MED-Midwest Medical Edition-July/August 2010

Table of Contents July / August Volume 1, Issue 3

4

Publisher’s/Editor’s Page

5

Celebrity Cancer Survivor to Open Avera Cancer Institute

Staff

Featured Article

Publisher Steffanie Liston

6

Eugene Hoyme, MD, and Fetal Alcohol Syndrome As many as one in 500 children is born with Fetal Alcohol Syndrome, a neurodevelopmental disorder characterized by mental and behavioral problems and a host of physical maladies and caused by alcohol consumption during pregnancy. Dr. Eugene Hoyme, head of the Department of Pediatrics at Sanford School of Medicine, has travelled the globe during his 30+ year career to better define, understand, and prevent FAS and related disorders. We will introduce you to this outstanding clinician and educator and his pivotal research in this month’s MED Cover Feature.

Editor in Chief Alex Strauss Magazine Layout & Web Design 5j Design - Sioux Falls, SD Creative Director - Jake Peterson Cover & Logo Design Darrel Fickbohm

Advisory Board: John Berdahl, MD Mary Berg, MD Michelle L. Daffer, MD James M. Keegan, MD, Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Luis A. Rojas, MD Daniel W. Todd, MD Published by: MED Magazine, LLC Sioux Falls, South Dakota

Contributing Writers Mary Olinger, Charlotte Hofer, John Mollison, Alison Tendler, MD, Heather Boysen

2010

12

Sanford Consolidates in New Sanford Center

14

Featured Article

Contact Us

Sep. / Oct. Issue August 5th

CNOS Physicians and Trainers help young athletes go the distance with intense

Steffanie Liston, Publisher 605-366-1479 Steff@midwestmedicaledition.com

November Issue October 5th

Plus1Power & Performance Camps

camps in the summer and strength and conditioning programs for all ages (even for weekend warriors!) throughout the school year.

16

Rapid City Regional Hospital and LifeSource Launch Organ and Tissue Donation Campaign

19

Lions Eye Clinic Opens in New Location

20

Featured Article

Colorectal Surgeon Using Minimally Invasive Techniques for Better Outcomes

Single port surgery provides area patients with a less risky and virtually scarless alternative to traditional open procedures.

24

Common drug poses risk in most common surgery

By Alison Tendler, MD

Featured Article:

South Dakota Doctors, Other Supporters Take Flight to Honor Veterans

Honor Flights ensure South Dakota’s WWII veterans get the chance to experience the nation’s gratitude firsthand in Washington, D.C.

29

Fax: 605-271-5486 Visit us on the web at www.MidwestMedicalEdition.com Mailing Address: PO Box 90646 Sioux Falls, SD 57109

December Issue November 5th **Ads/Copy turned in past deadline, subject to not make it in the issue. Not all copy will be published in the magazine; some copy may be put in later issues.

The features are subject to change. Please make sure all copy is ready for print.

Related photos or graphics are welcome.

Reproduction or use of the contents of this magazine is prohibited. ©2010 Midwest Medical Edition, LLC

The link between Flomax and cataract surgery complications: what you should know

26

Alex Strauss, Editor 605-359-8897 Alex@midwestmedicaledition.com

AD / Editorial Deadlines

News & Notes

Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year

by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

Letter from the Publisher

W

elcome to the third issue of MED Magazine. We have been amazed and grateful to see such a huge amount of support from physicians and other health professionals, hospitals, clinics and advertisers.

Thank you to all of you who have taken the time to give us feedback on this new publication. We are taking your comments and suggestions to heart as we work to build MED into a valuable resource and an interesting read.

Steffanie Liston

Please keep in mind that the ads you seen in these pages make it possible for you to receive MED,

with all its local news and information, free of charge. We hope that when you find yourself in need of the

services these advertisers provide, you will support their businesses as they have supported yours by advertising in MED.

Speaking of advertisers and support, we want to encourage you motorcycle enthusiasts to come out and enjoy the fun

at Make-A-Wish’s big annual fundraiser, Hot Harley Nights on July 9-11 in Sioux Falls. There will be live music, a casino run, auctions and raffles, food, and a motorcycle show and parade. Whether you ride or just like to look, we hope you’ll come out and enjoy the fun.

As I write, I am getting ready for a big couple of months myself. MED is celebrating its official ribbon cutting at the Sioux

Falls Chamber of Commerce on July 1st. Alex and I would love to have you join us. I’ll also be attending the SDMGMA conference in Chamberlain, August 25-27. Oh – and you may notice that my name is a little longer. By the time this issue of MED hits the streets I will be a newlywed.

Hope your summer is half as exciting as mine!

Steffanie Liston-Holtrop

Letter from the Editor

I

was a young television reporter doing a piece on the South Dakota state penitentiary in the early 1990’s when I first learned about the devastating effects of Fetal Alcohol Syndrome. At that time, I was

astounded to learn that a significant percentage of inmates were victims of this disorder, which can cause impaired judgment, social maladjustment and cognitive impairment as well as a host of physical symptoms.

Unfortunately, despite better education and better medicine, the condition still exists, in South Dakota and around the world. Clearly, Fetal Alcohol Syndrome is far more than a medical problem or even an educational Alex Strauss

problem. It is a societal problem.

Few people understand the disorder and its far-reaching impact, better than clinical geneticist Eugene Hoyme, MD, head of

the department of pediatrics at the Sanford School of Medicine and a leader in the fight to define, understand, and ultimately prevent FAS and FASD. We are proud to have the opportunity to showcase Dr. Hoyme’s influential work in this month’s cover feature.

Also featured in this issue is an exciting development in colorectal surgery. As surgical procedures become ever less invasive,

surgeon Scott Baker, MD, weighs in on the newest advance: single incision laparoscopic colectomy. And ophthalmologist Alison Tendler, MD, has some important information about a common drug and its impact on cataracts.

We appreciate the fact that these specialists have agreed to share some of their expertise with their colleagues through MED,

which is designed to be a communication tool for the widespread and diverse medical market that includes South Dakota, Southwest Minnesota, Northwest Iowa, and Northeast Nebraska. If you have some news or information of value to physicians in the region, we want to help you spread the word. Email me any time at Alex@MidwestMedicalEdition.com.

Here’s to a healthy, happy summer! See you in September.

Alex

4

Midwest Medical Edition - July / August 2010

Lance Armstrong to Open New Avera Cancer Institute World champion cyclist and cancer survivor Lance Armstrong will be the keynote speaker for the events and gala to officially open and dedicate the new Avera Cancer Institute this fall.

Armstrong, a seventime Tour de France

champion, is not just

a superb athlete, he’s

also an exceptionally

dedicated advocate for cancer research and

living testament to the human spirit’s ability to overcome disease.

He is a best-selling

author and founder of

the LiveStrong Cancer Support Foundation.

“Lance is in a class

by himself in regard to fighting and beating cancer,” said Fred

Slunecka, Avera McKennan President & CEO. “We’re excited to have a world class person be on hand to witness the opening of a world class facility.”

Armstrong is scheduled to appear during a black tie

(optional) gala to be held Friday evening October 29. The gala

and Armstrong’s speech will be open to the public and tickets are

Cheri Kraemer, RPh

available now, although they are limited. For more information

Clinic Pharmacies, Inc.

to learn more about the Avera Cancer Institute, go to www.

“Where your pharmacy is like family”

on Lance Armstrong’s appearance, to buy tickets online, or experiencebuildinghope.com.

The Avera Cancer Institute and Avera McKennan Hospital

& University Health Center have been providing care, hope and healing for cancer patients through comprehensive oncology

services since 1991. The new Cancer Institute building will be a

• Free in-town delivery • Fast, courteous service • Accepts most insurance • Helpful counseling

comprehensive healing environment, housing the latest diagnostic and treatment technology, including cutting edge radiation

Some compounded prescriptions require 48 hours for preparation.

• Hormone Replacement Therapy • Saliva Testing • Nutritional Consultation • Pain Management • Sterile Products • Sports Medicine • Pediatrics • Dental • Veterinary • Specialized Disease Management CHECK WITH US FOR ALL YOUR COMPOUNDING NEEDS!

oncology tools like the ARTISTE™ linear accelerator and IORT (interoperative radiation therapy).

Yankton Trail Professional Park 2333 W. 57th St., Suite 107 Sioux Falls, SD 57108

Linda Pierson, RPh 0000193355

2333 West 57th St. Sioux Falls, SD 57108 605-331-3190

Phone: 605-334-1672 Fax: 605-335-0855

Midwest Medical Edition - July / August 2010

5

“ These kids are just like other children all over the world and they deserve a chance to live the best lives possible. �

Clinical Geneticist Dr. Eugene Hoyme first became interested in FAS during his residency at the University of California.

