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2018

Medical Insider Professionals • Hospitals • Practices • Technology

Great minds, remarkable care Pushing medicine forward in Northern Michigan

Medical detective work: finding the source of hidden strokes Disc replacement— instead of fusion—a better MI 1 fix for MyNorth.com your back pain?

High-risk pregnancies: new close-to-home help

Ask your dentist about sleep apnea— here’s why

A-Fib: Is this “no blood thinner” a solution for you?

Diabetes: new tech reins in your sugar levels


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Dr. Kersti Bruining

Stroke Prevention

COVER PHOTO AND THIS PAGE BY MICHAEL POEHLMAN

New Monitor Reveals Stroke Source Kryptós … it’s the Greek word for hidden, and when it was imported to English as “crypto,” it became a combining word, stuck onto the front of other words to mean hidden this or hidden that. Cryptogenic stroke is an example. The medical term refers to strokes with hidden sources, which makes treating them an imprecise and frustrating task, and unfortunately, a third of all strokes have no clearly identified source. That sleuthing task becomes even more difficult when a stroke is fleeting, lasting a minute or less and leaving minimal or no damage. These types of strokes are important to diagnose because they can often indicate conditions exist for the formation of a larger stroke in the future. Many strokes originate with atrial fibrillation—an out-of-synch beating of the heart caused by irregular electrical signals. The abnormal rhythm leads to blood pooling in the heart and when blood pools, clots can form. Physicians always inspect a stroke patient’s heart rhythm looking for clues. But a-fib itself can be transient—appearing briefly, and then not again for days, weeks or months, explains Dr. Kersti Bruining, a neurologist who specializes in in-patient care. How can a doctor know if a-fib is

the source of a cryptogenic stroke if the irregular beat is so ephemeral, so sporadic? Physicians have a new tool that can uncover the hidden nature of a-fib-based strokes. Called Linq, the tiny implantable device (1 1/2 by 1/4 by 1/8 inches) is inserted under the skin just below the collarbone, and it continuously monitors the patient’s heart rhythm. Each night, the data from the day’s recording is automatically uploaded via a little device near bed to a cloud-based storage system. A computer analyzes the rhythm, looking for irregularities. If the computer spots a problem, the medical team is notified, and the patient is treated for stroke prevention.

“The median time for detecting a-fib is 84 days,” Bruining says, meaning half the patients take even longer than that to have their a-fib reappear. External monitors, with sticky electrode attachments, are also available and have been for some time, but “a New England Journal of Medicine study showed that the new implanted monitor detected seven times more instances of a-fib than the standard monitors,” Bruining says. Since March 2017, when her team began the monitoring, several patients have uncovered a-fib as the source of their strokes, removing the “crypto” from their diagnosis, and allowing targeted and precise treatment to begin. —J.S.

MyNorth Medical Insider is produced by MyNorthMedia. Advertising and editorial offices at: 125 Park St., Suite 155, Traverse City, MI 49684. 231.941.8174, MyNorth.com. All rights reserved. Copyright 2018, Prism Publications Inc. Reproduction in whole or in part without permission is prohibited.

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Diabetes

PHOTO BY MICHAEL POEHLMAN

Fine-Tuning Insulin Levels— Even While Sleeping The Food and Drug Administration surprised—and pleased—the diabetes medical community this year when they approved a new, high-tech insulin delivery system for Type I diabetics six months sooner than anybody expected, including the maker, Medtronic. The device, called the MiniMed 670G System, is the first to have insulin delivery regulated by real-time monitoring of a patient’s blood glucose levels, which allows the user to much more easily maintain healthy glucose levels, avoiding damaging episodes of high and low blood sugar. “For years patients have worn glucose monitors and insulin pumps,” says Dr. Jill Vollbrecht, medical director of the Northern Michigan Diabetes Initiative. “But until now, the monitor and the pump did not talk to each other.” The 670G device is external to the body, with a sensor and a catheter running just under the skin. The monitor/ pump pairing is able to adjust insulin delivery based on the glucose reading and administers micro-doses of insulin every five minutes. Patients still have to monitor things like insulin dosage for meals, but the delivery of the insulin is more nuanced than traditional pumps, and leads to more consistent blood sugar levels. A key benefit of the technology is helping patients avoid low blood sugar at night. Low blood sugar episodes increase the odds of dementia, and unfortunately, each low blood sugar episode a patient has diminishes the body’s warning system for low blood sugar conditions. With the MiniMed 670G, “Your spouse doesn’t have to be on alert for low blood sugar at night and you don’t have to eat special food before you go to bed, so it’s easier to lose weight,” Vollbrecht says. The Medtronic literature says patients have 75 percent fewer episodes of nighttime low blood sugar than people not using the device. Physicians also like that the data from the glucose monitor is uploaded to cloud storage, so the medical team can easily track the patient’s blood sugar levels.

Dr. Jill Vollbrecht was thrilled to be able to begin using the technology, but she concedes her team was challenged in wanting to implement it promptly and safely. She and her colleagues carefully screened patients who were interested in the pump, meeting with each one to explain that, while the device is a big advancement, “it is not hands-free,” as she says. “We wanted to do it right, put patient safety at the forefront and make sure we could get good data.” The first few patients went live with the device this summer. Vollbrecht expects 15 to 25 patients will be using the device in

Northern Michigan within a few months? Will combined glucose monitor/pump devices be standard for Type I diabetics soon? “It still all depends on the patient,” Vollbrecht says. “Take my mom for example. She has been diabetic most of my life and she still prefers the shot. She knows the process. She’s comfortable with it. It makes sense to her.” If people you know might be interested in the MiniMed 670G, have them talk with their physician to gain a thorough understanding of all the pros and cons and how it will fit into their lifestyle, Vollbrecht advises. —J.S.

Dr. Jill Vollbrecht

MyNorth Medical Insider

MI 5


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Atrial Fibrillation

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

The Watchman Technology Atrial fibrillation—irregular beating of the heart—is a dangerous heart condition that affects fully 25 percent of Caucasian men over age 70. Commonly the condition is caused by a flawed nerve that triggers rapid beating of one of the upper chambers of the heart. The out-of-synch beating that results can lead to pooling of the blood in the heart, and pooling blood leads to clots and eventually strokes, when a clot moves to the brain. “And unfortunately, strokes associated with atrial fibrillation tend to be big,” explains Dr. Jason Ricci, a cardiologist with McLaren Northern Michigan in Petoskey. Standard treatment of a-fib (medical shorthand for atrial fibrillation) involves stopping the problem-causing neuron from affecting heart rhythm and then putting the patient on blood thinners, like Warfarin. “But if people have bleeding issues or are frail or just refuse to take medicine, blood thinners are not a good option,” Ricci says. Now there’s a medical implant, called the Watchman, that can help some of those

