INHealth 04/01/2014 by The Inlander

INHealth

HEALTHY LIVING IN THE INLAND NORTHWEST • FREE

Finding

Strength

7 ways to get started

Kids & Pot Faith & Healing Hidden dangers 34

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Doctors talk religion

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Health SPOKANE • EASTERN WASHINGTON • NORTH IDAHO 1227 W. Summit Parkway, Spokane, Wash. 99201 PHONE: 509-325-0634

PRESENTS

EDITOR Anne McGregor

annem@inhealthnw.com

MANAGING EDITOR Jacob H. Fries

RESTAURANT WEEK

ART DIRECTOR Chris Bovey CALENDAR EDITOR Chey Scott PHOTOGRAPHER Young Kwak CONTRIBUTORS Cat Carrel, Heidi Groover, E.J. Iannelli, Jacob Jones, Clarke Humphrey, Laura Johnson, Mike McCall, Deanna Pan, Samuel Sargeant, Stephen Schlange, Carrie Scozzaro, Matt Thompson, Lisa Waananen, John White

BROUGHT TO YOU BY

PRODUCTION MANAGER Wayne Hunt ADVERTISING SALES MANAGER Kristi Gotzian DIRECTOR OF MARKETING Kristina Elverum

Because you raised your forks...

ADVERTISING SALES Autumn Adrian, Bonnie Amstutz, Bruce Deming, Gail Golden, Janet Pier, Carolyn Padgham-Walker, Emily Walden, Raevyn West

At 74 restaurants across the region for 10 nights of delicious dining

SALES COORDINATION Rebecca Rison, Gilbert Sandoval, Denise Brewer

We raise our glass

DISTRIBUTION MANAGER Trevor Rendall

Thank you diners, participating restaurants and sponsors for another successful year

DESIGN AND PRODUCTION Tom Stover, Derrick King, Alissia Blackwood Mead, Jessie Spaccia

BUSINESS MANAGER Dee Ann Cook CREDIT MANAGER Kristin Wagner PUBLISHER Ted S. McGregor Jr. GENERAL MANAGER Jeremy McGregor

Restaurant Week Returns February 2015

InHealth is published every other month and is available free at more than 500 locations throughout the Inland Northwest. One copy free per reader. Subscriptions are available and cost $2.50 per issue. Call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x223. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2014. InHealth is locally owned and has been published every other month by Inland Publications, Inc. since 2004.

SPONSORED BY

SUPPLEMENT TO THE INLANDER

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SUPERFOOD DR. MATT

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FROM THE EDITOR

Stick to the Basics

Anne McGregor is the editor of InHealth. Email her at annem@inhealthnw.com.

DEDICATION

“We’re not just a transport team, we’re critical care where and when you need it most.” – Terri Tickner, rn, nreMT-P

Terri is one of 1,000 dedicated inhs employees making a difference in our communities for the last 20 years. Find her inspirational story at inhs .org/inhs20

norThWesT MedsTar

y inbox regularly fills up with an onslaught of health information — from Berkeley Wellness Alerts to the Harvard Health Letter, and from the Nutrition Action Healthletter to Medscape and more. These credible sources pile on detailed, sometimes conflicting, often scary information about diseases, medications, risk factors and, nearly always, how to prevent the ravages of aging. There’s no doubt that countless people are enjoying healthier, more productive lives as a result of modern medical interventions. Amazing — miraculous, even — biologic medications have been game-changers for those diagnosed with autoimmune disorders like rheumatoid arthritis. Surgical interventions also leave us with a sense of wonder: The athlete whose horribly contorted knee causes us to look away is back in the game just a few months later. With all these advances, it can almost seem like our health is out of our control — that someone wiser and more highly trained will swoop in to fix whatever damage we do. But that’s just wishful thinking. For the most part, our health is up to us. In this issue, you’ll find lots of ways to take charge of your wellness — from the increased energy and confidence that comes with bodybuilding (page 36) to running as you age (page 38) to the role spirituality plays in health care (page 27). In fact, the need to eat well and exercise regularly are about the only things my inbox informers agree on. To your health!

INSPIRING COLLABORATION. CONNECTING COMMUNITIES.

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SPOKANE CONVENTION CENTER

April 25-26 Friday 1-9 p.m. Saturday 10 a.m.-6 p.m. Admission $5 Race for the Cure participants free

2014 Health screenings Goodwill fashion show NEW! Travel & adventure NEW! Wine & craft beer tasting Cooking demos Music & dancing More than 200 booths Prize drawings for fun gear & getaways!

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CHECK-IN STAY CONNECTED You can reach Editor Anne McGregor via email at annem@inhealthnw.com. The conversation continues on the InHealth Facebook page, and stay in touch with us at Inlander.com/InHealth.

ON OUR FACEBOOK

Recreational cannabis will only be legal for adults. But do you think legalization will affect how kids may use it? JOHN HALL: Kids already smoke it and have the impression from the adults that passed the legalization that it’s okay. Nothing will change except maybe the prisons won’t be as crowded, and the police will be able to focus on more dangerous issues. ANDREA WARD: Each child will perceive it in different ways, as it was before. It really does come down to education. Talk to your kids from an early age, give them honest, real examples, and they will make their own choices. You can only lead them to the right ones. Most importantly children need to know the effects it will have on their growing bodies — they should hear it from parents as well as teachers.

SUPERFOOD

Guac Star ATTRIBUTES: A rare fatty fruit, avocados weigh in at about 50 calories an ounce, or more than 200 calories in the average fruit. But don’t despair — the fat is mainly in the form of heart-healthy, inflammation-fighting monounsaturated fat. The Haas variety may be the most nutrient-dense. SUPER POWERS: Avocados are rich in oleic acid. They’re also they’re a good source of the anti-inflammatory carotenoids lutein and zeaxanthin, as well as vitamin E. Although a nutritional powerhouse on their own, avocados are a worthy sidekick for other superfoods. That’s because their abundant fat can dramatically boost the body’s ability to absorb nutrients from fellow nutritional top contenders, like spinach, tomatoes and carrots. WEAKNESSES: Avocados aren’t ready to eat when picked. In fact, the best way to store avocados, for those lucky enough to grow them, is right on the tree, where they can stay for months after maturing. To enjoy avocados at their peak, do what the growers do and plan ahead. Allow firm fruit to soften on the counter or in a paper bag for a few days before using. A perfect avocado should give slightly to finger pressure when cupped in your hand.

DR. MATT

Teen Tune-Up

BILL TONEY: When I was a kid it was much harder to score booze than some weed. With it being legal, perhaps it will be harder for kids to get? Of course that assumes that legal weed sales are so competitive that it crushes the black market. I think our tax and regulations system may make that unlikely. STEVEN BATEMAN: I think it’ll even out in the wash. And, really, there are worse things in the world for kids to get into. Like vodka. SHANE ASHTON: I think that the mindset about cannabis NEEDS to be changed, for youth and adults alike. In countries where alcohol is a part of every meal, young and old, there are not issues of abuse to the magnitude we see here. 

HOW TO USE IT: Carefully remove the avocado from its peel, retaining as much of the nutrient-rich, brightgreen outer layer as possible. Use avocado instead of mayo on a burger, toss half of one in a smoothie, or add slices to a salad. — ANNE McGREGOR

Matt Thompson is a pediatrician at Spokane’s Kids Clinic.

utbreaks of bacterial meningitis are just plain scary. The disease, caused by one of several strains of Neisseria meningitidis, can quickly cause devastating systemic illness in infected individuals. Cases are fairly rare, but when bacterial meningitis occurs, it often afflicts a number of people. There were outbreaks last winter at Princeton University and UC Santa Barbara, and a death in March at Drexel University was attributed to the Princeton strain. Surprisingly, various strains of the bacteria are carried, without any symptoms, in 5 to 10 percent of the general population in the U.S. However, the rate of carriage tends to be much higher in adolescents and young adults. When young people get together for periods of time in close quarters, such as at camp or in dormitories or barracks, the carriage rate can be as high as 50 percent. In those situations, individuals who are not carriers are susceptible to developing active infection — particularly if they have other risk factors, like a cold, or if they are tobacco users. Fortunately, vaccination can significantly reduce the risk of illness in non-carriers. Although there is not currently a vaccine for the B-strain in the U.S., one is being used effectively in Europe. That B-strain vaccine was made available during the Princeton outbreak with special authorization from the FDA. The good news is there is a readily available vaccine in the U.S. that protects against strains A, C, Y and W. We are doing fairly well at getting kids one dose of meningitis vaccine around age 11, but it is very important that they get a second dose at age 16 or older to keep them protected through the highest risk years ahead of them. — MATT THOMPSON, MD APRIL-MAY, 2014

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CHECK-IN DON’T MISS IT

Time for a Heart-to-Heart

ometimes the best way to really understand something is to step inside it. With the first Spokane appearance of the world’s largest interactive heart, you’ll be able to do just that. The 16-foottall, 22-foot-wide heart allows visitors to touch, hear and learn about the heart while walking through it. The thumping AmeriHeart contains all the things a real heart does, making it easy to see how blood circulates and what the heart’s sounds mean. It also illustrates some heart dysfunctions — what a hole in the heart is, how heart infection might look, and what happens during a heart attack or a coronary artery bypass procedure. The exhibit, sponsored by Washington Trust Bank, is free and open to anyone attending the Bloomsday trade show at the Spokane Convention Center, May 2 from noon to 8 pm, and May 3 from 9 am to 6 pm.

— ANNE McGREGOR

PILL BOX

A Potentially Deadly Mistake

rescription medications are so commonplace that we can start to view them as benign. This is far from the truth. They must be taken as prescribed, and even then they must be used with a high degree of vigilance. Medications taken incorrectly, or even at the wrong time, can be very dangerous — even deadly. Kerry Kennedy, daughter of the famous Attorney General and assassinated presidential candidate Robert Kennedy, recently learned this in a painful way. She says she woke up one morning and took what she thought was her thyroid medication, then got into her car and started driving.