The effort to understand the disorder, improve diagnostic capabilities, and reduce its prevalence worldwide have become a career-long passion.

6

Midwest Medical Edition - July / August 2010

and

Eugene Hoyme, MD, Fetal Alcohol Syndrome

By Alex Strauss

Sanford Researcher has Devoted Career to Understanding and Preventing FAS and Related Disorders Fetal Alcohol Syndrome (FAS) and the related set of disorders that fall under the title Fetal Alcohol Spectrum

Disorders (FASD) present many challenges for physicians, educators and researchers, not the least of which is the challenge of pinpointing their prevalence. CDC studies put the rate of FAS in the U.S. between 0.2

and 1.5 cases for every 1000 live births. Other studies using different methods have found it to be even more common – as many as 1 case out of every 500 live births. And scientists believe that there are at least three times as many cases of FASD as there are cases of FAS.

“There have only been two prevalence studies on FASD and both of them showed a rate of about

one percent among school-aged children, across the entire spectrum of the disorder,” says Eugene Hoyme, MD, Professor and Chair of the Department of Pediatrics at USD’s Sanford School of Medicine.

Few physicians have seen as many cases of Fetal Alcohol Spectrum

Disorders as Dr. Hoyme. He is the Chief Medical Officer of Sanford Children’s Hospital, Senior VP for Children’s Services at Sanford Clinic in Sioux Falls, and a renowned clinical researcher into the mysteries of these sometimes baffling disorders.

A graduate of Augustana College and the University of Chicago

Pritzker School of Medicine, Dr. Hoyme’s fascination with FAS began

Scientists estimate there are three times as many cases of FASDs as there are cases of FAS

more than 30 years ago during his pediatric residency at the University of California, San Diego.

“During my residency, the Chief of Pediatric Genetics there was Dr. Kenneth Jones, one of the first

people to describe Fetal Alcohol Syndrome back in 1973,” recalls Dr. Hoyme. “Dr. Jones inspired many of us to go into the field of birth defects evaluation and care. He is also the one who invited me to stay on as a post doctoral fellow and to stay on in clinical genetics with him.”

Midwest Medical Edition - July / August 2010

7

In the U.S., Fetal Alcoh ol Syndrome affects abo village that has been the ut one in 500 babies. focus of much of Dr. Ho But in the South Africa yme’s research, as many n as 8 percent of first gra ders have FAS.

Following his fellowship training in clinical genetics at the

They tended to be small children and small adults with smaller head

and Chief of the Division of Medical Genetics and Associate Chair

development of the frontal part of the growing brain, the face tends

University of California, Dr. Hoyme went on to become a Professor

of the Department of Pediatrics at Stanford School of Medicine in Palo Alto, California, where he continued to expand and refine his

study of FASD. He came to Sioux Falls and took on his post at Sanford and the School of Medicine in 2007. Dr. Hoyme is board

certified in Pediatrics and Medical Genetics and has authored

nearly 300 original articles, monographs, book chapters, research abstracts and a textbook. He has served on the editorial boards

circumference and restricted brain growth. Because FAS affects the to develop abnormally, resulting in tell-tale facial dysmorphology.

According to the CDC, the following facial features are essential for a diagnosis of FAS: a smooth philtrum (no groove between the nose

and upper lip), a thin vermillion border (thin upper lip), and small

palpebral fissures (small eyelid openings, when adjusted for age and race).

“Most of these babies are not born to women who drink daily…. Most are born to women who are binge drinkers.”

of five professional journals, including Pediatrics and Clinical Genetics.

Global Research Efforts

FASD was originally described by Drs. Kenneth Jones and

David Smith in the early 1970’s, although knowledge of the adverse effects of drinking during pregnancy had existed for centuries. These

investigators were the first to define the fact that children of drinking

mothers tended to have growth problems, both before and after birth.

8

Midwest Medical Edition - July / August 2010

A patient must meet all three of these criteria (growth deficiency,

small head circumference and typical facial dysmorphology) to be diagnosed with FAS, although many other physical characteristics

As one of four clinical geneticists that make up the NIAAA’s dysmorphology core, Dr. Hoyme has personally examined more than 3000 children who have been exposed to alcohol in utero and nearly 400 with full-blown FAS in the last 15 years.

Dr. Hoyme and a pair of twins in South Africa. To be classified as FAS, a patient must have growth deficiency, small head circumference and typical facial dysmorphology.

are often present and may include, among other things, malformed

Disorders” with his former colleague Dr. Kenneth Jones of the

the elbow joints, inability to completely extend the fingers, and

Prevention and Research” with Philip A. May, PhD of the University

ears, a short nose, congenital heart defects, decreased mobility of small finger and toenails. Typically, prenatal or postnatal height and weight tend to be below the tenth percentile. FAS may also cause mild to moderate mental retardation, neurological deficit, mental disorders and developmental disabilities.

University of California, and “Fetal Alcohol Syndrome Epidemiology

of New Mexico. Over the past 12 years, Dr. Hoyme’s research work has taken him to Africa for several weeks each year to study school children in a wine-growing region plagued by FASD.

“Our goal is to make this a condition that any physician can diagnose if he or she is careful and follows the guidelines.”

Although there is still much that is not fully understood about

the prenatal effects of alcohol use, much of what is known has been

uncovered by Dr. Hoyme and the other three clinical geneticists who form the dysmorphology core of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the NIH. He and his colleagues

have helped to more clearly define FAS and related disorders through years of research around the world.

is that most of these babies are not born to women who drink

world, but we were not convinced,” says Dr. Hoyme. However, it did

“One of the most interesting things we have come to understand

daily,” says Dr. Hoyme. In the course of his research, Dr. Hoyme

has personally examined more than 3000 children who have been

exposed to alcohol in utero and nearly 400 with full-blown FAS in

the last 15 years. “Most children with FAS are born to mothers who are binge drinkers, that is, they don’t drink during the week, but on

the weekend may consume a case of beer, for example. That is a huge amount of alcohol for a fetus to be exposed to.”

Dr. Hoyme’s current NIAAA research studies include projects

through the “Collaborative Initiative on Fetal Alcohol Spectrum

“For years our counterparts in South Africa had told us that their

country had the highest prevalence of FASD of any country in the

not take many trips of meeting and assessing hundreds of children

there for him and his fellow researchers to change their minds. “This is wine country with a climate similar to San Diego. Many families have been working in the wineries there for generations and it was

not uncommon for them to even be partially paid with wine. As a result, many, many of them became alcoholic.”

These alcoholic mothers, who were likely to drink at all stages

of their pregnancies, gave birth to unprecedented numbers of FAS children. Dr. Hoyme and his fellow researchers have found that

Midwest Medical Edition - July / August 2010

9

Dr. Hoyme has devoted much of his work to gathering data to help make FAS and FASD easier to diagnose. The four diagnostic categories he and his colleagues developed are now widely used in the U.S. and around the world.

about 8 percent of first graders in the Western Cape Province in

have developmental problems. These cases are harder to diagnose

South Africa, just outside of Capetown, have full-blown FAS.

“Our early research was focused on determining how common

the condition was,” relates Dr. Hoyme. “More recently, we have

looked at what can be done by way of intervention in the schools,

what works and what doesn’t. Our most recent study is focused on

prevention programs in order to reduce the rate of the condition.

We are looking at the most effective ways to help mothers to stop drinking.”

Making the Diagnosis

because you have fewer of the physical features to rely on.”

intervention for FASD patients is accurate diagnosis, Dr. Hoyme

and his research colleagues developed a set of diagnostic categories for use by primary care physicians. The categories and specific

guidelines for using them in diagnosis were laid out in the journal Pediatrics in 2005 and now constitute a widely accepted revision of the Institute of Medicine’s official guidelines for diagnosis of FASD.

“ Half of all children with FASD have an older sibling who also has the disorder. ”

During his 30 years of studying the effects of maternal alcohol

use on fetal development, Dr. Hoyme has helped to more clearly

define the spectrum of disorders that fall under the heading of FASD.

Although the children first identified by Dr. Kenneth

Jones as having FAS exhibited the tell-tale physical, behavioral

and neurodevelopmental signs of the disease, continued research

showed that many more children were affected by alcohol in utero, without showing all of the ‘signs’.

