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Play that heals ■

More than just fun and games, play therapy can help children overcome challenges

By Ann Bailey

Special Features Staff Writer

Play helps children work through a variety of emotional and mental health issues. Kristy Cavalli, Carol Schneweis and Cathy Colley, therapists at Play Therapy Zone Grand Forks use play therapy to help children work through a variety of issues from mild behavioral problems to being the victims of abuse. Colley also owns PlayWorks Therapy in Crookston. Children cannot always verbalize their feelings but “they can show you a lot in their play,” Cavalli said. “With us, the play in and of itself is the language.” Cavalli, Schneweis and Colley have master’s degrees in social work and clinical social work and Cavalli also is a registered play therapist. During play therapy time children can move around to several areas of the play therapy zone play room. The areas include a place for sand play, dressup and playing with toys. As the therapists play with the children, they pay attention to their actions.

Jackie Lorentz, Special Features staff photographer

Carol Schneweis, child and family therapist, plays with a young client during a session of role playing at Play Therapy Zone in Grand Forks.

Not just play

“It’s an interactive technique and kids have a lot of opportunity to tell their stories,” Cavalli said. “We’re trying to understand the story and connect it back to the real

world.” Besides playing with toys, dolls and puppets and dressing up, children also can play board games with the therapists or get their finger nails painted. Finger nail painting is one of the fun ways that children can express their feelings. They can have the nail polish colors represent different feelings, if they choose. “I have every color of the rainbow of finger polish. I paint their nails and they can paint mine,” Cavalli said. Playing with the children also helps the therapists to establish a relationship built on trust. Meanwhile, the children learn that the play room is a place where they are completely safe from any trauma that might have occurred in their lives, Cavalli said. Helping the children and families overcome challenges is rewarding. Even children who have undergone severe emotional or physical trauma can recover, she said. “Kids are so resilient. These kids make amazing changes.”

Surgery technique relieves pain for those suffering from varicose veins By Ann Bailey

Special Features Staff Writer

Men and women with severe varicose veins have another alternative when it comes to treatment. Dr. Jerry Smith, a surgeon at Aurora Clinic in Grand Forks, performs a procedure called VNUS ClosureFAST on patients who are suffering from superficial venous reflux disease. The surgery is a technique used for men or women who have severe leg pain or phlebitis. Superficial venus reflux disease occurs when vein valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. When the valves don’t close properly it can lead to a variety of symptoms including leg pain, phlebitis and skin ulcers and discoloration, Smith said. Phelbitis can lead to more serious conditions such as blood clots. Ulcerations, meanwhile, can result in wounds that weep or seep. Severe cases of varicose veins also are painful, he said. “People stand eight hours, and by the end of the day they can’t stand it because their legs ache so bad,” he said. Several factors, including

Jackie Lorentz, Special Features staff photographer

Dr. Jerry Smith, a surgeon at Aurora Clinic in Grand Forks, uses a VNUS Closure Procedure to treat people suffering from superficial venous reflux disease. family history, gender and occupations in which they stand all day can contribute to the occurrence of superficial venous reflux disease. Meanwhile, varicose veins are more common in women than in men.

Another alternative

Years ago, patients with those conditions would under go vein stripping surgery, a painful procedure with a slow recovery time. A procedure used commonly now is laser surgery. The VNUS Closure-

FAST is a procedure in which a catheter is inserted into the veins through a small opening in the skin. Smith has used the procedure for a couple of years. Radio frequency energy provides the power for the catheter, which delivers heat to the vein wall. “It heats the vein and cooks it and makes it go away,” Smith said. The VNUS ClosureFAST has the highest vein closure rate available, which is why he believes it is more effective than laser surgery.

Jackie Lorentz, Special Features staff photographer

Registered Play Therapist Kristy Cavalli shows some of the puppets she uses during play therapy at Play Therapy Zone in Grand Forks.

Health care at home Altru Homecare provides services for patients including nursing, light housekeeping and physical therapies

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By Ann Bailey

SpecialFeaturesStaffWriter

Though many patients receive care in the hospital or clinic, Altru Health System also brings its health care home. Altru Homecare provides services for patients including nursing, light housekeeping and physical, occupational and speech therapies, said Joyce Simmons, Altru Homecare and Hospice manager. Homecare is available in North Dakota at sites in Grafton, Park River, Cavalier and McVille and in Warren, Minn., she said. The majority of the homecare Altru Health System provides is shortterm care for people who are making a transition from the hospital to their homes, Simmons said. Patients who use homecare must be in need of skilled care. About a thousand people, including therapists, nurses and nurses aides and volunteers work in Altru Homecare. People who are being served generally are elderly, but include a variety of ages including newborn babies. “We really provide a whole gamut of care,” Simmons said. “The service we provide now is similar to what is in the hospital,” she said. Although people now are released from the hospital sooner than they

Jackie Lorentz, Special Features staff photographer

Joyce Simmons, manager of Altru Health Systems Home Health and Hospice, shows some of the fleece comfort blankets made by volunteers. The blankets are given to patients in hospice. were in the past because of insurance requirements, they may still need skilled care, she noted.

Hospice services

Hospice, another service Altru Health System provides, is available for

ALTRU: See Page 2

RiverView Health gets new CT Flash scanner 2 Grand Forks Herald/Sunday, May 16, 2010

By Ann Bailey

Special Features Staff Writer

Jackie Lorentz, Special Features staff photographer

Dr. Daniel Courneya, RiverView’s director of radiology, shows how the new Siemens Somatom Definition Flash CT scanner would be read on a computer. RiverView Hospital in Crookston is one of 18 hospitals in the United States to have this low dose radiation scanner that can do a full body scan in 4.3 seconds.

