INHealth 12/02/2014 by The Inlander

Antony Chiang’s Big Ideas

| Decoding Childhood Trauma

| A Ball of Energy in CdA

Health

HEALTHY LIVING IN THE INLAND NORTHWEST • FREE

Get-Fit Gadgets TECHNOLOGY IS REVOLUTIONIZING THE WAY WE WATCH OUR HEALTH PAGE 29 Bloomsday board member Carol Hunter clocks her run

DEC. 2014-JAN. 2015

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A special thank you to our business sponsors, guests, restaurants, wineries, breweries and volunteers for making the 33rd Annual Epicurean Delight the most fun black-tie gala in the Inland Northwest!

Culinary Award Winners • • • • •

Outstanding Hors d’oeuvres: Wild Sage Bistro - Steelhead Street Tacos Outstanding First Course: Downriver Grill - Roasted Corn and Chipotle Bisque Outstanding Entrée: Beverley’s - Filet Mignon and Potato Cake Outstanding Dessert: Sweet Frostings Blissful Bakeshop - Salted Caramel Panna Cotta People’s Choice Best Restaurant: Nothing Bundt Cakes - Pumpkin Spice Bundtinis

Restaurants

Ambrosia Bistro & Wine Bar; Beacon Hill Catering; Beverly’s; Chef’s de Cuisine; Deaconess Hospital; Downriver Grill; The Flying Goat; Herbal Essence Café; Huckleberrys; Just American Desserts; Knockaderry Irish Pub; Le Catering Co.; Mangia Catering; Masselow’s; Max at Mirabeau; Nothing Bundt Cakes; Saranac Public House; Simply Gourmet; Spencer’s for Steaks and Chops; Spokandy; Spokane Melting Pot; Sweet Frostings; Taste of India; The Wandering Table; The Yards Bruncheon; Wild Sage Bistro

Wineries & Breweries

Amavi Cellars; Arbor Crest; Bridge Press Cellars; Chateau Ste. Michelle; Columbia Crest; Coeur d’Alene Cellars; Cougar Crest; Domanico Cellars; EMVY Cellars; Finnriver Farm & Cidery; Iron Goat Brewery; Iron Horse Brewery; Liberty Ciderworks; Maryhill Winery; No-Li Brewhouse; Orlison Co.; Pend d’Orielle Winery; Ramblin Road; River City Brewing Co.; Rocky Coulee Brewing Co.; Robert Karl Cellars; Steam Plant Brewing Co.; Townshend Cellars; Twelve String Brewing Co.; Twilight Cider Works; Vintage Hill Cellars; Walla Walla Vintners; White Heron Cellars; Whitestone Winery

Culinary Judging Panel

Jeff Barstow, URM Food Service; Burke Blevins, Fidelity Associates; Brian Butler, Spokane Produce; Courtney Clyde, M.D., Columbia Surgical Specialists; Ashley Craig, Rosauers/Huckleberry’s; Dan Demchuk, Moss Adams, LLP; Dave Green, Blood Systems, Inc.; Debbie Haskins, Premera Blue Cross; Lynn Hurley, Randall & Hurley; Alex Jackson, Providence Health Care; Wendy Johnson, SDDS; Susan Lane, Allstate Insurance-Drew Hodgson; Jane McCarthy, KREM 2; Felix Martinez, M.D., Incyte Diagnostics; Robert McDaniel, Kootenai Health;Tamara McGregor, The Pacific Northwest Inlander; Melissa Proffitt, Moloney + O’Neill; Jason Ramey, Ramey Construction; Shelley Redinger, Spokane Public Schools; Steve Stevens, Greater Spokane Incorporated; Tony Sepanski, Delta Dental of Washington; Steve Storey, Umpqua Bank; Gary Sutter, Kalispel Tribe of Indians and Northern Quest; Steve Utt, Washington Trust Bank; Mel Watson, Camp BMW; Keith Western, AmericanWest Bank; Ian Wingate, The Davenport Hotel & Tower; Robin Woods, Gritman Medical Center

Grand Presenting Partners

Kalispel Tribe Northern Quest Resort & Casino; Numerica Credit Union

Event Sponsors

Spokane District Dental Society; Rosauers

Event Underwriters

Allstate Insurance – Drew Hodgson; AmericanWest Bank; Blood Systems, Inc.; Camp BMW; CellNetix; Columbia Surgical Associates; Davenport Hotel & Tower; Delta Dental of Washington; Fidelity Associates; Gritman Medical Center; Incyte Diagnostics; The Pacific Northwest Inlander; Kootenai Health; KREM 2; Moloney + O’Neill; Moss Adams; Northwest Farm Credit Services; Physicians Insurance; Premera Blue Cross; Providence Health Care; Ramey Construction; Randall & Hurley; Rosauers; Spokane Produce; Umpqua Bank; URM Food Services; Washington Trust Bank

Table Sponsors and Hosts

Asuris Northwest Health; Bank of America; Cambia Health Solutions; Cancer Care Northwest; Columbia Bank; Delta Dental of Washington; Dr. William & Mrs. Eileen Dittman, Jr.; EMS Connect; Jeff & Melinda Bryant; Dr. Michael Ferries; Gritman Medical Center; Inland Northwest Health Services; Integra Imaging; Jan-Pro Northwest; Kootenai Health; Marcia Mielke; Moloney + O’Neill Benefits; Premera Blue Cross; Terumo BCT, Inc.; Rockwood Health System – Deaconess Hospital – Rockwood Clinic – Valley Hospital; Thrivent Financial – Anthony Frei; University of Idaho Executive MBA Program; Washington Trust Bank

In-kind Supporters

ALSCO American Linen; A Personal Fit; Advanced Dermatology; Amari Cellars; aNeMonE Paper Flowers; Arbor Crest Wine Cellars; Barrister Winery; Be Loved Salon; Bozzi Media; Brickhouse Massage and Coffee Bar; Brides Time Magazine; Bridge Press Cellars; Chateau Ste. Michelle; Clover; Coeur d’Alene Cellars; Columbia Crest; Cork House; Costco; Domanico Cellars; Dry Fly; Eastern Washington University Athletics; Elements Therapeutic Massage; Emvy Cellars; Finder’s Keepers; Finnriver Farm & Cidery; Food Services of America; Garrison Creek Cellars; Georgette Grainger; Gonzaga University/IMG; Greg & Loreen McFaul; Hay J’s Bistro; Home Depot; Idaho Vandals Sports Properties; Jake and Emilie Krummel; Jan-Pro Northwest; Jeff Bryant; Jensen Distributing; Josef and Tricia Cheevers; Josefina’s; Ken Plank, CLO, Numerica Credit Union; Kirsten Stobie; Lamar Outdoor Adv.; Larry H Miller Hyundai; Laser Quest; LCD Exposition Services; Liberty Ciderworks; Linda J. Blessing; Lowes of East Spokane Valley; Lowes of North Spokane; Manito Tap House; Manny Hochheimer; Marcia Mielke; Maryhill Winery; Max at Mirabeau; The Spokane Melting Pot; Michelle Grabicki; MillsFly; MOR Furniture; Mustard Seed; N.W. Beauty Supply and Salon; Nordstrom Marketplace Café; Numerica Credit Union; Oxford Suites - Downtown Spokane; The Pacific Northwest Inlander; Pam McLaughlin; Pend d’Orielle Winery; Peters and Sons Florist; Planet Beach Contempo Spa; Pounder’s Jewelry; River City Brewing; Robert Karl Cellars; Scott Jones; Sherry Lewis; Silhouette Lights & Staging; Spiceologist; Spokane Chiefs Hockey Club; Spokane House of Hose; Spokane Indians Baseball Club; Spokane Symphony; Sport Town; Stacks Restaurant and Steam Plant Brewing Company; Standard Digital Print Co., Inc; SuperShots Portrait Studio; The Cronkites; The Marcus Whitman Hotel; Three Rivers Winery; TicketsWest; Total Wine & More; Townshend Cellars; Traci Hudson; Trezzi Farm; Tuxedo Gallery; Twelve String; Twilight Cider Works; Vino!; Vintage Hill Cellars; Walla Walla Cellars; Washington State University Athletics; Washington Trust Bank; Wayne Longo; WestCoast Entertainment; White Heron Cellars; Whitestone Vineyard & Winery; Whitworth University Athletics; Wild Walls; William Dittman, M.D.; Woodcraft; Young’s Market Company; Zak Foundation; Ziegler Lumber Co.

Media Partners

KREM2- Tom Sherry – Chief Meteorologist and Kevin Tompkins – Commercial Production Supervisor; The Pacific Northwest Inlander and InHealth

Health

Fall/Winter Savings Sale

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

EDITOR Anne McGregor

annem@inhealthnw.com

MANAGING EDITOR Jacob H. Fries ART DIRECTOR Chris Bovey CALENDAR EDITOR Chey Scott PHOTOGRAPHER Young Kwak COPY EDITOR Michael Mahoney

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ADVERTISING SALES Autumn Adrian, Bonnie Amstutz, Bruce Deming, Gail Golden, Janet Pier, Carolyn Padgham-Walker, Emily Walden, Raevyn West SALES COORDINATION Rebecca Rison, Gilbert Sandoval, Denise Brewer, Brynn Schauer DESIGN AND PRODUCTION Tom Stover, Derrick King, Alissia Blackwood Mead, Jessie Spaccia DISTRIBUTION MANAGER Zach Johnson BUSINESS MANAGER Dee Ann Cook CREDIT MANAGER Kristin Wagner PUBLISHER Ted S. McGregor Jr. GENERAL MANAGER Jeremy McGregor

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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: x215. 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.

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ON THE COVER | YOUNG KWAK PHOTO

CHECK-IN PAGE 9

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ASK DR. MATT 9 SUPERFOOD 10

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Health 5

FROM THE EDITOR

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

Thank you to our patients, customers, partners and providers for working together to improve our communities’ health. With a commitment to quality patient care and innovative technologies, INHS employees are providing collaborative health care services to benefit the entire region.

St. Luke’s Rehabilitation Institute • Engage Health Training • Northwest MedStar Northwest TeleHealth • Community Wellness COHE Community of Eastern Washington

This holiday season, consider making a gift to support our services. Visit www.inhs.org

It’s Easier Than You Think

hile the reasons to exercise keep adding up — better brain function, reduced risk for heart disease and cancer — we’re lucky enough to also have a slew of new ways to make getting and staying fit actually fun. I got inspired visiting with the happy trio of runners featured in our cover story and learning about fitness apps in Jordy Byrd’s story. Just like Mary Poppins says, “You find the fun and — Snap! — the job’s a game.” I recently read a study that showed how just one year of endurance and interval training transformed the hearts of a dozen couch potatoes into pretty good facsimiles of the highly efficient tickers of elite athletes. But even fairly minimal effort — as little as 11 minutes a day — can result in great benefits. Speaking of Mary Poppins, while a spoonful of sugar may or may not help the medicine go down, a new study published in Annals of Family Medicine has some research-supported advice for those who, like me, struggle to swallow big pills. Here’s the scoop: For tablets, which tend to be heavy, place the medicine on your tongue, seal your lips around a plastic water bottle, then lift your chin and suck the water in, whooshing the pill down your gullet. For capsules, which tend to float up, it’s better to put the medicine in your mouth, take a swig of water and tuck your chin down to swallow. To your health!

Inland Northwest Health Services (INHS) is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of the community and its member organization Providence Health Care.

