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Medical Insider Professionals • Hospitals • Practices • Technology

An Annual Look at Advances in

Northern Michigan Health Care Inside Munson’s Oral Cleft Clinic: 30 Years and 600+ Child Patients.

McLaren’s Mobile Diagnostic Heart Unit Serves Small Towns.

What Laser Dentistry Means for You.

Heart Device Can Warn of Pending Heart Attack.

Munson’s New President Discusses Health Care Evolution. From the publishers of

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Al Pilong speaks at a gathering at Kid’s Creek, just outside of Munson Medical Center.

Munson Medical Center

Checking In... with Al Pilong, President

Al Pilong settled into his new job as president of Munson Medical Center last April, most recently serving as president of Winchester Medical Center, a 445-bed hospital in Winchester, Virginia, where he was also senior vice president of Valley Health System. Pilong has a master’s in business administration, a master’s in divinity and a bachelor’s in pharmacy, the specialty in which he began his career in the health industry.


With everybody focused on evolving health care regulations and insurance, can you give us a broad brush look at what that means for Munson? At its core, hospitals across the country are being challenged to provide higher quality health care with lower reimbursement. Over a 10-year period, Munson is looking at in the neighborhood of $150 million in reimbursement cuts. For us that means looking at overall operational performance, figuring ways to deliver health care more efficiently and reducing waste in the system. What is one of the central strategies in working toward that goal of more efficient care? From the time a patient comes in the door, we want to have a tightly coordinated care plan for that patient. We want all the clinical disciplines communicating on a daily basis, with updates and feedback on care. So we have done things like multidisciplinary rounding on a daily basis. That could involve

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nurses, respiratory therapists, social workers, physicians, whoever is on the team. The goal is to make sure patients are taken care of safely and efficiently and are not in the hospital longer than they need to be. We keep hearing that in the new world of health care, hospitals will be held responsible for the health of their surrounding communities. What does that look like? Yes, clearly health care is transitioning the focus away from acute care to overall management of the health of the population. Patients will see a difference not just with Munson, but also with their primary care physician. They’ll have more of an ongoing

The goal is to make sure patients are taken care of safely and efficiently and are not in the hospital longer than they need to be.

relationship with Munson and their doctors, not just interacting in a crisis situation. There will be more following up on discharge instructions, making sure patients are compliant with the instructions, keeping up with their prescriptions. 

What do you see on Munson’s horizon that has you particularly excited? I’m very excited about the cancer program here. We are in the process of designing a new cancer center, which is going to funded to a significant degree by the community through philanthropic contributions. We have raised close to $16 million of our $17 million campaign. This is a very generous and supportive community and coming from the outside, and seeing that support, has been very impressive to me. We expect to open the doors in 2016.

What are the bullet points on your to-do list for the coming year? We have focused on four things. Build on the legacy of quality, driving a culture of safe care delivered every time. Invest in our people, making this a great place to work. Partner effectively with physicians, supporting the practice of medicine. Focus on continuous improvement—always get better in order to be a sustainable place in the face of the challenging impact that health care reform will bring.


Community Care

Taking Cardiac Diagnostics


On the Road Northern Michigan is a big place and many people must travel far to reach a major hospital, a situation made more challenging when people are compromised by health issues or when the roads are coated with snow and ice. All of that factored into McLaren Northern Michigan’s decision to convert a semi-truck into a mobile cardiac testing laboratory and put it on the road. “We’re taking cardiac testing to the communities where patients live instead of making them travel long distances to a fixed site,” says Marla Clark, senior director of McLaren’s Heart and Vascular Program. Named the Noninvasive Diagnostic Unit, the specially designed semi-truck carries equipment for nuclear cardiac testing, cardiac stress testing and echocardiogram imaging, and associated specialists: an echocardiogram tech, an exercise specialist for the treadmill stress test, a nuclear tech specialist and a registered nurse. A physician is required to be onsite for supervision. “There has to be special site preparation for the truck—most important is the electricity requirements—so we can’t just pull up anywhere and operationalize the truck,” Clark says. Currently a medical clinic in Gaylord and a clinic in Rogers City can accommodate the mobile testing truck. Elk Rapids is next on the site plan and other sites are being evaluated. The cardiac team designed the truck from scratch, determining which pieces of equipment would go into it and figuring the optimal layout for patient flow. The testing equipment itself is standard testing equipment, but the team chose smaller models to maximize the space in the truck. One unexpected benefit is the nuclear testing unit in the mobile unit allows the patient to sit rather than lie in an enclosed tube, as the fixed-base

The cardiac team designed the truck from scratch, determining which pieces of equipment would go into it and figuring the optimal layout for patient flow. The testing equipment is standard, but the team chose smaller models to maximize the space in the truck. McLaren hospital testing unit requires. “For claustrophobic patients, we will use that when the unit is parked at the Petoskey McLaren Northern Michigan location,” Clark says. And as for road worthiness: “We make sure the equipment is really locked down,” Clark says. Fully outfitted, the rig cost just over $500,000, and was paid for through donations to the McLaren Northern Michigan Foundation.


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Our Experience Improves

We know our way around hearts. The Munson heart team has provided advanced heart care longer than any other team in northern Michigan. We do more heart procedures than anyone else – and our experience improves yours. That’s why we were ranked #1 in Michigan for overall cardiac services in 2012 and 2013.*

*Healthgrades 2012, 2013


Great care and great outcomes make us the regional leader in cardiac care. Ask your physician to refer you to the Munson team – the most experienced and advanced heart team in northern Michigan. We’ll feel better when you do. 1-800-637-4033 |


Targeting Top Care In Northern Michigan, diabetes is a very bright blinking dot on the health care radar screen. Roughly 14 percent of Northern Michiganders are afflicted with diabetes, a rate nearly 60 percent higher than the national average. Part of the reason is lifestyle, and part of the reason is cultural: we have a heftier than average population; we have an older than average population; and we have a higher than average Native American population, a group that is susceptible to the disease. But regardless of the reasons, top-notch diabetes treatment training is important for Northern Michigan physicians. Dr. Jill Vollbrecht, an endocrinologist affiliated with Munson Medical Center, saw a need for better dissemination of state-of-the-art diabetes treatment information when she began practicing in Traverse City in 2007. “What I saw was physicians were practicing diabetes medicine in very different ways,” she says. Overall, she felt the care was good, but she felt she could improve diabetes outcomes across the north if she could reach key caregivers—general practitioners in particular—and explain in a clear and nuanced way the standard-ofcare protocols developed by the American Diabetes Association. “As a specialist, all I do some days is diabetes, so what seems easy to me can be difficult for a general

provider. They have to keep up on many, many issues,” she says. Vollbrecht developed what was in essence a diabetes road show designed for general practitioners. She arranged a time to present at a given medical practice so that all the physicians there could hear the information together, and then she would meet with some of the group’s diabetes patients along with the attending physician. A key goal was reinforcing the need to stay fresh on ever-evolving standard of care protocols developed by the American Diabetes Association. To track the effectiveness of the education program, Vollbrecht gathered diabetesrelated data for patients treated by the physicians to whom she presented. The data show that patients who were already meticulous about managing their diabetes showed no significant change. But among patients who had been performing more poorly, there was meaningful improvement even 18 months after the visit. Thus far Vollbrecht has presented to 22 medical practices and is exploring the possibility of using teleconferencing technology to spread the word farther and faster. Vollbrecht wrote up her study, and it was accepted for presentation at the recent annual national conference of the American Diabetes Association, a prestigious invita-

Heart Valves

Advances in Minimally Invasive


Implant Surgery

Dr. Jill Vollbrecht

“As a specialist, all I do some days is diabetes, so what seems easy to me can be difficult for a general provider. They have to keep up on many issues.” tion that included the results being published in the Scientific Sessions Abstract Book, a supplement to the journal Diabetes.