patients. It was developed after researchers studied clot formation related to a-fib, and discovered that 90 percent of clots formed in a small appendage off the left atrium. Think of the appendage like a tiny bay that opens off the inside of the left atrium, a small quiet space where blood could collect—and clot. The Watchman is a device that closes off the opening to that appendage, so blood can no longer pool there. “We understand some of the roles the appendage plays in the heart, we just don’t believe they are vital to optimal heart performance and feel the benefit of sealing the appendage outweighs any risk of losing its intrinsic function,” Ricci explains. Surgeons often close off the appendage during heart bypass surgery, so there is much evidence to indicate that the opening can be safely sealed. The extra good news for qualifying patients is that the Watchman is installed using catheter technology. The catheter,

with the device at the tip, is inserted into the femoral vein, at the top of the leg, and guided up to the opening of the left atrial appendage. “We’re basically putting an umbrella parachute in that opening,” Ricci says. The procedure takes less than an hour. Post-operatively, the patient stays overnight in the hospital and then takes blood thinners for six weeks while the body produces heart tissue to cover the device. Once the new heart tissue is in place, the patient can stop taking blood thinners, but continues to take aspirin daily. Ninety-two percent of patients are off blood thinners after six weeks and 99 percent of patients are off blood thinners after one year, Ricci says. Patients considering this procedure should keep in mind that there can be multiple causes of strokes, and the Watchman only addresses clots originating in the left atrial appendage. —J.S.

MyNorth Medical Insider

MI 7


Our Experience Improves

Yours.

We know our way around hearts. Munson Medical Center is recognized as a Blue Distinction Center+ for Cardiac Care by Blue Cross Blue Shield of Michigan* for demonstrating expertise in delivering safe and effective cardiac care. We do more heart procedures – and we’ve been doing them longer – than anyone else in northern Michigan. Simply put, our experience will improve yours.

Our heart team has one of the lowest 30-day heart failure readmission rates in the nation,** and we have been named one of “100 hospitals and health systems with great heart programs.” *** Great care and great outcomes make us a national leader in cardiac care. Ask your physician to refer you to the Munson Healthcare team – national leaders in heart care. We’ll feel better when you do. 800-637-4033 | myheartexperts.org

* Information and details online at munsonhealthcare.org/mmc-awards. ** Our 30-day readmission rate for the period July 2012 through June 2015 is 18.6% compared to the Michigan average of 21.8%. Learn more online at whynotthebest.org *** BeckersHospitalReview.com, 2016


Dr. James Fox

Healthy Eats

PHOTO BY MICHAEL POEHLMAN

Food as a Prescription? Food as a prescription for good health. It’s not a novel idea. But what is fresh is the idea of a foodie medical conference that teaches doctors and their colleagues how to get patients to cook and eat in a healthy way. Dr. James Fox, an advocate of the food-as-prescription idea at Munson Medical Center, organized just such a medical conference September 22–24, 2017, at Northwestern Michigan College’s culinary school to spread the idea throughout Northern Michigan. Fox is happy to admit that he just plain copied the idea of a foodie medical conference from similar conferences sponsored by Harvard University. He attended a few held at a Napa Valley campus, and he thought, We should have something like this in Traverse City. Essential to the conference success: “The discussion is really about food. Not nutrition. Not about diets. Not about good carbs. Bad carbs. Protein loading, whatever other topic,” he says. “It’s not about all the various ways people have found to try to put scientific principles over the top of food.” The mission, pure, but more difficult than it sounds, is to make people want to make food that tastes good and is ultimately also good for them, which is why chefs have a big part in the teaching.

For some patients, the food as prescription idea takes hold quickly. Fox writes them a simple healthy recipe and sends them to the farmers market. Others push back. “Like, this means I can’t ever eat anything good again,” Fox says. He understands the reason for that reaction. “Junk food is addictive. It makes you feel good when you eat it and makes you hungry so you eat more. We need something with an equal power of desire, so the patient says, ‘I’d eat that again,’ ” he says. Fox traces his food fandom back to his youth, when his cardiologist dad first had his own realization that food was essential to cardiac health, and he convinced the family to change cooking habits. About the same time, Fox’s mom started working, and each kid had to cook a dinner once a week. The more he got into food, the more he realized his parents weren’t accomplished cooks. But he determined he would be. Now he’s passing that passion and skill—and healthy food philosophy—along. Bonus: On-stage the opening night of the conference was the founder of the Harvard food medical conferences. —J.S.

MyNorth Medical Insider

MI 9


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Spinal Disc Degeneration

Disc Replacement Improves Finger Joint Replacement

BOTTOM RIGHT: PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Eliminates Arthritis Pain, Restores Much Function As people age, arthritis commonly affects joints in the fingers and at the base of the thumb, and it can progress to the point of making everyday activities, including cherished ones, difficult to continue. “I see so many women who have to give up knitting, for example,” says Dr. Mark Leslie, with Hand Surgery of Northern Michigan. But unlike other joints that people commonly think of replacing, like hip joints and knee joints, we don’t often think of replacing a finger joint. “Most people are not aware this is even possible,” Leslie says. But for the right patients, a finger joint replacement may be able to eliminate pain associated with an arthritic finger joint and bring back enough finger function to regain abilities like knitting or playing a musical instrument. Each finger has three joints and all can fall victim to arthritis. Unfortunately many older “stoic generation” patients feel there are no options and they must endure the pain. Leslie recalls a patient whose finger was frozen straight out and had been for years because she knew of no option. Leslie was able to restore nearly full motion with a brief surgery to replace the joints. The surgery to replace finger joints is brief, is done on an outpatient basis, and does not require a general anesthetic. A surgeon could replace multiple finger joints in one session, but the procedure for a single replacement typically takes about 45 minutes. Physical therapy to maximize range of motion begins within four or five days and lasts several weeks, with full improvement taking possibly more than three months. But as for the pain of arthritis: “That is gone immediately,” Leslie says. Not everybody is a candidate for finger joint replacement. Be sure to discuss your particular situation thoroughly with your physician.—J.S.

As people age, many come to experience pain related to spinal discs that begin to shrink, either because of herniation or a deflation caused by degenerative changes in the disc—most commonly this occurs in the neck or lower back. Pain from the condition varies. If the pain results from nerve compression, the person will feel pain in the arms from damaged discs in the neck, or in the legs from damaged discs in the lower back. If the pain is from the degenerative disc itself, the person feels pain in the neck or back. For decades, treatment has been to remove the disc and fuse the vertebrae using support pieces made of metal, plastic, or cadaver bone and held in place by screws. The procedure is remarkably effective at reducing pain, but it does come with a cost. The spine loses a measure of flexibility, and the structure transfers increased stress to the neighboring vertebrae, which accelerates their own degradation. Dr. Anthony Bozzio, MD, of Bay Street Orthopaedics, is offering an alternative to spinal fusion— replacing the damaged disc with an artificial disc—that can more closely replicate the natural function of the disc, thereby maintaining range of motion and reducing the stress transfer to neighboring vertebrae. “Good long-term data shows that disc replacement has lower re-operation rates compared to fusion, with better patientreported outcomes,” Bozzio says. The way it works is: the surgeon approaches the spine from the front of the body through a small incision. The frontal approach eliminates having to damage the back muscles and greatly improves recovery time.