6 Health DECEMBER, 2014-JANUARY, 2015

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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 Inlander Facebook page, and stay in touch with us at Inlander.com/InHealth.

ON OUR FACEBOOK

What’s your favorite fitness or health app?

PALOMA BRAUNGER MyFitnessPal because it’s a one-stop shop. You can keep track of your workouts, food intake, and there is the opportunity to join chat rooms for support. VANESSA WIXOM Sworkit. It creates body weight workouts based on intervals, upper/lower body, cardio and yoga. Very customizable. Highly recommend it as a quick-hit workout! CAMERON SOWER Dominos Pizza Tracker. DANIELLE MILTON MyFitnessPal is the winner. It is free, first of all. It has a website version as well, in case you prefer to use a computer. First you input your personal stats and goals and it will give you the amount of calories to consume per day depending on your goals. You can log all of your food easily — there’s a barcode scanner which is fantastic. Their food database is huge! You should be able to find pretty much anything you eat in it, and if you can’t find it, then you can create a food. There is also a recipe builder so you can find the stats of a serving size of your homemade meal. If you eat the same meals frequently, you can save them. This allows you to log the entire meal with one click. Overall, it’s a fantastic app. GRETCHEN ELIZABETH Definitely MyFitnessPal. SHARON PEGAU Fitbit. The app is free when you buy the Fitbit (which is not free). It really keeps me on track, especially since my friends see how I am doing. I also like OneHundredPushups. n

ASK DR. MATT

Inoculation Information

reat news! The FDA recently approved Trumenba, a new vaccine for the prevention of Neisseria Meningitidis type B. Until now there has been no effective option available to prevent type B, which is the cause of about a quarter of the total annual cases of invasive meningococcal disease in the United States. Right now the vaccine is indicated for 10-to-25-year-olds; hopefully there will soon be an option available for younger children, as type B is the most common cause of invasive meningococcal disease in children under age 2 in the U.S. This vaccine option is a long-awaited addition to the successful disease prevention programs that have been effective in the U.S. and worldwide in reducing the occurrence of numerous serious childhood and adult diseases. Although the vast majority of parents choose to vaccinate their kids — fewer than 1 percent of U.S. children are completely unvaccinated — many still have nagging concerns about side effects of those vaccines. Eula Biss’ brand-new book On Immunity: An Inoculation presents a highly readable and thought-provoking foray into this vaccine hesitancy, exploring its historical, philosophical, psychological, sociological and religious origins. A gifted essayist and poet, Biss reveals her own personal experiences with vaccine hesitancy, admitting that she shares many of the features of other vaccine-hesitant parents these days — parents who are often well-educated, middle class “irrational rationalists.” She offers interesting commentary on the role of myth in our communal psyche, the nature of fear, and the challenges of interpreting scientific evidence and risk perception, as well as the cultural trend in America, elevated to near-religion,

for pursuing purity in our personal hygiene, the clothing we wear, the foods we eat. She additionally raises some cogent points about the historical tendency for medicine to be paternalistic in nature, standing in opposition to autonomy, and how this issue alone may affect how willing some parents may be to follow medical advice, particularly if they have concerns about the safety or effectiveness of that advice. On Immunity is a quick read that was more illuminating for me than the many pages of words and graphs on this topic published of late in medical literature. I consider it a must-read. — DR. MATT THOMPSON

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

PILL BOX

Forbidden Fruit I just picked up my prescription for lovastatin. My pharmacist warned me not to drink grapefruit juice while taking this medication. Why? Can I drink orange juice instead?

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

he grapefruit juice warning is real and should be heeded! The food-drug interactions with grapefruit juice result in more of the active medication getting into your system. In the case of lovastatin and grapefruit juice, taking the two together can provide an amount of lovastatin to your body that is equivalent to consuming 15 doses of lovastatin without

grapefruit juice. This can result in significant toxicity. Many medications undergo this interaction, including some over-the-counter medications like dextromethorphan (found in Robitussin). Some grapefruit juice-drug interactions are worse than others and not all people respond in the same fashion. Also, there are differences in the interaction between different types of grapefruit juice. However, if the medication label or the pharmacist recommends “do not take with grapefruit juice” then you shouldn’t. Except for Seville or bitter orange juice, which is a specialty item not commonly consumed in the U.S., regular orange juice does not cause this interaction and is fine. — JOHN R. WHITE DECEMBER, 2014-JANUARY, 2015

Health 9

CHECK-IN LIFE COACHING

Revitalize Your Resolutions

re you getting ready for another round of New Year’s resolutions? Calendar year intentions seem to be the underdogs in the goal-setting world. Carla Brannan is a So why the bad rap? Think of an unrealized personal life goal from resolutions past and ask yourself coach in Spokane. these questions: 1) Were you physically, emotionally and mentally prepared to take the actions necessary to achieve your desired goal? If not, what needed to be different? 2) Was it really your own goal, or something you thought your spouse, parent, boss or society wanted? If there are hidden “shoulds,” it may be that it wasn’t solely your intention. 3) Did you wholeheartedly feel you would be successful? If there was doubt, ask yourself why. The answers may reveal obstacles you want to address. It’s not uncommon for us to unknowingly sabotage our goals before we even get started. For 2015, consider the questions above. Now you’re ready to write your resolution by applying the following guidelines to create a powerful statement of intention. 1) Use the present tense, writing as if it were already true. 2) Use positive language; write what you want rather than what you don’t want. 3) Make it personal and use your favorite words. I’m interested in hearing what you come up with for your 2015 New Year’s intention statement. Here’s mine: I have a vibrant yoga practice in my home sanctuary. May we all be fruitful in our resolutions! — CARLA BRANNAN

SUPERFOOD

Oh, Clementines! ATTRIBUTES: Just when the sun decides to skip town for 16 hours a day, lovely little mandarin oranges — one variety is known as a Clementine, the other a Murcott — make their bright return. Kids particularly adore the little winter-season fruits that contain only 35 calories each. SUPERPOWERS: With a peel that slips right off, the mandarin orange begs to be eaten in quantity — why stop at one? Two Clementines contain a respectable amount of potassium and folate, as well as some potent, citrus-only antioxidants. But they really shine in immuneboosting, disease-fighting vitamin C — with two little fruits supplying 120 percent of an adult’s recommended daily allowance. WEAKNESSES: All citrus fruits, including mandarins, may worsen indigestion. And like other citrus, most of the calories in a clementine are from sugars. HOW TO USE IT: Try this recipe from the American Institute for Cancer Research: Toss a medley of clementine sections, fresh spinach leaves, sliced celery, red onions, toasted walnuts and dried cranberries with a dijon vinaigrette for a bright winter salad. — ANNE McGREGOR

Never miss an issue. Find more local stories on topics important to you: parenting, health trends, super foods and much more! Search the full issue archives or by the category you are most interested in.

Only on Inlander.com 10 Health DECEMBER, 2014-JANUARY, 2015

THEIR OWN WORDS

Antony Chiang Antony Chiang is the president of the Empire Health Foundation. The Foundation has established goals of relatively rapid improvement on some of the most intractable public health issues facing the Inland Northwest — obesity, child abuse and trauma, and the shortage of health care providers. Some would say those issues seem overwhelming. How do you meaningfully tackle something like obesity on a community-wide basis? We do this thing called “bright spotting.” Sure, there are hundreds of communities across the U.S. where the obesity rate has gone up 300 or 400 percent in the last four decades. Instead of looking at all those dark spots, why don’t we find the one bright spot, where they’re actually turning it around? For obesity prevention, we decided to copy a couple different bright spots. There was one in Colorado, and there was one in Somerville [Massachusetts], and we actually mashed them up. Fast forward: The Cheney School District is a great example. They converted to healthy, scratch cooking. They have techniques where they’re being physically active while they’re learning. Volunteer parents go through a “bus route” and pick up kids, but they are a walking school bus, rather than a vehicle. So the school district partnered with Parks and Rec, and the mayor was a champion for it, and local restaurants did healthy choices for kids. Really a great multi-pronged effort. And their obesity has gone down as compared to a control group in two years. We think that’s amazing.

YOUNG KWAK PHOTO

Tell me about your new project to combat adverse childhood experiences — so-called ACEs? What’s the bright spot here? Right. How do you prevent abuse, neglect, substance abuse, incarceration of parents? These are all ACEs. It seems super-daunting. We actually did an ecosystem scan. Two of the sectors, or silos if you will, kind of rose to the top as promising right at this moment. One is the K-12 education system, our public school system; the other is our foster care system. We’ve set a bold goal to reduce the number of foster kids by 50 percent in our system in five years. We’ve gotten a lot of raised eyebrows, just because it is admittedly so bold. But if Medford [Oregon] can do it, if Alameda County [in California] can do it — I mean, that’s the home of Oakland — do we have a weaker community, do we have a less collaborative community than those two places? I don’t think so. I think we have an amazing community. — INTERVIEW COMPILED AND EDITED BY ANNE McGREGOR

Expanding Research From classroom to lab Washington State University health sciences professors in Spokane teach and engage in meaningful scientific research in sleep neuroscience, sleep and performance, genetics, cancer, cancer and aging, kidney disease, diabetes, drug addictions, neuropharmacology, exercise physiology and more. spokane.wsu.edu

DECEMBER, 2014-JANUARY, 2015

Health 11

CHECK-IN CHARITY CORNER

A Safe Place

Christina Hull in one of the Children’s Village’s newly decorated rooms. The nonprofit aims to double its capacity to serve up to 200 North Idaho kids who need a safe place to stay. YOUNG KWAK PHOTOS

hen no one else can answer the call, the Children’s Village in Coeur d’Alene opens its arms to the community’s most vulnerable children. Over the past two and a half decades, two residential houses on a quiet cul-de-sac on the northern edge of the Lake City have welcomed more than 2,000 abused, neglected, homeless or crisis-affected children. Right now, the 31-year-old nonprofit is in the midst of preparations to reopen one of those two facilities, the Miller House, which was forced to close its doors in 2010 when it lost most of its state funding. Development Director Christina Hull says the community banded together to help raise $650,000 to reopen the Miller House early next year and keep it operating for at least the next two years. “We’ve spent a lot of time and energy getting this house reopened, which is a priority because we have turned away more than 55 kids this year who came to live here, and we were full,” Hull says. “That’s why we want so badly to open the second house.” Because most of the nonprofit’s recently raised funds went to the renovations and other efforts needed to reopen the Miller House, the biggest need now is to raise and maintain funding for its first facility next door, the Moyer Home. That state-licensed facility receives less than 5 percent of its overall operating funding from the state, relying on grants, donors and other sources for the majority of its financial needs. The Children’s Village serves as a safe haven for children affected by any kind of crisis, short- and long-term, and does not place limits on the amount of time a child can remain under its care. Its services are in many ways similar to Spokane’s Vanessa Behan Crisis Nursery, except the Children’s Village can offer a home for children on a long-term basis, serving more like a foster home in some cases. “Because of that long-term factor, we serve on average 75 to 100 kids a year, and that will double with the second house,” Hull adds. At the moment, Hull says the public can help the Village continue its mission through monetary donations, volunteering with projects at the homes or organizing donation drives for items such as nonperishable food, diapers and clothing. During the holidays, she says many local groups organize toy drives for Village residents, but those interested can “adopt” a specific gender age group and donate items, for example, that would interest teen girls. — CHEY SCOTT Find out more about the history, mission and needs of the Children’s Village at thechildrensvillage.org.