Physicians at McLaren Northern Michigan have recently begun implanting aortic valves in a minimally invasive way directly through the chest wall, without open heart surgery. The procedure is a step forward in catheter technology and a key advance for especially frail patients. We asked Dr. John Talbott, a surgeon with Michigan Heart and Vascular Specialists, to explain the procedure. One of the more common forms of heart disease is aortic stenosis, a condition in which the aortic valve becomes stiffened by the accumulation of calcium on and around the valve tissues. A stiff aortic valve does not open and close adequately, and the blood flow through the valve can be greatly reduced. Of course any heart valve with reduced flow

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Heart Valves, from pg. 3

is a bad thing, but reduced flow through the aortic valve is noteworthy because it is the valve that blood passes through as it leaves the heart and surges out to the entire body. Generally, patients who suffer aortic stenosis undergo open heart surgery in which surgeons remove the damaged valve and implant either a tissue valve from a cow or a mechanical valve, Talbott explains. But some patients are too frail to withstand open heart surgery. In the recent past, those patients would have been told nothing could be done and they’d be sent home to wait for the disease to claim their lives. In response, researchers developed a way to install an aortic valve by using a catheter, thereby avoiding open heart surgery. The FDA originally approved a procedure in which the surgeon, via catheter, guides a balloon tip through arteries in the groin up into the aortic valve and then expands the balloon, widening the opening. The surgeon then retracts the balloon and a catheter delivers a compressed bovine valve mounted on a stainless steel mesh band. The valve is positioned and

a balloon expands it into place. Tiny metal prongs anchor the valve into surrounding tissue. “This is done without stopping the heart,” Talbott says. But even this procedure doesn’t work for all patients. In some patients with vascular disease or naturally narrow blood vessels, the surgeon is not able to fit the valve through the arteries, Talbott explains. “Now we have another option,” he says. “We make a small incision below the left breast, expose the heart in a small area and, using the same aortic valve as with the groin procedure, use a catheter to go in through the apex of the heart.” The apex is the lowermost chamber of the heart. Surgeons insert the catheter through the heart wall, guide it through the bloodfilled chamber of the left ventricle and position the valve. The McLaren team has thus far implanted 30 aortic valves via catheter, with four of them inserted through the chest wall. Recovery time is one of the most remarkable aspects of the catheter-placed implants. “I recently had a patient who left the hospi-

Dr. John Talbott

tal in three days and went home and booked a cruise,” Talbott says. Currently the FDA has approved the catheter implants only for patients not eligible for open heart surgery.


Infant Hearts


Spotting Congenital Heart Defects at Birth Sometimes a newborn looks fine and the baby’s heartbeat can sound okay even though the heart suffers from a life-threatening birth defect. If the baby doesn’t start to show signs of weakening during the standard 24-hour period to discharge, Dr. Steve St. Charles doctors can miss the heart problem and send the infant home, though the baby is getting weaker by the hour. Eventually parents notice their baby does not seem healthy, but by then the situation is likely to be much more serious because the baby is so depleted. Fortunately there’s a simple test that helps identify infant heart problems, and it will become mandated statewide on April 1, 2014. The inexpensive test (just $5–$10) with a pulse oximeter, evaluates the oxygen saturation of the baby’s blood. If the oxygenation levels are low, physicians will order an echocardiogram of the heart to make sure nothing serious exists.

“Every hospital with a birthing center will have to do the screening, but Munson is the only hospital in Northern Michigan that has the capability of performing pediatricspecific echocardiograms,” says Dr. Steve St. Charles, director of Munson Medical Center’s Neonatal Intensive Care Unit. Making use of the latest technology, echocardiogram technicians at Munson will be able to connect telemedically and work in real time with pediatric cardiologists on congenital heart teams, like those at the University of Michigan and DeVos Children’s Hospital, to evaluate the heart structures of newborns. If cardiologists do confirm problems, they can work quickly to stabilize the baby and develop surgical strategies before the baby weakens too greatly. “Only one in five or six babies that fails the screening will actually have a heart defect,” St. Charles says. The echocardiogram with telemedicine capabilities is a nice service to Northern Michigan families, St. Charles says, because per-

forming the echocardiogram in Traverse City saves most families from having to go downstate, which avoids the stress on the baby and shortens that anxious time when parents are wondering about their newborn.


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Atrial Fibrillation



Cryoablation Procedure Available the vein, which could leave gaps,” Overton says. Dr. Naomi Overton, an electrophysiologist at Also the procedure took a fair amount of time and McLaren Northern Michigan, began using cryoinvolved radiation exposure. ablation to treat a heart condition known as atrial fibrillation about a year ago. We ask her to proResearchers took a step further when they develvide some background on the disorder and to oped a way to use intense cold to cauterize the tissues in a process called cryoablation. The delivery discuss the new technology. Nearly 3 million people in the United States mechanism is still a catheter, explains Overton. But have atrial fibrillation, a disorder in which the at the tip of the catheter is a tiny balloon that, once heart’s regular pulse becomes confused and irregin position, is inflated to fill the space at the base ular because of interference from random electriof the veins. When Overton determines that the cal impulses that begin to fire in the heart—most balloon has complete contact with the target area, often from near the roots of the pulmonary veins. “It’s really amazing,” she fills the balloon with liquid nitrogen at nearly In mild cases, the condition may pose limited risk, -100 degrees F. The cold ablates the tissues in a more Overton says. but for many patients, the condition results in perfectly seamless ring—no gaps—and does not add “You can see the radiation to the process. significantly diminished heart pumping ability. In electrical impulses addition to fatigue and shortness of breath, stroke “It’s really amazing,” Overton says. “You can see start to diminish is a serious threat of the condition because the the electrical impulses start to diminish within 30 within 30 seconds, seconds, but we leave the balloon in place for two heart’s impaired pumping results in blood poolbut we leave the ing in the upper chambers of the heart, which minutes.” Generally she inflates the balloon with can allow clots to form. balloon in place for cold liquid nitrogen twice during the procedure. In recent years, researchers figured ways to Overton typically has patients spend the night in the two minutes.” block the random impulses from spreading to hospital for observation, and they go home the day the rest of the heart by cauterizing tissue at the base of the pulafter the procedure. In addition to improved heart performance, monary veins. Originally physicians used the pointed tip of a a key outcome of the procedure is it allows many patients to stop taking anti-coagulant medication as a stroke preventative. catheter to deliver radiofrequency radiation at the site to achieve ablation. But the technology had some drawbacks, Overton explains. “The physician had to move point by point around 800.248.6777,

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Moving in the right direction...

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For More Information Contact Dan Eaton, RN, CBIS, State Director 1-800-359-0903 MI 8

30th Anniversary!

Munson’s Oral Cleft Clinic


“How do you determine the value of a normal appearing face as you go through life?” asks Dr. Thomas Doerr, medical director of the Oral Cleft Clinic at Munson Medical Center. The question, of course, has no real answer, yet it touches each of us in a powerful way. Doerr came to understand that more than three decades ago during his plastic surgery residency and eventually vowed to do what he could to help children born with deformities related to the face and mouth. When he began practicing in Traverse City, Doerr formed the Oral Cleft Clinic, which has by now served more than 600 children and still serves children today. For many of us, the term oral cleft recalls something that might seem like a straightforward repair: smooth over a split in the lip. But cleft palates can be far more complicated, involving mouth structures, the ears’ Eustachian tubes, jaws and more. Beyond that, children dealing with facial surgery often need social and psychological support, hearing assistance, speech therapy and nutritional counseling, since chewing might be impaired. Doerr realized at the start that oral cleft challenges demand a multi-disciplinary strategy that keeps the whole child in mind as caregivers map out a health care future for a patient. Today Munson’s oral cleft team includes

Dr. Thomas Doerr

23 professionals from a range of specialties. Doerr appreciates the technical expertise required of the surgeries he performs and compares working in a small child’s mouth

Doerr realized at the start that oral cleft challenges demand a multi-disciplinary strategy that keeps the whole child in mind as caregivers map out a health care future for a patient. Today Munson’s oral cleft team includes 23 professionals from a range of specialties.

to performing surgery “inside a matchbox.” But the emotional rewards are what fuel his passion for the clinic three decades on. “I have never felt more responsibility than when I have taken a young child, even as young as four months old, from the mother and have her trust me to cut her baby’s lip apart and repair it. That is a profound trust, a sacred trust, and that is not lost on me,” Doerr says.

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Sound Dr. Eric Snyder and patient.

