substantial realignment of health services delivered in the Okanogan country. There are a lot of options and variables in response to the pressure to realign and squeeze dollars and become more efficient,” said Mike Billing, administrator of Mid-Valley Hospital.

6 HEALTH & WELLNESS

“In order for a rural provider to be successful, you’ve got to find a way to get affiliated with a larger, regional player in Spokane, Wenatchee, Seattle,” said Bud Hufnagel, chief executive officer of Three Rivers Hospital. “If you don’t do that, you’re a dinosaur – you’re going to go away. That’s true of any rural hospital in the state of Washington. It’s going to take awhile, but that’s where we are going.” Both administrators say small hospitals like theirs will have to develop new partnerships and consolidate services to continue providing highquality care in the face of enormous challenges.

Rural hospitals threatened

The American Hospital Association (AHA), in a 2011 report, said the 72 million Americans living in rural areas rely on their small community hospitals as an important source of care. Those 2,000 rural hospitals are often among the largest employers in the community. But the changing nature of health care, combined with the economic downturn, threatens these hospitals far more than their urban counterparts. “Rural residents tend to be older, have lower incomes and are more likely to be uninsured than residents of metropolitan areas,” according to AHA. “Insufficient Medicare and Medicaid reimbursement is compounded by the problem of the uninsured in rural communities.” When rural employers – many of them small or family businesses – do not provide health insurance, hospitals are required by law to provide treatment to those uninsured patients, and must absorb the costs. Many

Douglas District Hospital last year and is working to increase its visibility and attract more patients – especially from the Methow Valley, to the facility. But both hospitals continue to borrow money from Okanogan County to support day-to-day operations. Mid-Valley borrows money periodically during the year, and Three Rivers has reduced its debt from $3.2 million to $2.4 million. Photo by Sue Misao

Okanogan County’s rural hospitals are feeling the budgetary crunch. rural residents either make too much money to qualify for government assistance or, like many residents of Okanogan County, are ineligible for government health care programs because they are undocumented immigrants. “Together these challenges – small size, service mix, dependence on public programs and high numbers of uninsured – make small and rural hospitals less able to weather financial fluctuations,” AHA said. “The pressure to reduce

the costs of health care will vastly increase,” said Billing. “We dropped about 30 positions and redistributed the workload in 2009. We trimmed staff in many areas but kept the services.” Three Rivers Hospital has also cut staff and closed an assisted living facility and a clinic in Mansfield to cut costs. The hospital board last year hired Hufnagel, a health care consultant, with a mandate to work toward a “turnaround.” The hospital changed its name from Okanogan-

New service model needed

In the not-too-distant future, both facilities will need to move to a new model of service, the hospital executives agree. Rural hospitals are seeing a shift from inpatient to outpatient care. “We used to be 60 to 70 percent full all the time, and now we’re lucky to be 30 percent full,” Billing said. “Where we are going with this is more to an outpatient delivery mode,” Hufnagel said. “The expectation in terms of number of beds will probably change to be something less than 25. Perhaps around 15 beds total.” Hufnagel said patient care

at Three Rivers and other rural hospitals is moving toward a model in which “larger and more complex specialized services would be provided at a larger, regional facility, and follow-up and rehab care would be provided closer to home.” Aligning with other rural hospitals will also help hospitals attract skilled specialists and support expensive medical equipment. Hufnagel said he is in “preliminary discussion” about this type of partnership with Lake Chelan Community Hospital. “We’re talking about the things we might be able to do, and things they might provide,” Hufnagel said. “We might be able to share a general surgeon, or share some specialty like an ob-gyn [obstetrician/gynecologist].” Partnering with other hospitals might provide the “leverage” needed to attract medical specialists to rural areas, Hufnagel said. According to AHA, “specialist shortages are significantly more pronounced in rural areas than urban areas.” Two and a half times as many

specialists – such as cardiologists, neurologists, pediatricians and psychiatrists – practice in urban areas. It’s only a 25-minute trip from Three Rivers Hospital to Lake Chelan Community Hospital, making it feasible for a specialist to work in both hospitals, Hufnagel said. “Lake Chelan might have enough work for three days a week, and I might have enough for one day,” he said. “That would be enough to interest someone to come to the area. That’s the kind of thing we are going to do to get the clinical expertise and leverage to take care of people in our district.”