The surgeon removes the damaged disc and any other damaged cartilage at the site. Thin metal plates are inserted to line the vertebrae surfaces above and below where the disc was removed, with a plastic polymer piece that allows spinal motion between the metal surfaces. Bozzio studied the procedure extensively at the Texas Back Institute during his year-long spinal surgery fellowship. “They pioneered the procedure in the United States,” he says.  Following surgery,  patients typically go home after an overnight hospital stay or within a couple days. Recovery takes from several weeks to several months. “We expect people to feel normal after they recover,” Bozzio says. The caveat: “This isn’t for everybody, and a lot goes into the decision to determine if the patient is right for the procedure,” he says.  Bozzio’s advice for helping to avoid spinal surgery like this? “Healthy exercise and core strengthening to offload pressure from the weight the spine is bearing. This is extremely important for low back issues.  An active exercise program, healthy diet, and core strength activities such as yoga or pilates can be very beneficial.” —J.S. Dr. Anthony Bozzio

MyNorth Medical Insider

MI 11


Our team has your back . . . hips, knees, and more!

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The William and Leni Carls Hearing Clinic at Munson

Medical Center and the new traveling Mobile Hearing Clinic are staffed by experts who diagnose and treat hearing loss. To schedule an appointment, call 231-935-6455, or visit munsonhealthcare.org/hearing.

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Cancer Technology

PHOTO BY MICHAEL POEHLMAN

Advances in Finding Cancerous Cells in Lymph Nodes In the battle to stop cancer from spreading throughout a patient’s body, an essential tactic involves removing lymph nodes that contain cancerous cells. But removing the specific lymph nodes that might contain cancer has been an imprecise science because surgeons generally could not discern which lymph nodes are cancerous. To raise the odds that they removed cancerous nodes, surgeons often remove several nodes in the affected area—though only a few might be actually involved. The downside of this approach is that the flow of lymphatic fluids is compromised more than necessary and can even lead to permanent swelling in areas of the body—a painful and debilitating condition called lymphedema. Researchers have been working on a way to clearly identify the lymph nodes likely to be involved in spreading cancer cells, and thereby preserve as much of the patient’s lymphatic system as possible. The good news is physicians now have technology that greatly helps narrow the search for cancerous lymph nodes, explains Dr. David Michelin, of Munson Medical Center. Called the Firefly Procedure, the technology involves injecting a dye into the patient’s cancerous organ and then using a DaVinci Robot to spot which lymph nodes collect the dye. “Those nodes light up in a brilliant green, like a firefly—so that’s where the name came from,” Michelin says. A key thing to understand about the technology is that it doesn’t identify cancer but rather it identifies lymph nodes that are primary in draining the lymphatic fluids from a cancerous area of the body. So, for example, in Michelin’s work, many patients have cervical cancer. The lymphatic fluid

from the cervix drains primarily through a few lymph nodes—called sentinel lymph nodes. Because they are receiving so much of the fluid, they are also most likely to contain cancer cells that the fluid has carried from the cancerous cervix. “In the past, I might have had to take out 30 lymph nodes,” Michelin says. “But with the Firefly Procedure, we take out three nodes, one on each side of the pelvis and one near the aorta.” For Michelin, reducing the impact on the lymphatic system is essential because some gynecological cancers—most notably uterine cancer—are associated with obesity, and

those patients already have compromised circulatory systems. Focusing on just three nodes instead of 30 also improves tissue analysis because histologists can focus their research, looking intensively at ultra-thin slices from a few samples rather than dozens. The technology proved its worth when Michelin deployed it on his second patient. He easily identified a sentinel lymph node, removed it and it turned out to contain cancerous cells. The patient was quickly put into chemo and radiation treatment, which greatly improved her odds of surviving cancer, Michelin explained. —J.S.

Dr. David Michelin

MyNorth Medical Insider

MI 13


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Driver Assessment | Hand Therapy | Healthy Weight Center | Lab Pain Management Program | Pediatric Therapy | Pharmacy | Physical and Aqua Therapy | Sleep Center | Speech Therapy | Urgent Care | X-ray 550 Munson Ave., Traverse City | 231-935-5000

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For more information or services in your area, visit munsonhealthcare.org/outpatient

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Advertorial

929 Business Park Drive Traverse City, MI 49686 231-947-6246 gtoc.net

L-R: Jeffrey Wentzloff, M.D., Petra von Kulajta, M.D., Matthew Madion, M.D., J. Ryan McManus, M.D.

New Technology in Laser Cataract Surgery Would you like to be able to see without glasses or contact lenses? Would you like to get rid of your bifocals or reading glasses? Having cataract surgery with the Femtosecond Laser is new technology that can help you achieve this freedom. Cataracts affect 22 million Americans who are over the age of forty. Cataracts cause vision problems like blurriness, glare at night or in bright sunlight, or difficulty reading small print. Cataracts are removed with a commonly performed surgery that has been done efficiently and safely for decades. During the surgery, a lens implant is placed to help keep the eye in good focus. There are over 3 million cataract surgeries performed each year in the United States. The newest technology in cataract surgery is the Femtosecond Laser (Femto Laser). Surgery done with the Femto Laser allows for a highly customized cataract removal with precision not achievable with manual techniques. This leads to better results with less dependency on glasses. The Femto Laser is used in combination with choosing the right implant to restore vision to people who are affected by cataracts. There are several benefits to the new Femto Laser. One of the advantages is the ability of the laser to create a personalized map of the structures inside your eye. Every eye has a unique size and shape. The laser forms a custom 3D map of the structures inside your eye. This allows the surgeon to create a personalized treatment plan for each eye. Another advantage is that the surgeon can use the laser to soften the hard cataract. Softening the cataract with the laser enables the surgeon to remove the cataract gently. The surgeon can also use the laser to create more precise incisions than are possible with manual techniques. These tailored incisions are made both on the surface of the eye and inside the eye, and they reduce the need for glasses after cataract surgery. Lens implants are used during cataract surgery. After the cloudy cataract lens is removed with the Femto Laser, a clear plastic lens implant needs to be inserted into the eye. The next step is to choose the right lens implant to reduce or eliminate

your need for glasses. There are three types of lens implants to choose from: 1) Monofocal lens implants are for vision at one distance, either far or near. 2) Multifocal lens implants are for vision at multiple distances like far, intermediate, and near. 3) Toric lens implants correct for astigmatism. Each of these lens implant types may be used in combination with the Femto Laser to reduce or eliminate the need for glasses after cataract surgery. Cataract surgery usually takes less than 30 minutes, and the laser portion of the treatment usually takes just a few minutes. The laser is gentle with little or no discomfort. Recovery from cataract surgery usually only takes a few days, and most regular activities do not need to be restricted except for strenuous exercise. Cataract surgery along with personalized 3D mapping by the Femto Laser allows the surgeon to create a customized treatment plan tailored to the uniqueness of each eye. This new laser technology assists in gentle, safe removal of the cataract. Like most things in life, laser-assisted cataract surgery does not come with a guarantee. However, Femtosecond Laser along with cataract surgery and the right lens implant is the latest technology for a safe and gentle procedure to reduce or eliminate the need for glasses or contacts for your best vision. About the author: Dr. Wentzloff is a board certified ophthalmologist and specialist in cataract surgery and the treatment of glaucoma. He practices at Grand Traverse Ophthalmology Clinic (GTOC). Office phone: (231) 947-6246. Website: www.gtoc.net