Many people are able to hear perfectly fine in one ear but are essentially deaf in the other ear. It’s a condition some people are born with and one that others develop as a result of disease, such as Meniere’s disease or diseases that lock up the bones that transmit sound in the middle ear. Previous surgeries might have also caused damage to ear structures. The conditions stop sound from being transferred through the middle ear to the inner ear, but for many of these people, the inner ear itself is fully func-

Cancer Center

A New Building, a


New Paradigm in Care If all goes according to plan, Munson Medical Center will be opening the doors of a new cancer center in 2016, the realization of a dream long nurtured by Traverse City oncology professionals, including Dr. David Gordon, one of the physicians to first take the idea to the Munson board of directors back in the mid-aughts. “Yes, this is a building, but it really represents a change in the paradigm of care,” Gordon says. The change Gordon refers to involves a much more coordinated multi-discipline team approach to cancer treatment that will shape the future of the specialty. “To do that most effectively, you have to have the oncology team and equipment all in one place,” he says. These days, cancer treatment strategies are very complex, and opinions and evaluations from many specialties go into making the final diagnosis and treatment plan. “But with specialists in separate offices, it might be weeks before a patient makes all the rounds and ends up with the right plan,” Gordon says. Centralizing the specialists into one building “will cut short that diagnosis and planning time and reduce the emotional trauma on the patient,” he says. Munson leaders also recognized that if they are to continue to attract highly skilled cancer specialists, they need a quality center and a highly developed multidisciplinary paradigm because that is what top schools are teaching today, and is what top recruits will be looking for as they graduate. The center will also house critical ancillary professionals, like financial counselors and social workers. An important change will be the use of a patient navigator, a team member to whom the patient can turn for all of his or her questions. Gordon emphasizes the center will benefit surrounding communities as well. With a collaborative strategy, specialists at the Traverse City center will work closely with smaller regional hospitals in the Munson network to offer more services there—meaning patients could avoid traveling to Traverse City for some of the more routine aspects of treatment. The $45 million building relied on $17 million in private donations, and the foundation is about $1 million dollars from the goal. Local philanthropist and USRobotics founder Casey Cowell jumpstarted the effort by donating $5 million to the project.


for a Deaf Ear tioning, meaning if the sound could reach the inner ear, the person could hear it. Taking advantage of that inner ear functioning is the goal of the Bone Anchored Hearing Aid, tradename BAHA. The BAHA transmits sound to the inner ear by using the sound transmission qualities of the bone of the skull itself. “The real benefits are the patient feels more balanced and is much better able to hear when there’s a lot of background noise, like in a crowded restaurant,” says Dr. Eric Snyder, a physician with Petoskey ENT Specialists, who began offering the BAHA technology in March 2013. The device is comprised of two components. One component is a tiny titanium post that Snyder surgically implants into the patient’s skull a couple of inches behind the ear. The post, which is about as big around as an ink pen, goes about 4 mm into the bone—at the

“The real benefits are the patient feels more balanced and is much better able to hear when there’s a lot of background noise, like in a crowded restaurant –Dr. Eric Snyder target site, the skull is typically 8 mm to 10 mm thick, Snyder explains. The post protrudes above the skin about 2 mm. Once the implant is fully healed and anchored, which takes about three months, the patient clips a sound sensor device onto the post. The sensor is removable, so the patient would take it off during showers or bedtime. “My first patient was born deaf in one ear and she really loves the change,” Snyder says. He is currently the only physician offering the technology in Northern Michigan. Most insurance companies, as well as Medicare and Medicaid cover the cost of the device if the patient meets the criteria.

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Childhood Cancer

Camp Quality

Lets Kids Be Kids

Camp Quality, a year-round support program for children with cancer, celebrates its 26th year in Michigan this year. We check in with Executive Director Kristyn Balog to learn more about this service that means so much to children and their families. Give us the essence, the central spirit of Camp Quality. We are about letting kids with cancer be kids again while also providing yearround support for children with cancer and their families. So the form that takes is we provide recreation and camp activities for ages 4 through 17.


Can you share some specifics, what kinds of activities? We provide experiences that the children might not have the courage to do on their own, or have the equipment to do. So we have adaptive equipment and provide a safe environment for them to experience activities, like, say, downhill skiing as an amputee. We have equipment to let a child do that—the harnesses, the medical staff nearby. Or riding a zipline without a threat to their health. Or baseball. If a child needs somebody to push his or her wheelchair around the bases, we have that. They may not be comfortable having somebody do that at home, but here it’s all okay. Like I say, it’s about creating an environment that lets that child be a child. Do you hear stories of kids who carry on with a new activity after they’ve left camp? Sure. We had a child who tried downhill skiing, and then I heard the next year that he joined the ski team at school. Another child tried swimming and then joined the swim team.

Where are the camps? We have summer camps on Beaver Island, in Lake Ann and in Fenton. We also do weekend camps year round. Do parents accompany the children during the weeklong summer camps? No. Of course many ask for permission to accompany their child, but we don’t allow that. We emphasize that this is also a time to give parents a rest and to take time to focus on the other children in their family. How do you get parents to be comfortable leaving their child for a week? We prove that we understand their child’s needs. We know he wets the bed— they all do. We know she is bald, she’s going through chemo. We have a com-

panion assigned to each child and we have medical staff and equipment. It’s about building trust. Trust is the underlying thing. Our volunteers are so grateful for that opportunity to work with a child. We say thank you for allowing us to have your child for a week. How does a family sign up? Well, first of all it’s free. No charge to the family. If they are interested they can check out our website and then call or email. We have never turned down an applicant. And we have several children aging out of the camp this year, turning 18, so we have openings. Please encourage people to contact us.

231.582.2471 MyNorth Medical Insider

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Dr. Laura Lenkey and patient.


Fresh Hope

for Brain Health

Neuroplasticity, neurogenesis, synaptogensuffered brain damage. She came to Lenkey’s esis … each of these words relates to the idea practice nearly a decade later able to make The core of Lenkey’s practice that the normal human brain can adapt, grow only one sound, a high-pitched wheeze upon involves treating people with inhalation. After hours and hours of therapy, new cells and form new synaptic connections brain trauma and disease, but she throughout life. It’s a hopeful message to share, Abby D. can now formulate sentences of four says everyday people who are says Dr. Laura Lenkey, of Abby D. Center, a cogwords, order food in restaurants and is able not suffering those ailments can to display her sense of humor. “She’s amaznitive health and neuro recovery practice with learn about brain health from the ing,” Lenkey says. offices in Petoskey and Williamsburg, because for successes of patients Lenkey sees a growing need for her serso long people were told that the brain’s capacin rehabilitation. vice as the general population ages and Baby ity is fixed at birth and declines throughout life. Boomers start to focus on keeping mentally sharp as they grow older. The core of Lenkey’s practice involves treating people with brain “We can take a mental baseline for a patient,” Lenkey says. In this sittrauma and disease, but she says everyday people who are not sufuation, a patient would come in, take a test and then be able to check fering those ailments can learn about brain health from the successes future performance on similar tests against that baseline as they age. of patients in rehabilitation. Lenkey also sees good signs in a widening If they spot a problem area, like, say, word recall, Lenkey and her team awareness of the potential of the brain to heal and move forward. “I think the war has had something to do with this,” she says. “There has been can suggest brain exercises and services that would help improve perso much written about soldiers with brain injury, and I think it has carformance. ried over into a greater awareness about brain health.” Lenkey’s favorite example, and the person after whom she named 231.348.7777 her practice, is Abby D. As an 11-year-old, she was hit by a car and

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MI 15

We are Munson Healthcare. We are the people who care for the people of northern Michigan. We believe the best health care is delivered as close to home as possible by the people who live and work in our region’s unique communities. We are dedicated to high quality, safe, affordable health care. We are eight community hospitals committed to the well-being of our patients. We collaborate in a regional system of care, knowing that working together and sharing our strengths allows us to serve our communities better. We are eight supporting partners contributing to regional health care through coordinated services that result in quality, convenient, easy to use care for our patients and their families. Together, we are Munson Healthcare. Munson Healthcare Hospitals Charlevoix Area Hospital Kalkaska Memorial Health Center Mercy Hospital Cadillac Mercy Hospital Grayling Partners Kalkaska and Munson Dialysis Centers Munson Home Health Munson Hospice North Flight EMS

Munson Medical Center Otsego Memorial Hospital Paul Oliver Memorial Hospital West Shore Medical Center Munson Mobile Imaging Northern Michigan Supply Alliance Great Lakes Mobile PET Northwest Michigan Surgery Center

To find a physician in your area, call Munson HealthLink at 1-800-533-5520 or visit


Device Detects Heart Attacks, Sends Alarm


Dr. Brian Jaffe

When it comes to saving people from heart attacks, time is truly of the essence, but the numbers show that we have a long way to go to achieve the kind of immediate response that victims need. With every half hour left untreated, the mortality rate for heart attacks increases by 7.5 percent, yet on average today three hours pass before a heart attack victim receives treatment. A big part of the problem is that one-third of heart attack victims do not exhibit classic signs of a heart attack and are not even aware they are having one. Dr. Brian Jaffe, a cardiologist at Munson Medical Center, is currently helping test a device designed to address the treatment time-delay head on. The implantable device provides early warning of heart attacks and

helps ensure that patients receive help as soon as possible. The device is a widely used implantable defibrillator that has been modified to also be able to monitor a patient’s heart rhythm and trigger an alarm when things go awry. When the device— the Fortify ST, by St. Jude Medical—detects irregularity in a specific portion of the heart’s wave rhythm, a portion called the ST segment, the device vibrates, alerting patients to the irregularity and cluing them to seek immediate help. “The ST segment was chosen because when a person is having a heart attack, the ST segment typically becomes very abnormal,” Jaffe says. Munson became a test site after Jaffe heard about the testing protocol through professional channels. The plain logic of the

When the device detects irregularity in a specific portion of the heart’s wave rhythm, the device vibrates, alerting patients to the irregularity and cluing them to seek immediate help.

device instantly appealed to him. “There’s no better way to monitor heart rhythms than from inside the heart, and we have all these patients with implanted devices that are able to do that, defibrillators,” he says. “I thought, Great, sign us up.” Munson’s cardiac unit has a long history with St. Jude Medical, and the device maker was aware of the Munson team’s strong performance, so the hospital was soon added as a test site. Nationwide, 200 hospitals are implanting the research device, with a maximum number of 5,228 test subjects. Munson will implant 20, and as of September had implanted 11. “It’s exciting being a test site because we can try this new device that otherwise we would not be able to try for three more years when it becomes commercialized,” Jaffe says. The experimental device is currently approved only for patients who have already experienced a heart attack.