Technology will help

Billing said advances in health information technology are promising for rural hospitals and will alleviate problems related to their remote location. But, he said, new federal information technology requirements are expensive and time consuming. In 2009, Congress included measures for widespread adoption of health information technology as part of See HOSPITALS on P. 14

HEALTH & WELLNESS 7

Emergency Medical Service: If you call them, they will come By Mike Maltais The main fact folks need to know about emergency medical service in the Methow Valley is that if a 911 call is made for emergency help “there’s a 100-percent guarantee that someone is coming,â€? said Vikki Buzzard, a paramedic with Aero Methow Rescue Service in Twisp. That’s a pretty solid commitment, and it’s important for two reasons: • People in trouble need the assurance that help will be on the way, and • People who later decide that they may not require that emergency help after all need to know that help is still on the way unless responders are notified otherwise. The curious consistency about emergency medical events in the Methow Valley – and elsewhere for that matter – is that most, if not all, of them occur when they’re generally unexpected.

When you need it

One of the tradeoffs that comes with living in a remote rural paradise

Photo by Mike Maltais

Help is always on the way. is less-convenient access to some of modern life’s creature comforts, and sometimes necessities. But in this area

at least, that tradeoff translates into miles – not quality – where emergency medical response is concerned.

Just ask Nigel Cushing. Late last August, Cushing, a parttime Twin Lakes resident, decided to hop on his mountain bike for a quick workout on the Winthrop Trail. “The trailhead is near my home in Tiny Town,� Cushing said. “I usually take an exercise ride every day or two for 40 minutes.� As he had done on countless occasions, Cushing set off over familiar terrain he had traveled many times before. But somewhere along a routine ride Cushing found himself separated from his bike and suffering from a broken hip. Luckily he was carrying his cell phone and was in range. He called his daughter who in turn called 911. Then he called his wife in Seattle. Inside of an hour Aero Methow personnel were treating Cushing. An ambulance ride to Three Rivers Hospital in Brewster turned into another ride to Wenatchee for surgery. �Like me, you may not think you will ever need them, until you do,� Cushing said of his rescuers in a recent letter to the editor in the Methow Valley News.

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Washington state is divided into eight emergency medical and trauma care regions. The Methow Valley is in the North Central region and Aero Methow, the only EMS in the county, covers some 2,000 square miles of it under the direction of the Okanogan County Sheriff’s Office. “We’re considered a rural and wilderness area,” Buzzard said, “and some areas we serve like the Barron-Chancellor area near Harts Pass, where there are still active mining claims, are about as remote as it gets around here.” Aero Methow is a ground ambulance service with fourseason search and rescue capability, Buzzard said. That means they have the expertise and equipment to respond to emergencies in all weather. Both equipment and personnel are spread around for faster reaction time. There’s an ambulance stationed in Mazama, one in Winthrop and two in Twisp. Nearly 20 volunteers are scattered throughout the valley. The staff includes four full-time paramedics like Buzzard and five or six advanced EMTs.

Along with Fire District No. 6, “We’re automatically dispatched to every vehicle injury and every structure fire,” said Cindy Button, Aero Methow’s director. Each medical emergency brings with it a different scenario of actions, and local responders have tried to anticipate every contingency. They interface with Northwest MedStar in Spokane and Airlift Northwest in Seattle when air evacuation is a critical issue. In addition, a helicopter with winch capability can be called in from the Whidbey Island Naval Air Station’s search and rescue team. Injury and patient assessment begins the moment a call comes in and continues through constant contact with the destination facility throughout the transport process. Rendezvous sites for fixedwing aircraft are at both the Twisp and Intercity airports. Predetermined landing zones for helicopters are sited at strategic locations throughout the valley, such as Liberty Bell High School and McFarland Creek. “We’re 39 flight minutes by helicopter from Moses Lake

to Twisp,” said Wade Scoles, MedStar’s chief respiratory therapist, “It’s 35 minutes for fixed-wing from Spokane.” While that’s the optimal reaction time, Buzzard cautions that air arrival can require more