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12 Health DECEMBER, 2014-JANUARY, 2015

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Sudoku

3 9 8 5 2 7 4

RATINGS: Moderate (left), Tough (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.

2 8 1 6 3 6 4 7 6 8 7 3

Answers to all puzzles on page 42

7 3

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

3 2 9 1

Codewords

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 three-letter clue, turn to page 21. 23

26 22

21 17

11 2

22 21

3 7

7 1 3

7 1

5 6 3 9 2 7

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

2 2 4 4 6 2

8 5

9 5 6

4 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.

3 1

5 3 7 7 5 4

BRAIN EXERCISE

QUICK DOES NOT MEAN IT HAS TO BE UNHEALTHY

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Health 13

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NEWS

KIDS HEALTH

Curt Chambers, a counselor at Holmes Elementary: “We’re much more aware of the emotional needs of the kids who come from traumatic backgrounds.” YOUNG KWAK PHOTOS

Understanding ACEs Helping kids bounce back from adversity may lead to a healthier adulthood BY E.J. IANNELLI

ore than 20 years ago, a physician named Vincent Felitti began wondering why a successful obesity program offered by his employer, the health care provider Kaiser Permanente in San Diego, was seeing a significant patient dropout rate. Why would people quit, despite losing weight? So he delved into the personal histories of those who had left the program and discovered a surprising commonality: Many of the dropouts had experienced abuse or neglect as children. In 1992, Felitti teamed up with Dr. Robert Anda, who had taken a particular interest in Felitti’s unusual findings on account of his own related work for the Centers for Disease Control and Prevention. The pair then embarked on what would become a landmark research effort: the Adverse Childhood Experiences (ACE) Study.

As part of that study, beginning in 1995 more than 17,000 Kaiser Permanente patients were surveyed and given a routine physical examination. The first findings based on these data were published in the

late 1990s, and they revealed a surprisingly powerful link between childhood trauma — such as psychological, physical and sexual abuse, as well as chronic neglect — and the

likelihood of health problems in later life. Since then, more than 50 subsequent studies have expanded on those results. “I just went to an ACEs summit last week,” says Antony Chiang, president of Spokane’s Empire Health Foundation, which has identified preventing and mitigating the long-term effects of ACEs as one of its strategic priorities. “The kinds of stats are that if you have four or more adverse childhood experiences compared to one or none, you don’t just have a 20 percent increased chance of cardiovascular disease, you have a 400 percent increased chance. You don’t just have a 50 percent increased chance of being diagnosed with depression later on in life, you have, like, a 2,400 times [chance]. They’re just starting to understand the science behind why that’s true.” ...continued on next page DECEMBER, 2014-JANUARY, 2015

Health 15

NEWS

“UNDERSTANDING ACEs,” CONTINUED... Part of the reason may be that as people experience more childhood trauma, their propensity for engaging in future deleterious activities like substance abuse and promiscuity also goes up. But that’s not all, says Chiang. Trauma seems to change the growing body. Chiang says to picture an image of a bear ready to pounce: “Scary, right? We’re wired to do fight or flight. So what happens?” He snaps his fingers and leans in. “Your adrenaline kicks in, cortisol, you have all these biochemicals that bathe your body, kicking you into high gear … Now imagine: What if every night in your home, that bear was there? Imagine that your brain develops bathed in all these chemicals, that your organs develop bathed in all these chemicals.” In short, scientists theorize that exposure to traumatic stress is causing young bodies to wear out more quickly as they age.

16 Health DECEMBER, 2014-JANUARY, 2015

WSU’s Christopher Blodgett is collaborating with Head Start providers on research on ACEs in preschoolers. YOUNG KWAK PHOTO

ONE IN 10 KIDS

neglect from physical or sexual abuse. We would think about domestic violence. We would think Christopher Blodgett, a clinical psycholoabout community violence. We would look at gist at Washington State University, likens other kinds of the original The three types of ACEs include: factors like that, ACE study to but there was Rachel Carson’s ABUSE NEGLECT HOUSEHOLD DYSFUNCTION not really an Silent Spring organizing set of and that book’s principles.” impact on the PHYSICAL PHYSICAL MENTAL ILLNESS INCARCERATED RELATIVE With reburgeoning search showing environmental the variety of movement in health problems the 1960s. MOTHER ABUSED SUBSTANCE ABUSE EMOTIONAL EMOTIONAL in adults who Until the had weathered ACE study childhood consolidated trauma, retraumatic DIVORCE SEXUAL searchers began events into a SOURCE: The Robert Wood Johnson Foundation wondering what single score, effects ACEs had researchers had on people who were still young. tended to focus on discrete categories, says As head of the Area Health Education Blodgett. “We would think about child Center and the Collaborative Learning for maltreatment, and we would distinguish

talk about their children, they’re saying Educational Achievement and Resilience four out of 10 of the kids have already (CLEAR) Trauma Center, Blodgett and experienced three or more ACEs by the age his team studied 2,100 randomly selected of 4.” students in 10 elementary schools across To put that in less abstract terms, at Spokane in 2010. least 40 percent of those preschool-aged Using the ACE study as a framework, TIMELESS TALES OF SPOKANE children may already have been physically they asked educators to share what they AND THE INLAND NORTHWEST abused, gone for extended periods withknew about children. “We went on the out food or clean clothing, and witnessed assumption that, particularly in elementary someone in their household suffering from schools, school personnel get to know an depression or addiction. awful lot of what’s happening with their INLAND NORTHWEST HISTORY The reason findings like these are kids and with kids’ families,” Blodgett says. important in the short term should be quite The indirect method of questioning was clear. Taking a longer view, particularly able to produce a set of “conservative” yet in consideration of the well-documented reliable data. Timeless Tales of Spokane and the Inland Northwest, Volume 1 “What we ended up seeing is that one T i m e l e s s Ta l e s onotion f S p o k a n e a“that n d t h e I n one l a n d N oof r t hwethe s t , Vovery l u m e 1 best predictors for lifelong health is graduating from high in five kids were known to have expeEDITED BY TED S. McGREGOR JR. school,” as Blodgett points out, these findrienced two or more ACEs by the time you call yourself an Inlander, you need to know the stories. Do you ings quickly balloon into an urgent issue of they were in elementary grades,” Blodgett Ifremember those ancient ivory tusks pulled from a farm down on the Palouse? What happened after fur trappers set up their first trading post on the Spokane River? Or how a local basketball team captivated the nation? What about “The Biggest Thing That Man Has Ever Done”? A World’s Fair? Those are just a few of the tales that define the rich history of the Inland Northwest — stories that were first retold in the pages of the Inlander newspaper starting in 1993. In Inlander Histories, you’ll meet Nell Shipman, the silent film star who launched her own studio on the shores of Priest Lake. You’ll hop a flight over Mt. St. Helens on a particularly memorable day. And you’ll learn how Walt Worthy kept the dream of Louis Davenport alive in downtown Spokane. Noted local historians Jack Nisbet, Robert Carriker and William Stimson join Inlander staff writers, including Sheri Boggs, Andrew Strickman and Mike Bookey, to take you on a tour of some of the most important moments in the region’s past. Collected together for the first time, Inlander Histories pieces together the tapestry of Eastern Washington and North Idaho culture, creating a rare document of life in the “inland” part of this corner of the continent.

“ACEs stand as independent and principal predictors of progressive health problems, including behavioral health issues like mental health and substance abuse, and poor self-reported health and quality of life.” — WSU CLINICAL PSYCHOLOGIST CHRISTOPHER BLODGETT $14.95

recounts. “One in 10 ended up experiencing three or more. And we were able to show the ‘ACE-dose effect.’ That is, as ACEs increase, the rate of academic failure, of attendance problems, of school behavior problems dramatically increased, and the rate of poor reported health for the children also increased.” Their confirmation of that correlation suggested that this was “the right set of issues to be looking at.” More recently, Blodgett and his team undertook a similar study with even younger kids, in collaboration with the local Head Start program. In this new and still ongoing research, parents of the 3- and 4-year-old Head Start preschoolers are given the option to talk about their children’s and their own childhood experiences. While voluntary, the study has seen an 85 percent consent rate among parents, resulting in a total of more than 900 primarily mother-and-child pairs. “The results,” he says, “are kind of terrifying.”

EARLY TRAUMA PERVASIVE

“What we’re finding is that six out of 10 Head Start parents report that, when they were growing up, they experienced four or more ACEs,” says Blodgett. “When they

COVER DESIGN BY CHRIS BOVEY

individual and public health. “When you take everything else that you can consider into account, ACEs stand as independent and principal predictors of progressive health problems, including behavioral health issues like mental health and substance abuse, and poor self-reported health and quality of life,” he says. “And then it has been well-established to be associated with some of the major killers in the United States in terms of disease processes, including cardiovascular and liver disease.” Newer research is uncovering an additional chain of correlation between ACEs and the metabolic disorders that result in obesity.

FROM RESEARCH TO REAL WORLD

Knowledge that ACEs are impacting health and success both during childhood and on into adulthood has prompted researchers to begin focusing on finding ways to mitigate the damage. With a student turnover rate of close to 50 percent, the case of Holmes Elementary in Spokane’s West Central neighborhood is remarkable. “A teacher will take a snapshot of the kids on the first day of school in September. Take the same class picture in June at the end of school, and ...continued on next page

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Health 17

NEWS “UNDERSTANDING ACEs,” CONTINUED... half the children are different,” says Curt Chambers, a school community specialist at Holmes. “That is a huge ongoing issue that we have.” As a result of new knowledge about the role of ACEs, the school has changed the ways it works with kids experiencing multiple types of disruption in their lives. “What it comes down to is that there has to be an understanding, on the part of the teachers and other staff working with these kids, on how they are affected by the level of chaos and trauma in their lives, and how to be able to convince the kids that school is going to be a safe place,” Chambers says. Part of that process involves holding the students to a high bar in both behavior and academics. While there might be chaos at home, every aspect of the school day is characterized by order and support. “We’ve got to teach the kids how to come to school, basically,” says Chambers of the school’s Make Your Day program. “One of the staff’s primary roles is to assist in giving children gentle reminders about what the behavioral expectations are, and thereby reinforcing that consistently

through all the classes, by all the staff members, and by everyone during the day.” It’s a big shift, he says: “One school counselor, one school social worker can’t do this on their own. The job is too big. It takes a team effort, so that means bringing in the teacher, engaging the parent, bringing in the building’s administration, bringing in other providers.” But Chambers says teachers are passionate about it. “One of the teachers stepped forward and offered to open her family’s home to a sibling group that was going to be put into foster care, just so the sibling group wouldn’t be split up. That’s the level of emotional involvement and compassion that we’re seeing.” In addition to a building-wide commitment to support challenged kids, each child with a high ACEs score at Holmes is matched with a member of the learning support team. “Their responsibility is to check in with that student, with their teacher, with their family,” says Chambers. “I hesitate to use to the words ‘case manager,’ but they act as a point person or individual liaison. We’re much more aware of the emotional needs of the kids who come from traumatic backgrounds.”

He points to successful examples of this collaborative, community-wide practice, such as the Harlem Children’s Zone, currently being replicated in Spokane’s Hillyard neighborhood through the similarly named Northeast Children’s Zone. He also notes how area schools have been working with the education departments at Gonzaga and at Whitworth universities to raise awareness among teachers-in-training, so that they arrive better prepared for the real-world classroom.

