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Medical Insider Pro fes sio na ls • Hospit als • Pra ct ices

Tech no logy

Cancer Wellness THE NEW

On the Leadi ng Ed ge of Cardi ac Dev ice Research MI 1

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Cadillac Hospital

Charlevoix Hospital

Together We’re Stronger. 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 people who live and work in your community.

Grayling Hospital

Together, we’re stronger. Together, we are Munson Healthcare. Our Hospitals

Kalkaska Memorial Health Center

Mackinac Straits Health System

Munson Medical Center

Cadillac Hospital Charlevoix Hospital Grayling Hospital Kalkaska Memorial Health Center Mackinac Straits Health System

Munson Medical Center Otsego Memorial Hospital Paul Oliver Memorial Hospital West Shore Medical Center

Supporting Organizations Great Lakes Mobile PET Kalkaska and Munson Dialysis Centers Munson Healthcare Foundations Munson Home Health Munson Mobile Imaging

North Flight Aero Med North Flight EMS Northern Michigan Supply Alliance Northwest Michigan Surgery Center

To find a doctor in your area, call Munson HealthLink at 800-533-5520, or visit munsonhealthcare.org. Otsego Memorial Hospital

Paul Oliver Memorial Hospital

West Shore Medical Center

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Anne Gore

Infectious Disease

LEFT: PHOTOS COURTESY OF MUNSON MEDICAL CENTER, RIGHT: PHOTO BY MICHAEL POEHLMAN

Rapid Identification of Pathogens Is Good for All In the world of infectious disease care, identifying the precise cause of an illness is an essential step in treating the patient as effectively as possible. But with traditional methods, identifying diseases can often take days—several days—as lab clinicians wait for the pathogen to “grow out” in a laboratory culture (like your mold-growing experiments in biology class—but way more advanced). So you can understand the excitement of Munson Medical Center’s lab team when they were able to bring in technology called VITEK MS that, in some instances, cuts days off the time it takes to identify an infecting agent. The technology can identify nearly 200 specific strains remarkably fast. When Munson went live with the technology, one of the first cases was a child admitted to the emergency room at 11 p.m., very sick. By 8 a.m. the next morning, the child tested positive for salmonella, allowing physicians to treat

the patient accordingly in a timely manner. “Normally identifying salmonella would take three days,” says Anne Gore, microbiology lead technologist at Munson Hospital. The deep and constantly evolving database of diseases comes in especially handy for the Munson lab, too. “We have a lot of travelers in Traverse City, and so we can see some really unusual infections,” Gore says. The technology shaves so much time off the identification phase in part because it can identify a pathogen very early in the culture stage. The lab technician takes a tiny portion of a bacteria, puts it on a device similar to a microscope slide, then puts it into an instrument. This instrument then shoots a laser at the slide to break apart the cell wall of the bacteria. This sends microscopic ionized particles through a vacuum tube, explains Gore. When the cell bursts, the material creates a cloud of cellular proteins that are

then detected at the top of the vacuum tube. The machine analyzes the time it takes for the particles to travel a given distance. Each pathogen has a unique travel time, and is thus identified by its unique travel sequence. Early identification and response are obviously better for ill patients, but the broader community receives a big benefit as well. When physicians are able to quickly determine that a disease is a virus, they can avoid prescribing broad-spectrum antibiotics as a “just in case” response. And when a specific bacteria—is identified, a narrowly targeted antibiotic can be used. Less use of powerful broad-spectrum antibiotics—like fluoroquinolones or azithromycin—means slowing the advance of antibiotic resistance of bacterial pathogens in a community. “This is just exciting technology,” Gore says. “Every day these technicians are calling physicians and making a difference in a person’s life.”—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.