231.935.5000 MyNorth Medical Insider

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McLaren Northern Michigan– Elk Rapids Family Medicine Your best source for dependable family care When you want top-rate care from experienced health care professionals, choose McLaren. You can always count on us for the quality care your family needs and deserves. To schedule an appointment, please call (231) 2648282. For your convenience, same-day appointments are available. Now accepting new patients McLaren Northern Michigan– Elk Rapids Family Medicine 124 Ames St. Elk Rapids, MI 49629 (231) 264-8282

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NEW Licensed Adult Foster Care Home in Elk Rapids Township Cherry Suite, Assisted Living & Licensed Adult Foster Care Home (formerly Northwood Village Care Home) is 4,500 sq. ft., in a beautiful setting, wooded landscape, many windows facing maple & oak trees. 5 private rooms, 3 semi private rooms for male & female residents. Long-term care, rehab/short term care, or even day care. Accepting residents with long-term care insurance & private pay. Melanie White is the on-site resident/owner and an LPN with 25 years experience in the care of elders and adult foster care homes.

Melanie White, Owner

Licensed AFC

10774 US-31 S. • Williamsburg, Michigan 231.631.1836 •


From left to right: Michelle Green, PA-C, and family medicine physicians Peter Alvarado, DO, Ann Kuenker, DO, and James Lawrence Jr., MD

ating 100 Years Celebr Designers & Engravers of Domestic & Imported Granites 806 Hastings Street • Traverse City, MI 49686 231-943-8777 • 888-470-6591

A Family Business That Cares... Pre-Planning Consultations Available

Passion Knowledge Commitment Our goal is to engage individuals in functional and purposeful activities to regain and/or maintain communicative, cognitive, physical and occupational health and wellbeing. 2206 Mitchell Park #14, Petoskey

Call (231) 348-7777

Guaranteed Excellence in Workmanship Compassionate Attentive Service Northern Michigan’s Largest Indoor Showroom

Dr. Laura E. Lenkey





> Certified Assistants Bonded & Insured STAY Nursing IN THE COMFORT> Licensed, OF YOUR OWN HOME! > Light Housekeeping STAY THE COMFORT YOUR OWN HOME! ININ THE COMFORT OFOF YOUR OWN HOME! > Live-In Companions > STAY Meal Prep > Available 24/7 ng Assistants > Days > Licensed, Bonded & Insured > Light Housekeeping & Nights Assistance > Certified Nursing Assistants >> Bathing Licensed, Bonded & Insured > Light > Light Housekeeping Licensed, Bonded & Insured Housekeeping > Certified Assistants nions > MealNursing Prep >>Available 24/7 > Skilled Nursing Care > Errands & Shopping > Live-In Companions > Meal Prep > Available 24/7 > Meal Prep > Available 24/7 > Live-In Companions COMFORT OF> Bathing YOURAssistance OWN HOME! Serving Grand Traverse, Leelanau, Antrim, Kalkaska Counties > Days & Nights > Bathing Assistance > Bathing Assistance > Days & Nights g Care > Errands & Shopping STAY IN THE COMFORT OF YOUR OWN HOME!

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MyNorth Medical Insider

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My Vision Is Fine Why do I need an eye exam? BY Robert K. Butryn, M.D. Robert K. Butryn, M.D. Board Certified Opthamologist

Northern Vision Eye Care delivers state of the art medical, surgical and optical eye care with a passion for excellence, individuality and community service.

4033 Eastern Sky Drive Traverse City, Michigan 49684 (231) 932-9000

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Your sight is truly a miraculous gift. Did you know your eyes can see into the past? The Andromeda galaxy is 2.8 million light years from earth and can be seen as a fuzzy speck of light below the constellation Cassiopeia. The light you see traveled 2.8 million years to reach your eye; therefore what you are seeing is actually 2.8 million years into the past! Can you see the Andromeda Galaxy? Your eyes are your windows to the world. You go to your annual physical to screen for health problems without warnings like cardiovascular disease or cancer. Your eyes also need routine exams to screen for eye diseases without warnings such as glaucoma and diabetic retinopathy. With people living longer today, preserving your eyesight will enhance your quality of life as you age. Did you know that approximately 19 million adult Americans have diabetes, and diabetic retinopathy is the leading cause of blindness among working age Americans? Diabetic retinopathy can be the first sign of diabetes. Diabetes affects the small blood vessels throughout the entire body, including the eye, and these changes can be identified with a non-invasive eye exam. Several decades of clinical research and the advent of medical lasers and multi-center clinical trials have paved the way for treatment strategies that are 90% effective in preventing severe vision loss. Diabetic eye disease is best treated before you lose vision. With access to the latest technology, such as the Optopmap retinal scanner, fluorescing angiography,

OCT laser scanner, digital photography, and argon lasers, we can optimize our detection and treatment of diabetic retinopathy. Unlike diabetes, glaucoma only affects the eye and has no early symptoms. Nevertheless, glaucoma is the leading cause of legal blindness in the United States. The vision loss is painless and difficult to notice in the early stages. Over 7 million office visits occur annually to monitor patients who are at risk for or who have glaucoma. It is often referred to as the sneak thief of sight, because nearly half of those affected are unaware of their disease. In the past, glaucoma was synonymous with high pressure within the eye. We now have a much better understanding of the complexity of glaucoma and its risk factors. For example, glaucoma can occur with normal eye pressures and high pressures do not always mean glaucoma. Since there is no single test to detect glaucoma, we are diligent in screening and monitoring our patients who are at risk for developing vision loss. Combining eye exams with advanced technology such as retinal scanning lasers, corneal thickness measurements, and blue-yellow visual field analysis allows diagnosis of glaucoma in its earliest stages. This is important, because early diagnosis and treatment preserves sight. We often take for granted just how precious our eyes are. Unfortunately many people equate their eye health to simply needing glasses or seeing clearly and often do not realize that there are silent eye conditions which can result in vision loss if left untreated.


“When we discovered that Cooper needed to have a tonsillectomy performed this past August, we were relieved to know that our doctor would be performing the surgery at Northwest Michigan Surgery Center. We've now had three occasions to visit the facility and they've all been wonderful. They greet you with a smile, are very prompt and keep you well-informed. The staff provided extraordinary care and support before, during, and after the surgery. It's a well-oiled machine” - Julie Clark, Traverse City CAPTION: (L-R) Julie Clark, Cooper Clark and Richard C. Schultz, Jr., M.D.