Mary Schubert

High Risk Pregnancies

PHOTO BY MICHAEL POEHLMAN

Wrap-Around Care Nearby Each year, women in Northern Michigan give birth to about 5,000 babies, and of those pregnancies, about a third are considered high risk. The region, however, has not had a robust network of services for high-risk pregnancy. High-risk-moms-to-be have had to travel regularly to places like Grand Rapids and Saginaw for checkups and care, or try to squeeze into the packed schedule of a specialist from downstate who makes once-a-week rounds in the North. Munson Medical Center’s High Risk Perinatal Program has set out to improve regional care for high-risk obstetrics patients. Consider the situation from the patient and her family’s perspective, encourages Mary Schubert, executive director of women and children services at Munson. “You learn you are pregnant and are all excited and then the doctor says you have to see a perinatal specialist—a specialist in maternal and fetal medicine—and then you have to wait,” she

says. The situation adds anxiety and stress at a time that’s already emotionally charged. The fix? “We didn’t want to just bring one physician here, we wanted to bring a whole program,” Schubert says. “We wanted to create wrap-around care, a whole safety net for families with the goal of keeping more moms here.” The program will be based in Traverse City, and many patients will receive care there. But members of the team will also travel throughout the North, seeing patients on a regular basis at clinics close to the patients’ homes and thereby reducing the risk of travel—traveling adds risk to what’s already a high-risk pregnancy. With care nearby, more pregnant women are likely to seek care, too, rather than seeing distant care as out of their reach, for reasons like transportation and finances. The spectrum of care will include technology-based services, such as ultrasound

checkups and genetics counseling as well as addiction treatment services (in some Northern Michigan counties, 40 percent of pregnant moms smoke cigarettes), and social work services. “When it’s time to deliver, a social worker will figure out where the family will stay, and if there are other children, how they will be cared for,” Schubert says. Working hand in hand with the highrisk pregnancy program, the neonatal intensive care program is also increasing its capabilities. “We used to transfer anybody born at less than 28 weeks to Devos, in Grand Rapids,” Schubert says. Now the unit regularly keeps babies at 26 and 27 weeks. “It’s all about putting the family at the center, giving the family the best possible care,” Schubert says. “And keeping moms close to home.”—J.S.

MyNorth Medical Insider

MI 17


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Ophthalmologist

Optometrist

Dr. Chippi

Dr. Felger

Optometrist

Optometrist / Kalkaska Only

Traverse City Eye has recently added several new doctors to our team of professionals—Dr. Ashley Holdsworth, Ophthalmologist; Dr. Kristen Chippi, Optometrist; and in Kalkaska, Dr. David Felger, Optometrist. Traverse City Eye Consultants is committed to preserving your vision and providing a “clear vision of care” to all of our patients.

WE BELIEVE IN THE POTENTIAL OF ALL PEOPLE, REGARDLESS OF THEIR STORY. Since 1968 Eagle Village has been helping the kids and families of Michigan to overcome attitude problems, risky behavior, and the impact of generations of abuse or neglect. With decades of experience in treating delinquent and trauma-impacted children, Eagle Village is here to help with: ●

Intervention Summer Camps & Challenge Weekends

Residential Care

Assessment Center

Post-Adoption Services

Foster Care

Adoption

Tour our treatment facility and read more about the programs we offer at eaglevillage.org or schedule your own tour by calling 231-832-2234

5044 175TH AVE | HERSEY, MI 49639

MI 18

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Preventing Type 2 Diabetes

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Group Support is Key About 30 million people in the United States have been diagnosed with Type 2 diabetes, and an estimated 84 million more people are thought to be pre-diabetic, that is, in a condition that could lead to fullblown diabetes if health habits are not changed. “Those are alarming numbers, and the cost to human lives is very significant,” says Michele Sturt, a diabetes specialist with Internal Medicine of Northern Michigan (IMNM) in Petoskey. But, of course, the good news is health habits can change, and changing the health habits of pre-diabetic individuals to steer away from the brink of diabetes is the purpose of a new program, called the National Diabetes Prevention Program, being offered at the IMNM. “To participate in the program, you don’t need a diagnosis,” explains Sturt. “But there are criteria, such as being overweight, having a family history of Type 2 diabetes, and not being physically active.” In the program, participants agree to attend at least 16 support group meetings that meet every week for the first six months, then every other week for three months if participants choose to continue. The program offers education about key lifestyle changes and fosters support among group members for one another. Participants also commit to making lifestyle changes and to keeping a daily journal of thoughts and ideas. Support group meetings are times to review challenges faced and successes achieved. Each meeting also involves a weigh in, since weight loss is an essential piece of avoiding diabetes. “The weigh-in is part of an accountability factor—being accountable to yourself and to the group,” Sturt says. The groups are kept small so bonds can form; about 10 people were in the autumn group. “The people we’ve seen so far are very committed. They want to make a difference in their lives,” Sturt says.

The education and behavioral change support focuses on a few key healthy lifestyle areas. “First is nutrition,” Sturt says. “We spend a lot of time discussing healthy, well balanced diet.” Other areas are exercise—encouraging at least a half-hour of activity five days a week sleeping well, and tips for destressing, like meditation.

“The trajectory of diabetes can be dramatically changed if people are aware of their risks and know how they can change,” Sturt says. “Many people don’t feel they have that much control over this, but they do.” To learn more or to join the program, call Internal Medicine of Northern Michigan, 231.487.2460. —J.S. Michele Sturt

MyNorth Medical Insider

MI 19


Advertorial

Robotic Assisted Surgical Technology Available at OMH Otsego Memorial Hospital (OMH) is proud to offer the latest in robotic assisted technology for minimally invasive surgeries. OMH has already been offering laparoscopic minimally invasive surgeries, but the new state-of-the-art da Vinci® Surgical System is changing the way surgeons operate, and the way patients are recovering. OMH is one of only two hospitals in northern lower Michigan to offer the da Vinci Surgical System to patients for minimally invasive surgeries, a large feat for a rural community hospital, making OMH a hub for robotics in the eastern part of the state. The da Vinci Surgical System features a 3-D, high-definition vision system and small instruments that move in tandem with the surgeon’s hands, making the robotically assisted surgeries faster and more precise, while offering enhanced vision and greater control. But what does this mean for patients? Compared to traditional minimally invasive surgery, robotic assisted surgeries boast a faster recovery time, shorter hospital stays, smaller or fewer incisions, less pain and scarring, and decreased risk of infection and bleeding. Patients are able to return to normal life faster after robotic assisted minimally invasive surgeries. After experiencing pain and bloating for years, Juli, of Bellaire, had her gallbladder removed in the spring of 2017 by Jim Shurlow, DO, General Surgeon at OMH. Juli, an avid horseback rider, wanted to get back on her feet as quickly as possible post-surgery. “Dr. Shurlow explained all the benefits of this new robotic surgery, and it sounded great,” she says. Dr. Shurlow was able to remove Juli’s gallbladder in less than an hour with the da Vinci Surgical System, and