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Cardiac Research

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Heart Team Performs Internationally Influential Tests About 10 years ago, Dr. Louis Cannon, MD, had an epiphany. He loved going to his vacation place in Charlevoix, but he realized that, as president of what was then the largest cardiovascular group in Michigan, based near Saginaw, he never had the time to get Up North. So he started a dialog with Petoskey’s Northern Michigan Hospital—now McLaren Northern Michigan—about relocating. “They said, ‘We’ll move you and your whole research center up here,’” he says, still sounding a little incredulous at the offer. The benefit to Northern Michigan residents: Today, nationally respected research into leading edge cardiovascular treatments is happening right in their community, giving early access to devices and procedures that might not be widely available for, in some cases, years. Participation in clinical trials requires McLaren Northern Michigan to receive approval from the Food and Drug Administration and Institutional Review Board through a rigorous selection process for each trial. “We are currently involved in about 40 studies, all clinical trials, and almost all of them involve devices,” Cannon says. The research team has published about 200 medical papers based on their work in Northern Michigan, he estimates. In addition, Cannon lectures around the world on device implant procedures, including live demonstrations of surgical techniques. The team’s work with Absorb is a current example of leading edge device research. The device is a stent that is inserted into a blood vessel to prop it open—typically in the heart, but they are also used in other locations. Unlike metal stents that have been in use for more than a decade, the Absorb stent dissolves after a certain amount of time, during which the vessel wall has naturally strengthened and will remain open on its own. “It’s made of the same material as dissolvable stitches,” Cannon says. At the invitation of the device manufacturer, Abbott Laboratories, a patient for

whom the McLaren Northern Michigan team performed the Absorb implant was one of two patients in the United States to testify about the device success before an FDA panel in Washington, D.C. The absorbable stent is designed to overcome the main drawback to traditional metal stents, which is they are a source of possible blood clots. Metal stents are shaped like a spring, Cannon explains. “There are rungs in the stent, and that creates a certain amount of turbulence, and when you have turbulence, clots can form. That’s especially true when the stent is not a perfect size for the blood vessel, and especially when the stent is too small.” Adding to the concerns, if there are problems related to a metal stent, it’s not currently possible to go in and remove them.

Absorbable stents resolve these issues by being absorbed into the body over the course of a couple of years, by which time natural cell growth strengthens the vessel walls. On the horizon: stents custom-made to fit the patient’s blood vessel. “We will be able to take a picture of the blood vessel and use a 3-D printer to make a stent at the bedside,” Cannon says. And along the way, Cannon will continue to build his research team. “We are lucky up here because it’s so beautiful, we can recruit some of the best docs in the world. We are blessed,” he says.—J.S.

Dr. Louis Cannon

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Our Experience Improves

Munson Healthcare’s heart team provides exceptional advanced heart care. We do more heart procedures – and we’ve been doing them longer – than anyone else in northern Michigan. Put simply, our experience will improve yours. We have the third lowest 30-day heart failure readmission rate in the nation,* and have been named one of “100 hospitals and health systems with great heart programs.”** Great care and

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

* Our 30-day readmission rate is 18.2 percent, compared to the national average of 21.9 percent. Learn more online at whynotthebest.org. ** BeckersHospitalReview.com, 2016

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Cardio-Oncology

PHOTO BY MICHAEL POEHLMAN

When Chemo Affects the Heart Medical science continues to make steady progress toward treating cancer with chemicals that target very specific cancers. In addition to being more effective in stopping cancer, the targeted approach can also reduce the wide scale cellular damage that occurs with chemotherapy. But in a small percentage of patients, the new drugs bring about a dangerous side effect: harming the heart in a potentially life-threatening way. The heart damage can often be reversed, but it must be detected early on and adjustments made. To better understand the interactions of cancer drugs and hearts and to help prevent and reverse the side effects, a new specialty has emerged: cardio-oncology. The field is still so new that specialists are rare, but Munson Medical Center has the expertise in house through Dr. Thomas Andrews. Andrews shares a case to illustrate why the specialty is essential today. “I had a patient who was being treated for breast cancer, but she suddenly had significant weakening of the heart. She had been getting regular checkups, but when her heart began to weaken, it weakened very