Quality Care. Lowest Cost. Higher Standards. 4100 Park Forest Drive • Traverse City, MI 49684 • 231-392-8900 • 877-392-9800 Northwest Michigan Surgery Center was developed by local physicians, in a unique partnership with Munson Medical Center, to create a state-of-the-art surgical care center. A Center that is patient-focused, driven by exceptional outcomes. Quality Care. Like the Clarks, when you and your physician determine that Northwest Michigan Surgery Center is the right facility for your surgery or procedure, we stand ready to serve you...with the exceptional care that you deserve. Julie really appreciated how the nurses, and our real-time location system, kept her up-to-date throughout the procedure. “It’s very reassuring to know what’s going on at all times. I knew when Cooper was in surgery, when the procedure was complete and when he was in recovery. With so much communication and information, the stress and worries were greatly reduced. It was a great, great experience.” By only performing same day surgeries and procedures, Northwest Michigan Surgery Center is able to provide the highest level of care and jump-start the healing process by allowing patients to recover in the comfort of their own home, surrounded by family and friends. Today, Cooper is back in school and back to enjoying his electronic devices. Lower Costs. As in the case of the Clarks, our highly-specialized approach to outpatient surgeries and procedures allows us to lower the cost of health

care and pass along direct savings to patients through lower copays and out-of-pocket expenses. Private insurers, Medicare and Medicaid, and employers also benefit from the lower costs. According to the ASCA, Medicare saves $2.5 billion annually when surgical procedures are performed at an ambulatory surgery center instead of a hospital outpatient department. Highest Standards. Northwest Michigan Surgery Center is subject to rigorous oversight and independent inspections to assess compliance with both state and national clinical, operational and quality standards. In addition to state and Medicare standards, Northwest Michigan Surgery Center is also recognized by the Accreditation Association for Ambulatory Health Care (AAAHC), the national leader in accreditation of ambulatory surgery centers. We are also a proud winner of the prestigous Voyance 2012/2013 APEX Quality Award, recognizing healthcare organizations that demonstrated the highest level of excellence in patient satisfaction and overall care over the past 12 months. To learn more about Northwest Michigan Surgery Center, please go to: To learn more about the ambulatory surgery center industry, please go to: MyNorth Medical Insider

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Charlevoix Area Hospital 14700 Lake Shore Dr • Charlevoix, MI 49720 • 231- 547-4024 • Charlevoix Area Hospital is one of the 1,340 critical access hospitals in the United States today. Having served northern Michigan for over 90 years, we have seen our fair share of changes. The practice of medicine has undergone a transformation over the years and care provided in hospitals is likewise radically different than it was so many years ago. But what does it mean that today we are a “critical access” hospital? Fundamentally, it means that our hospital has been deemed vital to the area we serve. Roughly 1,340 rural hospitals, or a quarter of all American hospitals, serve rural communities and are deemed a critical access hospital. This means that a hospital cannot have more than 25 beds and be a certain distance away from another hospital, or be deemed a “necessary provider” hospital by a state governor. As a critical access hospital, Charlevoix Area Hospital provides a wide variety of services. From general surgical needs, orthopedics and neurosurgery, to primary care, obstetrics and pediatrics, we offer quality care close to home for thousands of people each year. Each year we welcome more than 200 newborns as one of only six critical access hospitals in Michigan maintaining full service Obstetrics care. Every month, on average, we perform more than 250 surgical procedures. Many critical access hospitals, including Charlevoix Area Hospital, are taking increasing care of an aging MI 24

population. We are most proud of our patient satisfaction scores that reflect the intensely personal, one-on-on attention our patients need and deserve. We believe that each person is unique; their care should be as unique as the individual. It is the caring and attentiveness of doctors, nurses, and all staff that distinguishes Charlevoix Area Hospital from other, larger hospitals. Within the city of Charlevoix, Charlevoix Area Hospital is the largest employer, employing over 350 individuals. Based on a steady increase of health care workers, the Hospital continuously offers new employment opportunities each month. The economic impact that each individual employee has on the local community is significant. Each year, the employee base has an economic impact on the community of 2.9 times of their annual payroll. This translates into a continuous positive economic growth for local businesses The importance of critical access hospitals continues to remain high within the health care industry. At a minimum, without critical access hospitals, individuals living in rural communities would have to travel greater distances to receive health care. Charlevoix Area Hospital, along with other critical access hospitals, continues to provide quality health care for individuals living in rural communities. We are proud to offer “hometown health care with worldclass caring”.


CAPTION: (L-R) Michael H. VanderKolk, MD, FACS, William P. Potthoff, MD, FACS, Richard N. Tooley, MD, FACS, Walter C. Noble, MD, FACS, Thomas J. Quinn, MD, FACS, William R. Ranger, MD, FACS

Surgical Associates 1221 Sixth Street, Suite 306 • Traverse City, MI 49684 231-935-2400 •

Growing our practice into the future… Surgical Associates has been caring for Northern Michigan for more than 30 years. Comprised of board certified specialists in general, colorectal, and vascular surgery, we provide the highest quality of care and the latest innovations in surgery. New to our practice this fall is Adrian Seah, MD, who joins us following General Surgery residency at the University of Vermont/Fletcher Allen Healthcare. Dr. Seah is also a graduate of both the University of Michigan and Michigan State. His special interests include esophageal reflux, vascular access, and abdominal hernias, Adrian Seah, MD and he offers all general surgery services. Dr. Seah is now accepting new patients. Drs. VanderKolk, Potthoff, Tooley, Noble, Quinn, and Ranger continue to offer expert care in the areas of breast, endocrine, colorectal, and vascular surgery. Together, they have over 130 years’ experience in their specialty areas. We offer routine EGD and colonoscopy screenings, as well as screenings for vascular disease. As always, we continue to incorporate new technologies and techniques into our practice to better serve the medical needs of you and your family. We now have two physicians utilizing the laparoscopic da

Services Include: • Hernia Repair • Breast Surgery • Endocrine Surgery • Colorectal Surgery • Cancer-Related Surgery • Gallbladder Surgery • Vasectomy

• Varicose Vein Treatment • Vascular Surgery, including AAA and PAD treatment • Vascular Ultrasound Testing • Laparoscopic Surgery • Upper Endoscopy • Colonoscopy • Flexible Sigmoidoscopy

Vinci Surgery System, which can decrease length of hospital stay and post-operative pain for patients with diagnoses such as colorectal cancer and diverticulitis. Drs. Tooley and VanderKolk have incorporated this technology into their practice. Our surgeons and administration keep abreast of the latest advances to serve you best. Our goal is to provide you with superior medical care, while helping you navigate the surgery process with ease. Our surgeons provide unequaled surgical expertise, and we strive to address your needs in a professional and compassionate manner that exceeds your expectations. For more information visit: MyNorth Medical Insider

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OMH Medical Group–Boyne Valley, offering walk-in services for same day appointments. Also offering occupational medicine, lab, and X-Ray services.

OMH Medical Group

OMH Medical Group includes the following practices and specialties: Anticoagulation Therapy Clinic Family Practice (Gaylord, Indian River, and Lewiston locations) General Surgery Internal Medicine MedCare Walk In Clinic (also offered through Boyne Valley, Indian River and Lewiston Locations) Obstetrics and Gynecology Oncology Orthopedics Pediatrics Urology

OMH Medical Group 829 N. Center Avenue Gaylord, MI 49735 (989) 731-2100

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Otsego Memorial Hospital (OMH) Medical group is the largest multi-specialty medical practice in northern Michigan. Home to a variety of specialties and primary care providers, the OMH Medical Group is setting pace with the dynamic nature of today’s patient. Several of the practices found within OMH Medical Group have been designated by Blue Cross Blue Shield as a Patient Centered Medical Home. To the patient this means that their primary care physician (pediatricians, internists and family practice doctors) will lead a care team bringing intensive focus to the patient’s health goals and specific needs. The care teams work with patients to keep them healthy and monitor their care on an ongoing basis. “The patient centered medical home is health care centered on the patient,” said Barb Miller,  FACMPE, Vice President Physician Services for Otsego Memorial Hospital. “We take a comprehensive approach to patient care, helping our patients meet their health goals while keeping track of all their specialist visits, test results and prescriptions.” Following every office visit, patients receive a detailed visit summary describing diagnosis, appointment vitals, and steps moving forward. 

To further communications, an online Patient Portal is available for all OMH Medical Group patients, allowing for online appointment and prescription refills requests, as well as access to parts of their medical record. Even with enhanced technology and communications, OMH Medical Group still holds on to the traditional values that make the primary care relationship strong. “Internal Medicine, Pediatrics, and Family Practice patients are seen by OMH Medical Group physicians as hospital inpatients. Our providers have strong working relationships with each other and our hospital, making the patient experience that much more reassuring and comfortable,” stated Miller. Most recently, OMH Medical Group has opened a new practice in Boyne Valley, offering walk-in services for same day appointments. OMH and the OMH Medical Group work in tandem to provide an excellent patient experience. Whether it is in the hospital or the medical practice setting, OMH is building an alliance of care throughout northern Michigan for the benefit of patients and their healthcare, one visit at a time.


31.5 million people or 10% of the US population have hearing loss.

65% of people with

hearing loss are younger than 65 years of age.

Hearing Solutions of Northwest Michigan was formed in 2008 by Dr. Leahy and Dr. Sawhill for the purpose of promoting better hearing care for the people of Northwest Michigan. In doing so, we provide complete hearing solutions. We provide these services with compassion and excellence that is expected from Doctors of Audiology. At Hearing Solutions of Northwest Michigan we provide complete diagnostic hearing services and a wide range of hearing aids, assistive listening devices, and ear protection devices. All services are provided by licensed and certified Doctors of Audiology. Prior to Hearing Solutions of Northwest Michigan’s inception, both Dr. Leahy and Dr. Sawhill practiced Audiology at Munson Medical Center. Combined the two doctors have over 30 years of combined experience as Audiologists. Our location at Logan Place West in Traverse City is easy to find, convenient, and parking is easy. Our approach is professional, personal, and caring. We offer flexible hours, so we can accommodate patients’ busy schedules and there is less wait for appointments. Helping people hear better ultimately improves their quality of life and is very rewarding.