“I absolutely guarantee you help will arrive.” – Vikki Buzzard, Aero Methow

like 45 minutes to an hour. And there’s no guarantee that a helicopter will be available when needed from the basin. “Often, if a case is critical, we can have the patient to the local hospital in that same time frame,” Buzzard said. At that point the patient can designate a hospital preference unless the nature of the injury renders a specific destination compelling. “Severe burn patients are transported by fixed-wing to

Harborview in Seattle,” Buzzard offered as an example.

Basic categories

In a recreation-rich environment like the Methow Valley, medical emergencies fall into two basic categories, life threatening and non-life threatening; two scenarios, injured and alone or with companions; and two areas, those with cell phone service and those without. Buzzard encourages those heading into the outdoors to always do so in the company of another person. When that isn’t possible, “Tell someone where you’re going and stick to that route and time.” Fortunately there is technology now available that makes quick communication possible from even the most remote locations. When minutes count, that’s faster than sending a friend for help. The service is called the SPOT Satellite GPS (Global Positioning System) Messenger and it allows the user many features including emergency distress call and locator capabilities. Despite false alarms from users who haven’t sufficiently

familiarized themselves with the devices, Buzzard says both users and devices are getting better. “We had only one false alarm this year and three legitimate calls,” Buzzard said, but she cautions owners to thoroughly learn how to use the SPOT technology. Buzzard also advises cell phone owners to try their phones even if they think they’re out of range, in a different service area or out of power. “All cell service providers will allow 911 calls to go through whatever the location called from,” Buzzard said she learned recently. And calling 911 brings us full circle to the statement that introduced this story. If you or someone on your behalf places a call to 911, it’s a sure bet help is on the way. That’s why its imperative that callers assume responsibility for making sure they either wait for EMS personnel to arrive, have someone else wait, or contact 911 to cancel the emergency. “Just don’t leave,” Buzzard repeated. “I absolutely guarantee you help will arrive.” 

HEALTH & WELLNESS 9

Seniors face health care, residential challenges By Laurelle Walsh The hard facts indicate that most of us will grow old. For the aging population, living in the Methow Valley presents unique challenges along with the blessings of being in this special place. “We didn’t think much about aging,” said former valley resident Suzanne Follis. “We were just happily living our lives.” Suzanne and Bob Follis moved to Winthrop in 1998, built a house in Wolf Creek, developed friendships and became actively involved in the community. Former performing artists, both Follises sat on the board of the Merc Playhouse and were instrumental in the formation of the Unitarian Universalist Fellowship. Their lives transformed when in 2009 Bob was told he had Parkinson’s disease, followed shortly thereafter by a diagnosis of prostate cancer. “My life got smaller and smaller,” Suzanne said. “Everything was about focusing on Bob.” That winter, the two spent six weeks at Seattle’s Virginia Mason Hospital, where Bob endured daily radiation treatments. After they returned

home to Wolf Creek, Bob’s followup care demanded frequent trips to Wenatchee to see medical specialists. Driving home from one of those appointments in May of 2010, Suzanne fell asleep at the wheel and “ran into a rock wall,” landing them both in the emergency room in Brewster. “We survived it,” said Suzanne, but her crushed ankle would require two surgeries by an orthopedic specialist in Seattle, from which she is still recovering. “That,” along with growing concern from their two adult sons in the Seattle area, “was the beginning of the last straw,” Suzanne said. The Follises made the difficult decision to leave the Methow Valley. They sold their home in August 2010 and moved into an apartment community in Woodinville, Wash.