Dr. Thomas Andrews fast,” he says. Making things especially delicate, the patient needed continued treatment with the specific drug that was causing the problem, so if at all possible, Andrews wanted to figure a way to keep her on that treatment. “I worked with her oncologist to change around the dosing and over the course of months we were able to bring her heart muscle back to normal,” he says. By contrast, in the past, a cardiologist would have said, “‘You are killing her heart muscle. You can’t give her this medicine any more,’ ” he says. Andrews concedes, however, there are still some cases today that require a certain medication be stopped. The cardio-oncology field is not only about “drugs that cause mischief,” Andrews adds. The specialty also helps people who have pre-existing heart problems, patients who have issues with blood cell count, or who are on anti-coagulants, for example. “Sometimes people get heart attacks in the middle of cancer therapy,” Andrews says. “There are many overlaps with cancer and cardiovascular disease.” With new precisely targeted cancer drugs being released every month, spe-

cialists in the cardio-oncology field are working hard to stay abreast of the changes and sharing information, and Andrews is grateful for his network of colleagues in the field, developed when working in a state-of-the-art cancer center in Texas. “This world is evolving quickly,” Andrews says. “You see things come up that are not in text books or even online. If it’s odd or unusual, you want to know if somebody has seen it before, I have connections throughout the country I can call—it’s still a small world of cardio-oncology.” Advice for patients? “Most oncologists will give the patient a copy of a treatment synopsis at the end of treatment, a list of drugs, schedule of radiation treatment, so on,” Andrews says. “It’s critical that patients keep that available. Take a picture of it with your phone and keep it saved there. Sure, we can call oncologists and get the records, but the longer it takes us to find things out the worse it is.” Also, be aware of shortness of breath. If you were on a regimen that could be cardio-toxic, tell your physician and specifically ask if this could be a side effect.—J.S.

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ATS Receives National Recognition Addiction Treatment Services (ATS) of Traverse City has been on a not so quiet crusade to change the way the region thinks about addiction. “For too long, addiction medicine has been segregated from the medical community, despite a 50-year history of understanding addiction as a brain disease” says Christopher Hindbaugh, CEO of ATS. “A consequence of the wellintentioned but ill-conceived War on Drugs has been that our public policy and public perception of addiction is one of a moral failing” he continues. “If it was as easy as being able to just say no, we wouldn’t be in the middle of the largest public health crisis since the HIV/Aids epidemic.” 6 years ago, ATS was losing the battle to merely survive, let alone have the capacity to make the kind of impact they wanted to have in the community. Hindbaugh explained that in 2010 the agency was on a finan ial trajectory that would probably have shut its doors if their approach didn’t change. Hindbaugh, in his role for a mere 6 months, along with a management team he assembled, decided that they needed to address addiction by using the research and science that was available but often not utilized by treatment centers with little incentive to do so. Hindbaugh discussed a lineage of 12 step-recovery programs that founded

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many of the non-profit agencies like ATS across the county. “We rely on our rich 12step history and each client is encouraged to find those or similar supports after they leave our care, but it isn’t treatment and it isn’t enough for many people. We needed to provide a better treatment experience that can be a foundation for long-term recovery” says Hindbaugh. “We felt a commitment to implement evidence-based, albeit expensive interventions, to make sure all of our staff had the most current research, that our therapists all had advanced degrees and that our facilities refle ted an environment conducive to healing.” In the few years since making the decision to change course, ATS has emerged as one of the state’s most innovative treatment centers. They grew from a staff of 45 to a staff of 85. They doubled their bed capacity, opened a women-only treatment center, opened a 15 bed detoxifi ation center, opened a community center, hosted a statewide conference and started holding community events at places like the City Opera House. Hindbaugh explained that “once we made a full throttle commitment to addressing this issue as a public health crisis, it motivated us deeply. We understood that we needed to throw everything we had at this issue.”