ALTRU/

Continued from Page 1

people in the final stages of their lives who need care. Hospice is staffed by people from a wide variety of disciplines including nursing, therapy and social work and chaplaincy, Simmons said. The Hospice care provided is not for only the patient. “The whole family is who we’re taking care of,” she said. Altru Health System continues providing bereavement care for the family for 13 months after the patient’s death, she noted. “It’s an ongoing process with the families,” Simmons said. The aim of hospice is to help patients and families deal with illness and help them to improve the quality of their lives. More than 100 people volunteer for hospice, helping with tasks

such as picking up prescriptions, light housekeeping or simply sitting with patients, Simmons said. Hospice is provided in the same areas of northeast North Dakota and northwest Minnesota in which Altru Homecare is provided. Recently Altru Health System Hospice began offering its hospice patients comfort blankets. The fleece blankets are made by people and service organizations throughout the area. Some of the organizations buy the fleece to make the blankets and others use material provided by Altru. Ella Bang, 92, and a resident of Valley Eldercare, was pleased to receive one of the blankets. “I use it all of the time, especially when it’s cold outside. It feels so warm and cuddly,” she said, with a smile.

Remember magnesium if you want to remember

Special Features Staff Reports

Those who live in industrialized countries have easy access to healthy food and nutritional supplements, but magnesium deficiencies are still common. That’s a problem because new research from Tel Aviv University suggests that magnesium, a key nutrient for the functioning of memory, may be even more critical than previously thought for the neurons of children and healthy brain cells in adults. Begun at MIT, the research started as a part of a post-doctoral project by Dr. Inna Slutsky of TAU’s Sackler School of Medicine and evolved to become a multi-center experiment focused on a new magnesium supplement, magnesium-L-theronate (MgT), that effectively crosses the blood-brain barrier to inhibit calcium flux in brain neurons. Published recently in the scientific journal Neuron, the new study found that the synthetic magnesium compound works on both young and aging animals to enhance memory or prevent its impairment. The research was carried out over a five-year period and has significant implications for the use of overthe-counter magnesium supplements. In the study, two groups of rats ate normal diets containing a healthy amount of magnesium from natural sources. The first group was given a supple-

ment of MgT, while the control group had only its regular diet. Behavioral tests showed that cognitive functioning improved in the rats in the first group and also demonstrated an increase of synapses in the brain – connective nerve endings that carry memories in the form of electrical impulses from one part of the brain to the other.

Bad news

“We are really pleased with the positive results of our studies,” says Dr. Slutsky. “But on the negative side, we’ve also been able to show that today’s overthe-counter magnesium supplements don’t really work. They do not get into the brain. “We’ve developed a promising new compound which has now taken the first important step towards clinical trials by Prof. Guosong Liu, Director of the Center for Learning and Memory at Tsinghua University and cofounder of Magceutics company,” she says. While the effects were not immediate, the researchers in the study – from Tel Aviv University, MIT, the University of Toronto, and Tsighua University in Beijing – were able to assess that the new compound shows improved permeability of the bloodbrain barrier. After two weeks of oral administration of the compound in mice, magnesium levels in the cerebral-spinal fluid increased.

Please recycle

CROOKSTON – RiverView Health in Crookston is home to a lowdose radiation scanner that can take an image in a flash. RiverView is the first Minnesota health care facility outside of the Twin Cities and was the 18th in the United States to receive the scanner. The CT scanner, called the Siemens Somatom Definition Flash, arrived at RiverView in March. The scanner takes images at speeds at least 10 times faster than other CT systems, said Dr. Daniel Courneya, RiverView Health radiology director “This is the fastest system available,” he said. The CT scanner can take a chest X-ray in 0.6 seconds, a heart scan in .25 seconds and a full-body scan in 4.5 seconds. One of the benefits of the new scanner is that children will not have to hold their breath or be sedated during a scan, Corneya said. “It’s fast enough that even with the most fidgety child we can get a CT scan – and in the lowest dose,” he said. The speed of the new scanner also is beneficial to patients because

Jackie Lorentz, Special Features staff photographer

RiverView Hospital Radiology Manager Dawn Bjorgo stands next to the new Siemens Somatom Definition Flash CT scanner.

“It’s fast enough that even the most fidgety child we can get a CT scan – and in the lowest dose.”

and the rate at which blood is flowing. Patients who had a normal EKG when tested, yet had chest pains, formerly had to have a blood test performed, Courneya said. Now the patients’ coronary arteries can be CT scanned instead. “This way you can come in and have chest pain evaluated,” he said Meanwhile, the scanner also has improved accuracy, providing images with optimum contrasts, according to RiverView Health.

Dr. Daniel Courneya radiology director

it can diagnose cardiac diseases that couldn’t before be diagnosed, he said. The scanner can speed up to follow the movement of the heart

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Opening Soon! Jackie Lorentz, Special Features staff photographer

Ella Bang, 92, enjoys her fleece comfort blanket from Altru Hospice. Bang lives at Valley Eldercare in Grand Forks.