Helping seniors stay independent

Raleigh Bowden, physician and founder of the nonprofit Lookout Coalition – a Room One program designed to help people facing difficult health challenges stay in their homes – acknowledges the “gap” in specialty care for valley residents living with

chronic disease. “The health care scene is a real challenge here,” Bowden said. For people who have to make the drive to Wenatchee or Seattle, “sometimes it’s easier just to leave the valley.” More specialists now have office hours at the Wenatchee Valley Medical Center in Omak, and a cardiologist sees patients twice a month at Winthrop Physical Therapy, “but it’s not for emergencies,” Bowden said. “There is no after-hour care available in the Methow Valley, so people end up calling Aero Methow,” Bowden said, and often get the care they need in the emergency room. “I think more people could stay [in the Methow] … if we had a 24hour clinic,” a facility that is likely to develop in the next couple of years, Bowden said. Even procedures that most of us take for granted become complicated for the elderly and infirm. “I’m about to send a diabetic client to a podiatrist in Wenatchee just to get his toenails cut,” said Bowden. Bowden and two other health professionals donate their services to the Lookout Coalition, making home

Photo by Laurelle Walsh

Nursing assistant Heather Smith listens to Mountain View resident Doris Mack. calls and assessing clients’ needs, supporting the treatment plans of their physicians, and collaborating with other organizations. “We look out for people,” and

The

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communicate with concerned family members living outside the valley, Bowden said. “If I see something going haywire, I’ll call them.” Another local organization looking out for the needs of the elderly is Guardian Angels, a project of The Cove Food Bank in Twisp. Nurse and Guardian Angels administrator Eunice Marchbank said the primary purpose of Guardian Angels is companionship, but the 30 volunteers who visit clients in their homes also help out with chores and housekeeping, go shopping, and provide transportation to doctor appointments. “Transportation is a big issue here,” said Marchbank, “and winters are especially hard if you are living by yourself.” The Methow Valley Senior Center in Twisp fulfills many needs for senior services in the valley. The lift-equipped Okanogan County Transportation bus is stationed there, and three hot meals a week are prepared and served at the center or delivered to homebound seniors.

The Senior Center runs a medical equipment loan program, and volunteers perform blood pressure checks and provide 15-minute chair massages. “We also keep an eye on people’s well-being,” said Senior Center president Rosalie Hutson. “A volunteer does a welfare check if one of our regulars doesn’t come in.”

Home care

Eight years ago, Kim Kenney chose to become the fulltime caregiver of his parents, Frank and Mary, at their home in Winthrop. “I realized that out of everyone in my family, I was the one who was going to step up to the plate with my parents,” Kenney said. “I wanted to and could put both feet into the commitment.” Mary is mostly bed-bound as a result of Alzheimer’s and osteoporosis, while Frank suffers from dementia. Kenney considered other options, including moving his parents to Seattle, or even Bogotá, Colombia, where he could afford to hire full-time nursing and housekeeping care, “but the

one thing I was not going to do was separate my parents after 65 years of marriage.” His parents have been on the waiting list at Jamie’s Place adult family home in Winthrop, but because there hasn’t been space for the two of them, Kenney has said “no” twice. From Kenney’s perspective, his parents have “tremendous access to health care” in the Methow. “Dr. [Joe] Jensen can see my mother on any given day; he will drop everything and help,” – a factor that “above all else made it attractive to keep my parents here,” said Kenney. Kenney has also availed himself of services provided through Aging and Adult Care of Central Washington, an agency that provides support to family caregivers. “They understand what your needs are before you do,” said Kenney, who heeded the counsel of a visiting nurse and now shares the burden of care with his “right-hand woman,” Leonides Dominguez. “My biggest mistake was thinking I could do it by myself,” said Kenney, who also See SENIORS on P. 14

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Prevention is key to good dental health By Marcy Stamper You can eat right, avoid smoking, and stay fit, but few aspects of our health can offer this tantalizing guarantee delivered by dentist Jill Calvert: “Dental disease is one of the few diseases that is 100 percent preventable. It takes good oral hygiene – brushing our teeth properly, twice a day, for two minutes.” Calvert may sound like a bit of an evangelist, but it’s because she regularly sees the benefits of basic preventive measures, many of which we can accomplish ourselves, simply and at relatively low cost. Calvert, who lives in Winthrop, practices dentistry in remote villages in Alaska, where she travels for weeks at a stretch to provide free oral care to native populations.