two days after surgery, Juli had made a full recovery. “This was by far the fastest recovery I’ve ever had from a surgery. The first thing I noticed almost right after I woke up was that my pain and bloating were gone.” Returning to normal life quickly is a top priority for many patients, making the da Vinci Surgical System an appealing choice for minimally invasive surgeries. Since her surgery, Juli was able to get back in the saddle and do what she loved without pain. “Last year I rode maybe three or four times. Now I feel like I can ride every day,” she says. “I feel like a new woman.” Alongside Dr. Shurlow, Dr. Wendy Frye and Dr. John Moffatt perform general surgeries at OMH, such as gallbladder removal and hernia repairs, with the da Vinci Surgical System, and Dr. Cortney Casper, OB/GYN at OMH, is performing gynecological surgeries. While OMH is currently only performing general and gynecological minimally invasive surgeries with the da Vinci Surgical System, more specialties, such as Urology, will be added as the Hospital grows to fit the increasing needs of the community. OMH will continue to recruit new providers in specialties that will increase the variety of robotic assisted surgeries offered, giving new physicians the opportunity to work with the latest technology, even in a smaller hospital setting.

For more information on the da Vinci Surgical System and minimally invasive surgery options at OMH, please call the Physician Referral Line at (989) 731-2300.

Partnering with

825 North Center Avenue Gaylord, MI 49735 989-732-2100 • myOMH.org


RNs | LPNs | CNAs

advanced orthopaedic care since 1975

Orthopaedic expertise

for Joints, Bones, tendons… are you living with pain? let our orthopaedic surgeons help to improve your quality of life.

When life changes, we help.

Serving all of Northern Michigan 24 hours a day, 365 days a year.

Companions & Homemakers | Nursing Services Diabetic Care | Foot Care Services | Medication Management & Reminders | Transportation/Errands Bathing & Personal Care | Respite & Dementia Care Light Housekeeping | New Mother & Baby Care

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baystreetortho.com 231.347.5155 800.968.5155

C O M PA S S I O N AT E Q U A L I T Y C A R E (231) 932.0708 | www.monarchhomehealth.com

Our Doctors of Audiology • Will provide a diagnostic hearing evaluation to determine if hearing loss exists and if that loss requires medical attention. • Will discuss appropriate options and recommendations. • Will provide a lifestyle needs assessment to determine which hearing aid options will best meet your needs. Dr. Kathleen Sawhill and Dr. Sandy Leahy

3241 Racquet Club Dr., Suite B Traverse City, Michigan 49684 Conveniently Located in Logan Place West

231-922-1500

www.hearingsolutionstc.com

• Fit hearing aids based on Real-Ear Measures. These measures allow the Audiologist to assess the performance of the hearing aids while in the ear. This measurement allows for the most accurate hearing aid prescription. • Are members of the American Academy of Audiology. • Are certified by the American Speech, Language and Hearing Association. • Participates with most insurance plans.

MyNorth Medical Insider

MI 21


Go for it!

Pain free joints are closer than you think. Munson Healthcare’s orthopedic team has the technology and capability to help your hips, knees, and shoulders work and feel better. With 39 orthopedic surgeons performing thousands of procedures each year, you can see your doctor right here in northern Michigan and enjoy an active life again. Cadillac | Charlevoix | Frankfort | Gaylord | Grayling Kalkaska | Manistee | Prudenville | St. Ignace | Traverse City To find an orthopedic surgeon near you, call 800-533-5520. Because, when it comes to joint pain – together we’re stronger.

munsonhealthcare.org/orthopedics


Direct Anterior Approach to Hip Replacement

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Less Pain, Faster Recovery for Eligible Patients So much of medical advancement involves new technology, new machines, new devices. But occasionally medical advancement can happen when somebody approaches a common problem from a fresh perspective, a novel direction while using existing tools. This kind of advance is evident in an innovative approach that physicians are taking with hip replacement, explains Dr. Austin McPhilamy, M.D., an orthopaedic surgeon with Bay Street Orthopaedics, in Petoskey. “It’s a result of somebody looking at hip replacement in a new light, giving physicians and patients another approach,” he says. Key benefits of the new hip replacement procedure, called direct anterior approach, are short recovery time, low postoperative pain and stability—of course all outcomes are based upon the patient’s individual condition. Quality research supports these benefits, McPhilamy explains, “and anecdotally, I have seen the same among my patients.” In McPhilamy’s original medical training he learned the posterior approach, but in a recent fellowship he trained to learn the anterior approach. The direct anterior approach is sometimes referred to as minimally invasive for a number of reasons. For one, no muscles are split or cut in this approach. For the right patient, this may account for much of the rapid recovery, reduced pain and increased stability. Though hip dislocation is uncommon among hip replacement patients, the direct anterior approach has been shown to further decrease dislocation rates because it involves no violation of the posterior hip capsule or rotator muscles. “At the two-week checkup, nearly all of my patients who’ve had this procedure walk in without a cane,” McPhilamy says. A nice cosmetic bonus: the incision for the direct anterior approach is only about four inches long. If you are considering a hip replacement, research anterior and posterior approaches on credible websites and put together a list of questions to ask your doctor. The most beneficial approach for each patient varies based upon individual medical conditions and recovery goals, which are determined following evaluation and consultation with your surgeon. —J.S.

Austin McPhilamy

MyNorth Medical Insider

MI 23


1226 S. Garfield Ave ● Traverse City, MI 231-922-7285 ● www.FITFORYOU.info

Where Oh Where Has My Balance Gone Now?

F

or years you’ve never thought twice about putting on your pants or your socks in the morning, but then all of a sudden, out of nowhere you find yourself looking for something to hold onto or lean on just to get dressed. Well you are not alone… It seems as we start north of 50, we start losing our balance (amongst many other things). But there is good news!

Senior Balance and Stability. There are some very specific exercises that will help you progress quickly and keep you safe and independent. You will be asking yourself—‘why haven’t I started this sooner?’