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Interpreters bridge a language barrier between doctors and patients By Doug Moore

St. Louis Post-Dispatch

ST. LOUIS – The discussion in the examination room had gone on for about 30 minutes. Patient and doctor were frustrated. The young woman from Iraq said she remains in constant pain. Solid food feels like a stab to the stomach. Her head is filled with “heaviness” and the medicines she has been prescribed are not working. An X-ray and other tests have not pinpointed a cause for the pain, said Dr. Arpit Agrawal. What the 29-year-old woman needed was a visit to a psychiatrist – something she is dead set against. In the middle of the discussion at Barnes-Jewish Hospital in St. Louis was interpreter Buddy Sultan. Toggling between English and Arabic, he explained the young woman’s resistance. She had been referred to a psychiatrist during an earlier exam at the hospital. A transportation mix-up left her stranded for hours after her appointment in Chesterfield. She is not willing to go through the anxiety again. Besides, she doesn’t think there is anything wrong with her mind and is upset that doctors continue to focus their attention there. And, as Sultan said in an interview later, in Iraqi culture, there is a strong stigma that comes with mental illness. Sultan works for the hospital’s Refugee Health and Interpreter Services, an office increasingly called upon to assist in communication throughout the hospital as the region becomes more diverse. Just as importantly, the office focuses on making sure the patient eventually gets the health care suggested by the doctor, including reminders on follow-up office visits. In 1996, the office had 7,300 encounters with patients in 13 languages. Last year, the office had 41,311 encounters in 81 languages, from Albanian to Zapotec. “When you cannot communicate, there is frustration by the patient and the doctor and trust decreases, which is toxic to the entire encounter,” said Barbara Bogomolov, director of Refugee Health and Interpreter Services. When doctors are unable to assess the problem in a conversation with a patient, they are more apt to order unnecessary – and expensive – tests, she said. Hospital stays are longer and readmissions increase because a patient is less likely to adhere to a treatment plan. Health care studies show that the main reason for medical mistakes is a breakdown in communication. Effective interpretation, however, must go beyond translation, said Eduardo Vega, project coordinator for Language Access Metro Project, which provides interpreter services in specialty fields such as medical and legal. “One of the fundamentals of doing interpretation correctly is that not only are you the interpreter, but the cultural broker,” Vega said. “For example, in Asian cultures, they might have a home remedies procedure that might sound strange to a Western person. But the interpreter has to, in his or her way, explain the meaning of the esoteric concept.” Bogomolov says that cultural understanding is why her 35 interpreters are refugees or immigrants as opposed to linguists. Her office is a part of the Center for Diversity and Cultural Competence. The center is charged with creating a more diverse work force, and offering training to hospital staff on understanding and recognizing cultural differences. Those trained work in various departments, from housekeeping and security to nursing and human resources. After completing the program, employees train coworkers. Most of those who sign up for the program do so on their own. In some cases, though, supervisors

Grand Forks Herald/Sunday, May 16, 2010

have suggested an employee could benefit from the training.

Fliers, not guns

“It’s important to touch all parts of the hospital,” Bogomolov said. She cites a security guard approaching a man lighting a cigarette near a “No Smoking” sign as an example. “Imagine if this guy has just come from a war zone and sees a man armed with a gun coming his way,” Bogomolov said. “He’s going to think that the guard is going to take me away and I won’t come back.” As a result, security guards now carry fliers they can hand out, which explains the new no smoking policy in 14 languages.

The 18-hour training for employees includes “understanding that our world view isn’t the same as someone else’s,” said Jelena Todic, a center pro-

BARRIER: See Page 4

Physician Michael Nassif, left, listens to his patient Hassan Osman, center, an immigrant from Kurdistan, as translator Buddy Sultan helps with communication during an appointment in the Resident Clinic Area of Barnes-Jewish Hospital. Doctors and other medical professionals are encountering more languages than ever before in treating refugees and immigrants.

McClatchy Tribune

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In North Dakota, Altru is the only hospital that offers the new cancer treatment, TomoTherapy. TomoTherapy is unique because it surrounds the entire body during treatment. It’s a more concentrated form of radiation, too, which makes it more effective for treating tumors. The end result – TomoTherapy is offering more hope for cancer patients like Jim. For additional information please visit altru.org/tomotherapy, or call 701-780-5860.

Taking care of all of you.

Research into stem cells of adults stirs hopes 4 Grand Forks Herald/Sunday, May 16, 2010

By Fred Tasker

McClatchy Newspapers

MIAMI – A year after President Barack Obama eased restrictions on research into embryonic stem cells and pledged billions in new stimulus money for it, researchers are almost giddy with enthusiasm about progress in the field. They’re confident stem cells will treat – maybe someday cure – heart disease, diabetes, spinal cord injury and other disorders. But the excitement is not generated by stem cells harvested from human embryos. Instead, researchers are coming to believe they can get results almost as good from adult stem cells taken from the patient’s own bone marrow or belly fat, and even full-fledged adult cells from muscle tissue or skin. “Adult stem cells have more flexibility than we thought,” says Dr. Joshua Hare, director of the Interdisciplinary Stem Cell Institute at the University of Miami Medical School. “The embryonic stem cell might not be the most valuable property in actual therapy. When you’re treating a heart attack, you might do better with an adult stem cell.” Already at the UM Medical School, adult stem cells have been injected around a patient’s heart to help heal a heart attack, and adult cells are being applied around injured spinal cords in hopes of restoring movement. Another new development exciting researchers is the “induced pluripotent adult stem cell.” Scientists at Harvard and in Japan took cells from the skin on a patient’s arm and genetically reprogrammed them to be almost as flexible as embryonic stem cells – without destroying an embryo. They hope to use them someday to build up entire human organs, cell by cell. “This is really exciting,” says Dr. Kenneth Zuckerman, a senior researcher at Moffett Cancer Center in Tampa. “If you need a liver transplant, you can make a liver out of cells from your own body. The same with a heart. It might replace embryonic stem cells in some ways.”