12 HEALTH & WELLNESS

Consistent brushing removes plaque, bacteria that combine with sugar and form an acid that will slowly break down the teeth, said Calvert. She sketched a simple equation: plaque + sugar = acid, which causes tooth decay. By eliminating one of the variables – either plaque or sugar – you short-circuit the equation and avoid the decay. The culprits are carbohydrates and foods with sugar, such as candy or fruit, or hidden in processed foods. While there are hundreds of types of bacteria in the mouth, only a dozen cause disease, and only one causes tooth decay – the rest are implicated in gum disease, according to dental hygienist Heidi Desmarais, who works with Winthrop dentist Steve Harrop. Sugars help the bac-

teria replicate – exponentially – and the destructive acid is a byproduct of that process, she said. It’s easy to tell if you have plaque on your teeth, because your teeth will feel “fuzzy” to your tongue, said Calvert. Carolyn Cilek, leaving the Twisp dental office of John Nickell after her semi-annual cleaning, is familiar with that fuzzy feeling and was savoring its absence. “That’s always been one of my favorite things – how good my teeth feel after a cleaning,” Cilek said. Cilek said she had even been able to draw on her memory of that clean feeling to help her quit smoking years ago.

Start early

Developing the habit of seeing a dentist from an early

now use fillings made from a composite resin that bonds to the tooth (and matches its color) instead of silver mercury fillings. The foul-tasting, gooey material used to take impressions for a crown is now often supplanted by a scan of the tooth that can be e-mailed to a lab for a customized crown, said Harrop. Crowns themselves are now fabricated from durable, tooth-colored zirconium instead of gold, which is more noticeable and has become prohibitively expensive. Some dentists, including John O’Keefe of Sawtooth Dental Care in Twisp, have switched to digital X-rays, which reduce exposure to radiation. Depending on the anatomy of their teeth, some children benefit from a sealant, which fills in the pits and fissures on the chewing surface and helps prevent decay, said Harrop. Another positive development in the field: “The things we put in people’s mouths today taste better,” said Harrop.

Financial challenges

Photo by Marcy Stamper

You can avoid too much time in the dentist’s chair with simple preventative measures.

age is also important. Harrop starts the youngest kids with a “chair ride,” where they sit and swivel in the chair while he looks at and counts their teeth. Later they graduate to tooth polishing, fluoride treatments and instructions on proper brushing. “Kids love coming – they always get a prize. By the time they’re 12, it’s no big deal,” said Harrop. A toothbrush itself performs most of the cleaning, but toothpaste is beneficial because its flavor tends to make your mouth feel better, said Calvert. Toothpastes with fluoride help strengthen tooth enamel, making it more resistant to an attack from acid, she said. The other important component of home prevention is flossing, which removes the microscopic bacteria that accumulate between the teeth, where a toothbrush can’t reach, said Calvert. If you follow these practices, you’ll still need to see a dentist for professional cleanings and exams, but good hygiene alone will decrease the risk of cavities and periodontal disease, said Calvert. “I like to emphasize that, even in this faltering economy, putting off elective care and regular, preventive care actually leads to more problems,” said Harrop. Plaque that has been allowed to remain for too long becomes calcified and adheres to the teeth and is known as tartar. Once tartar has formed, it can only be removed by a professional cleaning. “A lot of people put off dental care because they’re afraid,” said Harrop. “But they find it’s not as scary or as painful as they thought it would be – or as they remember. We work really hard at keeping people out of pain.” Changing technology has brought numerous benefits to dental care, from advances in pain management to new composites and high-tech screening techniques. Many dentists