John R. White chairs WSU-Spokane’s Department of Pharmacotherapy.

Shortly thereafter, she was awakened by police, slumped over her steering wheel. She had sideswiped a semi in a drug-induced blackout. Apparently, she had mistakenly taken the sleeping pill zolpidem (Ambien), which looks much like the thyroid medication that she claims she thought she was taking. This is an extreme case of a medication misadventure which fortunately did not — but could have — resulted in death. Always double-check your medications prior to taking them, and always take them as prescribed. Even when you do this, if you think that you may be experiencing a side effect, talk to your pharmacist or physician. Every person is different, and your reaction to a “standard” dose of a medication may not be “standard.” — JOHN WHITE

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THEIR OWN WORDS

Erik Strandness Erik Strandness, MD, studied and practiced neonatal, intensive-care medicine for more than 25 years before leaving the profession in 2009 to study theology at Whitworth University. His recently published book, The Director’s Cut: Finding God’s Screenplay on the Cutting Room Floor, documents to his attempt to seek answers beyond the physical. Do you see yourself as having left medicine for good? Yes, I’m not going to go back. It wasn’t that I was disgusted with medicine. I loved what I did. The reason why I left is because I became obsessed with this understanding of the spiritual being, together with the physical, and how I explain that. And medicine became very uninteresting to me, because these bigger questions were influencing me. Do those bigger questions ever arise while practicing medicine? One of the interesting things I found in medicine was that the families who had a [Christian] background were much better equipped to deal with death and suffering. The families who had no religious background whatsoever were the most difficult people to deal with of all, because when that baby’s heart stopped, that was it. There was nothing more but regret. For the Christian, that’s the start of something grand.

But if death is a welcome event, what’s the point of doctors? Personally, I don’t look at it that way. We live in a fallen world and things are not going to work out as planned. The way I see it, God has given me an opportunity as a physician to help that child. And our role is to take that pain and suffering and to redeem it, to work our way through it, just like Christ did. Where are you now on your journey? At this point, I feel like I’ve gotten some insight. I see faith and science as an integrated whole. We can’t live in this divided state, because that’s what drives people crazy. And that’s why patients don’t want just a physical diagnosis, because they recognize that we are spiritual/physical entities. That’s why alternative medicine has become so popular. But it makes “What’s wrong with me, doc?” a much more loaded question. It does. That’s why the best physicians are the ones who sit down and talk with their patients. — INTERVIEW BY E.J. IANNELLI

STEPHEN SCHLANGE PHOTO

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CHECK-IN

CHARITY CORNER

A Wicked Good Cause

he final show of the 2013-14 Best of Broadway season has been the talk of the town since it was announced last spring. While its title may convey a villainous sentiment, Wicked will do more than entertain audiences from near and far. A one-night event during the show’s three-and-a-half-week run is set aside as a fundraiser to support programs and services of the Spokane YWCA. The local branch of the national nonprofit provides emergency shelter, counseling, legal and job readiness services for victims of domestic violence and their children. “Overall, we’re really excited because we see it as a great opportunity to not only experience this award-winning show so many of us are very excited about, but also to create a fun environment to learn about the work of the YWCA,” says Executive Director Regina Malveaux. In addition to experiencing the award-winning performance, gala guests will enjoy Hollywood-esque red carpet treatment, with lots of photo opportunities, green martinis and heavy hors d’oeuvres before the show. — CHEY SCOTT

LIFE COACHING

Suffering Is Optional Cat Carrel is a certified life coach in Spokane.

n life, we all experience pain, but we don’t have to suffer. Pain is a physical or emotional response to a stimulus. Suffering is a choice. Those of us who live with chronic pain or disease can do so with a conscious decision to not let the pain victimize us. Likewise, when our hearts get broken, we can choose to let go of the past instead of clinging to it. When we grasp for what was, or hold on to identities that keep us in a negative space, what good are we creating for ourselves? How does suffering benefit us? The answer may be

surprising. Although suffering cannot exist in a positive energy space, it serves those who choose to suffer by fueling their created reality of being a victim. It allows them to continue to suck the energy from those around them, and in return receive all the benefits of dependency and codependency. By choosing to persevere and live in the moment rather than suffer, we can break the cycle of suffering and begin to heal for good. — CAT CARREL

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1 9

Sudoku

RATINGS: Gentle (left), Diabolical (right) To complete Sudoku, fill the board by entering numbers 1 to 9 such that each row, column and 3x3 box contains every number uniquely.

1 8 8 1

Answers to all puzzles on page 45

2 3 4

6 7 4 7

5 9 3

PUZZLES BY JEFF WIDDERICH & ANDREW STUART www.syndicatedpuzzles.com

Codewords

24 6

4 2

8 3

15 24

21 25

25 22

18 25

15 16

17 8

5 15

21 15

25 21

1 19

20 8

11 13

19 19

21 19

19 19

18 6

3 2 7 4

9 2 1 6 9 7 5 9

6 5

Each letter has been replaced by with a number. Using the starter clues, work out the words that must go in each cell on the codeword grid. Some well-known phrases and names may also be found. For a two-letter clue, turn to page 24. 18

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

3 9 3 6 9

Str8ts

RATING: Moderate Like Sudoku, no single number can repeat in any row or column. But rows and columns are divided by black squares into compartments. These need to be filled in with numbers that complete a ‘straight’ — a set of numbers with no gaps but can be in any order. Clues in black cells remove that number as an option in that row and column, and are not part of any straight. Glance at the solution above to see how ‘straights’ are formed.

5 6 8 7

7 1 7

2 3 9

4 3

5 7 6

6 1

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2 5

BRAIN EXERCISE

Health 13 3/26/14 12:15 PM

HE TRADED HIS M.D.

FOR AN M.A.

AND FOUND NEW WAYS TO HEAL. When neonatologist Erik Strandness felt faith leading his life in a new direction, he knew Whitworth’s M.A. in Theology would help him find his purpose. “It was the best decision I ever made,” he says. And it gave him the tools to transition from a career in medicine to a career in teaching.

, M.D. andness Erik St. rIN T H E O L O G Y M .A

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AT E

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NEWS

IN-DEPTH

“I feel normal,” says Alecia Crider, here visiting at her mom Tammy’s apartment, “but not like real normal.” YOUNG KWAK PHOTO

A Tattered Net

and those in jail are even higher. Estimates vary, but spending on mental health care totals at least $113 billion a year in the United States, or about 6 percent of national health care spending. Many like Alecia, diagnosed with bipolar disorder, ADHD and general anxiety, lead happy and healthy lives with the help of counseling and medication. But nationwide, only about half of those with mental illness get the treatment they need. population — nearly 80 In the worst years of the million people — has a This year, the Inlander and recession starting in 2008, diagnosable mental illness, InHealth are digging deeper into states across the country, including conditions like the mental health system. including Washington and depression and attentionVisit Inlander.com/stateofmind Idaho, sliced a total of $1.6 deficit disorder, and about to read the full coverage. billion from mental health 6 percent live with a Write us at editor@inlander.com funding. Idaho and Washingserious mental illness, like if you have a story to share. ton each cut mental health schizophrenia or bipolar funding by about 11 percent. disorder, according to Locally, some decision-makers are the National Institute of Mental Health (NAMI). The rates among the homeless ...continued on next page

A primer on our local mental health care system BY HEIDI GROOVER

or Tammy Crider, the moments that told her something was wrong were dramatic. Toys all over the floor in the middle of the night, violent outbursts, school suspensions. By the time her daughter Alecia was 15, Tammy made the decision to move her into a group home, calling it “the hardest thing I ever did.” Now, in a nation dealing with a long overburdened mental health care system, the signs that something is wrong may also be becoming clear. A quarter of the U.S.

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NEWS

A corrections officer stands at the end of the “suicide watch” cell corridor at the Spokane County Jail. YOUNG KWAK PHOTO

THE PROVIDER SHORTAGE

Talk of funding cuts and bed shortages is common surrounding mental health care, but there’s another challenge looming. “I can open more beds, but if I don’t have more psychiatrists, what’s the use?” says Kamal Floura, medical director at Eastern State Hospital, where he counts five unfilled vacancies for psychiatrists. Nationwide, about 30 percent of people — including some in Kootenai and Spokane counties — live in areas with too few mental health care providers. The shortage is especially dramatic among psychiatrists, who can prescribe and manage the medications given credit for allowing many with mental illness to live in the community instead of in hospitals. As a profession, psychiatrists are aging and too few are ready to replace them as the number of medical students specializing in psychiatry dwindles. Area psychiatrists say the profession suffers from some stigma and the fact that, compared to other specialities, it’s among the lowest paid. Offering multiple levels of medical education is one way to attract psychiatrists, says psychiatrist and Washington State University professor Matt Layton. Doctors are likely to stay in the place where they completed their residency, the practical training done after medical school. Currently, the count of psychiatry residency slots in the Inland Northwest is dismal: Less than one psychiatry residency slot is available for every 100,000 people, compared to a national average of 23 slots per 100,000. Spokane’s slots have generally been filled by University of Washington medical students specializing in psychiatry, but during the recession even those few spots were closed due to budget cuts. Now Layton and others are working to bring back the psychiatric residency program. If accredited this spring, the program will accept its first psychiatric residents next year. Not only will they make likely candidates for Spokane jobs once they’re finished, they’ll be available to offer advice about the field to students at the growing Riverpoint campus east of downtown. “You need that whole pipeline,” Layton says, “undergraduate through residency.” — HEIDI GROOVER

“A TATTERED NET,” CONTINUED... working to begin to address shortcomings in the ways the community responds to mental health issues. A recently released report from the Spokane Regional Criminal Justice Commission called for an evaluation of the Mental Health Court, a specialty court run by Municipal and District Courts. The report also called for an expansion of the Spokane Police Department’s training to respond to mentally ill offenders. Priority Spokane, a group of local organizations including the city, county and nonprofit groups, has named mental health care the next biggest challenge facing the region. Providence’s Sacred Heart Medical Center recently added seven emergency room beds in an observation unit specifically for those with mental illness. The rooms are designed to be safer: sharp tools are out of reach and there are fewer stimuli, helping patients stay calm. The beds are nearly always full. “There is not a family in the entire country that doesn’t know or live next door to or work with someone [who has experienced mental illness]. It’s time for us to start stepping up and owning this,” says Sandi Ando, public policy chair for the National Alliance on Mental lllness’ Washing-

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ton state chapter. “These are not those sick people. These people are us.”