Every Tuesday and Thursday at Fit For You Health Club we hold a Give us a call today at 231-9227285 and ask for Michele. class that tackles just that -

Protect your loved ones from falling! If someone in your life is at risk for falls, is living with pain, or suffering from dizziness help them to Love Their Life again by sending them to FYZICAL. Programs include FREE Assessments Physical Therapy Classes & Workshops Auto & Work Injuries ●

www.FYZICAL.com/ TC

(231) 932-9014

Two locations in Traverse City: Copper Ridge & Fit For You Health Club

MI 24

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Betsy Hardy

Early Childhood Development

PHOTO BY MICHAEL POEHLMAN

20 Years of Healthy Futures The more researchers learn about the earliest years of a child’s development, the more they see how important those years are to the long-term development of a child. The Healthy Futures program in Northern Michigan was created to make sure those earliest years, specifically the first two years, are as good as they can be for babies throughout the region. In the 20 years since Healthy Futures began, the program has served 25,000 children. The Healthy Futures mission is simple but also ambitious: in its service area, connect every family with a newborn to the resources they need to keep the baby healthy and developing, with an emphasis on encouraging breastfeeding, increasing immunization rates and accessing resources. The connection to the family begins right at the start, either prior to birth or in the hospital at birth. The family

meets a public health nurse, who will visit their house once they are home from the hospital to answer questions about being a new parent and to offer connections to other services in the community as needed. “The nurses are coordinating and linking, coordinating and linking,” explains Betsy Hardy, manager for women and children services for Munson Healthcare. The team does not create programming, but instead identifies needs and connects families to appropriate programs in their surrounding community. “For example, we don’t do playgroups, but we connect families to playgroups,” she says. After the nurse’s home visit, a visit in which the nurse will offer advice on breastfeeding, Healthy Futures will stay in touch with the newborn’s family through phone calls, texts and newsletters.

The results, Hardy says, can be seen in the numbers. Within the Healthy Futures participants, 68 percent are breastfeeding at two months, but the regional average is 50 percent breastfeeding at two months. Likewise with immunizations: 85 percent of Healthy Futures children are current with their immunizations at two years compared with 68 percent as a statewide average. In November 2016, Healthy Futures expanded to Grayling, which has had remarkable results with its own similar program. “We merged best practices with them and we are both stronger now,” Hardy says. “The hospital in Grayling is a very special place. The staff is super connected to their community.” One bit of proof: 95 percent of newborns are enrolled in the Healthy Futures Program. “It’s all about relationships,” Hardy says.—J.S.

MyNorth Medical Insider

MI 25


Advertorial

3291 Racquet Club Drive, Unit C • Traverse City, MI • 231-421-8000 or visit us at www.chroniccertcenter.com In today’s world, patients should have options. At Chronic, LLC, Pain and Addiction Management Center, we offer traditional as well as alternative approaches to symptomatic issues and aliments, pain, PTSD and addiction management. Empowering patients to take charge of their health and well-being is one of the most satisfying aspects of our professional practice. Whether we are assisting patients with getting certified for medical marijuana, closely monitoring their use of traditional pain management therapies or stabilizing patients addicted to opiates, we offer a holistic approach to treating the entire person. We want our patients to have a meaningful experience when they walk through the door.

Our doctors and staff maintain a position at the forefront of the ever expanding use of marijuana in the treatment of a variety of diseases and symptom combinations. We also offer traditional pain management for a limited number of patients who for whatever reason have been denied access to the larger pain management system. Through our experience with these patients we have come to understand the need for access to addiction therapies that have the ability to stabilize the patient’s symptoms while working with regional addiction counselors for coordination of care. Chronic, LLC, is now accepting new patients and welcomes you to make an appointment for an assessment today

New Look, New View!

Accepting New Patients Immediate Openings Available

Specializing in the diagnosis and treatment of arthritis and autoimmune conditions such as rheumatoid arthritis, osteoarthritis, gout and lupus.

BUY ONE GET ONE FREE! Change your look and your view with a new pair of glasses.

Purchase a pair of prescription eyeglasses or sunglasses and receive a pair of equal or lesser value ($250 max.) free. Current eyeglass examination is required. This offer includes designer frames and prescription sunglasses. * Some restrictions apply, see store for details. Offer also valid at Midland and Mt. Pleasant locations.

Irene Kazmers MD, FACP

Board Certified in Rheumatology Fellow Member, American College of Rheumatology Certified by American Board of Integrative Holistic Medicine

Dominic Giallombardo PA-C Adam Ancel PA-C

Members, Association of Rheumatology Health Professionals

www.facebook.com/TraverseVision 336 W. Front St. | Traverse City, MI | (231) 941-5440 | traversevision.com

MI 26

MyNorth.com

3280 Woods Way, Suite 1, Petoskey, MI 49770 Phone: 231-348-3800 l FAX: 231-348-3804 NMRheum.com


Accolades

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

McLaren’s Big Cardiovascular Award McLaren Northern Michigan was recently named as one of the 50 Top Cardiovascular Hospitals of 2018 by IBM Watson Health. The nationwide study is based on publicly available data for Medicare patients and is focused on performance in four key areas of heart care:  bypass surgery, angioplasty, acute heart attacks, and congestive heart failure. The study authors found that, taken as a whole, the Top 50 hospitals achieved higher in-patient survival rates, fewer complications, higher 30-day survival rates and lower readmission rates. “If all cardiovascular providers performed at the level of this year’s [Top 50]: More than 8,900 additional lives could be saved; Nearly 3,700 more heart patients could be complication-free; more than $1.4 billion could be saved,” the study states. Those numbers apply

only to Medicare patients; if the Top 50 results are extrapolated to all heart patients the numbers would be significantly higher, the authors point out. “We are elated to be recognized for this,” says McLaren Northern Michigan cardiothoracic surgeon J.D. Talbott, D.O. “This is what we do and how well we do it. It takes a lot of effort and everybody has to work hard to achieve this.” McLaren Northern Michigan is the only community hospital in Michigan to have received the award, and it places them in the top 3 percent of community hospitals in the nation. Hospitals do not apply to be part of the study, nor do they pay to be included in promotion of the results.—J.S.

MyNorth Medical Insider

MI 27


Advertorial

3930 Cedar Run Rd. • Traverse City, MI 49684 • 231-935-0390 vascularcentermi.com • info@vascularcentermi.com

A Fresh Approach To Vascular Care Board-certified, fellowship-trained vascular surgeons, Dr. Colburn, Dr. Boros and Dr. Roos have the education and training to offer a full range of vascular services, from time-honored traditional operative and endovascular procedures to new, convenient, minimally invasive outpatient procedures. Vascular surgery is the medical specialty that provides comprehensive care to patients with artery and vein disorders. Our team of doctors are experts in all aspects of vascular surgery including Carotid Artery Disease, Abdominal Aortic Aneurysm

Dr. Michael Boros, MD, FACS, Dr. Michael Colburn, MD, FACS, Dr. Matthew Roos, MD

Disease, Peripheral Arterial Disease and Varicose Veins. From evaluation, to treatment and follow up, Dr. Colburn, Dr. Boros and Dr. Roos take the time to carefully guide their patients through a customized treatment plan, precisely tailored to the individual patient’s needs to provide maximum benefit with the least possible risk. Trusted credentials, innovative technology and professional attention, the Vascular Center of Northern Michigan offers patients a fresh approach to vascular care. Contact us today to schedule an appointment.

I am living with diabetes. Northern Michigan Diabetes Initiative connects you to classes, seminars, and other resources to help you live life to the fullest while managing your diabetes. To learn more about how to thrive with diabetes, call 231-935-9227 or visit nmdi.org.