Other changes have proven less salutary. As pressures and costs build throughout the health care economy, insurance companies have cut reimbursements to dentists. “They’ve reduced payments on hundreds of services,” said Meghan Sullivan, who handles insurance and other matters at the front desk for O’Keefe. Last year, the biggest insurers in the state cut payments to dentists for contracted services by about 15 percent, leaving the dentists to absorb the difference. “They’re paying us less than it costs to provide the services,” said Sullivan. “It affects profit more than anything else,” said Nickell. “My overhead doesn’t change.” Another financial blow came two years ago, when Washington reduced reimbursements for patients covered by Medicaid. In addition to her work in Alaska, Calvert spent 13 years providing free dental care to children and adults in the Methow Valley, through an agreement with Harrop and O’Keefe, who donated use of their clinics and equipment. A small reimbursement from the state covered Calvert’s supplies, an assistant and malpractice insurance but, when the state stopped paying Medicaid for adults, she could no longer afford to provide the care. “A lot of people benefited – I provided $40,000 to $50,000 in free care each year,” said Calvert. “I don’t know what they’re doing now – it breaks my heart.” Sullivan sends people without insurance to Family Health Centers, which operates dental clinics in Okanogan and Brewster that receive some state subsidies and accept Medicaid coupons. “But it’s first-come, first served – you have to have all day,” she said. Regular dental check-ups also prevent periodontal disease, an inflammation of the gums and the bone that supports the teeth. Deep pockets build up around the teeth and set up a vicious cycle wherein the bone starts to disintegrate. Ultimately there is no bone left to support the tooth and the tooth will fall out, said Calvert. “Nothing is as good as your natural teeth – it really behooves you to spend the energy every day to preserve what you have,” she said. z HEALTH & WELLNESS 13

HOSPITALS the American Recovery and Reinvestment Act. The law provides partial reimbursement to hospitals to purchase software and hardware and provide training to their staffs. The health information system will ultimately allow medical providers around the world to share patient information. “The advantages are great because it will speed up communication between doctors and in the end patients will have better services on a more timely basis,” Billing said. Mid-Valley will likely spend about $2 million to fully comply with the new information technology requirements, and expects to be reimbursed for about twothirds of that amount, Billing said. The hospital has already received a $500,000 check for completing the first phase of implementation. Billing compared the development of the information network to building the national highway system. “By 2017 the main electronic

From Page 7

highway system will be laid down,” he said. “It’s by far the most sweeping change in the recording and reporting part of our business ever. The art and science of medicine will expand exponentially.” Hufnagel, too, is excited about the growth of technology, particularly “telemedicine” and its potential to connect doctors in rural areas with doctors at large urban medical centers. “Through the wonder of computers we would have a doctor in Seattle and a patient that presents in our emergency room with some subset of symptoms,” Hufnagel said. “It looks like he’s having a stroke and our doc in the ER talks with the doc in Seattle on a real-time basis. The doc in Seattle has the ability to look at tests and actually look at the patient. The two docs decide what’s going on and what’s going to happen next. “We’re hoping,” Hufnagel said, “to have some of this in place by the first quarter of next year.” 

SENIORS

From Page 11

attends the caregiver support group once a month at Room One.

A new home

Monica Pettelle, Methow Valley resident for most of the last 30 years, found herself taking more and more trips over the mountains to help care for her aging mother, Pat. A series of breaks due to osteoporosis landed Pat in the hospital, followed by a variety of assisted living and adult family homes where “lack of care at night” became a real source of worry for her daughters. When Jamie’s Place opened its second adult family home – Mountain View – in Winthrop in 2009, Monica was relieved to have Pat become one of Mountain View’s first residents. “They’ve got the whole system so dialed,” Pettelle said of her mother’s new caregivers at Mountain View. “It’s easy for the family to trust and know that everything is being done.” Jamie’s Place and Moun-

tain View are part of the nationwide Green House Project which is “working toward the goal of person-centered care,” according to nurse/manager Sheila Brandenburg. The two homes are “always full,” said Brandenburg, and, although limited to 12 residents at this time, the board has discussed future expansion dependent on land and funding. For independent seniors who are looking to downsize, a senior housing project has just been approved by the Town of Twisp, and the first model units will be built in spring of 2013, according to project manager John Hayes. Providing private ownership and independent living within a cohesive community “should keep people out of assisted living longer,” Hayes said. Getting older is tough, no matter where you live. With increased overall awareness of the needs of seniors, there is hope that more of us will be able to remain in the Methow as we age. 