Avoids controversy

Some adult stem cell experiments could get FDA approval for general use within five years; others are expected to take 10 years or longer. Using adult cells avoids

McClatchy Tribune

Ian McNiece, left, Ph.D., and Joshua Hare, M.D., are working on embryonic stem cell research at the University of Miami Miller School of Medicine in Miami. the controversy of destroying embryos. And, coming from the patient’s own body, they avoid the risk of rejection. The excitement doesn’t mean researchers are losing respect for the value of human embryonic stem cells. “The embryotic stem cell is the prototype, the ultimate stem cell,” Hare says. “It has the greatest capacity to become any other type of tissue. It’s essential to work with both kinds of stem cells.” “Embryonic stem cells remain central to our plan,” says Dr. Camillo Ricordi, who is studying both adult and embryonic stem cells as director of UM’s Diabetes Research Institute. “Everything we’ve applied to other kinds of cells we learned first by studying embryonic stem cells.” But the process of approving new lines of embryonic stem cells is complex, and is going slowly. The first new line created since Obama’s ruling was approved only in December. Only 50 lines have been approved so far, with 300 more still awaiting action. The NIH has awarded $143 million for the research to universities including Johns Hopkins, Stanford, University of Michigan, UCLA, Harvard and others. Harvard has 70 principal investigators studying embryonic stem cells in treating blood disorders, cancer, diabetes and diseases of the heart, kidney and nervous system.

One researcher who has received some of the new cell lines approved by the Obama administration is Paul J. Simmons at the University of Texas. He plans to use them first in test tubes, then in lab animals and someday in humans to create blood cells, also to help fight leukemia. But he says: “Most embryonic stem cell research is still very basic. My human tests could be years away.”

Current research

In January, the FDA approved the first clinical trial using human embryonic stem cells in human patients. Geron Corp., a

California biopharmaceutical firm, plans to inject the cells around the severed spinal cords of 10 paralyzed human patients to see if they can repair them. But the trial hasn’t reached the human stage. It was suspended in October over safety concerns in pre-clinical testing in lab animals. The company hopes to resume the trial later this year. At UM’s Stem Cell Institute, researchers are using both human embryonic stem cells and adult stem cells in studying how to repair the heart after a heart attack. The embryonic STEM CELLS: See Page 5

THE TIME TIM IS NOW

BARRIER/

Continued from Page 3

gram manager. For example, in some cultures, health care decisions of women are made by the husband or by family elders. Some cultures see breast cancer as a shameful disease brought on as a curse for bad behavior and reject treatment. And children have come to the U.S. labeled as retarded when in fact they were not responding and interacting in a traditional way because they were deaf. St. Louis ranks 10th nationally in the number of refugee resettlements. The city is viewed by the State Department as an attractive place to settle refugees based on a good supply of affordable housing, access to health care, and an expansive web of social services agencies including the International Institute. At the Language Access Metro Project, better known as LAMP, Spanish interpreters are in greatest demand followed by Bosnian and Vietnamese, Vega said. Dari, spoken in Afghanistan, and Farsi, spoken in Iran, are growing in popularity as is Arabic, reflecting the increased Iraqi population in the region.

‘Constant challenge’

The increased number of languages and cultures keeps health care providers constantly on their toes, Bogomolov said. “It’s a constant challenge,” she said. “But just because a language is exotic, I don’t get a pass.”

When a patient arrives who speaks a language not covered by her office, Bogomolov works with an interpreter group locally and other agencies nationally to find someone who can translate, even if it means interpretation by telephone. The Joint Commission, an independent nonprofit, is the accrediting agency for more than 17,000 health care organizations and programs in the U.S. At the crux of its evaluations is what the agency refers to as its vision statement: “All people always experience the safest, highest quality, best-value health care across all settings.” Barnes and other hospitals keep that in mind as they work to improve their efforts to provide health care to a population that gets more diverse in language and cultural differences, Bogomolov said. On her desk is the case file of the Iraqi woman who is fighting psychiatric treatment. She suffers from post-traumatic stress disorder and has not been getting treatment for it although she came to the U.S. nine months ago. “There was no way this was going to be solved in a single doctor visit,” Bogomolov said. She said she and an interpreter will talk with the woman about how treatment is for the head and the body and that her pain will not go away unless attention is given to both. They will also work to get her husband solidly behind the hospital’s proposed treatment. “We’ll figure out a way to get her on the meds,” Bogomolov said. “We’ll win ultimately.”

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Brothers and sisters of children with autism learn early to cope with differences

Grand Forks Herald/Sunday, May 16, 2010

STEM CELLS

Continued from Page 4

By Joe Burris and Rob Kasper The Baltimore Sun

BALTIMORE, Md. – During a recent first-grade class session at the McDonogh School in Baltimore, Md., 7-year-old Aidan Wade gave an impromptu discussion on what it’s like to have a sibling with autism. “My brother Conor is 11, but his brain thinks he’s 5,” said the Baltimore boy. “He acts kind of different, but that’s OK.” Aidan’s words reflect a broad spectrum of attitudes that one might find in siblings of children with autism, a complex set of developmental brain disorders. How a sibling reacts is often dependent upon the severity of the autism, where the child with autism falls in the birth order and how parents model behavior they expect from each of their children. Siblings of children with autism can face difficulties forming healthy sibling bonds, some studies suggest. Researchers from the University of Washington found in 2007, for example, that some young siblings they studied used fewer words and social smiles than those without autism in the family. The study found that parents reported some “social impairments” in siblings as young as 13 months. Siblings can face the prospect of tantrums and unexpected behavior from brothers and sisters with autism. They might have to compete for attention. But they can also learn empathy early, experts say. “We know that there are special demands growing up in a home with a child with autism,” said Cathy Groschan, a social worker in Kennedy Krieger Center for Autism and Related Disorders. “But if children view their parents and their peers as responding positively to their sibling’s disability, and if they have good factual understanding of the disability, they tend to have positive relationships and a positive outcome.”