“It was discovered that there were children whose brain

development was affected, but who lacked other features, such as a

facial characteristics,” says Dr. Hoyme. “This came to be recognized

as a question of timing. If the mother does not drink during the time that facial features are developing, but does drink earlier or later in her pregnancy, the child may end up with a normal face, but still 10

Midwest Medical Edition - July / August 2010

Recognizing that the first step toward possible life-changing

The four diagnostic categories named by Dr. Hoyme and his

colleagues include FAS, Partial FAS, Alcohol-related Birth Defects (which can include things like heart and kidney problems), and

Alcohol-related Neurodevelopmental Disorder, wherein a patient may demonstrate normal growth, normal head circumference and lack the typical facial findings, but have neurobehavioral problems

characteristic of FASD. These categories are now widely used for

FASD diagnosis not only in the U.S., but also in Africa, Europe, Eastern Europe, the Ukraine and Russia.

“The whole point of the research we are doing, and laying out

these categories, is so that a pediatrician can make a diagnosis of

which he suspects is higher than the national average. But despite

have to be a specialist to make this diagnosis. Our goal is to make

educators and parents.

FASD as early as possible,” explains Dr. Hoyme. “You should not

this a condition that any physician can diagnose if he or she is careful and follows the guidelines.”

the discouraging statistics, his message is one of hope to physicians,

“If you know that FASD is the cause, there are things that can be done… that can help direct the course of that child’s life.”

Early Invention is Key

Although FASD is not curable, as with many developmental

disorders, early intervention is the key to a better life for patients and their families.

“In addition to their physical problems, these children tend

to have learning problems, problems with judgment, ADHD, and

problems with interpersonal relationships,” explains Dr. Hoyme. “If you know that FASD is the cause, there are things that can be done

in the classroom and through early therapy that can help direct the course of that child’s life.”

Dr. Hoyme and his colleagues continue to research the most

effective types of intervention for FASD, but other studies have

already confirmed its value. Long-term studies in Scandinavia, where early intervention for FASD is mandatory, show that patients there did much better as adults than do many American FASD patients.

“The other reason to try to identify FASD and intervene as early

as possible is that half of all children with FASD have an older sibling

who also has the disorder,” says Dr. Hoyme. “That means that, if

you could find those children and get to those mothers and help

them with their drinking problem before they have another child, you could potentially prevent half of the cases of this disorder worldwide. That alone would be a tremendous impact.”

In addition to conducting global research, Dr.

Hoyme remains an active clinician, seeing patients with FASD and other genetic disorders a half day a week in

“These kids are just like other children all over the world and

they deserve a chance to live the best lives possible. If you give up

on them, then you have lost a life. We hope that, through the work we are doing, their lives can be improved because, by doing so, you

not only help that child and that family, but you also help society as a whole.” says Dr. Hoyme.

The CDC estimates the monetary lifetime cost of a single

individual with FAS at $2 million, putting the cost of FAS alone

(not including other FASDs) at $4 billion annually. Each day, from

6 to 22 infants are born with FAS in the U.S., and as many as 87 to 103 more are born with impairments related to prenatal alcohol

exposure. The primary goal of Dr. Hoyme’s work is to eventually change those figures.

“I would love nothing more than, by the time I retire, to have

had some impact on reducing the incidence of this condition around the world.”

South African students at one of the study sites for the Sanfordbased Safe Passage study on infan t mortality for which Dr. Hoyme is the dysmorphologist. The wine-growing regions of South African are plagued with FAS due to the high rate of alcoholism.

Sioux Falls and conducting clinics in Watertown, Pierre and Rapid City. He is currently the dymorphologist on a large longitudinal study of infant mortality being conducted by Dr. Amy Elliott of Sanford and has recently received an Oxnard Foundation grant to study identification of FASD in early infancy.

It is difficult to quantify the extent of the problem

of FASD in South Dakota. CDC estimates indicate that 57 percent of South Dakota women of childbearing

age (18 to 44) drink alcohol and 19.4 percent admit to binge drinking, one of the highest levels in the country. Dr. Hoyme hopes to receive NIH funding to determine the prevalence of FASD in South Dakota,

Midwest Medical Edition - July / August 2010

11

Sanford Consolidates in New Sanford Center for greater collaboration and fast growth, hopefully leading to more discoveries and cures,” says Dave Link, Senior Executive Vice President, Sanford Health-MeritCare.

The 300,000-square-foot Sanford Center is located near

I-229 and I-90 in Sioux Falls. Currently, 64,000 square feet will be research administration and laboratory space including wet

labs, offices and animal holding facilities (vivarium). Nearly 400

researchers and other employees will occupy the building, which will include all Sanford research centers:

Sanford Health-MeritCare’s research efforts, once spread out in multiple locations across Sioux Falls, are now located together

inside the new Sanford Center. Sanford Health recently converted the former Hutchinson Technology building in northern Sioux Falls into corporate offices and space for all Sanford research

centers. The Sanford Center was unveiled during a ribbon cutting celebration on June 8th.

“Consolidating our research efforts into one location allows

•

Cancer Biology Research Center

•

Health Disparities Research Center

• • • • •

•

Cardiovascular Health Research Center Sanford Children’s Health Research Center

Methodology and Data Analysis Research Center Women’s Health Research Center

National Institute for Athletic Health & Performance at Sanford

The Sanford Project – Curing Type 1 Diabetes Through Beta Cell Regeneration

“Our researchers continue to

be published and recognized for their

discoveries, and Sanford Research/USD offers exciting challenges both in wellestablished research projects and ever

expanding research opportunities,” said Ben

Perryman, PhD, President, Sanford Research/ USD. “As a result, we anticipate accelerated researcher and physician recruitment for

our entire health system. This facility puts

Sanford research recruitment capacity some three to five years ahead of schedule.”

The Sanford Center will also hold the

new Sanford Health-MeritCare Sioux Falls corporate headquarters for leaders from

both Sioux Falls and Fargo as well as other corporate functions including Executive

Administration, Sanford World Clinic, Health Policy, Public Affairs and Research Park Development, among others.

12

Midwest Medical Edition - July / August 2010

NICU at Children’s Hospital & Medical Center in Omaha Offers Immediate Access to Pediatric Subspecialists A newborn is critically ill suffering from gastroschisis. His

and critical care nurses specially certified in transport ensures

surgery soon after birth. Because this infant was immediately

condition, diagnosed early in his mother’s pregnancy, requires admitted to the Newborn Intensive Care Unit at Children’s

Hospital & Medical Center in Omaha, he was in the operating room less than 60 minutes after delivery.

“Children’s NICU is unique in that we are the only unit in

Nebraska and western Iowa that provides immediate access to a full cadre of pediatric subspecialists,” says Gary A. Perkins,

president and chief executive officer of Children’s. “We provide the full complement of subspecialty care from cardiac services

to comprehensive pediatric surgery, neurology, gastroenterology, endocrinology and more.”

Over the past five years, newborns from 21 states and 415

communities required intensive care at Children’s. In 2009,

the NICU received patients from 43 referring hospitals across Nebraska, Iowa, South Dakota and Missouri.

An active transport program with neonatal nurse practitioners

newborns in need have rapid access to Children’s services.

“When transport is needed, we understand the urgency

and importance of appropriate medical intervention. Our team provides the most advanced, cutting-edge care even before the newborn reaches our hospital,” explains Pam Carlson, chief nursing officer.

The Children’s NICU is the only unit in Nebraska meeting

all guidelines for a IIIC designation, the highest set forth

by the American Academy of Pediatrics. The top tier units,

according to the AAP, possess both the capability to provide

Extracorporeal Membrane Oxygenation (ECMO) and the surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass.

“We firmly believe that critically ill newborns need to be at

Children’s. Our specialists are uniquely qualified to treat these infants,” says Perkins.

Prosthetic and Orthotic Services for All Ages Our patients tell us we understand their needs better than anyone else in the field.

“I had gotten used to everyone saying there was nothing to be done about my situation, but the staff at Rehabilitation Medical Supply knew better.

They have literally changed my life.” -Brady, adult orthotics patient Sioux Falls

Todd Jensen, CP

Rapid City

Mike Watt, CO

Mark Wegleitner, CO Annette Vollan-Kerber, Eric Pickering, CPO Darin Olson, CO PT, MS, PCS

For appointment or details call (605) 782-2400 in Sioux Falls, or (605) 342-4412 in Rapid City.

Sioux Falls & Rapid City, SD www.cchs.org

Midwest Medical Edition - July / August 2010

13

minute warm-up followed by ten minutes of core exercises and forty minutes of strength training. The

rest of the day is spent in speed and agility drills, giving athletes a well-rounded workout in a short amount of time.