LOCKED UP

Emily Cooper, an attorney with the nonprofit Disability Rights Washington, says she knows of one case in which a s Tammy struggled to defendant has spent 111 days in jail, without trial or convicfind care for Alecia, tion, awaiting a mental health competency evaluation. she sought help from A state psychiatric hospital simply has been unable to Passages Family Support, a local schedule a visit from a licensed evaluator. agency that pairs people who “You just have an overly burdened system,” Cooper have a mental illness or who says. “The time people with disabilities spend in jail awaithave children with mental illness ing treatment is still growing.” with other people or parents. In 2012, Washington lawmakers tightened evaluation Passages is part of a growing deadlines to try to reduce the ever-growing backlog of peer-support movement that’s stalled trials and stranded inmates awaiting evaluations. hoping to give people friendly Those rules required defendants in jail to be evaluated access to care and to fill in some within seven days. Almost two of the gaps in the larger mental years later, a new audit shows wait health care system. times for local jail inmates seeking Generally speaking, most evaluations through Eastern State people with mental illness Hospital still average 33 days. receive outpatient care, like DSHS officials have cited a counseling or prescription drugs. shortage of local evaluators and Those with more severe or space limitations on admission long-term needs may seek care at community facilities like those Amanda Cook wards as significant challenges. They also blame some delays on run by Frontier Behavior Health external complications such as surges in referrals, attorney in Spokane or at state psychiatschedule conflicts and jail facility limitations. ric hospitals like Eastern State Independent financial reports have shown that delayHospital in Medical Lake. But ing the evaluations costs county jails millions of dollars without access to care, some in each year. Jail officials report inmates with mental health crisis end up in hospital emerissues often cost double that of other inmates after coungency rooms, where beds are seling and psychotropic medication expenses. limited. Complicating matters Much more important than any dollar value, Cooper are rapid changes in insurance says, are the “human costs” of locking people in jails with and Medicare and Medicaid unreasonable wait times for treatment. People with mencoverage. tal health issues may be victimized by other inmates or Today’s community-based their conditions may deteriorate. The seven-day deadline system has not always been the was established for a reason, Cooper says. A 2003 Ninth model. America’s early history Circuit decision found delays in treatment violated due is littered with stories of dank process rights. asylums and questionable treat“The [state psychiatric] hospitals at this point are ments: lobotomies, malaria injecrunning a very big risk,” she says. “They’re asking for a tions and insulin-induced comas. potential lawsuit.” Between 1955 and 1980, during Faster evaluations also could potentially save lives, a movement known as “deinstiCooper says, like that of 25-year-old Amanda Cook, who tutionalization,” the population killed herself in December after spending weeks in the in mental institutions across the Spokane County Jail awaiting a delayed competency country fell from 559,000 to evaluation. 154,000. Drugs were developed — JACOB JONES to treat symptoms, making it feasible for more people with mental illness to live in their communities. dren with mental illness. That prompted Slowly, states began moving people out plans for a significant overhaul of mental of their institutions and into nursing homes health care for young people in Washingand other facilities, but it wasn’t until 1993 ton. A bill passed last year in Olympia that they were actually spending more mandated that the Legislature create a task on community services than on state-run force to study possible reforms of the adult institutions. Patient advocacy groups like system. A report to the governor is due by NAMI say the system is still catching up. the end of this year. In Idaho, the governor In Washington and Idaho, some have has proposed funding for new “behavioral pushed for change. A 2009 lawsuit alleged health crisis centers” across the state. that the state of Washington was failing its ...continued on page 19 youngest and most vulnerable citizens: chil-

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Help Wanted: Eastern State Hospital has five unfilled positions for psychiatrists. YOUNG KWAK PHOTO

UPDATING THE INVOLUNTARY TREATMENT ACT Last summer, Joel Reuter, a 28-year-old software engineer living in Seattle, was shot and killed in a standoff with local police. He was ranting and waving a handgun from the balcony of his Capitol Hill condo. After hours of negotiations with police, Reuter fired a shot. He was killed by a sniper’s bullet. He thought he was defending himself against zombies. Reuter had bipolar disorder; for some time, he had been manic and Joel Reuter spiraling out of control. But he didn’t meet the criteria for involuntary commitment under Washington state law until months later, in May. By then, his parents say, it was “too little, too late.” Reuter’s parents moved to Olympia about six months ago to lobby for House Bill 2725 to revise the state’s Involuntary Treatment Act by allowing family members to appeal to the court if a mental health official denies a loved one emergency hospitalization. The bill failed to get a full Senate vote. Reuter’s death constitutes what the procommitment Treatment Advocacy Center calls “preventable tragedies” — incidents of violence involving people with mental illness that could

have been avoided had they received timely treatment. Under Washington’s Involuntary Treatment Act, only a “designated mental health professional” working for the county can petition the court to have individuals civilly committed if, as a result of mental illness, they are “gravely disabled” or an “imminent” danger to themselves or others. Those who meet the state’s criteria can be hospitalized at a psychiatric facility for up to 72 hours. Washington is one of a few states that doesn’t allow citizens to directly petition the court for inpatient commitments. Experts say that, even without HB 2725, Washington likely will see a rise in civil commitments this summer. In 2010, lawmakers approved several revisions to the involuntary treatment guidelines allowing DMHPs to consider historical behavior and patterns of deterioration when evaluating people for forced detentions. The implementation of the changes was postponed until July 2014 due to funding constraints. The Washington chapter of the National Alliance on Mental Illness has for years advocated expanding the state’s civil commitment criteria by removing the “imminent” requirement. “We need to get people treatment before they’re at the edge of the cliff,” says Sandi Ando, the chapter’s policy chair. — DEANNA PAN

“A TATTERED NET,” CONTINUED...

n her four years away from home, Alecia’s feelings about the staffed facility where she lives, and about her mom’s decision to send her there, have softened. She visits Tammy each weekend. They go shopping and watch movies together. “It’s nice for me, but it’s not here,” says the 19-year-old sitting on Tammy’s couch. She’s made significant progress since the

Visit Inlander.com/stateofmind to read the full coverage. Write us at editor@inlander.com if you have a story to share. move, though, and hopes to graduate from high school in another year or two and eventually move out on her own or with her boyfriend. “I feel normal,” she says. “I think of myself picturing normal, but not like real normal.” Tammy has worked to give Alecia that feeling of normalcy, but it’s never been easy. For many with mental illness, stigma is still a significant challenge. Along with widespread misunderstandings about mental illness, media coverage of high-profile incidents like school and workplace shoot-

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ings can blur the lines between violence and mental illness, leading the public to conclude that most people with mental illness are somehow dangerous. In fact, statistics tell another story.

Goodness from the ground up!

In the worst years of the recession starting in 2008, states across the country, including Washington and Idaho, sliced a total of $1.6 billion from mental health funding. The increased likelihood of violent behavior among those with mental illness, if it exists, is small. More significant may be that people with mental illness are about 11 times more likely to be the victims of violent crime than the general population. Ironically, as stigmas begin to fade and more people seek and receive treatment, the already stressed system currently in place to care for them will be increasingly stretched. Dr. Saj Ravasia, the medical director of Sacred Heart’s psychiatric department, says more people, with more serious illnesses, are seeking care. Often, Ravasia says, those without insurance or financial help are waiting longer to seek help, meaning their conditions are more severe once they arrive at the hospital, increasing the strain on hospital resources. He and his colleagues are also seeing more patients in need of both mental health and substance abuse treatment, complicating their care. And there’s a shortage of care providers, including psychiatrists. (“The Provider Shortage,” page 16.) Some 95 million people nationwide, including those in Kootenai County and parts of Spokane, are living in federally designated “provider shortage areas.” The wide array of challenges means the solutions must come from all corners, Ravasia says, but change will have to start with two things: more government dollars and a shift in thinking. “There needs to be a change in political will to care for the underprivileged in our society, because there’s still this misconception that people just have to pull their bootstraps up and get on with it,” he says. “These are medical illnesses. This is not because they don’t want to do better.” n

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NEWS

Eight Spokane-area Albertsons/Sav-On pharmacies are now offering testing and treatment for strep throat. INNOVATION

The Pharmacist Will See You Now A trip to your local drugstore may soon provide one-stop health care for minor conditions BY CLARKE HUMPHREY

he hunt is on for health care providers to attend to a burgeoning population of patients in Washington. More than 400,000 people have signed up for free or low-cost insurance through the Washington Healthplanfinder website as of mid-March, and more than 100,000 accessed private health insurance as well. One way to spread the work of providing health care for everyone — whether they’re newly insured or not — is for pharmacists to “practice at the top of their license.” In Washington, pharmacists already have the authority, generally in conjunction with a physician, to offer short-term,

immediate treatment for 21 minor ailments and conditions, from treating pinkeye to urinary tract infections. Now they hope to begin offering those services to patients at local drugstores throughout the state. The end goal is increasing access to care for minor conditions, allowing doctors to have the flexibility to focus on more complex situations that arise with patients. Linda Garrelts MacLean, a pharmacy professor at Washington State University, has been involved on both state and national levels in the push to develop new protocols broadening the scope of pharmacists’ practice.