3241 Racquet Club Dr., Suite B Traverse City, Michigan 49684 (231) 922-1500

Heart Disease and Hearing Loss Linked Hearing health is part of a person’s whole health. And increasingly, research shows that the link between cardiovascular and hearing health is significant. The connection appears to be so strong that some experts believe that certain types of hearing loss could potentially provide insight into the state of an individual’s cardiovascular wellbeing. Studies have shown that a healthy cardiovascular system – a person’s heart, arteries, and veins – has a positive effect on hearing. Conversely, inadequate blood flow and trauma to the blood vessels of the inner ear can contribute to hearing loss. David R. Friedland, MD, PhD, Professor and Vice-Chair of Otolaryngology and Communication Sciences at the Medical College of Wisconsin in Milwaukee, has been studying the relationship between cardiovascular and hearing health for years. He offers up this response: “The inner ear is so sensitive to blood flow that it is possible that abnormalities in the cardiovascular system could be noted here earlier than in other less sensitive parts of the body.” In one study, Dr. Friedland and fellow researchers found that audiogram pattern

correlates strongly with cerebrovascular and peripheral arterial disease and may suggest a screening test for those at risk. They even concluded that patients with low-frequency hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered. Other evidence exists. In fact, the authors of a study published in the American Journal of Audiology concluded that the negative influence of impaired cardiovascular health on the auditory system – and the potential positive influence of improved cardiovascular health on these same systems – have been found through a sizeable body of research conducted over more than six decades. The jury is still out on exactly why there is a connection and which comes first, but those 50 and older are encouraged to get their hearing tested as a routine part of their medical care. If you or someone you know is concerned about their hearing health, call Hearing Solutions of Northwest Michigan at 231-922-1500 and schedule an appointment with Dr. Sandy Leahy or Dr. Kathleen Sawhill. MyNorth Medical Insider

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Neuromuscular & Rehabilitation

3988 West Royal Drive. •Traverse City, MI 49684 231-935-0860 •

For over 30 years the physicians at Neuromuscular & Rehabilitation Associates Associates ofofNorthern Northern Michigan Michigan havehave been serving been serving the Grand theTraverse Grand Traverse Region and Region surrounding and surrounding communities. communities. Board certified Board certified in Physical in MedicineMedicine and Rehabilitation, our physicians in the treatment Physical and Rehabilitation, ourspecialize physicians specialize in of atreatment wide variety musculoskeletal and neuromuscular conditions, the of aofwide variety of musculoskeletal and neuromuscular conditions, perform electrodiagnostic evaluations (EMG), and perform electrodiagnostic evaluations (EMG), and provide intervenprovide interventional pain We alsowho treathave individuals tional pain management. Wemanagement. also treat individuals suffered who have suffered traumatic stroke, and spinal cordmobility injury, traumatic brain injury, stroke,brain spinalinjury, cord injury, other and otherinmobility in adultsPhysical as well Medicine as children. Physical disorders adults asdisorders well as children. and Rehab doctors (physiatrists) a team approach Medicine and Rehabtypically doctorsutilize (physiatrists) typicallyworking utilize aclosely team

approach with otherworking health-care closely practitioners with othertohealth-care optimize not practitioners only medical to optimize only issues, but alsoand the psychological, social, issues, butnot also themedical psychological, social, functional aspects of and functional aspectsultrasound of a problem. ultrasound and fluoroa problem. On-site andOn-site fluoroscopic (real-time X-ray) scopic (real-time X-ray) localization imaging allows localization for injecimaging allows precise for precise injection procedures. Such tion imaging procedures. enhances Such notimaging only the enhances effectiveness not only of the procedures, effectiveness but diagnostic clarity well. This technology the physicians at of procedures, butasdiagnostic clarity as well.allows This technology allows Neuromuscular Rehabilitation to the highest quality the the physicians at&Neuromuscular & provide Rehabilitation to provide Wehealthcare. have clinicsWe in have Cadillac, healthcare. highest quality clinicsCharlevoix, in Cadillac,Gaylord, Charlevoix, Gaylord, Kalkaska, City. Our andgoal Traverse is to provide City. Our comprehensive, goal is to Grayling, Grayling, and Traverse provide comprehensive, personalized and compassionate care. highly personalized andhighly compassionate care.


3291 Racquet Club Dr., Suite C • Traverse City, MI 49684 231-421-8000 • Chronic Certification Center offers a holistic approach to improve patients’ quality of life. Empowering patients to take charge of their own health is one of the most satisfying experiences of our profession. We want our patients to have a meaningful experience when they walk through the door. Our mission and goal is to provide patient centered education and assistance in the Medical Marihuana certification process. We are the only center that takes the time to really evaluate each patient, looking at all aspects of care; mind, body, spirit, and emotional

MI 28

needs. We listen. Your concerns, goals, and needs are important to us. Your privacy is guaranteed. Our doctors and staff of Medical Marihuana specialists in Northern Michigan maintain their position at the forefront of ever expanding scientific research of the medical use of Marihuana by actively studying the latest developments in this highly specialized field. Chronic Certification Center is now accepting new patients and would like to invite you for a personal experience with our staff. Please call us for an appointment or find us on our Facebook page.


Eye Health of Kalkaska 882 M-72 NW • Kalkaska, MI 49646 • 231.258.9781 • At Eye Health Of Kalkaska, our professional and knowledgeable staff is committed to providing each and every patient with innovative vision solutions and exceptional personal service. We offer complete vision care, including computer-assisted eye exams and co-management for laser and cataract surgeries. We also perform contact lens fittings, with many options to choose from, like the latest one-day disposable lenses. Should you ever encounter an eye emergency, we’ll take care of you promptly, the same day you call. At Eye Health Of Kalkaska, we carry the latest designer frames as well as prescription and non-prescription sunglasses. We feature precision eyeglass lenses from Zeiss, Essilor and other premium providers. Plus, eyeglass repairs and adjustments are available on a walk-in basis.

Because You’re Special …

At $24.95, Traverse Magazine Speaks to Your Wants & Needs

L-R: Wendy Daniels-Keene, Amy Lantzer, Dr. Jon Van Wagnen, Dr. Robert Molter, Jeremy Balliet, Denise Hannon, and Brendan Bohl

We here at Eye Health Of Kalkaska are happy to help you negotiate the new healthcare system and answer questions about any changes that you may have had to you insurance. Remember that eye care benefits are now mandated for children up through age 18 and should be included with all insurances. We recommend a comprehensive exam for all children. Learning is primarily visual and children need good vision to do their best. Remember, the eyes are the windows through which you see the world. In order to maintain healthy eyes, you need regular vision and eye health examinations. Call us today to schedule your next eye exam at 231.258.9781.

A Partnership of Care and Commitment Through patient-centered care, our team of 12 providers offer adult primary care, treat patients as individuals, foster a proactive approach, and work together to promote overall health and wellness. New patients welcome.

Lush landscapes? Sumptuous foods? You bet. And Traverse, Northern Michigan’s Magazine also provides you with important news to help you live life Up North. Subscribe to get timely, vital special sections in addition to 12 gorgeous issues of Traverse Magazine and 6 issues of Northern Home & Cottage.

A PAtient-Centered MediCAl HoMe



231.487.9702 · burns professional building, suite

300 · petoskey

MyNorth Medical Insider

MI 29

Medical Insider

Advances in Northern Michigan Dental Care MI 30

First Visit

Raising the Bar on


Examinations As dental diagnostic tools and understanding of mouth physiology has advanced, a first visit to a dentist has taken on more indepth investigation of the mouth and a more nuanced analysis of how to create a healthier future for that very important part of your body. We check in with Dr. James Reznich to discuss what patients should expect from a dental examination today.