The hard work has paid off for ATS. In 2013, they were given an award from the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that addresses behavioral health, for their community outreach efforts. In 2014, Hindbaugh was invited to the White House to participate in a discussion aimed at findi g an alternative to the War of Drugs, which eventually became the foundation for a new strategy announced by President Obama in the summer of 2016. Most recently, ATS was presented the “Change Maker” Award from the National Council of Behavioral Health and was asked to present at the National Conference this past spring. “5 years ago, we operated in the shadows because we thought that our clients would be more comfortable there. However, experience has shown us that the only way we can change how addiction is managed in this country is to be bold, to demand a public health strategy that promotes recovery and prevention activities, and to treat the whole person, not just their addiction” says Hindbaugh. To find out more about Addiction Treatment Services or to inquire about their various treatment options, visit www.addictiontreatmentservices.org or call 231-922-4810

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There is so much we can do. “This is the golden age of oncology. With some of the new medications, we’re making a lot of progress. It’s exciting. We can help almost everyone in some way.” – Zachary Hector-Word, MD | Medical Oncologist

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Cancer Support

PHOTO BY MICHAEL POEHLMAN

Blending East and West to Ease Cancer Trauma Cancer, like any major disease, attacks more than just the body. It affects a patient’s emotions, spirit, and mindset. The situation is exacerbated by treatment protocols—chemo and radiation—that take their own toll. Helping people deal with the broader effects of cancer and related treatments was an important part of the mission when Munson Healthcare was developing the Cowell Family Cancer Center, and today patients can access an array of services, such as meditation, massage, yoga, acupuncture, nutrition counseling and more, to help them weather the emotional and spiritual storm that cancer brings. Munson turned to somebody with an unlikely background to manage the cancer support services. Katie Horvath is an industrial and operations engineer with a law degree and a career in patent litigation. But after she endured a fight with breast cancer, she decided to devote her career to helping cancer patients. Using a holistic approach that blends Eastern health practices with Western medicine, L.C. Horvath and her team hope to ease the impact of treatment on patients and achieve greater wellness long term. “Every protocol is evidence-based. That was important to gaining the support of the oncologists,” Horvath says. To research the methods that are now part of the support services, Horvath tapped into her training as an engineer and patent attorney and relied on researchers in the Munson medical library. “I started in February and we were up and running in four months, which for a big organization like Munson is a land speed record,” Horvath says. The support services are a mix of free and fee-based, and while many require an appointment, some are delivered in very informal ways, adding to the holistic, supportive environment. For example, a masseuse might approach a patient in infusion and offer to do a hand massage for free. And patient comments suggest that Horvath and her team are on the right track. One day a classical guitarist played

for a meditation and music class, and when the class ended, a patient told the musician, “I don’t have a support system at home. You are my support, and you have given me a whole new day.” The team also understands the importance of supporting the patient’s personal support network. “A masseuse might see a weary family caregiver and offer a shoulder massage,” Horvath says. Also open to patients is a health and wellness library. “There is a huge nutrition section, with books like The Cancer-Fighting Kitchen,” Horvath says. The literature echoes the whole-person, wholelife theme of the support services. Casey Cowell, a major funder of the cancer center and a survivor himself, gives a copy of the book Anti-Cancer, a New Way of Life to each patient. “Casey challenged us to not just benchmark, but to lead,” Horvath says.—J.S.

Katie Horvath

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Expanding Orthopaedic Surgery Capabilities

Providing Essential Care for Accident Victims

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Austin McPhilamy, M.D.