NOT A LOST CAUSE

Not all schools have equally high hurdles to overcome, but it’s wrong to assume that ACEs and their effects are exclusive to economically disadvantaged areas. “This isn’t a socioeconomic issue,” says David Crump, director of student intervention and support services at Spokane Public Schools. “If you really look at the Kaiser Permanente study, all of these families that claimed multiple adverse childhood experiences had good insurance. So this [study] was not done on the Medicaid or uninsured. You see that it crosses all…bounds.” Blodgett partly agrees, saying that while there is a socioeconomic component

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to ACEs, drawing tidy arrows between crucial, because they have the potential to poverty and childhood trauma risks misoffset, at least in part, the impact of ACEs. representing the issues and their potential Such things as having a stable grandparsolutions. ent, a mentor, or “We know even involvement Possible Risk Outcomes: ACEs go up as in music can help BEHAVIOR poverty goes up in the short term. in communities. And research is It’s not because showing these LACK OF ACTIVITY SMOKING ALCOHOLISM DRUG USE MISSED WORK poverty causes assets are also preACEs, but that ventive, providing PHYSICAL & MENTAL HEALTH what poverty does a bulwark against is really steals the future stressors. resources from you By finding ways STDs SEVERE OBESITY DIABETES DEPRESSION SUICIDE ATTEMPT from being able to develop assets to do much about and resiliency, the ACEs. ACEs young children happen across the and teens may not HEART DISEASE CANCER STROKE COPD BROKEN BONES economic range, only go on to have SOURCE: The Robert Wood Johnson Foundation but if you can healthier adult move, if you can lives, but also escape, if you have ways of being able to have the capacity to break generational get the interventions or the support that cycles of abuse. you need, you’re much more likely to be “We in Washington are acknowledged able to navigate your way through this than as having been on the front end of this if you have none of those resources availconversation,” Blodgett says. “What you’re able to you.” seeing in Spokane… is the result of 10 or Those resources — also known as 12 years of trying to lay some foundation “assets” or “resiliency” — are absolutely for this conversation.” n

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Health 19

NEWS

INNOVATION

Dr. Frank Lamm (left), a radiation oncologist at Spokane CyberKnife, has treated about a dozen patients this year with a new treatment for skin cancer. Radiation therapist Shawn Van Horn (center) demonstrates. SARAH WURTZ PHOTO

Brachytherapy Breakthrough A new option for treating skin cancer skips the scalpel BY HEIDI GROOVER

t was tax season. The way accountant Greg Sweeney saw it, there was no way he had the time to skip work for surgery and then see clients with a bandage on his neck. So, against the best wishes of his doctors, he put off treating his skin cancer. “Had brachytherapy been offered, I would have taken it right away,” he says. Electronic brachytherapy is a new

20 Health DECEMBER, 2014-JANUARY, 2015

treatment for skin cancer that offers patients a shorter, knife-free alternative to the common surgical approach. In the oft-used Mohs surgery, doctors remove and examine thin layers of cancerous skin until they’ve removed all the cancer. They then close the incision and patients are left with downtime and often a scar. Electronic brachytherapy instead uses small amounts

of radiation targeted at the spot of cancer. The radiation is administered during eight treatments over four weeks, each taking less than five minutes, and the worst a patient is left with is redness in the area, like a sunburn. Once that heals, some patients will have slight discoloration but most see their skin return to normal. This summer, a few years after he eventually had surgery for the spot on his neck, Sweeney, 55, noticed a small bump on his chest that appeared “literally overnight.” This time, electronic brachytherapy was available at his dermatologist’s office, and he took advantage of it with quick treatments around lunchtime. “Here I am, I look at it and can’t even tell there was anything there,” he says. “So I’m very pleased with the results.”

reating skin cancer with radiation is not entirely new. Doctors have used electron beam therapy, which requires more treatments and must be done

in a lead-lined room (often at a cancer treatenvironment, and it’s not their doctor.” ment center) to protect staff from “ambient Like some other cancer treatments, raradiation,” says Wm. Philip Werschler, a diation treatment for skin cancer is orchesdermatologist at Spokane Dermatology trated by a team of doctors. Dermatologists Clinic who also teaches at the University will suggest electronic brachytherapy as a of Washington School of Medicine and lecpossibility for patients, then meet with a ratures across the country. His office started diation oncologist to determine the dosages using electronic brachytherapy at the start of radiation in each session of treatment to of 2014. The radiation used in electronic effectively get rid of the cancer. brachytherapy is contained inside the maIn many ways, the procedure seems chine, then emitted through a small, metal, too good to be true. And in some cases, it cone-shaped applicator. This helps keep is. Electronic brachytherapy can’t be used the radiation directed only at the cancerous to treat melanoma, the most serious and skin, minimizing risk and allowing it to be deadly form of skin cancer. It also can’t offered in dermatologists’ offices. treat cancerous spots that are too deep or Because skin cancer often appears in are wider than the largest metal cone on multiple places patients get to know their the machine (50 mm). The same goes for dermatologists well. And that can make goparts of the body on which the cone can’t ing to a cancer center for radiation a scarier fit flatly, like the bridge of the nose or the prospect than getting treatjawline. ment from their dermatolo“It’s meant to be an opgist, Werschler says. tion for patients,” says Frank from the puzzle on page 13 “Psychologically, skin Lamm, a radiation oncolo3 = I; 22 = E; 26 = S cancer patients don’t see gist at Spokane CyberKnife, themselves as being sick,” he says of those where he’s treated about a dozen patients who have non-melanoma skin cancers, with electronic brachytherapy this year. which can be treated with electronic While the new treatment is easier and brachytherapy. “They go to a cancer center quicker, Lamm recognizes the benefit of and… skin cancer patients don’t like that Mohs surgery is that “you get real-time

CODEWORDS: HINT

verification that you got it all.” Joann Berger experienced the treatment’s shortfalls this year when she had electronic brachytherapy, but then found out it hadn’t penetrated deeply enough to get rid of the entire cancerous spot. Berger, 82, has had multiple cancerous spots treated and was surprised by the ease of this new technique, though it ultimately didn’t work for her. Soon after, she had surgery on the same spot. “I put my face in their hands,” she says with a chuckle.

hile no new treatment is certain to work for everyone, doctors say electronic brachytherapy is providing an alternative that offers patients real physical and aesthetic benefits. And after a year’s worth of results, Werschler says, it appears to be about as effective as other forms of treatment. “The whole history of medicine is how do we make [treatments] safer and quicker,” Werschler says. “[Electronic brachytherapy] is faster, easier, and has the additional advantage that it can be done in a dermatologist’s office, because that’s where patients feel most comfortable.” n

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n the months of battles between the University of Washington and Washington State University over whether WSU will launch its own medical school in the state, one important fact has largely been glossed over. Washington state already has another medical school. Just not a public one. The Pacific Northwest University of Health Sciences in Yakima, which enrolled its first class in 2008, is an osteopathic school. It produces DOs — doctors of osteopathy — instead of MDs, medical doctors. Already, total class sizes have grown to 135 students, more than the annual number of Washington state doctors educated by the University of Washington.

Granted, there were a few hurdles getting started. “We were having hospitals who didn’t understand, that said, ‘We already take University of Washington students — we don’t take yours,’” says Robert Sutton, PNWU’s associate dean of medical education. “We put a bill through so a hospital could not discriminate against osteopathic rotations.” But for the most part, that’s been the exception. “Even in the last 14 years, there is growing understanding in mainstream medicine that DOs are mainstream medicine,” says Jeremy Graham, a local osteopath and medical school teacher for both WSU and UW.

A 2014 “White Coat” ceremony at Pacific Northwest University of Health Sciences in Yakima celebrates students’ future in the osteopathic profession. RICK BAUMGARDNER PHOTO

Today, the two degrees are nearly indistinguishable. Both require four years of school and a residency program, though the osteopath is trained more deeply in physical manipulation techniques, like popping joints and stretching muscles. “[Osteopaths] believe they have a unique role to play in American health,” says Norman Gevitz, author of The DOs: Osteopathic Medicine in America. “Our strength is in terms of primary care, looking at the whole patient.” In medicine’s long-running debate between prioritizing high-tech tests and low-tech physical examinations, osteopaths fall squarely on the physical exam side. In a typical exam, “I would do manual manipulation techniques, but also palpate the body, and feel the muscle tension to find the pain,” Graham says. In an office visit, he may assess range of movement and ease of motion, prescribe a medication or set up an exercise regimen, all with an eye toward mitigating future health problems. “You might say, ‘There’s a little old lady who’s got a tendency to fall over, what if I could make her stance better?’” He may help her change the way she walks, or even suggest specialized shoes or orthotics. Osteopathy, Graham says, came out of the post-Civil War explosion of new schools of thought related to medicine. Frontier doctor Andrew Taylor Still had

some radical ideas for the time. (Like, maybe it wasn’t a good idea for patients to drink mercury.) “He was very anti-poisonous drugs,” Graham says. Instead, osteopathy centered on eating certain foods, exercising, and body manipulation techniques. In the century that followed, however, medications being produced through mainstream medicine improved, and the osteopathic profession began accepting them. At the same time, traditional doctors began taking cues from the diagnostic tricks and preventive recommendations of osteopaths. In recent decades, there’s been an explosion in osteopathy. In 1974, Gevitz says, there were only nine osteopathic schools. “Today, there are 31 schools,” he says. “Growth has been remarkable.” By 2019, he says, a full quarter of U.S. medical school graduates will be DOs. One reason for the growth: It’s cheaper to create an osteopathic school, he says. The traditional medical school is much more than a school for teaching medical students. It’s generally a sprawling academic health center, associated with big hospitals, serious research labs, and pricey clinical facilities. But without the concentrations on specialities and subspecialties, an osteopathic school is able to focus on basics: “We don’t need 15 pathologists in order to run an osteopathic medical school,” Gevitz says. In many ways, the osteopathic model may be a prescription for what’s ailing the medical profession. A physician shortage is particularly acute in primary care, especially in rural areas. By tradition, osteopathy continues to emphasize primary care and serving rural areas. “[PNWU] is already starting supplying a meaningful number of residents,” Graham says. “Some of the ones I know are pretty intent on staying and anchoring in this community.” That’s no accident. “[Osteopathy schools] admit students, not just on high chemistry scores, but with an eye toward how likely they are to do primary care,” Graham says. “Kansas City [University of Medicine and Biosciences] would rather have taken a kid from a small town who was married and had a 3.7 GPA than a kid with a perfect grade point average who was not likely to stay in their town.” That’s what makes the osteopathic school a good fit for a place like Yakima, and Eastern Washington as well. “There’s a huge need for general practice physicians in a rural area. That is the mantra of PNWU in Yakima,” says state Rep. Norm Johnson, who represents the region. “We know that that need is increasing tenfold.” n

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Health 23

NEWS

HOW TO IDENTIFY SYMPTOMS

MENTAL HEALTH

Teri Koski reads her poem “The Truce” at an open mic night. YOUNG KWAK PHOTO

Words That Heal One woman’s story of how she manages her state of mind BY TERI KOSKI — AS TOLD TO DEANNA PAN

hat mental illness is to me is when you wake up feeling like shit and you have no reason to. Everything can be fine — I have a job, I have a wonderful partner, all the earmarks of success — but there are days when I wake up and I want to die. I always felt different from other people. I looked at things very negatively. I had a lot of anger. I couldn’t figure out why. The first time I attempted suicide I was 14 years old. I don’t think I understood what I was doing. All I knew was I was hurting and I