MI 28

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Advertorial

Dentistry with no shots, no x-rays and no drill! New advances in technology are making these dreams a reality. The STA “wand” computer controlled dental anesthetic delivery system allows for comfortable single tooth numbing that lasts for about an hour instead of the usual 2-4 hours. No more drooling or lip chewing for children and best of all, no painful shot. Our new CariVu system uses a patented transillumination camera to find cavities in teeth and is ideal for children. The process is much more comfortable than x-rays and uses zero radiation. For many procedures a laser can be used to prepare teeth instead of a traditional drill. We use the WATERLASE system to provide quiet, comfortable care. We were one of the pioneers in CAD CAM digital dentistry and have been using it since 2000. We have milled and placed more than 8,000 porcelain restorations. We custom shade match every case and are able to restore almost any tooth including implants in one appointment. No more gooey, gaggy impressions either! We are also a leader in diagnosing and treating occlusion related disease such as bruxism, TMJ disorders and sleep apnea. We utilize the highly accurate computerized bite analysis TEKSCAN system to analyze your bite and treat occlusal disorders. We practice holistic dentistry which involves taking a whole body approach and recognizing that all systems are connected. We look for the cause of problems rather than just treating the symptoms. We safely remove mercury silver fillings using tested IAOMT methods and use only nontoxic biocompatible materials such as Bis GMA free resins and metal-free porcelain. Our patients come from all over the state and country to experience quality patient driven care. Why not join them and experience the difference personalized care can make.

147 South Saint Joseph Street • Lake Leelanau, MI 49653 231-256-9142 • lisasiddalldds.com • IAOMT approved amalgam removal • Cosmetic metal-free BPA-free restorations • KOR whitening • Full mouth reconstruction • TEK SCAN bite analysis and equilibration • Zero radiation cavity detection CariVu • Laser periodontal treatment • Relaxing nitrous oxide in every room FREE • Botox and dermal fillers • Sedation dentistry • Non-toxic root canals • Sleep apnea and snoring appliances • One appointment crowns and bridges • Digital impressions • Interceptive orthodontics • Perfect fit dentures and partials • Implants • Straightening teeth (braces or aligners) • Zirconia implants • Laser correction of tongue ties in infants with nursing problems • Laser canker sore treatment • Correction of gummy smile • Closing of black triangles • Bite opening to give the look of a facelift • Ultrasonic and regular cleanings • Full periodontal treatment • Extractions • Pediatric dentistry • Geriatric dentistry • Special needs patients welcomed


Advertorial

Traverse Dental Associates

555 S Garfield Ave • Traverse City, MI 49686 231-947-0210 • traversedental.com

Dr. Van Horn, Dr. Lumbrezer, Dr. Swan, Dr. Mazzola, Dr. Mazzola

Relationship Based Dental Care We value the relational component of dentistry. We take time to get to know our patients and together, we customize a plan to meet the goals you have for your oral health and your smile. Drs. David Swan, Macare Lumbrezer, Dr. Christopher Mazzola, Josh Van Horn, and Christina Mazzola are all graduates of the University of Michigan School of Dentistry and continue to devote hundreds of hours to continuing education annually. Our dentists are leaders in their field; facilitating study groups and teaching other dentists at the distinguished Pankey Institute for

Advanced Dental Education. Our dentists, hygienists, assistants, and business team have a shared commitment of providing exceptional dental care, not the usual and customary. We understand that is it not in the best interest of our patients to allow insurance benefits to be the final determinant of care. Our goal is to provide you with the best options for care, the skills to give you excellent results, and the understanding that how you move forward with treatment is your decision.

ANDRIS KAZMERS, MD, MSPH, FACS

Board Certified in Vascular Surgery, Endovascular Medicine, Surgical Critical Care and Integrative Medicine

CORINNE H. TRUSOCK, PA-C TERESA KERSTING, PA-C At Integrative Cardiovascular Health and Wellness we provide traditional vascular surgery care, including medical management, and when appropriate endovascular and open surgical intervention. Our goal is to prevent or arrest progression of cardiovascular disease for those at all levels of health or illness. Our intent is to provide comprehensive, respectful care which takes into account the uniqueness and needs of each individual. Vascular lab onsite. 3250 Woods Way, Suite 5 & 6, Petoskey MI 49770 P: 231-881-9700 | F: 231-881-9698

MI 30

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Dental Technology

3-D X-Rays Improve Diagnostics One of the quiet technology revolutions to roll out in Michigan dentist offices in the past couple of years is the broader use of cone beam radiographic imagery—think of it as 3D X-rays. The system gives dentists far more precise information about several key aspects of a patient’s mouth: teeth, gums, bone and other hard tissues and even structure of the airway. While the technology is not new to dentistry, what is new in Michigan is that the state recently removed the requirement that dentists qualify for a certificate of need to purchase a cone beam machine. Now any Michigan dentist willing to invest in the equipment may do so, and many dentists have added this to their diagnostic arsenal. One of the key benefits of cone beam comes in planning and installing a single tooth implant, explains Traverse City dentist Phil Yancho, who recently purchased a cone beam imaging system. Because the

equipment shows such a complete and readable 3-dimensional view of a patient’s hard tissues, it greatly reduces uncertainties inherent in implant procedures. For example, say a patient has thin bone on one side of the implant. That can cause an implant to fail and is difficult to diagnose under traditional methods. With the cone beam technology, however, the hard tissue structures are clearly put on display, allowing the dentist to make adjustments. “You don’t have to open up all the soft tissue to assess it,” Yancho says. An important related bonus: the cone beam reveals nerves, helping ensure they are avoided and not damaged during surgery. The benefits of improved precision that results from cone beam is on display with an implant technique called “guided surgery.” The way it works is a dentist takes 3D images of a patient’s mouth and then sends the computer file

to a company that makes a sleeve that will precisely guide the implant into place. The sleeve is finely tailored to the specifics of the patient’s anatomy, helping ensure the post for the implant is mounted into the most solid hard tissue possible, which is essential to the longevity of the implant. The cone beam equipment can also integrate with CEREC in-office crown fabrication equipment, further improving the precision of the implant fit. Beyond the benefits to implant quality, Yancho also appreciates the improved diagnostic results. “I had a recent patient whose X-ray showed a dark spot. We didn’t know what it was, so we did a 3D image. It turned out to be not a problem, but we were able to diagnose it right then,” Yancho says. The equipment is also proving valuable in diagnosing sleep apnea because the cone beam can reveal narrow airways. (See related story on page 33.) —J.S.

MyNorth Medical Insider

MI 31


Advertorial

12776 S. West Bay Shore Drive Traverse City, MI 49684 67 South Benzie Boulevard Beulah, Michigan 49617 800-771-6951 www.northodontics.com

Dr. Northway

Advancements in Orthodontic Treatment On top of his comprehensive practices in Traverse and Beulah (both of which receive patients from all over Northwest Michigan) Dr. Northway is a contributor to and reviewer for the Angle Orthodontist and the American Journal of Orthodontics and a frequently invited speaker to the national and international orthodontic community. His most recent presentation, at the annual session of the American Association of Orthodontists, in San Diego, dealt with the treatment of congenitally missing maxillary lateral incisors and demonstrated how thousands of dollars could be saved by creatively closing the spaces, rather than placing expensive implants that are being shown to fail more frequently over time. He demonstrated that the closing technique is more aesthetic, and provides better function over the long term. On top of being less costly, space closure can be accomplished in the early teen years, rather than having to wait until cessation of growth (usually around 20), and avoids the need of fragile space maintaining appliances that further add to the cost. With carefully applied, sophisticated biomechanics, spaces can be closed in such a way that the common effects of congenitally missing permanent teeth can be mitigated; and a broad smile with full lip support can be provided. This is especially true when treatment is started early and the orthodontist can use growth to enhance tooth moving options.