A partnership between CNOS and the

Siouxland Surgery Center, the Siouxland Sports Medicine

Foundation

provides

more

sports

medicine expertise than any other organization in

the region. The team includes fellowship-trained CNOS orthpaedic surgeons, Certified Athletic Trainers, some of whom are also Certified Strength

and Conditioning Specialists, and Strength and

The PPelrfuorsma1nce Camps Power &

Athletes Go the Distance with CNOS and the Siouxland Sports Medicine Foundation Siouxland athletes who want to get the jump on their fall sports

season have an ally in the orthopedic experts of CNOS and their Siouxland Sports Medicine Foundation. Their popular Plus1 Power & Performance camps are once again helping young athletes build the skill and strength they need to safely excel in their chosen sport.

“Plus1 is the name of an entire

program designed to build strength

and improve power and performance,” explains Kevin Negaard, a Certified Athletic Trainer and Director of Sports Medicine Services at CNOS.

Conditioning Assistants. Throughout the year,

Plus1 Power & Performance puts the experience of these CNOS experts to work for students and

other sports minded people who are ready to take their skills to the next level.

“The idea behind the name ‘Plus1’ is that we

are enabling people to give that one extra percent, do that one

extra set of reps, that one extra sprint, that one extra anything to improve themselves,” explains Negaard. “When you add up all those ‘plus ones’, it puts you miles ahead of your competitor.”

While some of the best area athletes rely on Plus1 to improve

their game, Negaard says these programs are not just for the elite.

Professional training is available to athletes at all skill levels and

to anyone who wishes to build muscle and increase the stamina they’ll need to go the distance – on the playing field or in life.

when you add up all those ‘plus ones’, it puts you miles ahead of your competitor.

“Our

goal

is

to

help

every participant reach their full

potential,” emphasizes Negaard.

“If we can teach them to become

an outstanding athlete, that’s great.

But if we can teach them how to take care of their body so that they

“Summer camps are just one of the

don’t become obese, or how to participate at their highest level

strengthening and conditioning programs for athletes from

are never competing against each other. They are only competing

ways we serve local student athletes. But we are also providing elementary through college level, year round.”

Meeting three times a week for six weeks, Plus1 Power &

Performance summer camps give athletes a chance to improve their game – whatever their game may be – through intense, comprehensive training sessions. Participants who range from

late elementary through college start each camp day with a ten

without getting injured, that’s a win for us, too. Plus1 students against themselves, working to overcome their own limitations and achieve their goals.”

For more information on Plus1 camps and program, visit

CNOS.net and click on Siouxland Sports Medicine Foundation or call Kevin Negaard at 605-217-2879.

Sanford Health Opens Two New Clinics in U.S. and Abroad Children in Klamath Falls, Oregon and Dublin, Ireland will soon

investment that Sanford Health will bring to each project. Current

plans to open two new pediatric clinics. In Klamath Falls, Sanford

$1.225 million. Sky Lakes Medical Center will help facilitate the

have their own ‘Castles of Care’. Sanford Health has announced Children’s will bring together pediatric specialists from southern Oregon to a single location to better serve a metropolitan area of 45,000, including more than 5,000 children.

“Like many of the communities Sanford currently serves,

Klamath Falls is a growing area that is geographically isolated from other larger cities. Paired with local physicians and partners, the

services we provide will allow for a solid foundation from which

pediatric care can match the growth of the community,” said Dave Link, Sanford Health-MeritCare Senior Executive Vice President.

Partnerships will include the region’s largest hospital, Sky

Lakes Medical Center, and the Klamath Pediatric Clinic. The Sanford Children’s Clinic physician team will include two

pediatricians from the Klamath Pediatric Clinic and one from Sky Lakes and will grow through recruitment in subsequent years.

One of the site selection requirements for a Sanford Children’s

Clinic is local contribution to match the approximately $2.5 million

commitments from Oregon-based community partners exceed

donation of land on which the clinic can be developed and will also provide ancillary lab and imaging resources when the clinic opens.

The Dublin, Ireland clinic is Sanford’s second international

clinic. It is a cooperative effort with the Hermitage Medical Clinic and Vhi Healthcare, Ireland’s largest and only specialist insurance

company. The clinic will be located on the campus of the Hermitage Medical Clinic. Two full-time consultant pediatricians will have

practices in the clinic, and eight to ten subspecialty pediatricians will provide advanced pediatric services.

Sanford Children’s Clinics are designed to expand access to

pediatric care for children who might otherwise go without. The first Sanford Children’s Clinic opened in Duncan, Oklahoma in

August 2009;Sanford Children’s Clinic in Belize City, Belize broke ground May 2010 and will open in 2011; Sanford Children’s Clinic in Oceanside, CA will share space with Rady Children’s HospitalSan Diego in a facility set to open in spring 2011.

WE SUPPORT. From a warm welcome through treatment, recovery and healing, our services support you every step of the way.

910 E. 20th Street, Sioux Falls 605-334-6730 • www.sfsurgical.com

Before inpatient or outpatient surgery, ask your doctor about Sioux Falls Surgical Hospital.

Midwest Medical Edition - July / August 2010

15

Rapid City Regional Hospital and LifeSource Launch Campaign to Increase Organ and Tissue Donation Federal Funding Makes ‘Donate Life’ Black Hills Possible

commitment to donation with our communities.”

More than 2,800 people in the Upper Midwest are waiting

for a life-saving organ transplant. One donor can help up to 60

Rapid City Regional

people. If an individual chooses to be an organ donor, there is

the organ and tissue

Regional Hospital, which is not a transplant center, works with

in the Upper Midwest, are

donors are fulfilled.

to increase the number of

LifeSource for its organ and tissue donation program. “Rapid

organ and tissue donors

said LifeSource CEO Susan Gunderson. “Their dedication to

campaign, called Donate

passion for fulfilling people’s wishes to save lives through

of its kind featuring nurses

campaign.”

Hospital and LifeSource,

no additional cost to that individual or their family. Rapid City

procurement organization

LifeSource to ensure people’s wishes to be organ and tissue

partners in a new campaign

people who are registered

City Regional Hospital is a strong partner in our mission,”

in the Black Hills. The

the health of the communities they serve, combined with their

Life Black Hills, is the first

donation, makes them the perfect partner for this exciting

Rapid City Regional Hospital has been acknowledged by

sharing their commitment to organ and tissue donation.

Beginning

Monday, June 7, residents in the Black Hills began seeing advertisements Shaye Krcil, RN, Rapid City Regional Hospital Donate Life Black Hills Grant Project Coordinator

on television, radio and

billboards as well as online

and in area newspapers.

The advertisements feature nurses from Rapid City Regional

Hospital sharing their support of organ and tissue donation and encouraging others to register as donors. Rapid City Regional

Hospital nurses will also be sharing the life-saving message of

donation through workplace and community events, and driver’s

license bureaus will carry new materials that match the campaign.

Donate Life Black Hills is funded by a federal grant (No.

D71HS13417-01-00) from the Division of Transplantation,

Health Resources and Services Administration, U.S. Department

Registering as a donor brings hope to the men, women and

Dakotans who would like to register as an organ and tissue donor

of Health and Human Services.

children who are waiting for their second chance at life. South

and heals lives,” said Rita Haxton, Rapid City Regional Hospital

can do so by visiting www.DonateLifeSD.org.

“Organ and tissue donation is an incredible gift that saves

Vice President of Patient Care. “Our nurses are honored to

support the families of donors as their loved ones leave this

amazing legacy, and we are proud they will be sharing their

16

Dawn Bad Wound, RN, Grant Project Media Campaign Participant

Midwest Medical Edition - July / August 2010

New Sculptures Now on Display at Avera McKennan The Midwest Affiliate of the American Heart Association will

Harry B. Helmsley Charitable Trust to implement Mission:

the state in acquiring 12-lead ECG equipment and comprehensive

receive $8.4 million over three years from the Leona M. and

Lifeline, a community-based initiative aimed at improving the

system of care for heart attack patients throughout South Dakota.

“It is a tremendous affirmation of the importance of

Mission: Lifeline and positions South Dakota as a leader in our nationwide effort,” said Darrin

The grant will fund the critical elements of an optimal

STEMI system of care: assistance to every ambulance service in 12-lead ECG training; transmission and receiving equipment for STEMI-referring and receiving hospitals; a system-wide

data tool for quality measurement and improvement; ongoing

medical provider training and education; development of STEMI protocols for EMS and hospital

Smith, Senior Director of Advocacy

personnel; regional plans for

and State Health Alliances for the

rapid transport and/or transfer

Association. “This is a historic day

of patients; and an aggressive

for heart attack patient care in our

public education campaign on

state. As a lifelong South Dakotan,

heart attack signs and symptoms

I’m proud we will be leading the

and the need to activate the 9-1-1

way nationally right here in South

system.

Dakota.”