“There are officials who believe we can’t solve our health care challenges without utilizing all hands on deck,” MacLean says. “The goals of health care reform are to improve health. And oftentimes you improve health by making sure someone has access to people who can help them … We can’t have all these people seeking out primary health physicians. There just aren’t enough to go around.”

t seems like an easy fix. Doctors are on board, pharmacists are on board and patients are on board. But insurance companies are not. Right now, direct care

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from pharmacists is a cash-only system. MacLean says she’s working with a team on a pilot project that would make it possible for pharmacists to bill insurers for each of these encounters, but that could be a ways off. “The primary barrier, right now as it exists, would be that the insurance companies have a system in place that doesn’t allow for pharmacists to bill under the same code as other health care providers,” she says. “So right now the system excludes the ability for pharmacists to bill insurance companies.” They can, however, bill patients up-front for their services. Beverly Schaefer is a pharmacist in Seattle who’s been working with patients this way since April 2013. She sees about 10 patients a month and charges them a $35 fee to do things like treat animal bites and uncomplicated urinary tract infections. The process generally takes no more than 15 minutes, she says. Sometimes the patients don’t have their own doctor or insurance. Others have both, but find accessing care easier at the pharmacy. “If you offer a service that they want and they value, they are willing to pay cash,” says Schaefer, who owns Katterman’s Sand Point Pharmacy in Seattle, where she is the only pharmacist with prescriptive authority. “If it means the difference between taking a half day off work, losing that money and spending all your time in a waiting room, versus coming in for a quick consultation, people are going to go for it.” In her experience, people haven’t complained about the fee because in most cases, it’s close to the copayment they’d pay to see to a doctor. After she offers treatment, Schaefer notifies the patient’s doctor about the care they received. MacLean says pharmacists working with physicians in a “collaborative drug therapy agreement” ultimately allows both to take better care of their mutual patients. “It’s a less expensive way to deliver care at 8:30 at night, versus saying ‘I can’t help you, you’re going to have to wait to see your primary care provider in the morning’ or referring them to urgent care.” For now, MacLean says, pharmacists are working to raise awareness about their qualifications by offering direct access in a number of places. As they begin to build a track record of what she thinks will be effective and efficient care, insurers may begin to change their billing policies. “We believe it’s the right thing for the patient,” she says. “We believe it’s the right thing for our health care team members. It’s a responsible way to utilize resources.” 

NEW BUILDING, NEW ROLES PHOTOS BY YOUNG KWAK

ith the opening of the new Pharmaceutical and Biomedical Sciences Building at Spokane’s WSU Health Sciences campus (above) in January, pharmacy students, faculty and staff no longer have to travel between Pullman and Spokane. The $78.6 million building has 125,000 square feet — room for up to 24 researchers, as well as multiple anatomy and pharmacy teaching labs, student study areas, offices and a 150-seat auditorium. — ANNE McGREGOR

continues on next page…

Second-year pharmacy students practice working closely with patients and as part of a team. Here, Kyle Roberts, Julie McCullough and Aubrie Widhalm review a patient chart before entering the simulation lab.

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NEWS

NEW BUILDING, NEW ROLES

PHOTOS BY YOUNG KWAK

At the compounding lab, students practice custom-crafting medications. First-year student Cody Ray (left) measures deionized water as part of a lab on creating lozenges, while Hien Tran (above) considers which vessel to use. Second-year pharmacy students work in the simulation lab with a wirelessly operated, programmable mannequin, so realistic that its eyes blink and it can even cry or sweat. Here, Kyle Frazier and Taylor Bertsch interview their â&#x20AC;&#x153;patient.â&#x20AC;?

Behind a one-way mirror, Clinical Assistant Professor Kim McKeirnan takes notes as students (left to right) Julie McCullough, Aubrie Widhalm, and Kyle Roberts practice their physical assessment skills.

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r. H. Gilbert Welch makes people cancer death. More than half will have at uncomfortable. He seems intent on least one false alarm, 70 to 100 of them will upending a key tenet of modern undergo a biopsy, and three to 14 will be health care: early diagnosis and treatment overdiagnosed and treated needlessly with is best. surgery, radiation, and or chemotherapy, The Dartmouth professor, physician Welch says. and author of Overdiagnosed: Making People “To me, if you take 1,000 well patients Sick in the Pursuit of Health visited Spokane in and in a 10-year course, you alarm half of February for the 2014 Stier Lecture. them, that’s outrageous,” he says. The capacity crowd of health profesHe suggested a course correction is sionals, students and community members underway, with other criteria perhaps being listened attentively as Welch outlined his added to a diagnosis of cancer: “There are theory: Otherwise healthy Americans are hints that bigger lesions are more important being needlessly — even harmfully — given than small ones. Should we add a dynamic diagnoses and treatment for conditions that dimension to our diagnosis? Should we ask would have never caused them any real whether things are growing?” problems. Ultimately, Welch says the medical The conundrum of overdiagnosis is that system has failed to distinguish between it can only be identified when the condition two types of prevention: early diagnosis is left untreated and nothing bad happens. and health promotion. “Health promotion That’s not a risk many is what your grandmother clinicians, or patients, are would have told you: Get comfortable taking. “Once plenty of sleep, eat your from the puzzle on page 13 we have a diagnosis, we fruits and vegetables, go play 15 = R; 21 = E tend to treat everybody,” outside, don’t start smoking. said Welch. It’s not high-tech. It’s positive. So is it even wise to look for problems? Be healthy.” Welch tackles two diseases with the biggest Conversely, early detection can create a screening efforts: breast cancer and mamsense of foreboding. He recalled a thyroid mograms; and prostate cancer and PSAs. cancer awareness campaign with the tag “The PSA is a simple blood test but it line “Confidence Kills.” raises some of the most complex issues in So, “If you feel good, you’re about to medicine. ‘Do you want the test?’ My perdie,” Welch deadpanned, to laughter. But sonal right answer for me is ‘No, I don’t.’ more seriously, he continued: “The basic That’s not the right answer for everyone.” idea of screening is look hard for things to Mammograms raise similar questions. be wrong. But health is not just the absence Of a thousand 50-year-old women underof any abnormality. It is also a state of going mammography for 10 years, statistimind, and we have to be very careful not to cally speaking, 0.3 to 3.2 will avoid a breast disturb that.” n

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LIVING MIND & BODY

A Complex

God Incorporating faith into the practice of healing BY E.J. IANNELLI

framed print hangs prominently in Dr. John Torquato’s waiting room. It depicts another waiting room — far grander, it has to be said, than the one at the Family Medical Care walk-in clinic in a Spokane Valley Rosauers. A family is seated on a couch. The father, sleeves rolled up on his Oxford shirt, places a reassuring hand on his wife’s elbow; she holds their sleeping young son. To their left sits a doctor, a white lab coat over her floral dress, a stethoscope around her neck. Though hers are the only hands that are folded, all the adults have their heads bent in prayer. Above them, eyes also shut, stands Jesus Christ. His arms are extended in a downward embrace to form the visually satisfying triangular composition found throughout classical painting. It is, moreover, a gesture of comfort and of grace. The print might not be to everyone’s taste, aesthetic or theological, but it invites several questions. What place does faith have in the doctor’s office? In what ways do we deify doctors? Is there a greater need for spirituality when our physical selves are most vulnerable, or even a need to address spirituality at all? And for physicians, how does their private faith inform their medical practice? ...continued on next page

Family Medical Care in Hayden looks as much like a pastor’s office as a doctor’s office. YOUNG KWAK PHOTOS APRIL-MAY, 2014

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LIVING “A COMPLEX GOD,” CONTINUED...

r. Torquato has clearly been contemplating these questions for most of his 51 years, first as a registered nurse in California and later as a physician in Florida and Idaho. In conversation he has the rehearsed, rhetorical flair of an infomercial presenter or self-help guru. Every sentence is assured and cadenced. Every idea flows systematically toward a logical, inevitable conclusion. Much like Jesus, he prefers to speak in parables, starting with an account of his own father’s medical nightmare. A sudden heart attack. A defibrillator — two times, once while fully conscious. A frantic ambulance trip to a bigger facility. A finger-sized catheter in his groin. “People running around in spacesuits while he’s naked.” Then films of his salvaged arteries. Doctors’ stern warnings about his smoking: “Quit or you will die.” The grim punch line? On leaving the hospital, Torquato’s father turned to him and said, “I think I need a cigarette.” Torquato momentarily goes silent as he waits for the point to hit home. Where, he continues, is the self-preservation instinct? It’s not as if the desire isn’t there. He estimates that 95 percent of the 1,000 smokers he sees every year would like to quit, but can’t. There’s no shortage of anecdotal examples. The anxious woman who’s unwilling to forego one of her 20 cups of coffee per day. The man in his late twenties, roughly 150 pounds overweight, who despite suffering from life-threatening hypertension, high cholesterol and obesity, stubbornly refuses to change his diet. “He’s got this disease that’s going to kill him. He knows what to do. But he can’t fix it because something about him has kept him from it. Now, what is it?” Torquato says. To answer that, Torquato compares his training as a registered nurse to medical school. “In nursing, they taught us the four areas of wholeness: physical, mental and emotional, spiritual, and social. In medicine, I got physical and maybe sometimes mental/emotional.” The medical profession’s wider reluctance to deal with the social, and above all the spiritual, is in his opinion a glaring deficiency. Not only is it at odds with its own teaching, it ignores patients’ yearning for more holistic care, as measured by oft-quoted Pew polls and research surveys. “The data out there show that the majority of Americans believe in a god,” he says. “It might not be the same god,

Dr. John Torquato prays with his patient, Gerben Roukema, at the Hayden Family Medical Care clinic. YOUNG KWAK PHOTO but they believe in a god. The majority of Americans pray. The last figure I saw was 75 to 80 percent. Almost 50 percent of Americans pray daily. At least 25 percent want their physician to talk to them about their spiritual lives. And the data show that the people who are tending to their spiritual life live longer.” Where applicable, his preferred treatment is to find physical cures by tapping

into the metaphysical. This kind of approach is commonly employed in the first three steps of putatively spiritual 12-step programs like Alcoholics Anonymous: an admission of powerlessness over an addiction, a discovery of a positive power outside of oneself, and a deliberate selfsubordination to that power. Torquato welcomes the comparison. He says he’s seen the results of such an