Tolerance

Peter Bell, vice president of Autism Speaks, a New York-based autism science and advocacy organization, says one thing siblings of children with autism learn is tolerance. “Many of these siblings grow up knowing that a brother or sister might be a little bit different than others,” Bell said. The Pennington, N.J., resident has a 17-year-old son, Tyler, with autism, and two younger children, Derek, 15, and Avery, 11. “They see it as a part of everyday life and OK to be different and unique,” Bell said, “and that sometimes there will be good and bad days, but at the end of the day, you are who you are and what you stand for.” Autism Speaks says that an estimated one in every 110 children is diagnosed with autism, making it more common than child-

McClatchy Tribune

John, left, and Pam Gillin, center, are pictured in their home with their three children including sons Johnny, (on couch, right) 17; Hunter, 15, back right, and daughter Ryan, 10, in Baltimore. “Because Johnny is the oldest, his other siblings accepted him at face value – they didn’t know that he should be any different,” Pam added about Johnny who has autism. hood cancer, juvenile diabetes and pediatric AIDS combined. And Bell said that many services for children with autism are not covered by insurance, creating significant financial strains on families. That, he says, sometimes affects what a family has to spend in general, let alone on each child. But he added that siblings of children with autism generally adapt well to the challenges, and because of it foster a keen sense of selflessness and caring. Some grow up to devote themselves to careers in autism awareness and research. Conor Wade was diagnosed with autism about two weeks after younger brother Aidan was born, said their mother, Alisa Rock of Baltimore. “Aidan has not known anything different,” she said. “The first couple of years were more stressful for us. My older son did have challenging behaviors, and Aidan didn’t understand why Conor would have tantrums, bit his hand or hit (Aidan),” said Rock. “Conor had tantrums from age 5 to 8 at varying levels of intensity, but he could have them for hours.” When Conor turned 8, that behavior subsided significantly, and the two of them became very good friends, Rock said. “Aidan took on the caregiving role, and I was able to say to him, ‘Keep an eye on your brother,’ or ‘Help me here.’” Rock said that Conor’s tantrums have recently returned. She added, “Aidan doesn’t understand. He doesn’t remember those challenging behaviors, and he’s feeling very stressed with the re-emergence of those behaviors. But still, he’s a happy-go-lucky kind of kid with a positive attitude.”

‘Double blessing’

Marlo Lemon of Randall-

stown, Md., calls her 5year-old twin boys Matthew and Joshua a “double blessing.” To hear her tell it, the boys have been a blessing to one another as well. Matthew has autism. Joshua, born a minute earlier, does not. “Joshua is such a good big brother, and though he’s older by just a minute, he takes his responsibility very seriously,” said Lemon, who also has a daughter, Victoria, 4. “No matter what Joshua’s doing, he wants Matthew to be included. If we’re in a public place, and Matthew wants to run off, Joshua will say, ‘Mommy, I’ll go get him.’” Lemon said that for a time, Matthew would run away from Victoria, but she and Joshua eventually got him engaged in their activities. And, in making sure that he fits in with all they do, they show him that he, too, must put his plate in the sink after meals. Sometimes, however, the two wonder: Is Matthew going to talk someday? Why is Matthew allowed to jump on a chair and eat chicken nuggets while they cannot? There are times, Lemon says, when she and her husband, Frissell, must devote 90 percent of their attention to Matthew, “and I need them to be good, because you never know if Matthew is going to run off.” But Lemon said she and her husband get plenty of family support; both sets of their parents live within 20 minutes of their home. She added that she makes individual time for each of her other children as well. For Lemon and Rock, their children without autism were either born after or close in age to the one who has the disorder. Trish Stone of Towson, Md., had her first two children, David, 22, and Megan, 18, well before her

son Matthew, 8, who has autism. She also has a younger daughter, Kendal, 6. “When Matthew was born, they were both excited about having another sibling,” said Stone of her elder children, “and then it became difficult. They weren’t used to it, and like some other families, it caused a distance between them. “Shortly after that, David learned how to drive, and when he could get out of the house he did. Megan was 11, and she began to take on the parental role. It was tough on each one of the siblings in different stages, but they ended up being more compassionate and caring than typical siblings.” AUTISM: See Page 6

stem cells are used in basic lab research in test tubes but not in humans, says Ian McNiece, the institute’s director of experimental and cell-based therapies. Hare, McNiece and colleagues are conducting a clinical trial using adult stem cells to treat 53 human heart attack patients. They extracted adult “mesenchymal” stem cells from the patients’ bone marrow, purified and multiplied them, then injected them into veins in the patients’ arms and legs. The stem cells migrated to the heart, drawn by chemical signals put out by the heart’s damaged tissue. The stem cells appeared to become heart cells, helping to repair the damaged organ. In early results, the mended hearts pumped blood more strongly and had fewer dangerous arrhythmias. At UM’s Diabetes Research Institute, Ricordi and colleagues are using both embryonic stem cells and adult stem cells to seek a cure for diabetes. In a trial with lab rodents, embryonic stem cells were harvested from a human donor, reprogrammed into pancreatic cells and transplanted into the pancreas of a diabetic mouse – with some success. “We’ve shown we can reverse diabetes in rodents. We’ve had them off insulin for a month. In California, researchers have had them off it for a year,” Ricordi says. In another trial, with human patients, adult pan-

creatic islet-cell clusters containing insulin-producing beta cells were harvested from a cadaver’s pancreas and injected into the patients’ pancreas. “We dramatically reduced insulin requirements and got better control of glucose levels,” Ricordi says. At the Miami Project to Cure Paralysis, researchers are working not with stem cells, but with full-fledged adult cells called Schwann Cells. They are extracting the cells from muscles in the patient’s arms or legs, injecting them around the injured spine and trying to induce them to turn into myelin, a sheath that wraps around the spinal cord and protects it. In an earlier trial, the method restored the ability of lab rats to walk, albeit imperfectly. The Miami Project has no current plans to apply for embryonic stem cells, said Pantelis Tsoulfas, a neurologist at the project. Given the advances in both embryonic and adult stem cell research, researchers debate which will be more important in fighting disease. “If I had to bet which will be the most important in the long run, it would be adult cells from the patient’s own body,” Ricordi says. Says Simmons: “There’s a whole array of diseases that afflict humans. Some will be amenable to therapy with adult stem cells. Other more complicated procedures will probably be based on embryonic stem cells. “You need different horses for different courses.”