Each year, hundreds of

enhance our existing systems and

thousands of Americans have an

enable us to create new systems

ST-elevated myocardial infarction,

of care for heart attack patients in

or STEMI, in which blood flow is

areas we have only dreamed about

completely blocked to a portion

until now,” said Tom Stys, M.D.,

of the heart. Currently, around

an interventional cardiologist with

two-thirds of STEMI patients

Sanford USD Medical Center and

fail to receive the best available

member of the American Heart

treatments to restore blood flow.

Association’s Midwest Affiliate

Mission: Lifeline seeks to save

board of directors.

lives by closing the gaps that

separate STEMI patients from timely access to appropriate

“Mission: Lifeline will

More than 20 stakeholders

from across the state will be

involved in the implementation

treatments. Although Mission: Lifeline is focused on improving

of Mission: Lifeline, with representation from large and small

year, improving that system will ultimately improve care for all

of Cardiology, the South Dakota Department of Health and the

the system of care for patients who suffer from a STEMI each heart attack patients.

According to the Centers for Disease Control, South Dakota

is in the Class 5 category for STEMI death rates, making it one of the states with the highest STEMI death rates in the nation.

“The full implementation of Mission: Lifeline with this grant

will save lives in the Black Hills region, throughout western South Dakota, and indeed all across the state,” said James

Walder, M.D., cardiologist with Regional Heart Doctors in Rapid City and chairman of the South Dakota Mission: Lifeline Task Force.

hospitals and ambulance services as well as the American College South Dakota Office of EMS.

“The success of Mission: Lifeline will translate into

dramatically improved heart attack patient care all across South

Dakota, and improved patient care means lives saved,” said Tom Isaacson M.D., Medical Director at Avera Heart Hospital and

interventional cardiologist with North Central Heart Institute.

The Mission: Lifeline funding is part of the Helmsley Rural

Health Program which over the last two years awarded a total of more than $41 million in grants to institutions and organizations in the upper Midwest.

Midwest Medical Edition - July / August 2010

17

The Time is Right for White want a glass of wine when it’s hot and humid, the last thing I

By Heather Taylor Boysen Since we have finally started experiencing the kind of

weather one might equate with summer, my husband

Reed was out on the front patio drinking a Chardonnay

with our one-year-old poodle Gus. I joined him for a

glass and was astonished to see him with a white wine in

his hand and our “hoity-toity” dog at his side. Somewhat

abashedly he said, “I think I need more guy time.”

To my husband’s credit, Gus is a young, big, gangly

Standard Poodle with somewhat questionable manners and he doesn’t have a frou-frou hair cut. But the surpris-

ing thing was that that Reed was enjoying a Chardonnay. I

had seen him taste

Chardonnays before, don’t get me wrong.

I mean, I drag him to wine tastings all the

time and he certainly tries enough whites,

but here he was, really

enjoying a white wine.

He hadn’t chosen

anything but a red for dinner in at least two Heather Taylor Boysen

Pinot Noir.

years and even with seafood he picks a

It makes me think about the seasonality of

wine. As in my husband’s case, there comes a

time when a red just doesn’t work. And I don’t

mean with food, I mean with the heat and humid-

ity that makes up our balmy South Dakota weather. If I

think of is a big heavy Cabernet. On that hot summer night,

my husband rediscovered his love for crisp, refreshing, thirst quenching white wines.

“I really like this Chard,” he told me. “A dose of oak, kind

I don’t know that I was totally surprised, but it reminded

of buttery, crisp finish…We should drink more Chardonnay.”

me that we should all revisit those varietals that we thought we had gotten past or become too “sophisticated” to enjoy. I have an expression in my store that I use frequently in the summer months: Deck Swillers. By no means do I mean the wines

are inferior or cheap, but rather they are those wines you can chill down ice cold, pour in your wine glass, take a sip and

make your mouth water with pleasure and your body temperature drop a few degrees. You know what I mean – when the

outside of your glass starts to sweat because your beverage is tongue-pleasingly cold and refreshing.

If Chardonnay isn’t your thing, there are many other white

varietals I can recommend. Please consider a Torrontes from Argentina, Pinot Gris from Oregon, Albarinõ from Spain,

Riesling from Germany, Vouvray from France and Sauvignon Blancs from New Zealand and California. All of them have

several things in common. They are great by themselves, awe-

some with a lot of your favorite summer foods and can stand to be a little overly chilled without completely losing their flavor.

I will tell you the one thing I tell all of my clients. Most

people serve their whites too cold and their reds too warm.

Room temperature in South Dakota during the summer is

sometimes 70 degrees. The optimum serving temperature of a white wine is around 48 to 50 degrees and a red around 58-63 degrees. That being said, remember in the summer that your wine is going to warm up in the glass much faster than you

may anticipate particularly if you are outside. Putting a bigger

chill on both your white and red wine prior to serving will only enhance your summer wine drinking experiences.

Some of you may ask, “Did you just say put your red wine

in the refrigerator?” Would you be shocked to know that I put a chill on many of my reds? We will have to talk about that

next month as I am running out of space! In the meantime, if you think you have lost your appetite for whites, revisit and

reinvigorate your palate. Quench your thirst this summer with a great white wine.

18

Midwest Medical Edition - July / August 2010

Lions Eye Clinic Opens New Location While the gift of sight may be priceless, the cost of an eye exam

or getting glasses may be too much for some to afford. But those in need of eye care can get help with the Lions Eye Clinic, now in a new location.

In June the Sioux Falls Lions Clubs unveiled the new

location for the clinic which is held the first and third Wednesday

afternoon of each month at Falls Community Health in downtown Sioux Falls.

Doctors from seven clinics volunteer time for the

SF Downtown Lions Club President Dr. Tom White and Nathan Schock, grandson of Lion Al Schock. The new exam room was named in memory of Al Schock for his years of dedicated service as a Lions member.

appointments: Sioux Falls Family Vision, Vance Thompson

Vision, Sanford Ophthalmology, Exact Eye Care, Barnett Vision, Pearle Vision and Great Plains Eye Clinic

exams. If a patient needs glasses, they receive a voucher and can

Sioux Falls Family Vision offered the free eye exams at his clinic

them find financial services.

Prior to finding its new home downtown, Dr. Jeff Sayler with

for eight years.

“Many people have trouble filling out an application because

Now people with poor vision who don’t have insurance

they cannot see anything,” Dr. Sayler said.

or those who may be low income can be eligible for the free

purchase a pair for $10. For more serious needs, doctors can help

“This is medical missionary work right at home we can help

More than $30,000 in grants helped fund equipment for the

with,” Dr. Sayler added.

exam room, named in memory of Lion Al Shock for service as a Lions member.

Midwest Medical Edition - July / August 2010

19

C

Colorectal Surgeon Dr. Scott Baker of Surgical Institute of South Dakota

olon cancer is the third most commonly

Jolanta Bremer of JBremer Lifestyle Portraits

diagnosed cancer in the United States behind breast and lung cancer and is

second only to lung cancer as a cancer killer. About one in twenty people will develop colorectal cancer,

which usually starts with non-cancerous polyps in the lining of the colon that undergo cancerous changes.

Depending on the location of a malignancy in the

colon, a colorectal surgeon like Scott Baker, MD, of

the Surgical Institute of South Dakota in Sioux Falls may be called upon to remove it.

“As with many types of surgery, studies have

shown that outcomes are better for these patients

when they are operated on by someone who does a lot of these types of surgeries,” says Dr. Baker,

a board-certified general surgeon and one of only two fellowship-trained colorectal surgeons in

South Dakota. “All the data for colorectal cancer

indicates that you have fewer colostomies and better

management overall when the surgeon has fellowship training. The more cases the surgeon does, the better the outcomes tend to be.”

Dr. Baker, who practiced general surgery for three

years at Surgical Institute before pursuing fellowship training at Ohio Health in Columbus, estimates that about 85 percent of his surgical practice consists of

colorectal cases. He does four to five colon resections weekly as well as surgeries for other conditions such as rectal prolapse, Inflammatory Bowel Disease,

ulcerative colitis, Crohn’s Disease and diverticulitis.

Fortunately, the majority of these cases can be dealt

with using advanced minimally invasive laparoscopic techniques.

“Laparoscopic techniques really revolutionized

the way we perform colorectal surgeries,” says Dr.

Baker, who has been performing colorectal surgery

with the laparoscope for five years. “But it used to be

Scott Baker, MD

Fellowship-trained Colorectal Surgeon Uses Minimally Invasive Techniques for Better Outcomes

By Alex Strauss 20

Midwest Medical Edition - July / August 2010

that there were a number of things, such as adhesions,

which would prevent us from being able to do some of these types of surgeries laparoscopically.”