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approach firsthand, even among the most abject cases at the clinic he works for in Hayden, Idaho. “I’ve had people with blood sugar in the 300s down to normal (about 100). Four months. No drugs. How can they have the power to change their lifestyle? Where would they find the strength to continue that? From the kind of supportive environment that comes from a person who’s spiritual by themselves. If you leave out the spiritual, I can change your diabetes, and I can change it in four months, but you’ll never keep it if you don’t have a spiritual foundation.” He says this concept highlights that spirituality isn’t at odds with science or medicine, but rather that spirituality is at odds with the convenience we expect of science and medicine. That goes for patient as well as practitioner. “As a physician, I want to take care of you, but the faster I can get you out of my room, the faster I can take someone else and bill them. It’s very unfair, and it fails — outright fails! — when it comes to chronic, lifestyle-related illness. We can put people on drug after drug, and all we’ve done is made them think that’s the way back to normal. Now I’ve got 14 drugs, and I’m going to take them for the rest of my life with all the side effects they cause, rather than changing my diet, exercising, finding a way to interact. They require time and a purpose bigger than a prescription.” In line with the tenets of his Seventh Day Adventist faith, Torquato shuns compartmentalization. For him, considering the whole, though dauntingly complex, is the only proper way for a physician to diagnose and treat illness. He readily concedes that atheists and agnostics might balk at the particulars. Some patients have been staunchly opposed to his suggestions and walked out. He bears them no ill will and often tries to help them find a doctor more suited to their needs. “I don’t care who you are,” he says. “If you’re suffering, God wants you to be well.”

nlike Dr. Torquato, Dr. Jared Wyrick’s religious leanings are not conspicuous. There are no Creationist coloring books in his waiting room, no pictures of horses underscored by quotes from Isaiah. On the wall of his tiny corner office in the Rockwood Heart and Vascular Center at Northpointe is a black-and-white photo of sunlight beaming through trees. Behind him are his children’s drawings of Gumby and a fisherman. Little

here proclaims that he’s a self-professed “devout Christian, born and raised” who does not take his faith lightly. “I try to say it is my life.” Wyrick, 36, is also less polished in his speech. When discussing his faith and its influence on his practice, his sentences are unruly concatenations of clauses: a preface, then a statement, followed by qualifications, loopbacks, asides, caveats, revisions. He frequently disrupts a thought to identify himself as being “flawed,” a “sinner” and a “meager human.” Before quoting Scripture, he warns that he might flub it; afterward, he routinely apologizes. “I’m not trying to preach at you.”

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“I don’t care who you are. If you’re suffering, God wants you to be well.” The hesitancy might seem unusual, even undesirable, in a cardiologist. We tend to look to doctors, and highly trained specialists like Wyrick in particular, to be unflappable monuments of confidence, since our well-being depends on the precision of their diagnosis and their recommended course of action. The slightest hint of doubt opens the possibility of error, and error is not easy to forgive when lives are at stake. Yet confidence doesn’t equate to infallibility. Nancy G. Brinker, who founded Susan G. Komen for the Cure in honor of her late sister’s struggle with breast cancer, has written publicly of their tragically misplaced trust in physicians who brimmed with self-confidence. In Wyrick’s case, what seems like self-doubt is something closer to humility, a key component of his religious faith. “It’s an awkward topic to talk about, humility. As soon as you say you’re there, you’re not. What’s the old joke? ‘I’m the humblest person in the world,’” he chuckles. “One of my jokes is that God calls it heartburn to confuse and humble cardiologists.” Without a pause, he adds, “That usually draws a laugh.” For Wyrick, the Biblical reminders of his own shortcomings are what keep him on his toes. “C.S. Lewis always said that pride is the worst sin, because you can ...continued on next page

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LIVING “A COMPLEX GOD,” CONTINUED... track every other sin to that. I am someone who’s just used by the Lord,“ he says. “I realize that I am flawed, and that gets back to what makes me, I hope, a little better doctor — and I don’t mean that in a bragging way. My accountability to God is something maybe patients don’t notice, though I do hope they notice the fruits of it.” As a heart specialist, Wyrick frequently conducts end-of-life counseling. He says that his Christian views on death — namely, that eternal life in Heaven follows this one on Earth — often provide comfort to patients, though he’s careful not to foist his religious beliefs on those who wouldn’t welcome them. Nor should his beliefs suggest that he looks upon death with any kind of perverse joy. When Wyrick recalls his own mother’s death from cancer two years ago, there’s every indication that the emotional sting is still fresh, regardless of the unflagging strength of his convictions. “Death is a huge thing. Boy, as I found out on March 22, 2012, it’s very painful to lose someone. I’ve dedicated my life to physical medicine, and obviously my goal

Before a procedure, Dr. Jared Wyrick prays with his patient Greg Boyle at Deaconess Medical Center. YOUNG KWAK PHOTO is to help people live as long as possible. I take that very seriously.” Despite his concept of this physical life as being distinct from an afterlife, Wyrick doesn’t view re-

ligion and medicine as mutually exclusive. Quite the opposite. “I see science as being propped up by Christianity and such,” he says. “I look at

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things and see the beauty of design and artistry. I don’t want to digress or get into arguments I’m not smart enough to win, but I see, for example, the beauty of the human heart. As a Christian, I see the Lord as the great physician. And I try to take my patients as a whole person.”

“I’ve described in my own literature a bio-psychosocial-spiritual model of medicine,” he says, echoing Torquato’s emphasis on the four pillars of his nursing training. “We’ve done a poor job of integrating the ‘psycho’ and the ‘social’ into medicine, and

“My accountability to God is something maybe patients don’t notice, though I do hope they notice the fruits of it.”

t the University of Chicago, a whole program has formed around this recurring idea of the “whole person” and the overlapping aspects of medicine and religion that are a part of Torquato’s and Wyrick’s daily medical practices. “Our society tends to sometimes look very pragmatically and reductionistically and instrumentally at many things, including ourselves, and we can run into problems when we think there is a technological solution for everything in human experience,” says Dr. Dan Sulmasy, who directs the university’s Program on Medicine and Religion. “When someone is having trouble sleeping, we’re immediately thinking it might be insomnia and that it can be addressed by a pill, rather than the fact that they might be having trouble in their relationships.”

we’ve done an even poorer job of integrating the spiritual. People are not simply their bodies, and when they’re ill, it’s a spiritual event that shakes them by the soul. Healing in a deeper sense is more than just fixing their heart rhythm.” This enlightenment, so to speak, goes in the other direction too. “People are beginning to recognize that physicians are not just scientists. They are spiritual beings who have pledged to help other spiritual beings who are sick. For that reason, physi-

cians must also cultivate a spiritual life,” Sulmasy says. “More medical schools are teaching this, and there’s more literature on this subject.” What Sulmasy terms a newfound “groundswell of interest” in spirituality

within the medical profession makes physicians like Torquato and Wyrick appear positively cutting-edge. Their age-old religious beliefs, far from casting them in an atavistic light, are re-emerging as a means of addressing the shortcomings of modern medicine. “To heal a person, one must first be a person,” Sulmasy says, quoting the Jewish philosopher Abraham Heschel. “I think patients and physicians are both beginning to recognize that.”n

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LIVING

Flying Goat Chef Darrin Gleason; (facing page) Spinach Salad with Quinoa Pilaf, and a look inside the Goat. YOUNG KWAK PHOTOS COOKING

Flying High At the Flying Goat, unique menu creations are all part of a day’s work BY CARRIE SCOZZARO

arrin Gleason knows the food industry. He’s worked at virtually every level of the business in his long career — from food expeditor to banquet chef to pastry prep to executive chef. One thing has been consistent through it all. “My philosophy,” says Gleason, who has been in the restaurant industry and cooking since 1994, “is to know your basics.” Twenty years ago, Gleason started out at Tomato Street in Spokane, a job followed by a short stint as banquet chef at the University Inn in Moscow. After graduating from Spokane Community College’s culinary program, Gleason worked as a sous-chef and pastry chef at the former Combray in Pullman, eventually landing a long-term gig at Klink’s Williams Lake Resort in Cheney. At Klink’s, Gleason settled down and spent 10 years learning all the ins and outs of running a restaurant: hiring, training and supervising staff, as well as quality control, purchasing, menu planning, and of course

food prep. In 2003, Gleason caught the eye of respected chef Jonathan Sweatt, who opened the Downriver Grill with family members in 2003. Gleason became their executive chef. When Sweatt and John Stejer created the Flying Goat in 2010, they brought Gleason along. Seasonal ingredients and food trends help direct some of the menu choices at the Goat, says Gleason. For this issue, he shares a salad recipe pairing quinoa with spinach, root vegetables and maple syrup vinaigrette. The spinach quinoa salad provides a complete protein, notes Gleason, making it ideal for those following vegetarian and vegan diets. The dressing is also gluten-free, like all the Goat’s salad dressings. And it’s adaptable — in the warmer months, he recommends substituting blueberries for the root vegetables, and going with a white balsamic vinaigrette. Like their salads, the Flying Goat’s pizzas vary throughout the seasons, featuring

a new special every Thursday. Some offer twists on classic flavor combinations, like the Lacrosse, with olive oil, mozzarella, Italian sausage, red pepper preserves, fresh basil and shaved Parmesan. The D Street is a spin on Thai pizza, with yellow coconut curry, chicken, potato, carrot, jalapeño, cilantro, lime juice, Sriracha sauce and cheese. Other menu options are a definite departure, such as the weekly pizza specials that might feature any number of unusual ingredients: calamari, étouffée, chorizo, blood oranges, veal pistachio meatballs. For Gleason, it’s just another day doing what he loves: being the go-to guy in the kitchen. When he’s not in the kitchen, the 43-year-old father of two young boys likes to hunt, fish, and do carpentry and landscaping. He likes being the go-to guy, says Gleason, both at home and at work. “I can even plumb a sink for you,” says Gleason, who notes that there’s no job in the kitchen that chefs shouldn’t be able to handle — blocked sinks included. 