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Linking electronic medical records 6 Grand Forks Herald/Sunday, May 16, 2010

By Veronica Torrejon

The Morning Call (Allentown, Pa.)

ALLENTOWN, Pa. – Hariteeny Fritz was vacationing in Maine when she started getting double vision and had to see a doctor. She went to a clinic and, in lieu of answering dozens of medical history questions, she gave the clinic staff a login and password to her online account at Geisinger Health System in Danville, Pa. Her entire medical record appeared, including all her recent lab results and doctor visits. The doctor in Maine didn’t have to rely on her memory to treat her or order any extra tests. “They were flabbergasted,” said Fritz, 80, of Bloomsburg, Pa. “They couldn’t believe that I had that information that I could carry with me all the time.” Her experience may soon be the norm. The days of sitting in a doctor’s office filling out medical history forms could be fading faster than floppy disk drives and doctors who make house calls. Beginning next year, doctors and hospitals that are able to share computerized medical records – including a list of prescriptions, drug allergies, doctor visits and test results – will qualify for a share of $1.5 billion in incentives from the federal government. By 2015, those that don’t will face Medicare funding cuts. “It will happen one way or another,” said Ann Torregrossa, director of the Governor’s Office of Health Care Reform in Harrisburg, Pa. “When it does, it will totally transform how health care is delivered in a number of ways.” A major part of the effort to reform health care, linking computerized medical records across the country is supposed to save money and reduce medical errors, but it is not without controversy. Also, less than 1 percent of hospitals surveyed by the American Hospital Association in January said they could meet the proposed requirements at the time they were surveyed. The region’s two largest health care providers, St. Luke’s Hospital & Health Network and Lehigh Valley Health Network, believe they can get systems in place in time to collect the federal incentives. The process has proven complicated and expensive. To get to the point where it could share patient records electronically, Geisinger Health System has spent more than $100 million. LVHN began the move to computerized records about 10 years ago with a system for ordering prescriptions that is now used in all network hospitals. Within the hospitals, doctors can order medication that is checked against a patient’s prior prescription history and drug interactions. Laboratory tests are also automated and results can be checked by doctors as

McClatchy Tribune

Erika Keller, nurse midwife, left, and Dr. Michael Sheinberg, talk about Electronic Health Records at Lehigh Valley Hospital-Cedar Crest in Allentown, Pa. soon as they become available. But outside the hospitals, getting individual doctor’s offices, clinics and laboratories hooked into the system has become a more challenging prospect. LVHN has already spent more than $8 million and expects to spend as much as $10 million more to meet the government’s criteria, said Harry Lukens, LVHN’s senior vice president and chief information officer. “Part of that is driven by our size,” he said. “We have over 1,000 physicians that will have to be trained and we have to supply our hardware.” More than 200 doctors in the network have already computerized their patients’ records. One of the more dramatic changes has come to the labor and delivery unit at Lehigh Valley Hospital-Cedar Crest, where almost everything is computerized and linked with ob-gyn offices miles away. Pregnant women’s medical records used to be faxed to the hospital when a woman was about four weeks from delivering. But if a baby came earlier than 32 weeks, the on-call doctor had to scramble to get medical records. Even under normal circumstances, the system left a gap in a woman’s records. “You’d miss the last four weeks of her pregnancy,” said Dr. Michael Sheinberg, an obstetrician and LVHN’s medical director of quality assurance and performance. Now, ob-gyn practices in the network have computers in exam rooms to update information that is instantly available to doctors in the labor and delivery unit. When pregnant women arrive at the hospital, they are hooked up to fetal monitors that are now computerized, showing the mother’s contractions, blood pressure and pulse. Because the records are digital, Sheinberg can also monitor the progress of his patient’s labor from home or his office in South Whitehall Township. The difficulty comes in trying to combine com-

puter systems and different units and doctors both in and outside the hospital, said Lori Yackanicz, who is in charge of clinical applications for LVHN’s information services department. The network has more than 200 computer systems. All the software has to be compatible, Yackanicz said. LVHN does have a head start on many hospitals across the country. The American Hospital Association was so concerned that many hospitals won’t be able to meet upcoming deadlines that it sent a letter to the federal Centers for Medicare & Medicaid Services in March asking for a more flexible timeline. Pennsylvania hospitals are slightly ahead of the rest of the country, but not by leaps and bounds, said Martin Ciccocioppo, vice president of research for the Hospital & Healthsystem Association of Pennsylvania. The Governor’s Office of Health Care Reform, using

a $17.1 million grant, is moving forward with a plan to connect medical records from all hospitals and doctors in Pennsylvania. Torregrossa estimates it will take more than $100 million to get the system running. From there it will be up to health care providers to get to the point where they can connect to the exchange by 2015. “Not all health care providers will be ready to do it,” Torregrossa said. “We’ll connect people who are ready to connect as soon as possible.” Before that can happen, hospitals and health networks also will have to get doctors to agree to electronic medical records. For some, particularly those who’ve been using paper charts for decades, that can be a difficult prospect, said Dr. Donald Levick, a pediatrician who serves as the liaison between the technology de-