24 Health DECEMBER, 2014-JANUARY, 2015

wanted to make the hurt go away. My turning point came when I was in my early 20s. I went to Central Washington University and one day, as I was driving home from school, I drove my car through the barrier and into the ravine. Luckily, my car hit the barrier and was towed home. When I got home, my now ex-husband stuck his head out the door and asked me if the car was OK. (That’s why he’s now my ex-husband.) I told him, “I think something is wrong with me. I ...continued on page 26

Nearly one in five Americans experiences mental illness in any given year. Of those, about 19 percent suffer from anxiety disorders (the most common mental illness), followed by major depression (6.8 percent), bipolar disorder (2.8 percent), eating disorders (2.1 percent) and schizophrenia (0.45 percent). Here’s how you can identify symptoms of these mental health problems. u ANXIETY DISORDERS: For most people, a little anxiety is a normal and healthy reaction to stressful situations. For others, severe anxiety is debilitating. Types of anxiety disorders include generalized anxiety disorder (GAD), obsessivecompulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder and specific phobias. Common symptoms are unreasonable and excessive fear, worry and dread; phobic or obsessive compulsive behavior; rapid heartbeat; hyperventilation; nausea; restlessness. u DEPRESSION: Unlike the occasional “blues,” a major depressive disorder lasts for at least two weeks and disrupts a person’s everyday life, relationships and activities. Common symptoms are unusual sadness, loss of interest in previously enjoyable activities, low energy, suicidal thoughts, difficulty sleeping, loss of interest in or excessive eating. u BIPOLAR: Previously known as “manic depressive disorder,” bipolar disorder is a type of mood disorder, like depression. Bipolar is characterized by severe mood swings. People with bipolar disorder can sometimes experience psychosis — meaning they lose touch with reality — during manic or depressive episodes. Common symptoms during a manic episode include high energy, increased activity, extreme happiness, little sleep, rapid speech and grandiose delusions. u EATING DISORDERS: There are three types of eating disorders recognized by medical professionals: anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (EDNOS), such as binge eating. People with eating disorders can be underweight, normal weight or overweight. Common symptoms are disordered thoughts revolving around food, excessive vomiting, extreme weakness, low or irregular heartbeat, low body temperature and a body mass index below 16. u SCHIZOPHRENIA: A chronic, severe and often misunderstood genetic brain disorder, ...continued on page 26

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Health 25

NEWS “WORDS THAT HEAL,” CONTINUED... don’t think other people feel like this.” I saw a counselor through my work’s employee assistance program. I remember telling him all of my symptoms when he looked at me and asked, “Do you ever feel like your brain is in a cloud?” “Yeah,” I said. “All the time.” And then I completely lost it. He didn’t know it, but I’d been writing poetry for years to deal with my depression. One of the lines I wrote over and over again was, “The cloud I call my brain.” That was the first time I realized there were other people like me in the world that didn’t really fit in anywhere. My first diagnosis was bipolar, followed by borderline personality disorder, obsessive compulsive disorder and post-traumatic stress disorder. I went through years of different counselors and medications before I finally found one that stabilized me. As I went through counseling, my dosage was gradually reduced. I’m at the point now where I’m not on medication. But everything I do in my everyday life is to compensate for that — from the way I eat to the way I go to sleep, the apps I use on my phone to my exercise and meditation. It’s all to keep me from wigging out on a daily basis. I’ve been stable for about four years now. I slip sometimes, but I notice I slip less and less often. The hardest thing I’ve ever had to do is to stay stable. Our lives are vey much self-fulfilling prophecies. We’re trained by reinforcement. If we say to ourselves a hundred times a day, “I hate myself. I’m not worth anything,” then that’s what we’ve taught ourselves to believe. You have the power to change that thought process. When I do my meditation in the morning, I tell myself, “I am a good person. I do good things. I make good decisions.” You’re not going to believe it at first. Hell, I know I didn’t. But then, every once in a while, you’ll catch yourself realizing that you did make a good decision, that you did do something positive, that something good did happen because of something you did. And you kind of keep building on that. I can look at things now with an attitude of acceptance: I am a good person. I do have worth. I deserve to be here as much as anybody else. n Teri Koski, 38, is the vice president of the National Alliance on Mental Illness-Spokane, a case manager for the elderly and disabled and an accomplished poet. Her story was first published in the Inlander as part of its “State of Mind” series.

26 Health DECEMBER, 2014-JANUARY, 2015

CONTINUED... schizophrenia distorts the way people interpret reality and requires lifelong treatment. Symptoms typically manifest between the ages of 16 and 30. Common symptoms are delusions, hallucinations such as hearing voices, difficulty concentrating, lack of drive, social withdrawal, inappropriate emotional reactions, unclear thinking and psychosis. — DEANNA PAN

HOW THE SYSTEM WORKS

In Washington, state and federal mental health care funding is distributed through Regional Support Networks, administrative agencies tasked with distributing money to local service providers. The RSN covering Eastern Washington serves eight counties, including Spokane,

where Frontier Behavioral Health (838-4651) is the largest mental health service provider. Gov. Jay Inslee has said he wants to better integrate mental health, primary care and substance abuse treatment. In Idaho, the state contracts with local organizations to provide mental health care and has “regional behavioral health boards” to advise state agencies on how to better provide mental health and substance abuse treatment in each area of the state. For those on Medicaid, the state recently began contracting with a national company called Optum to manage that program. In Coeur d’Alene, Kootenai Behavioral Health Center offers stabilization for youth and adults in crisis and chemical dependency treatment. Reach them at (208) 625-4800. — HEIDI GROOVER

HOW TO FIND SUPPORT

Whether you’re the one suffering from mental illness or whether it’s a loved one, it can often feel like you’re alone. That’s what NAMI Spokane — the regional chapter for the National Alliance on Mental Illness — is all about addressing. They not only run numerous education courses about several mental illnesses, they have two different types of monthly support groups. One is for those with mental illness. “It’s peer-supported,

facilitated by people who have the illnesses themselves,” says Ron Anderson, president of NAMI Spokane. Anderson has a relative with schizophrenia. He relies on the second type of group, where family members struggling with mental illness meet. “We talk about what we’re going through and get help from each other,” says Anderson. “We listen to each other’s experiences. We learn from each other. Families are just as traumatized as those who get the illnesses themselves.” The conversations each group has are freewheeling and wide-ranging — a facilitator is there, but mostly to keep order and make sure everyone has a time to talk. “We have the tools there to help people understand what they’re going through,” Anderson says. “It’s knowing that you’re not alone, it’s knowing that things get better usually.” And while the conversations can occasionally dive into some difficult territory, “we always end on a high note,” Anderson says. “We’re usually laughing by the time we leave.” Go to NAMI Spokane’s website, and click on Support Groups for a schedule of when they meet. Or check out other support groups through the Spokane Consumer Advocacy Network (spocan. news@gmail.com) or the SEER Support Group through the Community Colleges of Spokane (2796259). — DANIEL WALTERS

HOW TO HANDLE MEDS

Medication may play a crucial role in stabilizing mood or mental function, but it can often be difficult to manage or maintain. Doctors emphasize that, like antibiotics, it’s essential to continue taking prescribed meds after you start feeling better to keep a consistent dosage. u TO START, GET ORGANIZED: Most drugstores sell plastic dividers for separating pills out for each day of the week. Store meds in an easyto-see location and set a regular schedule. u STRIVE FOR CONSISTENCY: Many medications must build up in a person’s system before they become fully effective, while others can be sensitive to missed doses. A doctor can best dial in meds or dosages with a consistent baseline. u IDENTIFY AND ADDRESS SIDE EFFECTS: Keep track of unusual symptoms and talk to others about what changes they may observe. Talking to doctors, friends and family about side effects can help quickly root out symptoms and will make it easier to mitigate any negative effects. u OVERCOME RELUCTANCE: The National Alliance on Mental Illness recommends approaching medication as a routine, empowering experience. Learn about the meds and potential side effects, but also tie doses into regular tasks, like a morning vitamin routine. — JACOB JONES

HOW TO HELP SOMEONE

First, slow down. Frontier Behavioral Health’s Esa Lariviere says some people want so badly to help that they end up treating their loved one like a problem to be fixed, worsening tension in the relationship. Separate the person from their symptoms, Lariviere says. “It’s so scary to be experiencing symptoms, because there’s such a stigma associated with mental health that people lose their identity as a mother or a teacher or whatever, and all of sudden become ‘mentally ill,’” she says. Work to find possible avenues of help and present those as options rather than a mandate. Don’t try to fight someone else’s delusions. You don’t have to validate them, but respect what the person is experiencing and, instead of arguing, focus on options. Always ask if they’re considering suicide, and seek help right away if that’s the case. If you’re having difficulty understanding or handling a family member’s mental illness, consider seeking out other families for support. The local chapter of the National Alliance on Mental Illness offers support groups specifically for families of those living with mental illness. For more information, call 838-5515. Finally, create boundaries. If you’re feeling like the situation requires professional input or the person is a danger to him or herself, seek help. — HEIDI GROOVER

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r o f e t i t e p Ap h t l a He hnology c e t g in r o it al mon goals How person d achieve your weight get fit an u o y lp e h can

D BY JORDY BYR

arol Hunter is efficient. The attorney keeps herself and her family healthy with a seamless blend of modern technology and practical wisdom. A longtime runner — she’s completed 32 Bloomsdays and serves as the race’s Corporate Cup Chair — Hunter says part of her success is due to e-health technology. More specifically, a love affair with her Garmin watch. Hunter ran her first marathon in 1992, but first incorporated the watch into her routine while training for a race in 2002. The difference was phenomenal. “It was a question of being efficient.” she says. “The Garmin made me feel like I was using every minute. I wasn’t spinning my wheels or wasting any time. It was a revelation.” ...continued on next page

Tate Kelly, Michelle Neill and Carol Hunter on the Centennial Trail in West Central Spokane. YOUNG KWAK PHOTO

DECEMBER, 2014-JANUARY, 2015

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“APP-ETITE FOR HEALTH,” CONTINUED... Since then, she’s incorporated apps like MapMyRun to track her routes, MINDBODY Connect to find the nearest yoga studio, and Interval Timer to log box jumps, planks and kettlebell swings with her trainer. Although this technology helps improve her performance and dedication to training, Hunter is quick to say she doesn’t rely on the tools. “It’s really about creating a healthy balance,” she says. “I’m big into health and nutrition for myself and my family, but there is a sense of needing, at some point, to step away from all of that…

30 Health DECEMBER, 2014-JANUARY, 2015

Michelle Neill, organizer of Bloomsday’s Marmot March, uses fitness technology to juggle training and a busy life. YOUNG KWAK PHOTO to listen to what our bodies are saying versus what a piece of technology is telling us.” Health experts and athletes alike say e-health apps and devices hold users more accountable for their food intake and exercise output, while social components add an element of fun and keep users engaged in healthy living routines. For a culture already obsessed with smartphones, these user-friendly tools are proving effective in everything from weight loss to marathon training to food management for people with diabetes.

unter is loyal to her Garmin, replacing worn-out versions with newer ones. She currently runs with the Garmin Forerunner 620. The high-resolution color screen tracks distance, pace and heart rate in addition to ground contact time and vertical oscillation. The watch features live tracking and social media sharing opportunities alongside free training programs. Hunter says the slim fit for females, high-resolution screen and smartphone display make it convenient. “I am definitely of the school of thought