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RECIPE

Spinach Salad with Quinoa Pilaf and Maple Vinaigrette QUINOA PILAF 1 cup quinoa 2 cups vegetable or chicken stock 1 shallot, minced 2 cloves garlic, minced 1 carrot, medium dice 1 parsnip, medium dice 1. In a three-quart saucepan, sauté shallots, carrots and parsnips until tender. 2. Add garlic and sauté until fragrant. 3. Add quinoa and stock. Bring to a boil then reduce to a simmer. Season with salt to taste and cook for 15 minutes or until liquid is absorbed. 4. Remove from heat and chill. MAPLE VINAIGRETTE ½ cup rice wine vinegar 2 tablespoons plus 2 teaspoons maple syrup 1 teaspoon Dijon mustard 1 teaspoon Worcestershire ½ cup olive oil ⅛ teaspoon eachFILENAME: salt and pepper

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SPINACH SALAD 1 pound spinach leaves, washed and dried 1 tablespoon pine nuts, toasted 1 tablespoon dried currants (can substitute raisins, dates, dried cherries, etc.) ¼ cup Pecorino cheese, shredded (can substitute Romano, Asiago, etc. or leave out)

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LIVING

PARENTING

Linda Thompson, executive director of the Greater Spokane Substance Abuse Council: “This is all new territory.” STEPHEN SCHLANGE PHOTO

Reefer Badness Despite legalization, studies show cannabis poses risks to young brains BY JACOB JONES

t probably seemed like a normal chocolate bar. A student at Riverside High School north of Spokane received the tasty treat from a 15-year-old classmate in early March. Only after he had eaten the entire candy bar, investigators say, did the classmate mention the chocolate had been laced with marijuana. The drugged student went to the hospital as a precaution, testing positive for psychoactive THC, while his deceptive classmate suffered an immediate expulsion from the school. He may also face criminal charges. Linda Thompson, executive director of the Greater Spokane Substance Abuse Council, says she continues to hear more of

these types of unsettling stories from school officials and parents as the state moves toward legalization — bringing with it new retail stores, advertising and easier-to-hide infused products. School administrators, including some at middle schools, have told Thompson they already see more students experimenting with marijuana, particularly with edible forms such as candy, drinks or the notorious brownie. “The edibles are a great concern,” Thompson says. “How are [parents or teachers] going to know if that’s a brownie from home … or a brownie with marijuana in it?” Following the extended public opin-

ion debate over marijuana legalization, Thompson says more and more teens see marijuana as a safe drug. Studies show their “perception of harm” has dropped as marijuana supporters have pushed to decriminalize and destigmatize recreational use. Thompson argues young people still need to understand the potential risks. “They are getting a mixed message,” she says. “If adults are going to choose to do that, it’s their right, but we want to protect children. … It’s not healthy for a young person to smoke marijuana.”

esearch on the developmental effects of marijuana on young minds remains limited. But a number of studies suggest the growing teenage brain may suffer harmful delays or restructuring with early marijuana use. A 2013 study from the University of Maryland suggests marijuana use, like alcohol, poses much different dangers to children than it does fully developed adults. The Maryland study exposed juvenile mice to low doses of THC for 20 days and then allowed them to continue developing

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naturally. Upon dissection, the drugged mice showed “gross” alterations in brain structure as well as impaired behavioral performance. However, adult mice exposed to the same dosage did not have the problem, nor did unexposed young mice. “Long-term cognitive impairments and elevated risk of psychiatric disorders in regular marijuana users are less pronounced when use is initiated in adulthood, instead of in adolescence,” the study concludes. A 2012 study from Duke University, based on a survey of 1,037 people, also offers evidence that regular youth marijuana usage may reduce lifetime IQ levels. When comparing IQ at age 13 to 38, researchers found individuals who started using marijuana at a younger age saw their IQ drop by up to 8 points. The more they used, the greater the deficit. Researchers also say the results suggest the delayed brain function appears permanent. Even people who stopped smoking as adults could not restore the lost brain function. Other studies have made tentative links to marijuana use causing brain restructuring similar to schizophrenia. With some studies disputing that finding and suggesting that the IQ results may stem from other factors like socioeconomic

status (or that marijuana can get you kicked out of school), a definitive verdict on the risks of youth marijuana usage remains elusive — particularly when considering the often higher concentrations of THC in modern cannabis or infused edibles. But much of the consensus seems to lean toward the same conclusion: If you want to use marijuana, it’s safer to wait until adulthood.

hompson says funding for substance abuse prevention has declined just as legalization has gone into effect. Only two local high schools, East Valley and North Central, still have intervention officers to speak with students about drug abuse. She says she regularly fields calls from parents looking for help educating their children about marijuana legalization. “This is all new territory,” she says, adding, “I personally think it’s going to be devastating.” Chris Marr, a member of the state’s Liquor Control Board responsible for writing new regulations on marijuana legalization, says state agencies consider the prevention of youth marijuana use a high priority. New licensing regulations impose severe

consequences for even allowing a minor in a store. Furnishing marijuana to a minor constitutes a felony. “The rules lay out some pretty harsh penalties,” Marr says, noting fines quickly jump to a 30-day suspension, then revocation of license. Marr explains that new marijuana regulations also require childproof packaging as well as prohibiting the use of cartoons or youth-targeted advertising. As far as tracking supply, the system has instituted a wide variety of safeguards to monitor marijuana from growhouse to retail shelf. The biggest challenge, similar to alcohol, will be keeping adults from illegally passing along or selling marijuana to minors, he says. The Liquor Control Board can’t mandate personal integrity — that requires individual responsibility from parents, family members and friends. “We still have to rely on adults,” he says. “[But] we’re doing as much as we can do.”  For information on youth drug abuse prevention contact the Greater Spokane Substance Abuse Council at (509) 922-8383. The cola gummies are THC-infused.

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ON THE COVER

Brenna Grover trains under the watchful eye of Brooke Holloman at Chrome Personal Fitness Centre. STEPHEN SCHLANGE PHOTO

No Excuses

Want to look like a bodybuilder? Start to train like one BY DEANNA PAN

fter her first training session at Chrome, Brenna Grover cried the whole way home in her car. Her body ached. It was the hardest she’d ever worked out in her life. “I just wanted to fall over about five minutes in,” she says. But Grover came back. Again and again. A few weeks earlier, at the Empire Classic bodybuilding, fitness and figure competition in Spokane, Grover won a year’s worth of free personal training and nutrition counseling at Chrome Personal Training Centre. Grover, who’s 23 and lives in Spokane Valley, was going through a bitter divorce at the time. She was a fulltime student with no income and two small children. She was donating plasma for gas money. At 5-foot-2, she weighed 185 pounds at her heaviest. There was no way she could afford a gym membership. She was unhappy and unhealthy. She

wanted to change her life in more ways than one. Enter Brooke Holloman, who handpicked Grover after receiving dozens of video submissions for her personal training ambassadorship program. Holloman, who has been a personal trainer for almost two decades, opened Chrome Personal Fitness Centre in Spokane in 2009. She started seriously training bodybuilding competitors two years later. Last year, Chrome athletes won the coveted Empire Classic “Team Award” — a big honor for a relatively inexperienced group of competitors. “A lot of people think [bodybuilding] is a crazy glamorous sport and it really isn’t. It’s highly challenging mentally and psychically,” Holloman says. “It literally is, not to be cliche, eat sleep and breathe, blood, sweat and tears. … It’s a hell of a process.” And Grover can attest to that. Train-

ers at Chrome have a reputation for being tough. Holloman says her approach has been called “Jillian Michaels-esque.” They push you, Grover says, until you know what you’re truly, physically capable of. “They’ll make me do something that I wouldn’t choose to do by myself,” Grover says. “I’ll be completely out of it — have my eyes shut and crying — and I can still get 10 more reps in. I would never have known I could do that unless someone was forcing me to try.” But within a month of training at Chrome, Grover, who had never enjoyed exercising before, says she “couldn’t go without [her] workouts.” “I had to be there. I wanted to be there,” she says. “It’s like an addiction. You love the feeling you get. You love seeing the progress.” Nine months later, Grover dropped 38 pounds. She went from eating two large meals per day to six small meals — carefully crafted with Holloman’s nutritional expertise — full of lean proteins and complex carbs. She started off doing a 5-pound shoulder press; now, she can push herself to press 35 pounds. Her energy levels improved and her confidence skyrocketed. A couple months ago, Grover applied for a better paying job as a bank teller. She walked in Bank

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7 Ways to Get Started Want to get in the best shape of your life? Here is some of Brooke Holloman’s diet and fitness advice that even non-bodybuilders can use.

1 2 3 4 5 6 7

DITCH THE SCALE

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You heard it before: Muscle weighs more than fat. So if you’re losing fat and gaining muscle, don’t obsess over the number on the scale. “You should be able to go to the gym, work hard, eat what you’re supposed to and gauge your progress on how you look, how you feel and how your clothes fit, rather than what the scale says,” Holloman says. “You should have more energy. You should have more confidence. You should feel tighter. Your posture should be better.”

DRINK UP

Water, that is. Holloman advises her clients to drink between one and two gallons of H2O throughout the course of a day. Proper hydration fuels muscle growth during training, detoxifies the body and lubricates joints to stave off injury. Sufficient water consumption will also help you look a little leaner. “When you’re dehydrated, you tend to hold water on the outside of your muscle,” Holloman explains. “When you feel kind of squishy, sometimes it’s not even fat; it’s water.”