Similarly, Dr. Northway’s ground breaking publication regarding “hemisection” to resolve the congenital absence of lower second premolars, has provided a method of avoiding the use of implants while almost always creating a situation where the removal of the lower wisdom teeth can be avoided – another huge cost savings to the patient and for the healthcare industry.

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Ask Your Dentist

Sleep Apnea Diagnosis

Dental Information

Know the Source The internet: a marvelous sharing of information and research that will help promote advances in dental science and care. The internet: a tremendous opportunity for people who want to exploit the internet with fake dental information and hokey products. The issue of fake dental news has been on the mind of Dr. Pete Piché in recent years as he has seen one patient after another rely on dubious products to care for their teeth and then end up with dental issues that need extensive care. “It’s complicated, because even if a particular product is effective in some cases, the real question is whether that product is right for you,” Piché says. If a patient doesn’t know the root cause of a dental condition, they have no real way of knowing if a given product will solve the problem. “I see products advertised as being able to heal cavities and stop gingivitis,” Piché says. “But they can be misleading if the diagnosis is incorrect.” What’s often surprising to dental patients is how quickly dental problems can develop when correct care stops. Piché recalls a patient who moved away and also let his dental care habits lapse. Just a year later, the patient returned because he was concerned about the state of his teeth and gums. “He had a lot of issues. Visible accumulation of bacteria around his teeth and gums, a significant infection. We started an intensive program with a special rinse and toothpaste and meticulous home care. Four weeks later it was like night and day—so much better.” The secret: good, scientifically proven products guided by professional

advice and a commitment by the patient to stick with the treatment protocol. Cases like that vividly illustrate that the mouth is a complicated place. Take, for example, the balance of bacteria there. “Think of the mouth as the first part of the digestive tract,” Piché says. There are multitudes of bacteria in the mouth, much of which is helpful, even essential, to our health. But some products and foods throw off that balance of bacteria. Xylitol, for example, is a sugar derived from birch trees. As promoted, it can be useful in reducing harmful bacteria in the mouth—and that’s true, Piché affirms. “But too much of a good thing can be a bad thing,” he says. If a person consumes too much Xylitol, there can be a negative impact on the later stages of digestion, such as creating bloating and diarrhea.” In addition to the fundamentals of flossing and brushing (ideally with an electric toothbrush), what’s one DIY technique that Piché does like? A swish with a dilute wash of baking soda, because the simple practice rebalances the pH of the mouth. “Many things can make the mouth too acidic, and that demineralizes the teeth,” Piché says. Chief culprits in creating acidic conditions: medicines that dry the mouth, smoking, and acidic foods like tomatoes and oranges and carbonated beverages. If you are doing at-home dental remedies, Piché is not saying to necessarily stop them, but definitely let your dentist know about the products you are using so he or she can help you make a scientifically informed decision regarding your oral health.—J.S.

Dr. David Swan still recalls the first time he learned about how dentists could be valuable in helping spot sleep apnea. “It was 1995, and I had already been in practice for 11 years,” Swan says. The instructor who was discussing sleep apnea was an inventor of a widely used sleep apnea device. But several years passed before Swan saw the topic of sleep apnea begin to appear in professional dental journals. Today, there are extensive courses and even mini-residencies in sleep apnea, which seems like an obvious development, since dentists are regularly focused on the key parts of the anatomy that affect sleep apnea. Consider as an example, people who grind their teeth. Dentists call that “bruxism,” and researchers have found that it can be a manifestation of sleep apnea. “Bruxism is a sign of interrupted sleep, and interrupted sleep can be related to sleep apnea,” Swan says. Patients with unusual wear on their teeth are now likely to be asked by their dentists if they are waking a lot, or if they have headaches. People with sleep apnea tend to be middle age and older, “so the radar goes up a bit with the age of the person,” Swan explains. Other indicators are people with shorter, thicker necks. Men are more likely than women to have sleep apnea. Snoring—does the sleep partner complain? Obesity can be a trigger—when the person goes to sleep, his or her tongue relaxes and falls back. But children are not immune from sleep disorders, including sleep apnea, and it’s important to diagnose as early as possible. In children, airway obstruction is more often the culprit than central nervous system problems. Sleep and breathing disorders can even affect the development of a child’s face, explains Swan. “If a child breathes through the mouth all night, the tongue doesn’t rest in the normal position—in the roof of the mouth—and then the arch develops narrowly, and then you can have dental problems because the teeth don’t mesh appropriately, he says. There’s even a connection to ADHD: sleep apnea wakes people often and lack of sleep makes ADHD worse. If you suspect sleep apnea might be affecting you or somebody you care about, bring up the topic at the next dental visit. —J.S.

MyNorth Medical Insider

MI 33


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office back home.” Digital x-rays, one visit CAD CAM designed crowns, and paperless records all contribute to the office’s advances in technologies. Although technology is important, the biggest point of pride for the doctors is the experienced, caring staff. Seeing a familiar face at appointments helps to establish relationships with the patients thus making visits enjoyable and relaxing. The most rewarding part of their day is helping patients change their smiles. Drs. Holcombe and Hall have emphasized this in their practice and are thrilled to see a new smile change a patient’s life.

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MyNorth MyNorth Medical Guide

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Medical Guide Area Agency on Aging of Northwest Michigan

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Acme Dental Health Care

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Audicare Hearing Centers

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Bay Street Orthopaedics

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Boardman Lake Glens

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Cosmetic Skin & Laser

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Cowell Family Cancer Center

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Cedar Run Eye Center

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Culver Meadows

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Munson Healthcare Community Health

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Northern Lakes Community Mental Health

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Northern Vision Eye Care PC

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Northway Orthodontics

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I love my patients’ courage. “My patients face the ultimate adversity, and yet they find ways to get up every day and live their lives and go to work and take care of their kids and fight for their life. I aspire to be a little bit like them every single day.” – Yelena Kier, DO I Medical Oncologist

Our regional cancer team works together to detect, diagnose and fight cancer. Wherever you live in northern Michigan, you have access to Munson Healthcare’s system of expert, coordinated cancer care. Together, we’ll make a plan. Together, we’ll get through this.

231-392-8400 | munsonhealthcare.org/cancer Cadillac | Charlevoix | Gaylord | Grayling | Manistee | Traverse City


Medical Insider 2018  
Medical Insider 2018  

Great minds, remarkable care: Pushing medicine forward in Northern Michigan / Medical detective work: finding the source of hidden strokes /...