AUTISM/

Continued from Page 5

Kids Who Roar

Many youngsters with siblings who have autism get involved with programs and organizations that promote autism awareness and research. Some have been soliciting donations for Kennedy Krieger Institute’s autism research and treatment programs, a task that used to be solely the work of adults. But this year, a group of about 19 kids and young people, ranging in age from 6 to 20, began doing some of the fundraising. They call themselves Kids Who Roar. They also planned some of the activities at a Kennedy Krieger event to be held Sunday at Oregon Ridge State Park in Cockeysville, Md. There will be a bike ride called ROAR, short for Ride for Autism Research. Riders pay $5 to $30 to register and pedal anywhere from 5 to 50 miles. Hikers have a similar arrangement for jaunts through the park. This year, thanks to ideas offered by the kids committee, there will also be a dinosaur dig, where toddlers can burrow for hidden treasures, as well as a place to make your own beaded bracelet, and a jump rope station. Those involved in the fundraising include Hunter Gillin, 15, of Owings Mills, whose 17-yearold brother Johnny has autism. Hunter says that he and Johnny are best friends, that they enjoy watching movies, wrestling or just hanging out. In fact, he says it wasn’t until he was 11 that he even discov-

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ered Johnny had autism. “Johnny and I have been best friends through the years, and it really didn’t matter,” said Hunter. “But I had a couple of friends come up to me, and they were just asking questions, nothing mean or anything, but they would ask, ‘Does your brother have autism?’ “I said, ‘No, I don’t think so.’ Then I went up to my parents and they sat me down and explained the whole thing to me.” Gillin’s experience reflects how many children with a sibling who has autism seldom view the development disorder in a negative way, if at all. “Our goal has always been to see our son first, and his autism second. We have focused on, and celebrated, what Johnny can do, instead of what he can’t,” said Pam Gillin, the boys’ mother “Because Johnny is the oldest, his other siblings accepted him at face value – they didn’t know that he should be any different,” she added. “They saw that he was a great reader, well before they could read, and was a master at puzzles. They genuinely saw him for his strengths.” That’s why Pam Gillin, who works at Kennedy Krieger, said that there the motto is, “If you’ve met one child with autism, well then, you’ve met one child with autism.” “There are many perceptions of autism, affected children, and their families,” Gillin added. “These perceptions may be reality in one family, but not in another – so it’s important to put them aside altogether and take each child with autism as they come.”

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Doctor shortage? 28 states may expand nurses’ role Grand Forks Herald/Sunday, May 16, 2010

By Carla K. Johnson AP Medical Writer

CHICAGO – A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.” For years, nurse practitioners have been playing a bigger role in the nation’s health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics. Those newly insured patients will be looking for doctors and may find nurses instead. The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients. Nurse practitioners argue there’s no danger. They say they’re highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less. “We’re constantly having to prove ourselves,” said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she’s just like a doctor “except for the pay.” On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training. Medicare, which sets the pace for payments by private insurance, pays nurse

RECORDS/

Continued from Page 6

partment and medical staff at LVHN. Doctors have gotten more used to technology. But training doctors, nurses and other staff to switch to a computerized system can take several months, he said. Nationally, computerized medical records have met with skepticism and criticism. A study published last year in the American Journal of Medicine looked at whether more computerized hospitals had lower costs or better quality care. It found that, on average, hospitals that were more computerized did slightly better with certain measures of

practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60. The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make – and that may be just the beginning. States regulate nurse practitioners and laws vary on what they are permitted to do: ■ In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances. ■ In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June. ■ In Montana, nurse practitioners don’t need a doctor involved with their practice in any way. ■ Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor. ■ In some states, nurse practitioners with a doctorate in nursing practice can’t use the title “Dr.” Most states allow it. The AMA argues the title “Dr.” creates confusion. Nurse practitioners say patients aren’t confused by veterinarians calling themselves “Dr.” Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title? The feud over “Dr.” is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing. Many with the title use it with pride. “I don’t think patients are ever confused. People are not stupid,” said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses “Dr. Roemer” as part of her e-mail address. What’s the evidence on the quality of care given by quality of care, but didn’t fare better than others in administrative costs. Statistics from Geisinger suggest otherwise. A program that standardizes patient care using the computerized record system there has improved outcomes for coronary artery bypass, reducing inhospital mortality, readmission rates and complications, said Dr. James M. Walker, chief health information officer at Geisinger. Other industries have been using computerized systems and tracking for years, said Dr. Edgardo Maldonado, whose Centro de Salud LatinoAmericano is one of the clinics at LVH-Allentown. All of them are using electronic medical records. Maldonado has found

Associated Press

Amanda Cockrell, 32, left, a nurse practitioner at Rush Lifetime Medical Associates examines Shanequa Reeves, 18, in Chicago. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

nurse practitioners? The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups. “The argument that patients’ health is put in jeopardy by nurse practitioners? There’s no evidence to support that,” said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health. Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care. The nonpartisan Macy Foundation, a New Yorkbased charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the lead-

ers of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care. The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do. “A shortage of one type of professional is not a reason to change the standards of medical care,” said AMA president-elect Dr. Cecil Wilson. “We need to train more physicians.” In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee. One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn’t prescribe a powerful enough medication and the doctor couldn’t be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn’t be reached in the middle

the system particularly helpful in keeping his diabetic patients healthy. It sends him e-mails when his patients need routine screenings, eye exams and other tests. Maldonado said he’s amazed that it’s taken so long for the health care industry to computerize records and other systems. He said he got an auto-

mated call from his local grocery store recently informing him that a bag of potatoes he purchased had been recalled. “I couldn’t believe that I was getting that from a grocery store,” he said. “Of course, health care is more complicated than potatoes.”