“High energy trauma injuries” refers to injuries sustained from car accidents, motorcycle accidents, snowmobile accidents, falls … any injury that involves great impact to the body. Understandably, high energy trauma often leads to extensive injuries and a constellation of health problems, and historically, in the Tip of the Mitt region, emergency surgery required a medi-vac flight or long ambulance ride downstate. Recently, however, Petoskey’s Bay Street Orthopaedics added high-energy trauma surgery to their skill set by inviting Austin McPhilamy, M.D. to their team. McPhilamy recently completed an orthopaedic trauma fellowship, training under Dr. Timothy Bray at the Reno Orthopaedic Clinic. The McLaren medical team turned to McPhilamy during his very first week in Petoskey, following a serious motorcycle

accident that involved two people. “One of them was hemodynamically unstable— meaning the patient had very low blood pressure and was losing blood. We were able to stabilize him, fixing a significant pelvic ring injury and other multiple fractures in his lower extremity,” McPhilamy says. Previously, the patient, despite his highly unstable condition, would have been transported to a distant hospital for care. Adding high-energy trauma orthopaedic surgery to the specialties offered by Bay Street Orthopaedics was also an important step toward a longer term goal of McLaren Northern Michigan to achieve Level II trauma certification, which the American Trauma Society defines as “able to initiate definitive care for all injured patients.” Achieving Level II accreditation requires a multidisciplinary team that includes general surgeons, vascular surgeons and other

specialists to provide “cohesive trauma care,” McPhilamy says. “I’m one piece of that puzzle.” McPhilamy’s expertise also applies to longer term care in the area of posttraumatic reconstruction. “Unfortunately some patients might develop a malunion or a nonunion that needs additional care down the road,” he says. “Malunion” refers to when a bone heals in an incorrect position—crooked, for example. “Nonunion” describes when a bone does not heal. How unusual is it to have this level of orthopaedic surgery in a small community? “You really don’t see that very often. It’s very atypical,” McPhilamy says. “It shows the uniqueness of the area, the need to serve a large seasonal influx of people, and the commitment of Bay Street Orthopaedics and the hospital to commit the resources needed to achieve this.”—J.S.

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First, the BAD NEWS: “If you live long enough, you will need cataract surgery.” Since cataracts form as a natural part of aging, every individual’s vision is gradually affected and eventually clouded (hindered) by the yellowing and thickening of the lens, what we call a cataract. The first sign of the aging process of the lens that most people experience is difficulty reading small print, presbyopia. As more symptoms develop (glare with night driving, needing more light to read) patients can undergo surgery to remove the cataractous lens and have a clear intra-ocular lens implanted. Now for the GOOD NEWS: Cataract surgery has come a long way, sometimes eliminating your need for glasses completely! In 1949, when the first intra-ocular lens (IOL) was implanted, it required a large incision, many sutures, a lengthy hospital stay and spectacles afterwards for both distance and reading vision. Innovative eye surgeons devise continuous improvements in measurements of the eye, surgical techniques, surgical instruments and the design of intra-ocular lens implants. Each of these innovations have brought us closer to a painless procedure, with lower complication rates, a quicker recovery and better visual outcomes. Recently, premium IOLs have been developed and refined so that surgeons can provide both distance AND NEAR vision to a wider range of patients! One year

ago, eye surgeons in Traverse City began operating with the new Femto-Second Laser to make even more precise cataract incisions and soften the cataract, lessening the amount of ultrasound energy needed. Today, while planning cataract surgery, a patient is asked what is most important to them after surgery – distance vision, reading vision or both (almost completely reducing their dependence on glasses after surgery). A complete ocular history and examination determine which lenses would be the best for a patient. Measurements of the length and shape of their eyes are carefully taken. These measurements go through numerous, complicated calculations to predict a lens that will result in the best vision to meet their goals. The calculations have a margin of error, resulting in an occasional unexpected outcome, especially if the patient has had previous refractive surgery, trauma, ocular disorders or unusual anatomy. It is important to educate patients about the risks and benefits of cataract surgery, and also all of the options now available to them. As the measurements get more precise (thanks to those with unexpected outcomes), the calculations get more refined (thanks to those who were outliers), and surgical technique continues to advance (thanks to innovative minds) — vision after cataract surgery just keeps getting better and better!