Aging and Adult Care of Central Washington http://www.aaccw.org/ (509) 886-0700

The Cove Guardian Angels

http://www.thecove cares.com/angels.html 997-0227

The Lookout Coalition (206) 227-2491

Methow Valley Senior Center 997-7722

Jamie’s Place & Mountain View adult family homes 996-4417

Methow Valley Senior Housing Project (509) 393-9141

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Directory of Advertisers Pharmacies Family Health Centers........................ 6 Ulrich’s Valley Pharmacy................. 10

Herbalists Methow Valley Wellness Center..... 13

Medical Clinics Caribou Trail Orthopedics and Sports Medicine.................... 15 The Country Clinic.............................. 4 Eye & Ear Clinic.................................. 9 Family Health Centers........................ 6 Omak Clinic....................................... 16

Ayurvedic Practitioners Methow Valley Wellness Center..... 13

Home Care Suppliers Three Rivers Hospital......................... 3 Ulrich’s Valley Pharmacy................. 10

Mental Health Counselors Ann Douglas...................................... 14 Megan Schmidt, Psy.D...................... 12

Recycling Methow Recycles................................. 7

Beauty 3rd Avenue Salon.................................. 6

Hospice Services Amedisys Hospice Services............... 6

Midwifery North Glover Healing Center............ 7

Cardiopulmonary Rehabilitation Three Rivers Hospital......................... 3

Hospitals Mid-Valley Hospital ........................... 2 Three Rivers Hospital......................... 3

Naturopathy Methow Valley Wellness Center..... 13

Acupuncture Methow Valley Wellness Center..... 13 North Glover Healing Center............ 7 Adult Care Aging and Adult Care...................... 11 Amedisys Hospice Services............... 6 Harmony House Health Care......... 12

Chiropractic Services Methow Valley Chiropractic Clinic.. 9 Dentistry/Orthodontics Family Health Centers........................ 6 Robert N. Nau, DDS......................... 13 Steven Harrop, DDS......................... 11 Sawtooth Dental Care......................... 6 Emergency Services Aero Methow Rescue.......................... 7 Health Food Vendors 8th Street Greens................................. 12 Main Street Market Natural Foods.13 Misty Fjord Seafood Producers....... 12

Hearing Aids & Services Eye & Ear Clinic.................................. 9 Micron Audiology............................. 14 Moomaw Hearing Center.................. 8

Human Resources The Support Center............................. 4 Insurance Services Gayen Willett Insurance................... 14 Massage Practitioners / Bodywork Circle M Massage ............................... 6 Green Lotus Massage......................... 5 Glō Massage Therapy....................... 10 Methow Valley Wellness Center..... 13 New You Massage Therapy............. 10 North Glover Healing Center............ 7 Spirals................................................... 6 Therapeutic Bodywork & Massage.... 11

Nutritional Therapy North Glover Healing Center............ 7 Optometrists Eye & Ear Clinic.................................. 9 Family Vision Care................................ Spectrum Eye Care............................ 12 Orthopedic Surgeons Methow Institute of Sports Traumatology..................... 4 Orthopedic Surgeons, Cont. Caribou Trail Orthopedics and Sports Medicine.................... 15

Pregnancy/Birth Control North Glover Healing Center............ 7 Okanogan Family Planning............. 14

Reflexology Lucinda Tear........................................ 9 Retail/Gifts 8th Street Greens............................... 12 Lucinda Tear........................................ 9 Misty Fjord Seafood ......................... 12 Spirals................................................... 6 Ulrich’s Valley Pharmacy................. 10 Winthrop Mountain Sports................ 5 Schools Little Star Montessori......................... 5 Methow Valley Community School.11 Spa Services Nectar Skin Therapy......................... 10 Fitness, Yoga and Dance Classes MethowValleyYoga.com.................. 12 The Studio.......................................... 10 z

HEALTH & WELLNESS 15

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Health & Wellness 2012