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You should know by now that eating “clean” foods (lean meats, complex carbs and healthy fats) is key to achieving your fitness goals. But that doesn’t mean you have to choke down a diet full of plain chicken, brown rice and steamed veggies. “People make health food taste like crap,” Holloman says. She suggests setting aside some of your free time on the weekends to prepare healthy and convenient meals for the rest of the week that you’ll actually enjoy.

PERFECT YOUR FORM

Whether you’re doing eight, 10 or 12 reps a set, what’s most important, Holloman says, is that you’re performing the exercise correctly. “If you can’t feel that muscle contracting, you’re not using it,” she says. “It’s not about the weight of the weights, but the efficiency of the exercise. Form is imperative — sending the signal to the proper muscle, making sure your whole body is tight through the whole exercise.” Proper form also prevents injury. Check out online instructonal videos at sites like FILENAME: bodybuilding.com to learn how to correctly perform various strength-training exercises.

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No magic pill, shake or faddish diet is going to give you long-term, sustainable results. “You have to go in with the mentality that this is going to take some time. You have to be patient and consistent,” Holloman says. “Quick fixes are a really good way to fall off [a regimen] because you might see great results for the first month, but then you’re going to plateau and you’re going to quit.”

IT’S NEVER TOO LATE TO GET FIT

“There’s literally no age limit,” Holloman says. Or fitness level. You’re never too out of shape or 5.0 h overweight to get started. “I believe anybody can do anything,” she says. Bodybuilding competitors don’t typically begin with a lean and chiseled physique, either; they have to build it over time. “To me, that’s a big old excuse. You’re giving yourself an out from looking and feeling how you want,” she says. “If you want to accomplish something, you have to take the steps foward to do it.” — DEANNA PAN

of America — something she never would have had the confidence to do before — and was offered a job on the spot. “I’m so much more active and my mood is just better on a consistent basis,” Grover says. “It’s affected the whole family in a positive way because I just feel good daily and it’s not even about how I look —

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it’s my actual body. I actually feel good and I just wake up feeling better.” A full year after her fitness journey began, Grover will step on stage in a sparkly bikini at the Empire Classic this May. She’s not nervous; she’s excited. She never thought she’d wear a two-piece bathing suit ever again. 

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LIVING several years later ran her first marathon. This spring, at age 69, she’s running her 250th marathon. “It was love at first step, I would say,” she says. “And I just haven’t stopped since.”

t’s clear that time is not kind to runners. Joints can wear out, muscle mass declines and every runner inevitably gets slower. But many aging runners, like Swanson, have found that a slower pace doesn’t mean leaving racing behind. While studies have shown health benefits, including a “notable survival advantage” for runners as they age, perhaps most important, runners love running. Recreational distance running caught on across America in the 1970s, and that popularity is creating a demographic shift at the starting line. In 1988, less than 3 percent of Bloomsday runners were over 60. Last year, nearly 10 percent were over 60. Almost 1,000 participants were over 70. While many of those older runners have been putting in miles since their high school days, many others have taken up running later in life. John Shull, 62, ran in the military for years but didn’t make a point of it until he was nearly 40. Then, after finishing the San Francisco Marathon, he was hooked. “You get the bug, and once you get the bug you just keep running,” he says. He’s now run a marathon on every continent. Shull says he’s not “fast or flashy,” and he runs more for the lifestyle than the competition against other men in his age group. “If I live long enough, I’ll become competitive,” he jokes.

Gunhild Swanson with proof of her passion. MIKE McCALL PHOTO BOOMERS

Still Running Older runners prove that slowing down a little isn’t anything like stopping

BY LISA WAANANEN

unhild Swanson first thought about running during a conditioning class at the YWCA when she was 34. It was 1977, the year of the first Bloomsday run, and the class instructor was talking to some ladies in the class about the race and the then-new concept of “jogging.” At the

end of class, anyone who wanted to try it out could stay to run laps around the gym. Swanson still remembers clearly that it took six weeks before she could run the full 24 laps without walking. And she remembers it with a laugh, because that following year she ran her first Bloomsday and

hysical training works the same way at any age, says Wendy Repovich, the exercise science program director at Eastern Washington University — you push your body to do more, and it adapts to do that work more efficiently. Older people may see improvements more slowly when they begin a fitness program, but a person will see the benefits of increased activity at any age. But what about the risk of injury? Repovich says the most common cause of injury is overuse — training too hard without adequate rest. “That makes no difference whether you’re just starting out or you’ve been doing it forever,” she says. Ingrid “Piper” Peterson, 67, grew up playing “girls’ sports” like field hockey, started playing co-ed soccer in her 50s and loved it, but realized it was too easy to get hurt. After running a marathon in Paris in 2007 — “I wanted an excuse to go on a

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vacation,” she says — she started training in earnest with the the Leukemia & Lymphoma Society’s group, Team in Training, and has since run marathons in cities around the globe. A physical therapist, Peterson understands how strong muscles protect joints and has stayed injury-free. Now, as a coach with Team in Training, she reassures others that listening to your body is more important than sticking to a preset training schedule. “Runners just keep running when they hurt,” she says. “If something hurts a little bit, I slow down, and if it still doesn’t go away I take a break.” When you ask runners why they keep lacing up their shoes and putting in the miles, they rarely mention the health benefits first. Instead, they’re motivated by the joy of running and the network of fellow runners. Five and a half years ago, Swanson lost her husband, Jack — her training partner and travel companion — to leukemia. Running was therapeutic, she says, and provided a supportive community of friends. Swanson set her personal records in

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hether it’s because of former injuries, chronic conditions or just a matter of preference, not every senior is going to run a marathon. And that’s completely fine. The important thing is staying physically active in some way, and walking has huge benefits for those looking for a place to start. The American College of Sports Medicine guidelines for older adults recommend doing a moderate-intensity exercise — like walking — for 30 to 60 minutes most days, for a total of 2½ to 5 hours a week. Or, for vigorous exercise — like running — guidelines recommend at least 20- to 30-minute activities for a total of 1½ to 2½ hours each week. Resistance, flexibility and balance exercises are also recommended. Find more at acsm.org. To stay motivated for any level of physical activity, experts recommend exercising with a companion or group for the social component. Setting goals is also critical, and signing up to walk in an organized race is a good, concrete goal. Don’t be surprised if you end up running at least part of the way. In many ways, speed is relative — if a 60-year-old woman and a 20-year-old man finish a race at the same time, her performance is a lot more impressive. But how do you compare? Many older runners and running organizations use “age grading” to place all participants on a level playing field based on the world record times for each age and gender. Similarly, the qualifying times for the Boston Marathon are based on age — a man under 35 needs to run a 3:05 marathon to qualify; a man in the 65-69 age group needs to run a 4:10 marathon. Find age-grading calculators online at runnersworld. com/tools/age-graded-calculator or howardgrubb.co.uk/athletics. — LISA WAANANEN the early 1980s — “a long, long time ago” — and that’s not what running is about these days. It’s about being outside the first spring day in T-shirt and shorts, and watching for the flowers to bloom; seeing the seasons change and going out, even when

the the weather is less than pleasant, for an adventure. “Just enjoy the fact that you can keep moving,” Swanson says. “And keep doing that for the rest of your life.” n

APRIL-MAY, 2014 LIVING inhealth 4-1-2014.indd 39

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LIVING APRIL - MAY EVENTS INFANT/CHILD CPR Class for new parents, grandparents, babysitters and others, teaching basic first aid, CPR and how to help a choking baby or child. Classes offered on evenings or weekends. $30/pair. Held at Sacred Heart and Holy Family hospitals. (474-2400) HEALTHY COOKING CLASS Monthly classes are taught by registered dietitian Joan Milton and include recipes to take home with you. Offered on April 9 and May 14 from 5:30-7 pm. $10; online registration available. INHS Community Wellness Center, 501 N. Riverpoint Blvd., Ste. 245. cherspokane.org (232-8145) UNCORKED! The 7th annual wine-tasting event hosted by the National Association of Women Business Owners (NAWBO) features wine from local women-operated wineries, food pairings and beer, a silent auction and more with a portion of event proceeds benefiting the local nonprofit Transitions for Women. April 11 from 6-9 pm. $60/person. The Lincoln Center, 1316 N. Lincoln. nawbonw.org DIABETES FAMILY RETREAT This weekend retreat is offered to children with Type 1 diabetes and their families, and provides opportunities for families to share perspectives with each other, as well as activities and entertainment. April 11-13. $100/family. At the YMCA’s Camp Reed. tgregory@hugosonthehill.com (624-7478) BABYSITTING BASICS This course is designed for youth ages 10-15 to prepare them to become successful babysitters, and includes instruction in infant care, CPR, discipline issues, safety and more. Offered April

12 and May 10 from 9 am-2 pm. $40; online registration available. Providence Sacred Heart Hospital Auditorium, 20 W. Ninth Ave. cherspokane.org (232-8138) CHOCOLATE & CHAMPAGNE GALA Lutheran Community Services Northwest hosts its 30th annual fundraiser gala, featuring decadent dessert and bubbly, and a steak dinner. Proceeds from the event benefit the organization’s Sexual Assault and Family Trauma Response Center and anti-human-trafficking programs. Sat, April 12 at 5 pm. $85/person, $170/couple, $680/table of eight. Mirabeau Park Hotel, 1100 N. Sullivan Rd. lcsnw.org (343-5078) YWCA SPRING FLING This 9th annual champagne brunch and silent auction fundraiser is hosted at Anthony’s Restaurant and supports local programs and services of the YWCA of Spokane for women and children. April 12 from 10 am-12:30 pm. Registration required by April 5. $50/person. Anthony’s Restaurant, 510 N. Lincoln. ywcaspokane.org (326-1190) EVENING OF ELEGANCE FOR AUTISM Fundraiser gala featuring a silent and live auctions, dinner, live music, and a Dry Fly whiskey tasting, with proceeds benefiting Northwest Autism Center. April 12 from 5-9 pm. $75/ person, $140/couple. Spokane Club, 1002 W. Riverside Ave. nwautism.org (328-1582) ADOPT A ROOM Ferrante’s hosts its fourth annual fundraising event benefiting the Ronald McDonald Charity House, donating all profits to the organization which allows families to stay at no charge while a child undergoes medical treatment. April 16 and 17. Includes dine-in and takeout orders and gift shop sales. Ferrante’s Marketplace Cafe, 4516 S. Regal St. (624-0500)