Laparoscopic colectomy presents a number

of challenges over other types of laparoscopic surgery. The surgeon must work in multiple quadrants of the abdomen at the same time,

requiring an excellent understanding of depth

perception and internal anatomy. Laparoscopic colorectal surgery may require not only a

surgeon, but also an assistant and a separate person to manipulate the camera. Because

of its complexity, several recent studies have suggested that a colorectal surgeon needs a

minimum of 20 laparoscopic cases to become proficient. But according to the American Board of Surgery, most general surgeons

perform fewer than 20 colon resections per year and only about half of those are done laparoscopically.

While too many adhesions or especially

With Laparoscopic Colectomy instead of traditional open abdominal surgery, patients have fewer complications, less pain and shorter hospital stays.

large tumors can still make laparoscopic

colectomy inadvisable, as technology and

expertise have advanced, Dr. Baker says there

are now very few cases that cannot be done in a minimally invasive way by an experienced surgeon.

“It is definitely more challenging to manipulate instruments in a small space and to rely on the laparoscope for visualization, but in the long

run it is so much better for patient outcomes,” he says.

While all surgery carries risks, open abdominal

surgery results in longer hospital stays, more pain, and greater risk of complications such as blood

loss and infection, compared to minimally invasive

Jolanta Bremer of JBremer Lifestyle Portraits

surgery. On average, patients who have colon

becoming even less invasive. Dr. Baker recently

days in the hospital recovering, in contrast to

operate on the colon through a single incision.

resections through an open incision spend eight the three or four days spent in the hospital by patients who have laparoscopic colectomies.

In addition, laparoscopic patients tend to be

happier with the cosmetic aftermath of their

surgery: just two one-inch incisions on either side of the abdomen and a 5-inch incision

hidden in the umbilicus, as opposed to one large incision across the abdomen.

But laparoscopic colorectal surgery is

once again undergoing a transformation: it is

became one of the first surgeons in the region to

of the future for colorectal surgery,” says Dr. Baker.

“Instead of putting your trocars through separate

incisions on either side of the abdomen and your

laparoscope through an incision in the umbilicus, you are able to insert everything through just one

central port.” Because that port is inserted through an umbilical incision, the surgery is virtually scarless for patients. Likewise, pain and recovery time are also reduced.

By allowing multiple trocars to be inserted through a single incision in the umbilicus, the SILS port from Covidien makes it possible for surgeons to perform laparoscopic colorectal surgery with virtually no scarring.

Jolanta Bremer of JBremer Lifestyle Portraits

“Single incision laparoscopic surgery is the wave

Dr. Baker has performed more than a half dozen

surgeries with the advanced new technique, including a total colectomy. While there are still challenges

with the new system, most notably the difficulty of manipulating multiple instruments within a small space, Dr. Baker says he expects that advancing

technology will eventually supply answers for these challenges, too.

“One of the advantages of robotic surgery that

you don’t have right now with this Single Incision

technique is the ability to simulate wrist rotation with your instruments for better maneuverability. I expect that we will eventually see a combining of these

technologies to create a minimally invasive, single

incision technique that is both better for patients and easier for surgeons.”

MidwestMidwest Medical Medical Edition -Edition July / August - June 2010 2010 21

CCHS Physician Publishes Fracture Study In her role as Medical Director of Rehabilitation Programs at

or Duchenne MD). A DXA scan of the

Sioux Falls, S.D., facility in a study published in the March 2010

time as the distal femur scan on 229 of

Children’s Care Hospital & School, Julie Johnson, MD, led the

issue of the Journal of Bone and Mineral Research. Children Care

participated in a nationwide collaborative effort with experts in the

field from universities and children’s centers and hospitals in North Carolina, Pennsylvania, Ohio, Nebraska, Virginia, New Mexico and Delaware.

The study tested the hypothesis that the measurement of bone

mineral density (BMD) in the distal femur correlates with fracture rates in children with limited or no ability to ambulate. Results

demonstrated that there was a strong correlation between fracture rates and BMD Z-scores in the distal femur.

Eight centers, including Children’s Care, used a technique

that was developed involving dual-energy X-ray absorptionmetry (DXA) measures of the distal femur project in the lateral plane.

A total of 507 subjects met the established criteria (ages 6 to 18 and CP of sufficient severity to significantly impair ambulation

22

Midwest Medical Edition - July / August 2010

lumbar spine was obtained at the same these subjects. The study group had a

mean age of 11.8, was 78 percent white and 15 percent black, and 46 percent of the CP students were female.

Children’s Care was one of two

residential centers involved in the study

Johnson

with 51 patients involved from the two centers. Staff at Children’s Care in conjunction with Bonnie Specker and colleagues from

South Dakota State University measured the patients’ bone density after receiving one-on-one training in the technique.

Dr. Johnson is also on staff with Sanford Children’s as a

pediatric rehabilitation specialist and is an Assistant Professor of

Pediatrics at the Sanford School of Medicine of the University of South Dakota.

New Research Advances Medical Science, Quality of Life To remain on the cutting edge of medical science, research is a continual and growing emphasis at Avera McKennan

cancer; cervical and ovarian cancers; melanoma; myelodysplastic

Hospital & University Health Center.

leukemia; and other cancer sites.

The Avera Research Institute conducts basic,

applied and clinical research while the Avera

The Avera Research Institute has been

selected as a type 1 diabetes (T1D) center to

Institute for Human Genetics, the state’s only

collect clinic-based patient data to go into a

genetics lab, is doing groundbreaking research

first-of-its kind T1D registry/biobank. Through

on the roles genetics and environment play in the

a network of T1D centers, some 45,000 patients

development of behavioral health conditions and

with T1D will be enrolled in order to collect

other illnesses.

syndrome; kidney, colon and prostate cancers;

data on their management, glycemic control, and complications. In addition, a biobank is planned,

Current projects within basic research

include studies of obesity-linked kidney disease;

with specimens collected for storage from patient

skin cell repair following the damage induced

website will be established, expected to enlist

the relationship between stress and psychiatric

The goal is to create new research opportunities

and addictions.

disease.

control of kidney filtration and growth; DNA

participants. Separately, a patient-oriented

by the ultraviolet component of sunlight; and

approximately 55,000 additional T1D patients.

disorders, such as post traumatic stress disorders

through a more comprehensive study of human

Current applied research at Avera could

revolutionize the way peripheral arterial

disease (PAD) is treated. A novel cross-linking

“ The only constant

we see is change.”

technology allows the collagen in an arterial wall to be remodeled into a distended state after traditional angioplasty, increasing the

efficacy of angioplasty without the need for the traditional metal stent. The technology is based on a light activated compound that cross-links

and is used with a novel catheter based delivery system. This technology is in the third of three animal studies designed to prove both safety

and efficacy. The technology was demonstrated to be both safe and effective in the first two trials and the third trial is scheduled to be

Learn how MMIC is continually developing ways to protect you from and to help you prevent medical malpractice lawsuits.

For 28 years, we’ve seen how malpractice issues can challenge physicians.

We’re here to help protect your assets with medical professional liability insurance coverage that is backed with: � � � �

Unsurpassable risk management and patient safety resources Competitive pricing through effective underwriting Strong defense-minded philosophy to protect your interests Service and support that puts you rst

complete in the third quarter of 2010.

To learn more about how MMIC can help protect you, call (888) 397–3034.

“A” Excellent rating from A. M. Best

Over the past 10 years, cancer has been a

growing focus of research at Avera. Through a partnership with the Avera Research Institute,

MMICGroup.com Exclusively promoted and recommended by the South Dakota State Medical Association.