Laser Technology


Filling Cavities Without Pain Most of us don’t need to be reminded how a standard dentist drill causes pain, but in case you’ve forgotten, Dr. Melissa Makowski, of Lakeview Dentistry of Charlevoix, explains. “A high speed drill generates heat, vibration and pressure,” she says. As a result, dentists have become masters of numbing the mouth, which is an appreciated advance, no question, but what if fillings could be filled comfortably with no anesthetic at all? That idea appealed to dentist Makowski, so five years ago she adopted into her practice a new technology, a dental cutting tool that relies on laser energy and water. “The laser doesn’t create heat, vibration or pressure, so the procedures can be done without local anesthetic,” she says. People like not having to leave the office with a numb lip or mouth, and avoiding the need for painkiller shots speeds the overall process—for a straightforward cavity fill, patients can be in and out in 20 minutes. But Makowski says there are other, even more important, dental care reasons for choosing laser technology. When fixing a cavity, the dentist’s goal is to remove only the material that is decayed, and while fine-tipped drills approach that ideal, Makowski says the laser is even better. “The laser removes just the decayed material,” she says. “It’s very, very precise.” Removing only the decay is especially important for children who are looking at a lifetime of dental care ahead. “I see a lot of Baby Boomers who had big fillings as kids, then they get new decay around the filling, then they get a crown because there’s not enough tooth left to work with. With the laser you can keep the preps very, very small, conserving natural, healthy tooth,” Makowski says. Other uses for the dental laser include reducing bacteria associated with tooth loss, cosmetically shaping gum tissues when they inflame due to braces, and eliminating dark spots on the gums of smokers and reducing TMJ pain.


On a first visit to a dentist, what kind of dental analysis should a patient expect? A comprehensive evaluation with the dentist. Many practices begin with a dental hygienist cleaning the patient’s teeth, followed by a quick check by the dentist. That represents treatment being delivered without examination, diagnosis or treatment plan. Often early signs of disease are missed or glossed over, and while a preventative attitude is implied, it is not effective. An intake interview performed by the dentist helps the dentist understand the patient’s concerns, both physical and emotional. A thorough analysis includes a head and neck oral cancer screening, evaluation of the bite and coordination of the jaw joint with the bite. (A history of clenching and grinding can be read on teeth like tea leaves to predict the future.) The analysis should assess the teeth for decay, but also 

Dr. James Reznich

MyNorth Medical Insider

MI 31


Risk Assessment, dental insurance, and did I miss something?

Dr. Reznich has devoted his professional life to refining his clinical and communication skills in order to better serve his patients needs. He believes in providing thorough information about dental health, and is committed to helping his patients make healthy choices regarding their dentistry. Dr. Reznich is a strong believer in continuing education in order to stay current with the latest dental information. He has completed advanced course work in all aspects of dentistry. Dr. Reznich considers it a privilege to serve his patients and thanks them for placing their trust in him.

Figure 1, Molar Life Cycle. Source: Health Partners of Minnesota. Reprinted by permission.

Dr. James Reznich Dr. Frederick Arnold Dr. Travis Mattson 5011 Skyview Drive Traverse City, Michigan 49684 (231) 947-3530 Make an Appointment Today!

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In reading the September issue of our state association’s dental journal I came across an article about risk assessment and evidence based dentistry. I’m explicit about minimizing the risk of contracting dental disease so I dove right in. I was disappointed. The article cited a recent scholarly study which concluded that ‘little evidence supported biannual preventive care for adults’. This caught the attention of Catherine Saint Louis of the New York Times who wrote ‘Rethinking the Twice-Yearly Dental Visit’ in the June 10, 2013 edition. Insurance companies noticed her article and speculation is that ‘. . . benefit plan decision makers may use “evidence-based” design to . . . [decrease] traditional coverage frequency for dental cleanings’. Translation: pay for one cleaning per year rather than two. How should we feel about that? Risk assessment predicts the likelihood of needing dental work. Behaviors and conditions that indicate disease susceptibility include smoking (inhaling hot, poisonous gases), diabetes (relates to gum infection), and ineffective oral hygiene. In addition, genetic testing, history of decay, gum disease, oral cancer, age, the presence of specific bacteria, salivary function, changes in your systemic health, fluoride use, physical or developmental conditions that make self-care difficult or impossible, and your history of dental visits for examination, hygiene treatment, and health coaching have all been identified as risk factors. An exhaustive list to be sure, but it is not all inclusive. To be clear, I feel that it is our role as dentists is to evaluate, diagnose, and coach patients to minimize the risk of new disease. In consultations, you’d hear that creating a healthy environment creates health. Your body is capable of healing itself. When individual patients are treated as such, generally a healthy, stable, beautiful, functional mouth follows. Insurance companies assess risk to predict potential claim payments. One example would be to limit coverage for advanced treatments in a group with active tooth decay. Many dental policies contain ‘pre-existing conditions’ clauses; in other words: homeowner’s insurance

can’t be purchased when the house is on fire. In our practice, we discourage patients from ‘throwing good money after bad’, or having us place restorations designed to be permanent in a mouth that has active decay. The principle at work is that crowns and fillings don’t prevent decay, preventing decay prevents decay. Particularly disheartening in the article were dentists expressing concern about assigning risk levels to individual patients. If dental insurance companies required reporting, the dentist could be reduced to the role of ‘gatekeeper’ with potential animosity between the dentist and patient when insurance benefits are denied. I understand a dentist’s reluctance to report individual risk to insurance companies, especially if it could reduce benefits otherwise designed to aid their health. On the other hand, talking to patients about health risks they’re living is the core of any preventive program. Figure 1 (midddle left) contrasts potential futures of a molar tooth. The path of high risk is one of disease, pain, and loss. Dentistry’s sad story is that it has been more interested in the $7,200 per molar than seriously helping patients minimize disease risk. By changing the risk profile of the molar, the need for treatment would not have happened. The healthy molar exists in a healthy, low risk environment. Examples of risk factors utilized in our practice include: periodontal charting and plaque scoring, dental caries stability, medical history review relative to systemic disease (diabetes, cardiovascular, smoking), smoking cessation encouragement, and an explicit program to control bacterial plaque effectively. Our goal is to help you understand what is necessary on your part to allow your body to create health minimizing the need for dental treatment. Once you have addressed and minimized risk factors, you will have taken responsibility for your health, you will feel better, and you will be able to access the miracles that modern dentistry provides with the confidence that they will last and last. My take on the number of cleanings per year allowed? However many or few required to help you create a healthy lifelong smile. I hope this helps.

Dental Exams, from pg. 31

the form and function of existing restorations (catches around old fillings or food getting stuck continually in a single site promotes both future decay and gum disease), and evaluate the gums for infection (gingivitis) and loss of supporting bone (periodontal disease). We at Dentolutions are explicit about the findings and meaning of the findings during the examination in order to increase understanding of risk factors for disease and prevention in the future. Once I’ve learned

your mouth’s condition by heart, we’ll consider together the alternatives and options for reaching your goals of your mouth feeling, working and looking better. What’s one really important thing a patient can do for his or her dental health? Patients need to be their own best advocates. For me, a good patient is not somebody who blindly does what the doctor says to do. Good patients want to take

responsibility for their health, and I’m dedicated to helping them do just that. I’m more their coach. They are the ones playing the game. Patients don’t want to throw good money after bad. Once patients discover that they are in control and can heal themselves, they tend to access the miracles that modern dentistry can provide.


Gum Care


Stop the Bleeding Physicians have long known that dental health is central to a person’s overall health. But after a 1989 study suggested a connection between gum (periodontal) disease and heart disease, several subsequent studies have picked up on that research thread. Some studies have looked more deeply at the connection to heart disease and others have tried to determine if there is a connection between periodontal disease and other diseases as well. “Researchers are finding correlations between gum disease and stroke, diabetes, even low-birth weight babies and premature babies,” says Traverse City dentist Dr. Phil Yancho. A nuanced understanding of the mechanisms that transfer disease from the mouth to the rest of the body is still coming into focus, but at a broader level, Yancho says the basic connection seems clear. “When you have constant infection in the tissues and bones of your mouth, that bacteria is in your bloodstream and travels to your entire body,” he says. Regular cleanings at the dentist office, careful brushing along the gum line, flossing(!) and antiseptic mouthwash are effective in keeping gum disease in check for most people, but others need more treatment. Yancho has begun relying on a test that is able to identify specific strains of bacteria that people have in their mouths. He can then prescribe antibiotics that target those bacteria. “We also have a new high powered microscope that allows you to see the bacteria living in your saliva,” Yancho says. It’s a dra-

“Your dentist should be able to suggest a way to clean between your teeth that works for you. That is where the trouble starts, and most people do not clean there at all.”–Dr. Phil Yancho

Regular cleanings, brushing, flossing and mouthwash keep gum disease in check for most. Others need even more treatment.

matic and compelling view: people with healthy gums have saliva that looks clear under the microscope. “Like a clear, flowing river,” Yancho says. But saliva from people with infected gums can look like “a swarming bee hive of activity.” The No. 1 take-away is no level of gum bleeding is acceptable. “If every time you bumped your finger it started bleeding, you’d go to the doctor right away,” Yancho says. “We need to start thinking of bleeding gums the same way.” The other No. 1 take-away is “be your own hygienist,” Yancho says. Surveys show only 12 percent of Americans floss every day. “Your dentist should be able to suggest a way to clean between your teeth that works for you. That is where the trouble starts, and most people do not clean there at all,” he says. Of course, in addition to possibly improving your systemic health, flossing has other well-documented benefits as well: It saves you money by avoiding dental bills.