KIDICAL MASS Spokane Summer Parkways’ family bike ride series returns, offering the first of three 3-mile rides this spring/summer. April 26 at 1 pm, as part of West Central Neighborhood Day. Free. Begins at A.M. Cannon Park, 1920 W. Maxwell. Also May 17 at 1 pm at Chief Garry Park. summerparkways.com RACE FOR THE CURE The annual fundraiser offers a 1-mile survivors walk and a 3-mile walk/run, with proceeds benefiting the mission of Susan G. Komen’s Eastern Washington affiliate. April 27. Registration fees $15-$35. Starts at Spokane Convention Center, 334 W. Spokane Falls Blvd. komeneasternwashington.org (315-5940) LILAC CITY FAMILY FUN RIDE The 21st annual bike ride offers route distances (15-, 25-, 50-, 66- and 100-mile) for every level of rider, with a baked potato feed at the finish. April 27, races starts staggered. Spokane Falls Community College, 3410 W. Fort George Wright Dr. lilaccentury@ gmail.com (850-2808) BLOOMSDAY Participate in the 38th running of the Lilac Bloomsday Run, an Inland Northwest tradition. This year’s benefiting nonprofit is the Northeast Community Center. May 4 at 9 am. $17-$35. Downtown Spokane. bloomsdayrun.org (838-1579) CATHOLIC CHARITIES GALA “Bringing Color to Life” is the theme of the sixth annual fundraiser event, featuring a special guest performer, dinner, awards and dancing. May 9 at 6 pm. $60-$100/person. Davenport Hotel, 10 S. Post. catholiccharitiesspokane.org (358-4254) April-May Events continues on page 44

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LIVING APRIL- MAY EVENTS RUN OR DYE 5K race during which runners are sprayed with eco-friendly cornstarch dye every kilometer. A portion of proceeds benefit a local charity. May 10 at 9 am. $42-$57. At Riverside State Park. runordye.com ETHICAL DILEMMAS IN SERVING VULNERABLE ADULTS Workshop by the Senior Assistance Fund of Eastern Washington featuring Wendy Lustbader and Karen Sayre. Topics include “Responding to Self-Neglect and Slow Suicide” and “Options for Managing Finances.” May 14 from 8:30 am-4 pm. CE credits available, cost TBA. Lincoln Center, 1316 N. Lincoln. safe@altcew.org (458-2509) WOMEN’S CANCER SURVIVOR RETREAT This retreat for women who have or are currently experiencing cancer treatments offers a weekend of bonding, reflection, sharing, presentations and more. May 16-18. $195 (fee assistance available). The Franciscan Place, 1016 N. Superior St. sjfconline.org (483-6495) TOUR DE CURE This annual cycling race/ride raises funds for diabetes research and prevention, offering 2-, 25-, 50- and 100-mile rides. Hosted by the American Diabetes Association of Spokane. May 17 at 8 am. $15 registration fee; $150 fundraising min. Northern Quest Casino, 100 N. Hayford Rd. tduncan@diabetes.org (624-7478) BREAKTHROUGH FOR BRAIN TUMORS A 5K run/walk to raise awareness and funds to support brain tumor research and services for those living with a diagnosis. May 17 at 8:30 am. $35/person. SFCC, 3410 W. Fort George Wright Dr. abta.org (773-577-8762) SK BALL Annual barn dance fundraiser benefiting Ronald McDonald House Charities of Spokane, featuring dinner from Longhorn Barbecue, beverages, line dancing, bull riding and more. May 17 at 6 pm. $75/person. Spokane County Fair & Expo Center, 404 N. Havana St. deek@ rmhspokane.org (624-0500) WOMEN HELPING WOMEN FUND The annual luncheon features its first male keynote speaker, Christopher Gardner, a philanthropist and entrepreneur and author

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of national bestseller The Pursuit of Happyness. Proceeds benefit a number of local charitable organizations serving women and children. May 22. Spokane Convention Center, 334 W. Spokane Falls Blvd. whwfspokane.org (328-8285) WINDERMERE MARATHON This USATF Certified and Boston Marathon qualifier race offers both full and halfmarathon distances. Proceeds benefit the Windermere Foundation, which assists local low-income families. June 1 at 7 am. $80-$115. From Liberty Lake to Riverfront Park along the Centennial Trail. windermeremarathon.com

VANESSA’S PROMISE BENEFIT LUNCHEON The annual luncheon raises funds to operate the crisis nursery, which offers care for children during emergency situations. June 3, from noon-1 pm. Spokane Convention Center, 334 W. Spokane Falls Blvd. vanessabehan.org (535-3155) n The calendar is a free service, on a space-available basis. Mark submissions “InHealth Calendar” and include the time, date, address, cost and a contact phone number. Mail: 1227 W. Summit Parkway, Spokane, WA 99201; Fax: 325-0638; or E-mail: calendar@inhealthnw.com.

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Adam Sahlberg (above right and inset) evaluates a team of medics as they evacuate and treat a mannequin with life-threatening injuries during a simulated “care under fire” scenario last November in the high desert outside Fort Bliss, near El Paso, Texas.

First on the Scene Spokane Valley Army medic Adam Sahlberg trains the next generation to be prepared for worst-case scenarios BY LAURA JOHNSON I am in a unique position of witnessing the worst war has to offer on both the active battlefield and in the reactive hospital (better known as an aid station). … I get to experience firsthand the bullets flying overhead and the bombs detonating outside my vehicle and then also witness the aftermath of those devices as the wounded get evacuated into the trauma room. — journal entry from U.S. Army Staff Sgt. Adam Sahlberg; Iraq; Nov. 2, 2007

t war in the Middle East, the thing a soldier can never train enough for is the drudgery of downtime. The constant wait — sand everywhere, flies gnawing at your flesh, oppressive heat that causes sweat to drip no matter what time of day — just aggravates the mind-numbing

boredom. But when a soldier is called into action or an emergency strikes, preparation is paramount. “The most important thing to train for is what you’re called to do when it really matters,” says Staff Sgt. Adam Sahlberg, a medic with the U.S. Army. After serving a 14-month tour in Iraq from 2007-08 as a line medic and an evacuation CEO (the EMTs and paramedics of the Army world), Sahlberg, 30, now travels to other bases training new medics who are soon to be deployed. “I’m telling them the things I wish I knew before I went,” says Sahlberg, who grew up in Spokane Valley. From a young age, Sahlberg and his father participated in shooting competitions

(shotguns, pistols, rifles) around the country, earning the title of grand master at 17. Wanting to serve his country, he enlisted the year after graduating from University High School in 2002. Even though his mom is a nurse, Sahlberg wasn’t initially interested in a health care role. Instead, he joined military intelligence. But after taking medic classes and loving them, he knew that was what he was called to do. Coming home from his overseas mission, Sahlberg was stationed at Fort Irwin in California, where he became involved in the extremely demanding Army’s Best Warrior Competition. In 2010, he was named the Medical Command Noncommissioned Officer of the Year after acing a series of rigorous written, oral and physical tests, including one in marksmanship. Along with getting to meet the President and First Lady, Sahlberg says winning various awards meant the opportunity to choose his current assignment teaching trauma medicine. It also meant moving the family to Texas. With four young children and a wife at home in San Antonio, it has been understandably hard for Sahlberg to be away, missing birthdays, lost teeth and family meals. That’s one of the reasons journaling was so important for him while in Iraq.

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“You get removed from your support base, and you’re never the same,” Sahlberg says. “But I have it easy compared to what my wife has to endure. She’s raising the family.” A big part of what a medic does in the field, outside of handling mostly rare high-trauma situations and serving in the infantry, is to make sure other soldiers are taking care of themselves. Sahlberg says it can be mundane — checking to make sure underwear and socks are changed regularly and directing attention to personal hygiene. But he says these things help troops maintain a healthy attitude, and also make them less susceptible to infections while in the field. In a way, he compares it to being an active-duty mother. “I’m talking about the deglorified things, but that’s the more important stuff,” says Sahlberg, on break from training in North Carolina. There are times when a medic’s technical training is essential. Traumatic injuries to the body and brain, as well as longerlasting problems like traumatic stress disorder, are major areas of study for the Army. Teaching others how to quickly contain an emergency is key, since a medic can’t be everywhere at once on a battlefield. “A medic is only as effective as his men — the person who’s placing the first tourniquet, the person closest to him,” says Sahlberg. Advanced on-the-field triage developed by the Army has spread to the civilian world. Sahlberg points to the Boston Marathon bombing last year, where emergency responders applied tourniquets on-site, saving limbs in the process. “Tourniquets are often used only as a last resort,” Sahlberg says. “But to see them used so aggressively in Boston, that’s Army lessons learned.” The Army also has developed a kind of combat gauze that accelerates the natural clotting process for wounds where a tourniquet can’t be applied. In August, Sahlberg is planning on changing tracks, transitioning into the Army’s physician assistant program — he earned his bachelor’s in health sciences in 2012. Along with all he’s taught the next generation of medics, his medic training will always remain with him. “To be a great medic you need discipline,” Sahlberg says. “Medics have to be innovative. You’re told this is your set of equipment, but that doesn’t always line up. Sometimes you have to make a tourniquet or a creative air supply. Above all, medics need to be resilient. They’re exposed to the worst sides of war.” n

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