SWEET DREAM DEVICES

-health apps can do more than track your fitness — they can also monitor your sleep. “It’s not a very accurate form of measurement from an academic perspective, but I’m not saying it’s not useful,” says Greg Belenky, research professor with the Sleep and Performance Research Center at Washington State University. Movement and motion tools like ActiGraph, used in the academic The ActiGraph wGT3X-BT monitor community for 20 years, now are finding applicability at home. These personal biometric monitors are placed on your wrist or bed to provide a rough indication of how well you’re sleeping. That information can then be used in performance prediction models — available as open source software — to track sleep/wake history. Once this information is tracked, individuals may adjust their routines to increase quality of sleep. “The people who use these devices swear by them,” Belenky says. “Of course, the placebo effect can be very strong. I mean, you just don’t know. Most of the systematic studies that have been done on these apps have been sponsored by the companies themselves.” Despite the current devices’ shortcomings, Belenky says using this type of personal health monitoring has a bright future. “Biometric status monitoring systems are going to be astronomical,” he says. “It’s going to happen quickly, and it already has to a degree. It’s going to blow the top off chronic conditions like diabetes, hypertension and insomnia.” — JORDY BYRD that I don’t want to be a slave to my Garmin,” she says. “I mostly wear it when I’m training for an event, because there comes a time when I need to let my own body be my guide.” Runner and cyclist Matt Bogue agrees. “I enjoy finding different activities and ways to be healthy,” says Bogue, a creative director at Seven2 digital advertising agency who runs with the Nike+ Running app. The app tracks route, distance, pace, time and calories. Users can receive personalized coaching and real-time audio feedback, share photos, compare progress and get in-run cheers from friends. “It’s a really cool way to track your mileage,” he says. “You set a goal for the week and because it’s an app, it’s right there, you can open it up and hold yourself more accountable and see all the statistics.” As a result, Bogue says he logs more miles on the pavement, and the social feature motivates his results. “It’s kinda like a social network,” he says. “You can see what your buddies are running, compete and even set up challenges with your friends.” Seven2 has even created its own inhouse network. Each employee is given a Nike+ SportBand — a watch that tracks pace, distance, time and calories burned. “One of the great things about Seven2 is how our bosses, Nick Murto and Tyler Lafferty, believe in a healthy and balanced culture,” says Creative Director Jesse Pierpoint. “Each employee is given a pair of Nike running shoes, a wearable band to track progress, and a nice gym in the basement to use.”

Pierpoint trains four to five times each week, balancing a mix of cardio and strength training. “I started using the Nike+ Running app two years ago to monitor my exercise during rehab for a tough Achilles tear,” he says. “I truly disliked running, but it really helped having this app to track everything and ‘game-ified’ the experience.” Pierpoint has also used Charity Miles — an app that donates money to charity for every mile run or biked — and Couch-to5K, a training program that helps beginning runners train for their first race. He says while the apps are simple and intuitive, the key is to actually use them. “They [apps] are a nice mix of accountability, monitoring distance and time, tracking my friends’ runs and knowing when to update my running gear based on usage,” he says. “I appreciate some of the tips and information they provide to help me live healthier.”

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uke Lollis has seen it all. He’s seen heart rate monitors, Fitbit trackers (clip-on devices that track steps, distance and calories burned with goal setting and social components), Jawbone trackers (advanced sensors that capture how you move, sleep and even vibrate when you’ve been sitting too long) and the BodyBugg, a device that measures exercise, food logging, sleep efficiency and more. The certified personal trainer had worked for big gym chains since 1995. Last November, he opened a strength training ...continued on page 33

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GEARING UP: GADGETS AND APPS The new iPHONE 6 has a much-touted emphasis on health tracking. From sleep to diet to exercise, it allows you to monitor yourself with your phone. If a new iPhone isnâ&#x20AC;&#x2122;t on your list, hereâ&#x20AC;&#x2122;s are some other popular new health and fitness gadgets and apps that do many of the same things: WAHOO FITNESS: A Bluetoothpowered running, cycling and fitness tracker with GPS and workout plans.

MISFIT: A variety of apps tied to an activity tracker that provide sleep monitoring, step, calories and distance tracking, and a daily photo food journal.

HEALTH MATE: Apps that track everyday activity and heart rate using sensors in your iPhone that challenge you to move more.

TRX FORCE: A 12-week conditioning program used by athletes and in all branches of the U.S. military.

JAWBONE: Fitness trackers that measure resting heartbeat as well as sleep. They also learn as you go, distinguishing different activities and automatically recording them.

COUCH TO 5K: Features virtual coaches to push you through different workouts; includes GPS functionality and workout storage.

NIKE+ FUELBAND: Transcribes the energy you expend doing activities into Nike Fuel, a standard metric to measure your progress based on age, weight or gender.

NIKE+ RUNNING: An app that tracks the distance, pace and time of your runs and allows you to share and compare with others.

FIT BIT: A line of activity trackers that provides you with fitness stats, sleep tracking, and syncs wirelessly with your phone to play music or notify you about phone calls.

STRONGLIFTS: A simple workout consisting of three exercises, three times a week, for 45 minutes, to build muscle or lose weight.

MAP MY RUN: A route-mapping, activity-tracking, food-logging, friend-sharing fitness app.

SPRINTTIMER: An advanced sports timer featuring video finishes.

GARMIN: GPS-enabled fitness watches that track calories burned and include metrics for swimming.

32 Health DECEMBER, 2014-JANUARY, 2015

“APP-ETITE FOR HEALTH,” CONTINUED... and conditioning gym called The Lab. “I saw a need for more hands-on help than what people were getting at bigger gyms,” Lollis says. “Our mission is to empower people through foundational strength. To train them in a way that is natural; to run, jump, crawl and climb.” Although body monitors are getting more popular, his clients primarily use nutritional apps. His team at The Lab recommends MyFitnessPal, a free caloriecounting and food-tracking app that boasts nutritional information on more than 3 million types of food. Users can search the massive database for everything from brand-name foods to scratch-made items like “homemade chocolate milkshake,” scan barcodes or upload their own unique food and calorie information. The app tracks daily calories, as well as protein, fat and carbohydrates, and progress toward a weight goal. More than 65 million people have used the app to achieve their weight loss goals, manage conditions like Celiac disease and share online testimonials. Why is monitoring what you eat so important? “It’s about creating awareness, knowing yourself and knowing your body, and asking, ‘How does this food make me feel, and how does this help me perform?’” Lollis says. MyFitnessPal is recommended by more than just fitness professionals. Dietitian Kara Roberts uses the app as a tool with clients who need to lose weight, manage diabetes and maintain a healthy lifestyle. “Studies show that people who track their food intake are more successful in losing weight,” Roberts says. “They are more mindful of what they’re eating, more accurate in counting calories and balancing proteins, carbohydrates and fats.” Roberts is a registered dietitian nutritionist, certified diabetes educator and diabetes technology clinician with Columbia Medical Associates. She is also a board member of the Greater Spokane Dietetic Association, a nonprofit organization that helps increase nutritional awareness through community outreach programs. Roberts has used MyFitnessPal with her clients for four years. “For most of my clients, the app is an easy, free tool to use that’s more accurate than pen and paper,” Roberts says. “Clients can create calorie guidelines that correspond with their weight loss goals, add food that isn’t already logged into the database and log exercise routines which help keep people on track.”

MyFitnessPal also allows users to share their food logs and communicate on message boards instantaneously, which helps keeps people motivated. “Apps and smartphones are already part of our daily routines,” Roberts says. “This allows us to seamlessly adopt nutritional technology into that routine … as technology gets better and less expensive, these sorts of e-health applications will continue to have broader and broader appeal.”

ichelle Neill ran the race of a lifetime this year — the 2014 Boston Marathon. After the tragic bombing in 2013 near the marathon’s finish line took three lives and injured hundreds of others, Neill says this year’s race was an inspiration. “It was amazing, one of those experiences you can never repeat,” she says. “There were over one million spectators — it was like running 26 miles through a rock concert. It was that loud, and people were cheering the entire way.” Now a stay-at-home mom of three, Neill ran her first marathon in 1999. She now organizes the Marmot March, the children’s race held at Bloomsday, and runs Soles4Youth, a nonprofit that provides running shoes for Spokane-area kids in running programs. Neill says finding time to train while caring for three young kids is difficult, but she manages to juggle volunteer work, home life and running with help from MapMyRun and MyFitnessPal. “I started using MapMyRun on my phone because my watch quit, and now I love it,” she says, laughing. “I like that I can go back and see the actual mapping, and the convenience of having it on my phone because I always have it with me.” MapMyRun records workout details, including duration, distance, pace, speed, elevation change, calories burned and route traveled on an interactive map that can be uploaded and shared with others. Neill recently began synchronizing her MapMyRun workouts with her food log-in on MyFitnessPal. “I like that I have a record, that I can see the full picture of distance, pace, and calories burned, and then gauge if I’m getting enough or too much food,” she says. “I like seeing those two connected together. And it’s easy.” Despite her love of the technological tools, Neill says she doesn’t use them every day. “For some people, logging their food and exercise really becomes an addiction,” she says. “I don’t want to be like that. I love them, they work great for me, but I remind myself it’s just a tool.” n

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Health 33

LIVING

Darci Barman with a plate of cranberry pecan energy balls at Pilgrim’s Market in Coeur d’Alene. YOUNG KWAK PHOTOS COOKING

Confident Cooking Healthy meals are easy when you consider the rainbow BY CARRIE SCOZZARO

sk Darci Barman “What is the best diet?” and this registered dietitian with a Master’s of Nutrition and Dietetics from natural health innovator Bastyr University has an unusual answer: “Eat the foods our ancestors ate 100 years ago. “The greatest thing I took away from growing up around agriculture,” says Barman, originally from Madison, Wisconsin, “was understanding that eating seasonally, locally and traditionally is also the simplest and most effective way to nourish our bodies.” The implications, explains Barman, impact our whole relationship with food:

34 Health DECEMBER, 2014-JANUARY, 2015

“Our ancestors grew — and raised — much of their own food, understanding and participating in the process from farm to fork.” By contrast, says Barman, too many people, especially kids, are unaware of where their food comes from. And there’s an overreliance on quick fixes for our dietary woes — from fad diets to weight-loss medications to superfoods. “Nutritionally, I think the biggest issues Americans are facing today are, number one, information overload, creating confusion as to what really is best for us. Number two, lack of skills, time and effort in the kitchen, and number three, under-

estimating the link between nutrition and well-being.” Barman hopes to correct that — one client and one recipe at a time — in her role providing a range of services at Coeur d’Alene’s Pilgrim’s Market. Through its Wellness Clinic, she consults with patients, addressing such issues as allergies, Celiac disease and digestive ailments. In the upcoming year, Barman plans to teach cooking classes and conduct food demonstrations. Her 2015 Eat the Rainbow collection — two recipes from which are provided here — was inspired by the U.S. Department of Agriculture’s MyPlate program (formerly known as the Food Pyramid). They’re all from scratch, says Barman, who developed the collection as part of a collaboration with a colleague to create an annual educational booklet focusing on cardiovascular health. “We wanted to give our clients the tools to make half their plate colorful fruits and vegetables, so we decided to provide two recipes from each color of the rainbow.” n