231.941.2201, MyNorth Medical Insider

MI 33


CAPTION: (L-R) Dr. David Whalen, Dr. Michael Hutchison

Associates in Family Dentistry

10850 E. Traverse Hwy Ste 2250 • Traverse City, MI 49684 231-946-9644 • Nestled in the beautiful surroundings of Northern Michigan, in the heart of Traverse City, MI, you will find a dental office unlike any other. Amidst the relaxing view of West Grand Traverse Bay, a dental team committed to the endless pursuit of excellence is waiting to welcome you. We are Associates in Family Dentistry. Our practice is excited to announce that Dr. David Whalen joined our team in September 2013 after completing his residency at San Francisco VA Medical Center in California. Dr. Whalen is a highranking graduate of the University of Michigan School of Dentistry, also receiving a certificate of excellence from the American Academy of Oral Medicine. Underscoring our continued commitment to excellence, we are thrilled to welcome such an excellent provider to our team. From same-day crowns to exceptional laser dentistry, dental implants to routine cleanings, our team is committed to providing the highest quality in dental healthcare. Our practice always welcomes new MI 34

Services Include: • Complimentary X-Rays for New Patient • Same-Day Crowns • Dental Implants • Cosmetic Dentistry (Accredited in Academy of Cosmetic Dentistry)

• Laser Dentistry

• Porcelain Veneers • Metal-Free Fillings • Root Canals • Sleep Apnea • TMJ Treatment & Management • Periodontal Therapy • Digital X-Rays

patients and provides complimentary digital x-rays to all new patients at their initial exam and cleaning appointment. Dr. Michael Hutchison and Dr. David Whalen, along with their entire team, invite you to experience the difference today. Welcome!


What Every Parent Needs to Know:

How regular dental visits and simple procedures promote your family’s health and well-being.


Dr. Makowski and her team at Lakeview Dentistry of Charlevoix are committed to providing exceptional care by utilizing the most advanced dental technology for patients. She has undergone extensive laser training obtaining mastership status with the World Clinical Laser Institute and is a member of the Academy of Laser Dentistry. She has also received training in Botox use specific for dentistry in the treatment of temporal mandibular joint disorder. Dr. Makowski is also a member of theAND dental honor Omicron AMILY ASERsociety ENTISTRY Kappa Upsilon, the Academy of General Dentistry, American Academy of Cosmetic Dentistry, American Dental Association, Michigan Dental Association and the Vacationland District Dental Society. Dr. Makowski dedicates herself and her team to continuing education to bring the most advanced dental care to her patients.






Conservation. Education. Prevention.

109 West Hurlbut Charlevoix, Michigan 49720 (231) 547-4347

According to the American Academy of Pediatric Dentistry (AAPD), tooth decay is still the single most common chronic childhood disease—4 times more common than early childhood obesity, 5 times more common than asthma, and 20 times more common than diabetes. This is an unfortunate statistic considering dental decay is completely preventable. Half of all children between the ages of 2 to 5 have never even visited the dentist. Children in this age group who have not visited a dentist within the past 12 months are more likely to have decay in their baby teeth. Dental decay can cause numerous problems such as pain, infection, chewing difficulties, speech impediments, and tooth alignment issues that can impact the child’s overall wellbeing even into adulthood. Children should visit a dentist no later than their first birthday because bacteria that cause cavities are shared between family members. So if you have an untreated cavity, then these bacteria could spread through saliva. Sharing spoons, testing food before giving it to baby, and cleaning off a pacifier with your mouth instead of water are common ways in which it can spread. The American Dental Association (ADA) asserts that it should be as soon as their first baby tooth erupts. Children will usually get their first tooth around six months of age, and by the time they are three, they should have a full set of twenty baby teeth. The earlier the visit, the more the opportunity to become accustomed to the sights, sound and smells of a dental office. Parents will also be able to learn about their child’s dental development and gather valuable information about diet and care that will aid in the prevention of decay. Begin a mouth cleaning routine early in the child’s life. First, an infant’s gums should be wiped with a clean damp cloth or gauze after each feeding. Make it a calm and pleasant part of their routine. If you are stressed about it they will be stressed about it too. As soon as the first tooth appears, an infant sized brush

should be used after each feeding. Consult with your dentist about the need for using toothpaste. If the baby falls asleep while eating, the teeth should be cleaned before putting them to bed. They should never be put to sleep with a bottle of milk, formula, fruit juice, soda pop or water sweetened with sugar or artificial flavoring. As children grow, make brushing a fun time- try reciting nursery rhymes, count or sing. A dentist will advise when flossing is necessary. Parents should be an active participant in brushing at least until age six. Healthy eating and drinking habits need to be established early on. Non-processed foods are the best for your dental and overall health. Unfortunately, children between the ages of 2 and 5 that do not eat breakfast and have less than 5 servings of fruit and vegetables per day have a greater risk for dental decay. Simple carbohydrates such as white breads or crackers are broken down into sugars by the bacteria that live in the mouth and cause dental decay. The AAPD and the ADA recommend that children should never be allowed to sip on soda pop, sports drinks or non-diluted juice as the sugars and acids in these drinks, even the diet ones, will rapidly cause decay. Water, fresh fruits, vegetables, cheese and yogurt are healthy choices. For instance, did you know that cheese stimulates saliva production and helps to keep the pH of the mouth neutral, not acidic? It also contains pyrophosphates which help to keep enamel strong. Laser cavity detection is the most cutting edge adjunct to diagnose dental decay at the earliest stages. If your child does develop a cavity, the dental laser is a wonderful tool for removing the decay because it is a precision instrument only removing unhealthy tooth structure. Further, lasers can be used to remove cavities without using local anesthetic, which means less pain during procedures. This allows the child’s visit to be less invasive and reduces anxiety for not only the child, but the parents as well. MyNorth Medical Insider

MI 35


Dr. John Holcombe Dr. Steve Hall 1299 South West Bayshore Drive • Suttons Bay, MI 49682 231-271-6700 • Dr. John Holcombe and Dr. Steve Hall are proud to provide high quality dental care to their patients. Established in 1977, the Suttons Bay Dental Center has been providing Leelanau County with conservative esthetic and family dentistry for over 30 years. A dedication to personalized, comprehensive dental care with a special focus on each patient’s comfort helps to define their team’s mission. Now on their second decade of offering computerized CAD CAM dentistry, the office is often described by patients as high tech and cutting edge. Dr Holcombe remarks, “Many of our new patients are retired to the area and often are surprised that our

Leelanau County office is more advanced than their ‘big city’ 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.


Schulz Chapman Dentistry 127 S. Madison St. •Traverse City, MI 49684 231-946-3900 •

Schulz Chapman Dentistry is a father-daughter dental practice located near Munson Medical Center. Dr. Wes Schulz founded the practice in 1974. He was joined by his daughter, Dr. Brooke Chapman in 2007. Together they have over 40 years of experience in providing preventative and comprehensive care for the entire family. The team at Schulz Chapman Dentistry offers a full array of general dental services to help you maintain healthy teeth and a bright smile. The office utilizes the latest technological advancements including low radiation digital x-rays, laser technology for diagnostic and treatment procedures and newest to our office, MI 36

ViziLite Plus for oral cancer screening. Both Drs. Schulz and Chapman are graduates of the University of Michigan School of Dentistry and are active in their professional associations. In addition Dr. Chapman is a member of the American Academy of Dental Sleep Medicine and works with area physicians to address snoring and sleep apnea concerns. The office is honored to have both Drs. selected by their peers as TopDentists™ in Northern Michigan! Please visit the website to learn more about their services or call the office to set up an appointment.


Friend ly Staff, Brand New Facility

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Accepting Newoffer Patients! We state

of the art orthodontic treatment for adults and children.

Mention this ad when scheduling your complimentary new patient exam.

545 S. Garfield Ave. Suite A Traverse City, MI 231.935.1440

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231.935.1440 545 Garfield Ave. Suite A Traverse City, MI Mention this ad when scheduling yourcomplimentary patient exam. Dr. Jan A Manning 231.935.1440 new patient exam. 862 Munson Avecomplimentary • Traverse City • 231.946.4443

Member American Association of Orthodontics Lic# 2009015015

Monthly payment plans available for qualifying patients

Member American Association of Orthodontics Lic# 2009015015

We salute the dental professionals listed by topDentists™ in Northern Michigan.

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