Avera Cancer Institute patients have access to many new studies (and potentially new treatments) for breast cancer; lymphoma; cancers of the brain, head and neck; lung

Protecting Your Peace of Mind

Midwest Medical Edition - July / August 2010

23

Very common drug poses risk in most common surgery Intraoperative Floppy Iris Syndrome (IFIS): The Link Between FLOMAX and Cataract Surgery Complications created during cataract surgery). Fortunately, there are instruments

By Alison Tendler, MD Cataract Surgery is

surgeons have at their disposal such as pupil expanders and

performed surgery in

of controlling this).(Many of these methods to diminish intra-

patients’ age, one of

is identified and ackwnoledged properly PRE-OPERATIVELY).

is the interaction of

lead to intra-operative complications.)

take. Fortunately, in

hosting an online webinar on August 10 to explain the risks

are very few drug

to properly educate their patients about these risk. For more

the most commonly

various (pharmacological agents to help control this). (methods

the Unites States. As

operative complications, however, can only be utilized if the IFIS

their chief concerns

(But this is only if IFIF is identified properly preoperatively it can

the medications they

Ophthalmology there

associated with IFIS and what medical providers should do

interactions that concern medical professionals. However, one of

information, or to register for this webinar call Chelsea Asmus at

the most commonly used medications utilized for benign prostatic

(605) 328-3933 or email her at asmusc@sanfordhealth.org.

to a condition called Intraoperative Floppy Iris Syndrome (IFIS)

Educational Overview: The association between IFIS and use

to surgery. Intraoperative Floppy Iris Syndrome (IFIS) was first

literature since 2005. The effects of the medication increase the

the occurrence of IFIS has been determined to have a strong

can be reduced when planned for preoperatively. Actual patient

hypertrophy (BPH), Flomax® (tamsulosin HCL), has been linked which can complicate cataract surgery when not identified prior

of tamsulosin (FLOMAX) has been widely published in the

described in the peer-reviewed literature in 2005. Since then,

likelihood of cataract surgery complications. These complications

association with patient use of Flomax®. Since the cataract

cases will be discussed.

there is roughly a 10 percent incident of IFIS in cataract surgery

Objectives:

2. To understand how (tamsulosin) effects the

surgery candidate and FloMax® patient populations intersect, candidates nationwide.

1. To review the pharmacology of tamsulosin.

relaxes the prostate to assist with proper urination; unfortunately

iris and why IFIS occurs.

the eye (during cataract removal. This typically affects the stibilty

in patients who exhibit IFIS.

to prolapse or protrude from the cornea wounds). In addition,

management of cataract patients with IFIS

the surgeon’s ability to see the cloudy lens (and safely perform

Alison Tendler, MD, of Vance Thompson Vision, is a Refractive & Advanced Cataract Surgeon specializing in the reduction of patient dependence on contacts, spectacles, or reading glasses after surgery. She is a leading authority on tear film chemistry and anterior segment surgery.

Flomax® is (a selective alpha-1 andrenergic antagonist) that

it also relaxes the iris of the eye causing it to become floppy inside

3. To review potential cataract surgery complications

of the anterior chamber of the eye and can often cause the iris

3. To discuss preoperative and intraoperative surgical

Flomax® can cause the pupil to become smaller decreasing

other intricate technical aspects of the procedure, thus increasing risks). (properly and thus effectively remove). (Other symptom of IFIS includes the floppy iris’s effect on Anterior chamber

stability and the ability of the iris to protrude from the wound Editor’s Note: If Dr. Tendler looks familiar to you, you may have seen her on advertisements for Restasis (cyclosporine ophthalmic emulsion), a medication for dry eyes. Dr. Tendler is a national spokesperson for Restasis and is the featured physician in the company’s national television advertising campaign.

24

Alison Tendler, MD, of Vance Thompson Vision will be

Midwest Medical Edition - July / August 2010

References:

1. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin (Flomax). J Cataract Refract Surg 2005; 31: 664-673.

2. Chadha V, Borooah S, Tey A, et al. Floppy Iris Behaviour During Cataract Surgery: Associations and Variations. Br J Ophthalmol. 2007; 91:40-42.

3. Oshika T, Ohashi Y, Inamura M, et al. Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha (1)-adrenoceptor

Seven Make-A-Wish Teens Graduate

individuals. Along with their families, these young patients either

By Mary Olinger Make-A-Wish Foundation® of South Dakota

experienced a trip to Walt Disney World, went on a trip with a

During the past few weeks, we have been thrilled with the blessing

received a computer. At Make-A-Wish® we believe that granting

will to overcome adversity with hope, strength and joy. Our wish

National Geographic photographer, took a Disney Cruise, or

of seven Make-A-Wish® children graduating from high school.

a very sick child the wish of a lifetime can help strengthen their

with life-threatening medical conditions. As children, they

recipients consistently tell us that neither they nor their families

leukemia, cystic fibrosis, spina bifida and more. They have

excruciating surgeries and loss of hair. These seven teens have

situations and having the fortitude to persevere.

worked hard and kept up with their studies. As a result, all were

condition in South Dakota, please call 1-800-640-9198. With their

These teenagers have all gone through their lives suffering

suffered through the pain, fear and agony of brain tumors,

will ever forget their wish experience.

endured chemotherapy treatments, radiation, spinal taps,

still going through regular treatments, for accepting their difficult

missed many days of school over the years but they have all have

able to celebrate their high school graduation day.

physician’s approval, we can help make their wish come true.

Congratulations to each of these brave youngsters, who are

If you know of a child with a life-threatening medical

Make-A-Wish® has granted a special wish to all of these

antagonist. Am. J. Ophthalmol 2007; 143:150-151.

4. Nguyen DQ, Sebastian RT, Kyle G. Surgeon’s experiences of the intraoperative floppy iris syndrome in the United Kingdom. Eye. 2007; 21:443-444.

5. Chang DF, Osher RH, Wang L, Koch DD. A prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax).

Ophthalmology 2007; 114:957-964.

6. Blouin M, Blouin J, Perreault S, et al.

Intraoperative floppy iris syndrome associated with Alpha-1 adrenoreceptors. Comparison of tamsulosin and alfuzosin. J Cataract Refract Surg 2007; 33:12271234.

7. Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A et al. Intraoperative Floppy Iris Syndrome Associated with {alpha}1-Adrenergic Receptor Antagonists. Ann Pharmacother 2008; 42:558-563.

8. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 2003; 170:530547.

9. Palea S, Chang DF, Rekik M, et al. Comparative effect of alfuzosin and tamsulosin on the contractile response of isolated rabbit prostatic and iris dilator smooth muscles. Possible model for intraoperative floppy iris syndrome. J Cataract Refract Surg 2008; 34: 489-496.

10. Chang DF, Braga-mele R, Mamalis N, et al.

Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 2008; 34:1201-1209.

Coming July 28 & 29 to Sioux Falls!

Do It Right!

A Leadership Development Program with Impact!

Join us at the Hilton Garden Inn, Sioux Falls, South Dakota to learn how all employers have the potential for exposure to Employment Practices Liability (EPL). SilverStone Group’s Do It Right!

Series helps focus your risk dollars not only on insurance, but also on loss reduction or prevention, by educating your staff and executives on how to properly manage this exposure. Employers of all sizes and industries can count on this workshop series to offer proactive, effective and proper solutions and skills to increase your organization’s performance!

Workshop Topics Hire Right – the First Time!

Coach Right – for High Performance Correct Right – Getting Back on Track Employee Rights – Understand Employment Law For more information, pricing and to register, please visit www.silverstonegroup.com/newsandevents/events/seminarsandtraining.html

*The use of this seal is not an endorsement by the HR Certification Institute of the quality of the program. It means that the program has met the HR Certification Institute’s criteria to be pre-approved for recertification credit.

800.288.5501 www.silverstonegroup.com

Midwest Medical Edition - July / August 2010

25

, s r o , t s c r o o D t c a o t D o k a a t D o k h a t D u o h S Sout rss teer rt or po pp up Su rS O heer th Ot o to tt ht igh Fllig T kee F ak Ta nss an ra teer Veet rV or H no on Ho

J

ust to be clear, World War II was no mere war.

The six year period between 1939 and

1945 remains a powerful influence behind such

contemporary issues as the Asian economy, European union,

nuclear proliferation, world communications and even the Health Care debate. World War II changed everything. And if there was

ever a face to the war’s victory over tyranny, there is little debate as to what it would look like: the American Soldier.

Yet, today, the faces of those soldiers are rapidly disappearing.

Though WW2ʼs influence will extend well into this new century, in five or ten more years, the men and women who experienced the war first-hand will be no longer. If ever there was a time to

take a last look, another listen, or give one more “Thank you,” the moment is now.

One local group is working to ensure that those “Thank

Youʼs” are delivered in a very personal and meaningful way. ment Group enjoys the shade Edward Vacek of the 381st Bombard outside of the WW2 Memorial trees in his original flight jacket just in Washington D.C.

Honor Flight is a national organization of state and

regionally operated groups dedicated to ensuring that

“When you’re at a memorial, with someone who played a part in earning that memorial, the passing of time and the present blur into one moment.”

– John Mollison

any American World War II veteran who wishes to

can experience the nation’s gratitude through a visit to

the World War II Memorial in Washington, D.C. The

veterans fly free of charge, their expenses paid by the

contributions of individuals and businesses.

“The recollections, the memories and the insight that this distinguished group of people provide is extraordinary.”

– Rick Tupper

Though the numbers of surviving WW2 vets diminishes daily,

the Honor Flights are full. The South Dakota Honor Flights consist of approximately two-thirds veterans and one third support staff.