Header is: 00% Scratch Made Make the picture "box" where the logo is bigger. RECIPE Stack the green icon on top of the Bug and make them Darci’s Cranberry both a bit bigger. Energy Balls Put wood grain (greys) under the address hoursPecan info at Perfect to take on the go, this can also be bottom. Probably need to make the font darkerpressed brown into aor 9x9-inch baking dish, refrigerated for an hour, and cut into squares. white so it will show up on wood background. 2 cups pecans 1 cup dried dates, pitted and roughly chopped ¾ cup dried cranberries ½ teaspoon mixed spices, such as cinnamon, ginger and nutmeg ¾ cup shredded coconut, unsweetened 1. Place pecans, dates, cranberries and spices in a food processor bowl fitted with an “s” blade. 2. Process for at least 1 minute, stopping and pulsing as needed to break down mixture. 3. Once mixture has become thick and sticky (it will have the consistency of sticky rice), roll into 1-inch balls, and roll in coconut. SOURCE: Eat the Rainbow by Darci Barman

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ilgrim’s Market has URL plentyLINK: to be thankful for this year. In a competitive national inhttp://www.inlander.com dustry that accounts for $110 billion in annual sales, the Coeur d’Alene store was named “Retailer of the Year” at the most recent Natural Products Expo, beating out 19,059 other natural food stores, including larger chains, to snag top honors in the “Most Innovative” category. The judges awarded Pilgrim’s for excelling in the key areas of: “tapping into medical knowledge, full-service holistic clinic, education hub.” Pilgrim’s Wellness Clinic features “naturopathic, acupuncture, osteopathic, dietetic, ayurvedic, mental health and massage practitioners on-site, many of whom accept medical insurance,” says Joe Hamilton, who founded Pilgrim’s in 1999 with his wife, Sarah. “We do not sell organic and natural foods because they are trendy and a way to make a quick buck in just one or two aisles of our store,” says Hamilton. “We are committed to organic and healthy whole foods and supplements because of the benefits to the consumers, the producers, farm workers and to the environment.” n

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Health 35

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PARENTING

Growing Up Too Soon Why are more and more girls experiencing early puberty? BY LISA FAIRBANKS-ROSSI

very once in a while, my children show interest in topics I research for stories. When my older twin found out I was doing a story about early puberty in girls, she panicked. “No, mommy! You are NOT going to talk about me! Are you?” “Nah,” I assured her. There’s no need to discuss her development, as I’ve conducted my own general, and highly anecdotal, studies while working as a substitute teacher. “Wow. Girls look like that in the fifth grade?” They do in fourth grade, too. In fact, sprouting breast buds at age 8 is within the range of “normal” puberty. “Clinically, less

36 Health DECEMBER, 2014-JANUARY, 2015

than age 8 would be a concern,” explains Dr. Jeanne Hassing, a Spokane pediatric endocrinologist. Central precocious puberty (CPP) refers to a condition in which very young children’s brains start sending pubertytriggering hormones throughout the body much too soon. It occurs 10 times more often in girls than in boys. “Every hundred years … even every decade, the age [of central puberty] begins to go down. In the 19th century, it used to be age 16 or 17,” says Hassing. For girls, breast growth is the first physical symptom of puberty, and trends earlier with each generation. In 1970, for instance, the average age was 11.5 years. Today’s average is

10.5 years. “I have treated precocious puberty for 30 years,” Hassing says. About 10 years ago, however, “the number of girls spiked like crazy.”

recocious puberty requires medical treatment, but it can be difficult to diagnose. Early breast development can sometimes happen in isolation, and without other hormonal changes, most doctors will maintain that a girl isn’t going through central puberty. This tricky fact, along with hundreds of potential lifestyle, health and environmental influences, make pinning down an exact cause of precocious puberty nearly impossible. “There has always been a difference between girls with higher and lower BMIs [body mass indices], and the correlation between obesity and early puberty is certainly not new,” says Hassing. “But the sheer numbers are new,” she admits. “We know that nutrition and the reproductive system are linked,” says Dr. Sasha Carey, a Spokane pediatrician who specializes in adolescent medicine. “We see this in anorexics ... you have to have enough body fat to have a period.” Carey says

scientists assume that when kids aren’t at a normal weight — if they’re either under- or overnourished — production of the growth hormone leptin is altered. Body fat is estrogenic, and the amount of fat also affects insulin levels, both of which have an impact on the onset of puberty. “There are so many confounders in this,” remarks Carey, who longs for conclusive evidence of why precocious puberty happens. However, “to do a really good study, you have to control for so many factors,” such as diet, access to chemicals inside the home and in food and water supplies. Carey suspects both phthalates, found in soft plastics and cosmetics, and pesticides and hormones in beef and dairy are culprits. “These chemicals are proven to affect cellular processes,” she says. Carey references a case of a 5-year-old girl who had breast budding. “All they could point to was that she’d been using her mother’s hair products.” And while the FDA maintains that only safe levels of recombinant Bovine Growth Hormone (rBGH) are used on cattle, neither doctor is convinced. “It also depends on what the animals are being fed.

I, myself, only buy organic meats and cagefree, antibiotic-free chicken and beef. I’m suspicious,” Carey admits. “But again, there is no hard proof.” Hassing believes a likely culprit is plastic bottles, which contain both phthalates and BPA (bisphenol A), a known estrogen mimicker. “In about 2004, I saw this dramatic increase... and the correlation to me was seeing all the drinks in plastic. There’s a message: ‘Don’t reuse this plastic bottle,’” Hassing points out. “Why was it OK the first time?” she asks.

he concerns doctors and parents have about CPP are both social and medical. An urgent problem with early puberty is that it kick-starts bone development, before the rest of the young body is ready, and then stops bone development too soon. When puberty ends, height growth stops. Hassing uses X-rays to check bone maturation and blood tests to detect levels of sex hormones in otherwise immature bodies. The typical treatment involves leuprolide injections, which block the pituitary gland from producing the hormone that

triggers estrogen production. “The main indicator for precocious puberty is being short, but there’s more than height at risk,” says Hassing. Both she and Carey, as well as parents, worry about the emotional toll of early puberty. “The way people interact with you is different” when you have developed too soon, says Carey. “You look older, so you are potentially treated differently by teachers and coaches.” She says girls and boys weather body changes distinctly. “Boys become more confident as they develop, but girls go the other way. They don’t tend to like physical changes, and when those changes happen in a less mature person,” the impacts are worse. “There is research that shows they can be victimized, and they get into more dangerous relationships, earlier.” In addition to the social and psychological toll of early puberty, it also can increase the likelihood of estrogen-related diseases like ovarian cysts and breast cancer. While about one in 5,000 children are maturing at too young an age, precocious puberty can be managed with medication. “We want to normalize a child’s life and give them an opportunity to not be different,” says Hassing. n

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Not Home For the Holidays? How to stay healthy while traveling BY LINDA HAGEN MILLER

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38 Health DECEMBER, 2014-JANUARY, 2015

bola in West Africa, dengue fever in Japan, enterovirus D68 in Kentucky, bedbugs the world over. What’s a traveler to do? With disease and epidemics making headlines, it’s natural and prudent to be concerned about packing a suitcase and leaving home for a spell. However, armed with knowledge and common sense, you can have a safe, healthy and memorable travel experience. A little perspective is valuable. Cautionary tales abound for travel outside the United States, but it’s important to keep in mind that you are far more likely to be in an automobile accident within 20 miles of home than you are to get seriously ill abroad. Health and sanitation conditions in Canada, Australia, New Zealand and Eu-

rope are similar to America, but that’s not the case in much of the rest of the world. However, don’t let that deter you. You can boost your odds of staying healthy if you get the recommended inoculations, avoid unpeeled fruit and vegetables and undercooked meat, wash your hands frequently, drink bottled water and beverages, practice safe sex, get plenty of sleep and stay hydrated. Booking your trip with a travel agent is another solid way to keep abreast of the rapidly changing international medical landscape. There’s nothing more comforting than the face-to-face conversation you can have with an expert who can allay your fears or help make itinerary changes if necessary.

Frequent traveler Stephanie Leek considers a purchase at AAA Cruise & Travel. SARAH WURTZ PHOTO “Travel agents have resources that are exclusive to their industry, which is very beneficial to their clients — to get real-time information if there is something that could disrupt their trip, or if something goes wrong while on their trip,” says Jennifer Cook of AAA Washington. “For example, we recently received notification from two prominent cruise lines that they were changing their screening process for guests due to the Ebola outbreak. We were able to immediately let our clients know.” If you’ve booked a trip on your own, the Centers for Disease Control and Prevention (cdc.gov) lists all vaccinations you should have before entering a foreign country and has detailed information on health issues. The CDC’s no-nonsense information is so straightforward it will either put your mind at ease or convince you to stay home. Ebola will dominate the news until it’s contained, which could take months and result in continued tragic loss of lives. Before you hit the panic button, remember that the Ebola epidemic is now contained to West Africa and that Ebola spreads only by direct contact, through broken skin or mucous membranes, with the bodily fluids of an infected person. It is not transmitted through the air, water or food (except bush meat, which you’re not likely to consume here or in Africa).

“Concerns about contracting Ebola during international travel are out of proportion to the risk,” says Joel McCullough, M.D., health officer at the Spokane Regional Health District. “Enhanced protocols are in place to screen and monitor people entering the U.S. from Ebola-infected Sierra Leone, Guinea and Liberia. In reality, travelers are more likely to experience gastrointestinal problems or catch the flu than they are to contract Ebola. “To stay healthy when traveling, especially to areas with sanitation standards below that of the U.S.,” Dr. McCullough continues, “wash your hands frequently, don’t drink tap water or consume ice. Avoid unwashed or raw food in developing countries. Carry hand sanitizer and use it, even on the airplane.” Food prepared by street vendors, especially in Third World countries, is usually not advised. However, if it’s steaming hot, the germs are probably gone. But if it makes you nervous, skip the cultural experience of street-stall dining. Some people have sensitive stomachs, some don’t. Follow your best judgment. Closer to home, nearly 600 cases of enterovirus D68 (EV-D68), a severe respiratory illness that affects mostly children and asthma sufferers, have been reported in 46 states and the District of Columbia. Like the common cold, EV-D68 spreads through coughing, sneezing and touching contaminated surfaces. Check the CDC’s website for a list of states where EV-D68 has been reported. Be on the lookout for bedbugs, nasty critters that have migrated from hostels to five-star hotels across the world. They won’t kill you and don’t spread disease, but can make you itch so badly you’ll want a sedative. Bedbug bites can lie dormant for several days and not erupt until days after you’ve been infected. What to do? Check the sheets, mattress (look in the seams), headboard, nightstand and crevices in the floor and walls for tiny (.2 inches long), six-legged, brown, white or red bugs. Look for minuscule blood spots or feces. Keep your suitcase closed and off of the floor, and don’t throw your clothes on the floor or over furniture. If bites erupt, use anti-itch topical treatments like cortisone — and don’t scratch the bites! If you do and a secondary infection occurs, apply antiseptic lotion or antibiotic cream. See your doctor if bedbug bites don’t diminish within in a week, or if your bites become infected. Should you stay or should you go? Silly question: Of course you should go. Just follow these common sense suggestions. Bon voyage! n