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Start where you are! That bit of advice and encouragement is at the heart of a community-wide health initiative coordinated through Munson Healthcare that is aimed at helping people live more active and healthy lives in Northern Michigan. The initiative, called Shape Up North, was formed in response to a community health needs assessment survey that revealed Northern Michigan has one of the highest diabetes rates in the nation and has high rates of obesity and overweightness. To propel the effort forward, this November, Shape Up North is going public with a website—ShapeUpNorth.com—that helps people find the resources and ideas they need to lead healthier, more active lives Up North, explains Alyson Kass, coordinator for Shape Up North. Looking for a source for healthy local foods? Follow the link to a farm directory. Looking for a place to kayak? Check the activity finder. Nutrition classes? Shape Up North has a list of those, too. Free apps for your smartphone that help people lose weight? The site has links to those as well. Events that celebrate a healthy lifestyle? Lots of those, from races to classes to casual community bike rides. “It all gets back to the ‘start where you are’ idea,”

Kass says. “If you are super athletic and looking for something intense, you can find it. If you are just looking for ways to start a new healthier life, that is there too.” The Shape Up North initiative is part of a broad national trend in which health professionals are trying to shift healthcare’s focus away from fixing people when they get sick to preventing sickness in the first place, Kass says. One of Kass’s priorities is visiting community health leaders in the five-county area (Antrim, Benzie, Grand Traverse, Kalkaska and Leelanau) that Shape Up North covers to identify successful community health ideas and then sharing those ideas with other Northern Michigan communities. In addition to healthy resources and advice for the everyday person, the Shape Up North website also has resources for companies wanting to start workplace health programs, schools wanting to improve the health of students and physicians looking for ideas to share with their patients.—J.S.

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Dr. Bradley Hochstetler

Cataract Surgery

New Generation Lenses Focus Both Near and Far

PHOTO COURTESY OF CEDAR RUN EYE CENTER

Normal vision

Vision with cataract

Among the highest profile, gee-whiz surgical advances in recent decades are new techniques that have dramatically reduced recovery times for cataract surgery while simultaneously greatly improving vision. But medical researchers are not content to rest on past achievements, and the process continues to improve. One of the most recent advances that has eye surgeons and their patients excited is called the multifocal intraocular lens implant. “It’s a new generation of lens implant that increases the range of focus and reduces the need for glasses for both reading and distance,” explains Dr. Bradley Hochstetler, of Cedar Run Eye Center. Deconstructing the name for the lens helps explain it. The term “multifocal” means the lens is able to deliver focus throughout a broad range of distances, and does so significantly better than previous iterations of the multifocal lenses. The term “intraocular” means it resides in the eye, as in, it is implanted in the patient’s eye after the cataract is removed and remains there.

Unlike multifocal lenses in eyeglasses, the implanted multifocal lens does not take “getting used to.” Patients adapt to their new vision without trouble, explains Hochstetler. Another benefit of the lenses: they do not wear out. “We expect that patients would have these the rest of their lives,” Hochstetler says. “We see patients who had lens implants back in the ’80s, and their lenses are doing fine.” The procedure takes about 15 minutes per eye, and surgeons typically would repair one eye and then wait two weeks to repair the other eye. Patients typically are able to do most normal activities the day following the procedure. Most people are candidates for the lenses, with the caveat that a patient’s eyes must be generally healthy. Multifocal lens implants are generally not recommended for patients with glaucoma, diabetic retinopathy or other serious eye disease.—J.S.

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Jennifer Wedge, N.P.

Genetics Counseling

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Using the Genome to Guide Cancer Treatment Decisions One of the iconic achievements of the genetics research field emerged in the 1990s when scientists identified the BRCA1 and BRCA2 genetic mutations, which greatly increase the risk of breast cancer and other cancers in men and women. But though the discovery was powerful in its ability to provide important cancer risk information, the test cost was high, and the results could take 10 weeks to report. The upshot: the benefits of the research were not as widespread as healthcare providers would have liked. In the ensuing years, however, the test cost has dropped precipitously—to as low as $400 in some cases and is often covered by insurance—the results can be ready in as little as six days, and test accuracy has improved. Taking advantage of those changes and having a desire to offer the important screening technology regionally, Karmanos Cancer Institute at McLaren Northern Michigan has been