of the night, nurses told The Associated Press. Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers. That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. “That greatly opens up the supply of primary care providers,” Hart said. But it hasn’t helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

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The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable. “We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners,” said Dr. Mario Motta, president of the state medical society. The new U.S. health care law expands the role of nurses with: ■ $50 million to nursemanaged health clinics that offer primary care to low-income patients. ■ $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients. ■ 10 percent bonuses from Medicare from 201116 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce. ■ A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor’s. The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees. “We know we need to get to 100 percent for everybody. This is a crack in the door,” said Michelle Artz of ANA. “We’re hopeful this sets the tone.” In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners. She believes patients get real advantages by letting her manage their care. Nurse practitioners’ uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment. Joseline Nunez, 26, is a patient of Cockrell’s and happy with her care. “I feel that we get more time with the nurse practitioner,” Nunez said. “The doctor always seems to be rushing off somewhere.”

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States want to share patient Rx use to curb abuse 8 Grand Forks Herald/Sunday, May 16, 2010

By Greg Risling

Associated Press Writer

LOS ANGELES – On his night shift in a busy emergency room, Dr. Jacob Khushigian inevitably finds a few patients more likely to be hunting for drugs than medical attention. The guy who claims he has severe abdominal pain doesn’t grimace when sitting up. A woman who recently moved to the area fails to disclose she sees a doctor elsewhere. An ambulance patient complaining of a sore leg and back doesn’t reveal she was turned away by another hospital. There was a time Khushigian’s hunches took weeks to confirm and required phoning or faxing the attorney general’s office to obtain a patient’s prescription drug information. Nowadays, a computer helps him catch cheaters. But it can only reach so far. While a state online drug database went into effect last year to thwart addicts who bounce from doctor to doctor to feed a habit or make a small fortune peddling meds, there’s now a push to extend it beyond state lines to snare socalled doctor shoppers and curb drug abuse. “The whole purpose of

Associted Press

Dr. Jacob Khushigian looks over drug bottles with his portable computer data base shown in the Kaweah Delta Emergency Room Visalia, Calif. Doctors in Calif. like Kushigian can check a patient’s prescription drug history through a secure website that gives up-to-date information. this is to have states communicating with one another,” said Dr. Laxmaiah Manchikanti, chief executive officer of the American Society of Interventional Pain Physicians. “If you know a patient is abusing, a doctor isn’t going to give that patient a prescription any more.” Doctors can be hamstrung in making critical decisions about prescribing painkillers if they aren’t able to find out if patients filled prescriptions

elsewhere. A nationwide network might have helped Michael Jackson’s doctor better monitor the medication he was receiving from multiple doctors. Dr. Conrad Murray, who was recently charged with involuntary manslaughter in the singer’s death, told police Jackson gave few details when Murray repeatedly asked about Jackson’s medications, according to an affidavit. The Los Angeles County

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coroner said Jackson was killed by a mix of a powerful anesthetic and a sedative. Police have searched for information in three states to see if Jackson’s medical history played a role in his June death. Jackson’s death and those of other celebrities such as former Playboy Playmate Anna Nicole Smith and actor Corey Haim highlight the dangers of prescription drug abuse. More U.S. teens used prescription drugs over any other illicit drug except marijuana, the Office of National Drug Control Policy reported. Forty states have passed legislation to allow prescription drug monitoring programs, but only 34 are operating. Under the National All Schedules Prescription Electronic Reporting Act signed by President Bush in 2005, more than $50 million has been appropriated to states for programs where doctors and other authorized users, such as police in some cases, can access patient records. The law aims to have a coordinated national system, but there are no estimates what that would cost and a majority of the federal money hasn’t been allocated. Joanee Quirk, who runs

Nevada’s prescription monitoring program, said having access to other state databases would help stop those from Southern California or Hawaii who come to Las Vegas or Reno to score Vicodin or OxyContin. Nevada’s four-year-old program has grown to more than 225,000 patient requests in 2009 from about 155,000 in 2008. Most prescription monitoring programs are voluntary, but Nevada requires doctors to check a patient’s drug history during a first visit. “If we took it away the practitioners would have a revolution,” Quirk said. “It’s almost like getting a lab test, where the doctors are trying to figure out what is wrong with this person and whether they are trying to get drugs legally.” Some privacy groups are concerned databases could invade patients’ privacy. Virginia’s database was hacked into in April 2009 and millions of electronic records were stolen by a thief still at large. “There is a significant intrusion into the lives of individuals who are taking these medications legitimately,” said Pam Dixon of World Privacy Forum, a nonprofit public interest research group. “There

needs to be more restrictions about who can access this information.” The response to having secure, online access to patient records has been overwhelming so far in California. More than 2,300 doctors, pharmacists, physician assistants and registered nurses have used the Web site since September to access more than 134,000 patient reports. The state had averaged about 60,000 requests annually when they received requests by phone or fax. Katherine Ellis, who runs the database of about 100 million prescriptions, said emergency room doctors would benefit most from a multistate system. “If there was a way for ER doctors to sign on as they are triaging that patient and see if that person has been doctor shopping, then they may not elect to give them the controlled substances,” she said. Khushigian, 52, who works at Kaweah Delta District Hospital in Visalia in the Central Valley, is glad he no longer has to rely solely on his gut every night. He uses the database two or three times a night to shut down potential abusers. “When they get caught, there isn’t much they can say,” he said.

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