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LIVING DECEMBER - JANUARY EVENTS BLOOD DONATION Give blood at the Inland Northwest Blood Center, which requires up to 200 donors each day to ensure the blood bank is adequately stocked. Donors can schedule an appointment online or donate during walk-in hours. Spokane office: Mon, Fri, Sat from 7 am-3 pm, Tue-Thu 11 am-6 pm. Coeur d’Alene office: Mon and Fri 7 am-3 pm, Tue-Thu 11 am-6 pm, Sat 10 am-3 pm. inbcsaves.org (423-0151) SECOND HARVEST FOOD SORTING Join other volunteers to sort and pack produce and other bulk food for delivery to local emergency food outlets. Ages 14+. Shift dates and times vary; sign up at inland.volunteerhub.com/events. Second Harvest Food Bank, 1234 E. Front (252-6267) TREE OF SHARING The annual program collects and distributes items to regional nonprofits and social service agencies serving low-income, disabled and elderly members of the community. Pick up a tag and drop off items by Fri, Dec. 14. Tags available at NorthTown, River Park Square and Spokane Valley malls. treeofsharing.org SANTA EXPRESS The 21st annual holiday store offers items at allowance-friendly prices for area children to purchase for their friends and family, with proceeds supporting the mission of the Vanessa Behan Crisis Nursery. Through Dec. 23; open Mon-Fri, from 11 am-8 pm, Sat, from 10 am-8 pm and Sun, from 11 am-6 pm. At 707 W. Main (skywalk level). vanessabehan.org EXCHANGE CLUB CRAB FEED & AUCTION The 48th annual event raises funds for programs and services that help

prevent child abuse, including the Vanessa Behan Crisis Nursery, Children’s Home Society of Washington and Support Care and Networking (SCAN). The event includes a social hour, dinner and silent and live auctions. Sat, Dec. 6, at 4:30 pm. $65/person; table sponsorships available. Spokane Convention Center, 334 W. Spokane Falls Blvd. downtownspokaneexchangeclub.org (226-2448) JINGLE BELL RUN This annual event is a fundraiser run for the Arthritis Foundation, with holiday-themed costumes strongly encouraged. Sat, Dec. 6, at 8 am. Riverfront Park. spokanejinglebellrun.kintera.org MOBIUS SANTA BREAKFAST The 11th annual breakfast event benefits programs at Mobius Children’s Museum, and is held in conjunction with Christmas Tree Elegance. Sat, Dec. 6, from 9-11 am. Davenport Hotel, Grand Pennington Ballroom, 10 S. Post. mobiusspokane.org UNION GOSPEL MISSION VOLUNTEER ORIENTATION Learn about volunteering and services offered through the ministry at monthly orientation events. Dec. 9 and Jan. 13, from 6-8 pm, at both UGM locations: CdA, 196 W Haycraft Ave., and Spokane, 1224 E. Trent. uniongospelmission. org/events (535-8510 x2 or 208-665-4673) A CHRISTMAS CAROL BENEFIT PERFORMANCE Attend the Spokane Civic Theatre’s production of the holiday classic and help the Northeast Community Center continue supporting its programs and services. Wed, Dec. 10, at 7:30 pm. $35. Spokane Civic Theatre, 1020 N. Howard. necca.myspokane.net (487-1603)

MIRYAM’S HOUSE HOLIDAY PARTY The Transitions for Women facility houses women who are recovering from crises such as homelessness, abuse or addiction, and celebrates the hard work of the women served there with a holiday party open to the public. Thu, Dec. 11, from 5:307:30 pm. RSVP requested. Miryam’s House, 1805 W. Ninth. help4women.org COMMUNITY MEMORIAL TREE Hospice of Spokane hosts a holiday tree, encouraging the public to decorate a white paper dove in memory of a loved one to hang on the tree. There is no cost to participate. Dec. 13-21. On the third floor of River Park Square, 808 W. Main. hospiceofspokane.org (456-0438) CHRIST KITCHEN GINGERBREAD BUILD-OFF The annual gingerbread house build-off features teams of local bakers, architects and pastry chefs competing to build the most elaborate gingerbread house, as voted by the public. This year’s theme is “Christmas Carols.” Sun, Dec. 14, from 10 am-1 pm; kids’ activities from 10 am-4 pm ($7 to build your own house). Free to watch. Davenport Hotel, 10 S. Post. ccckministry.org INFANT/CHILD CPR CLASS A course for all caretakers of children under the age of 5, covering how to properly give CPR, basic first aid and basic newborn care. $30/two attendees. Offered Dec. 13 (Providence Medical Park), Dec. 17 (Sacred Heart) and Dec. 21 (Holy Family). Sign up at washington.providence.org/events. (474-2400) ELF AT THE BING Celebrate the holiday season at this benefit screening hosted by the Inlander and benefiting Catholic Charities of Spokane’s Fatherhood Project. Wed,

Invested in Your Comfort and Your Care Hospice of Spokane’s first priority is patient care so our patients can focus on what’s important to their lives.

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Dec. 17, at 8 pm. $5 suggested donation. Bing Crosby Theater, 901 W. Sprague. catholiccharitiesspokane.org HARMONY FOR THE HOLIDAYS A musical benefit in support of Catholic Charities Foundation featuring internationally acclaimed singers and local artists, including a special segment for kids. Fri, Dec. 19, at 8 pm. $15. Bing Crosby Theater, 901 W. Sprague. catholiccharitiesspokane.org ADULT FIRST AID/CPR CLASS A class to teach steps that could be lifesaving, including CPR for adults and children, how to use an AED and basic first aid. $55/person, including a certification card. Dec. 27, from 1-5 pm. Providence Sacred Heart Medical Center, 101 W. Eighth. washington.providence.org (474-2400) ANTI-HUMAN TRAFFICKING VIGIL Lutheran Community Services NW hosts its annual vigil to bring awareness to this human rights violation. Sun, Jan. 11, from 3-4 pm. Free. River Park Square. tinyurl.com/ohu4zvu (343-5091) BABYSITTING BASICS Youth (ages 10-15) learn skills and techniques to care for kids of all ages, including CPR and first aid, discipline, personal safety and business basics. Courses offered Feb. 28 and April 11, 2015, starting at 9 am. $40, registration required. Providence Sacred Heart Hospital Auditorium, 20 W. Ninth. wellness.inhs.org 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.

CHARITY CORNER

Lend a Hand, Warm Some Feet

ith the advent of another winter comes the promise of colder weather, snow and the inevitable gift of socks under the Christmas tree. The latter causes most of us to roll our eyes and sigh, not again. But for the homeless, the importance of a good pair of socks cannot be understated. “Some of the main health problems that we see with the men that are homeless have to do with their feet,” says Tim Braach, the Union Gospel Mission’s director of men’s rescue. “Their feet get exposed to the cold, to the wet, and the socks that they have on get ruined fairly quick,” he says. The UGM clothing room at 1224 E. Trent Ave. struggles to keep up with demand during the winter months, Braach says. Every weekday, from 1-2 pm, the room is open to anyone to come through and take what they need, with socks, warm gloves and coats going the fastest. While UGM will accept all footwear donations, thick, warm gym socks or wool socks are preferred, Braach says. In addition to the clothing room, socks also were distributed at the shelter’s annual Thanksgiving dinner at the Spokane Convention Center. Donations can be dropped off at the men’s shelter on East Trent. “We’re just extremely appreciative to Spokane and the Spokane community,” Braach says. “They’ve always been very, very generous and very supportive of everything that we’ve done here.” — CHRISTIAN VOSLER Union Gospel Mission Sock Drive • Drop off donations daily, from 7 am-6 pm • 1224 E. Trent • uniongospelmission.org • 535-8510

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LIVING

Bill Bialkowsky, founder of the Vanessa Behan Crisis Nursery, and Amy Knapton, executive director. SARAH WURTZ PHOTO PEOPLE

Shelter from the Storm The Vanessa Behan Crisis Nursery cares for 4,000 children a year BY LINDA HAGEN MILLER

he 1982 coroner’s report listed 2-year-old Vanessa Behan’s cause of death as a ruptured bowel caused by a blow to her tummy. But that wasn’t all. An autopsy revealed a fractured arm and skull, cigarette burns and head trauma from having her hair pulled and twisted. At trial, Vanessa’s mother and stepfather refused to testify against each other. The case

46 Health DECEMBER, 2014-JANUARY, 2015

fell apart and they were set free. A Spokane father of two, Bill Bialkowsky, couldn’t get Vanessa out of his mind. “It was incomprehensible to me that someone could do that to a 2-year-old child,” Bialkowsky says. “I wanted to get involved in the fight to prevent child abuse. I didn’t want to see that kind of thing happen ever again.”

Through friends, Bialkowsky learned of a crisis nursery in Phoenix where children from birth to age 6 could be temporarily housed in a safe and loving environment. “I talked with the director and decided then and there I would come back to Spokane and get involved in whatever program existed like that,” he says. “But there wasn’t anything.”

ialkowsky had a happy family with two toddlers and a job in sales. He had no experience in starting or running a nonprofit. Undaunted, he researched drop-in crisis centers, gathered friends and acquaintances, formed a board and started fundraising. “We thought we’d be able to open in a year,” he says, chuckling. “It took five. On January 9, 1987, five years to the day after Vanessa died, we opened our doors. We weren’t too busy the first three months, but gradually word got out, and today we serve more children in one month than we did in our first year of operation. We have taken care of over 77,000 children over the past 27 years.” By the late 1980s, the Vanessa Behan Crisis Center had outgrown its modest bungalow. A capital campaign raised the funds to build the current state-of-the-art, 12,000-square-foot facility. Open every day of the year, 24 hours a day, the center provides refuge to an average of 4,000 children a year, offers parenting classes and directs parents and caregivers to social services agencies that assist with housing, food, transportation, day care, substance abuse treatment and more.

In October, Bialkowsky received Providence Health Care’s Sister Peter Claver Humanitarian Award in recognition of his contribution to the community. Not every child who comes to Vanessa Behan is a victim of abuse or neglect. When families live in poverty or have no reliable family support, something as simple as a sick babysitter can throw a working mom’s life off kilter. Maybe Grandma is in the hospital and Mom needs to spend time

Children 6 and under can stay at the Vanessa Behan Crisis Center for up to 72 hours. They may return if the family finds itself in crisis again. Call (509) 535-3155. with her. Or the furnace broke down and while Dad’s fixing it, the house is way too cold for an infant. “We are a prevention-based facility,” says Amy Knapton, the crisis center’s executive director, “a place parents can turn to before they parent in a way they will regret.” In the 18 years Knapton has been with Vanessa Behan Crisis Nursery, she’s seen firsthand the positive impact it has on children, families and the community.

A staff of 55, including child care workers, program staff and social workers, keeps the center humming. Hundreds of volunteers spend countless hours playing with kids, helping in the kitchen, fundraising and staffing the reception area. “We wouldn’t be here without volunteers,” Bialkowsky says. “Their time adds up to a monetary value of $500,000 a year.” For an organization that relies completely on public donations to maintain an annual budget of $1.5 million, volunteers are its lifeblood. Even though a heartbreaking tragedy is at the root of the Vanessa Behan Crisis Nursery, inspirational stories happen every year. There’s 23-year-old Kylie, who came back to the center recently to tell the staff that the days she and her three siblings spent at Vanessa Behan were the happiest of her young life. Their home was in constant turmoil, with both an alcoholic mother and grandmother, and Kylie, less than 6 years old herself, often took charge of feeding and changing her siblings. “When she started to make a bottle at the center,” Knapton says, “we told her, ‘No. Let us do that. You just be a kid.’” n

DECEMBER, 2014-JANUARY, 2015

Health 47

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