Volunteers, family, friends and medical professionals accompany the veterans to ensure that their trip is not only memorable but safe.

Leading the medical staff for this year’s South Dakota’s

Honor Flight has been Sioux Falls emergency physician Don

people are more than twice my age. Their commentary, their

thoughts, their experience is at once seasoned and fresh. They see the human experience with a far greater perspective and wisdom than I can.”

Mollison chose to raise his own support for his Honor Flight

South Dakota Honor Flight’s goal is to provide each of the

as a way to help spread the word about the program.

Kosiak. In addition to his work in the ER at Avera McKennan

Hospital, Dr. Kosiak also serves as a Major in the South Dakota Army National Guard.

“Honor Flight, to me, is simply an honor,” says Dr. Kosiak.

“I am a veteran of Operation Iraqi Freedom, spending two tours

of duty in Iraq. My experience is so small compared to that of the

men and women who fought in World War II. I am proud to help in

Wendell Hanson, 341st Bomb Group, holds an actual “CBI Theater Patch” at the Air Force Memorial in Washington D.C. Hanson flew B-25 bombers in Burma during WW2.

any way to say thank you from a grateful nation.”

Dr. Kosiak leads a team of medical professionals including

other MDs and EMTs. Though there’s no prescribed mix of health care providers on each flight, and the medical team is tailored to the needs of the veterans making the trip, Dr. Kosiak will be on each of South Dakota’s future Honor Flights.

Honor Flight participants have a packed agenda. The flights

leave Sioux Falls early for mid-morning arrival in Washington.

stateʼs WW2 veterans their free flight, depending upon funding.

before returning home the next day. Approximately 50 wheelchairs

individuals and corporate sponsors like Sanford Health, South

Veterans will typically visit seven to nine historical memorials are brought along on each flight, just in case.

Accompanying the veterans and medical staff are designated

“Guardians” - volunteers who pay their own way to help ensure the veterans are well

South Dakota Honor Flight veterans wave to the camera at the Iwo Jima Memorial in Washington D.C. during part of their April trip.

cared for.

“When youʼre at a

memorial, with someone who played a part in

earning that memorial,

the passing of time and

the present blur into one moment,” says aviation

artist and historian John

Mollison, a Guardian on a recent South Dakota

Honor Flight. “These

Each flight costs about $120,000. Thanks to the support of Dakota has had six Honor Flights so far and four more are

planned. The group estimates they are about two thirds of the way through the list of the state’s eligible veterans.

“We are a cost-only group. There is no counting for profit,”

explains Rick Tupper, a founder and director of the state’s Honor Flight program. “The remaining veterans stay on the list to go

until we can ensure that we have the funds to book the plane, hotel and food.”

“The recollections, the memories and the insight that this

Medical professionals interested in supporting the Honor

distinguished group of people provide is extraordinary,” he adds.

Flight mission are encouraged to visit the groupʼs website: www.honorflightsd.org for more information.

“Honor Flight to me is simply an honor.”

– Dr. Don Kosiak

Leading the future of HEART CARE takes singular vision.

Bringing the most innovative heart care to the region takes a team with the same foresight. These specialists always look beyond convention. They lead research.

They publish. Sharing knowledge, exploring breakthroughs, and bringing the world’s most innovative solutions to you. The future of heart care is here.

To make an appointment, call 605-328-2929.

For more information, visit BeHeartSmart.org.

28

Midwest Medical Edition - July / August 2010 Š Sanford Heart Hospital

News & Notes in family medicine and earned her Medical

Avera

Degree from the University of South Dakota

Avera Brady Assisted Living celebrated 10 years of operation June

Sanford School of Medicine, Vermillion, S.D.

6. The facility was opened for business on June 1, 2000, and their

She completed her residency in Family Medicine

first admission was June 6, 2000. Avera Brady Assisted Living is

licensed for 24-30 people and in the last 10 years, 153 individuals have called it home. A staff of 16 is employed at Avera Brady Assisted Living.

at St. Cloud Hospital/ Mayo Family Medicine Tjaden

Residency in St. Cloud, Minn.

Rapid City Regional Hospital (RCRH) recently honored eight

Avera Queen of Peace Hospital in Mitchell has opened a new

Balance Center to serve individuals who struggle with vertigo and other balance problems. Dr. Patricia Larson Shields, AuD FAAA MACCCSP/L, who currently provides audiology and speech

pathology services to Avera Queen of Peace patients, has trained with NeuroCom International, Inc. to help bring the service to

outstanding employees with Nursing Recognition Star Awards.

The Star Awards, developed by RCRH’s Nurse Shared Governance Council, encouraged employees to nominate their fellow nurses for the following awards: Guiding Star–Mentor, Gold Star–Service,

Shining Star–Community, Rising Star–Novice, Super Star–Expert, Blazing Star–Advanced Practice and Supporting Star.

Mitchell. The program will take a multidisciplinary approach

to treatment which can include medication and/or diet, special

maneuvers involving simple movements of the head and body, and surgical intervention or physical therapy and exercise.

Regional

Lead-Deadwood Regional Hospital (LDRH) recently

completed two new hospice

Rapid City Regional Hospital employees honored with Nursing Recognition Star Awards included, L- R: Carol Carey, Melanie Tish, Jennifer Hart, Sandy Wright, Wendy Asher, Jeanne Anderson, Carolyn Sigel and Dana Darger.

rooms and a family room, paid for entirely by local donations.

The recently converted regular Hospice room

Siouxland

After 33 years of medical practice and

patient rooms are the first in

service in the Siouxland community, Dr. William

the Lead-Deadwood area to offer a place for patients who require

Blankenship has announced his retirement from

end-of-life care in a home-like setting. Each hospice room features

Midlands Clinic, P.C. A public reception was

medical equipment for patient care but furnishings that offer the

planned for July 7th at Midlands Clinic.

comforts of home. The family room has living room furnishings, a television, and activities for children. It is also located close to the cafeteria providing easy access and support for the family.

The final tote board for the June 5th Children’s Miracle Network

(CMN) Celebration Broadcast was $355,008. The money will be used to help ill and injured children in the area served by Rapid

City Regional Hospital. The one-day event was televised live from the Rushmore Mall on Black Hills FOX.

Regional Medical Clinic is pleased welcome back of Karen Tjaden, M.D. to the clinic staff. Her office is located at Lead Deadwood

Regional Medical Clinic, 71 Charles St. Tjaden is board-certified

Blankenship

Others

Meeta R. Patel, Ph.D., BCBA-D will present “Using a Behavior-

Based Approach to Assess and Treat Pediatric Feeding Disorders”

at Children’s Care Hospital & School, 8 a.m. to 5 p.m., Friday, July 16th. This workshop will equip professionals to successfully assess and treat children with feeding problems, including total food

refusal, liquid dependence, selectivity by type and texture, lack of

oral motors skills, and medical issues. Cost is $185 per person. For details, contact Christina Baldwin at (605) 782-2371 or christina. baldwin@cchs.org

Midwest Medical Edition - July / August 2010

29

DOUG

BURG

COMMERCIAL PHOTOGRAPHY

PEOPLE

9

PRODUCTS

;

TECHNOLOGY

9

ARCHITECTURE

;

LIFESTYLE

9

FOOD

;

MEDICAL

doug@burgstudios.com 712/251/6000 NOW OFFERING PHOTOGRAPHY WORKSHOPS

intensive one-day one-on-one photo workshops • your schedule, your level get from where you are to where you want to be 30 years commercial and fine art experience • 3 years teaching college photo classes

Index of Advertisers Avera........................................................................................................................................... Inside Front Cover Chuk-it.......................................................................................................................................................... Page 5 Pharmacy Specialists..................................................................................................................................... Page 5 DT-Trak Consulting...................................................................................................................................... Page 12 CCHS.......................................................................................................................................................... Page 13 Make-A-Wish / Hot Harley Nights............................................................................................................... Page 23 Sioux Falls Surgical Hospital........................................................................................................................ Page 15 Swenson Investments.................................................................................................................................. Page 19 MMIC.......................................................................................................................................................... Page 23 Silverstone Group........................................................................................................................................ Page 25 Sanford........................................................................................................................................................ Page 28 Doug Burg................................................................................................................................................... Page 30 Make-A-Wish...............................................................................................................................Inside Back Cover Children’s Hospital - Omaha..................................................................................................................Back Cover

30

Midwest Medical Edition - July / August 2010

Intensive Care for Newborns

In whose hands will you place her?

PHYSICIANS’ PRIORITY LINE

1.888.592.7955

When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment.

It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small.

www.ChildrensOmaha.org