offering the tests as part of its genetic counseling services. To determine if a given patient should be tested for BRCA1 and BRCA2, genetic specialists first have the patient complete a family history questionnaire, explains Jennifer Wedge, MSN, ACNP-BC, a nurse practitioner specializing in genetic cancer risk assessment. “We are looking for red flags, like multiple cancers in a single individual or young onset of cancer, or several women in the family who have had breast cancer,” she says. If those red flags are spotted, Wedge recommends the test. The information becomes especially urgent when a woman is diagnosed with breast cancer and is evaluating treatment and surgery options. “Testing positive for the mutations means she has a greatly elevated risk of developing further breast cancer and so might opt for a double mastectomy rather than a lumpectomy,”

Wedge explains. Of women who have the BRCA1 mutation, 55 to 65 percent will develop breast cancer, and 45 percent of women with BRCA2 will develop breast cancer, according to government statistics. The two genes produce proteins that suppress tumor growth, and when they mutate, that function is impaired, allowing tumors to grow more easily. A similar genetic test is now being used for colon cancer, and Wedge sees the possibilities expanding rapidly. “The difference between what we know now and what we will know five years from now will be amazing,” Wedge says. Advice? “We are trying to identify high-risk people who do not have cancer yet, so people should consider their family history, and if there are young people with cancer or people with rare cancers, they should talk with their physician to determine if genetic testing is appropriate,” Wedge says.—J.S.

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AUTUMNWOOD OF MCBAIN Welcome to Autumnwood of McBain. Our beautiful, five-star rated, AHCA Bronze Award recipient, 95-bed skilled nursing facility is nestled in the rural community of McBain, just 15 minutes southeast of Cadillac.

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Addiction Treatment

PHOTO COURTESY OF MCLAREN NORTHERN MICHIGAN

Bear River Health’s Innovative Approach In the past year, the issue of addiction has taken on a new tone in the discourse of America. National leaders from both the conservative and liberal camps are acknowledging that society must treat the addicted not incarcerate them. That healing, supportive approach is already being implemented at Bear River Health at Walloon Lake, a new clinic designed to treat people addicted to alcohol, prescription drugs and illegal opiates like heroin in both residential and outpatient settings. When Bear River Health was being founded, the goal was to create a program very focused on the individual and that took a holistic approach toward the individual, explains Sue Hoffman, Clinical Director for Bear River Health. The treatment professionals turned to a program called Wellbriety to serve as the core of the clinic’s treatment strategy. The evidence-based program combines traditional 12-step methods with cultural and spiritual elements from Native American communities to create a respectful, supportive, accepting and caring environment, Hoffman says. Bear Creek staff attended training at White Bison, in Colorado Springs, Colorado, an organization that developed the principles of Wellbriety. The name Wellbriety is a hybrid of wellness and sobriety, conveying a key principle of the treatment—”the inspiration to go beyond sobriety and

recovery, committing to a life of wellness and healing every day,” as stated on the White Bison website. Native American influence is vividly on display with the program’s use of the traditional talking circle. A typical talking circle begins with people forming a circle and then handing around a sage smudge. “The sage is smoldering and you use an eagle feather to brush the smoke over a person to purify and cleanse them before starting. You can pass if you want, nobody cares,” says Hoffman. “The person holding the eagle feather speaks from the heart.” When the person is finished talking, he or she passes the feather to the next person, but there is no pressure to talk. The treatment protocol connects well with Native Americans, for obvious reasons, but Hoffman says the positive outcomes cross cultures easily. “When people leave here, whether they are traditional Native American or a businessman from downstate, we hear so many of them say it is a life-changing experience, that it is transforming, and that they have found the connection they have been looking for.” Many of the people who graduate return to become mentors, expanding the support network and sense of a healing community. “We get sick in isolation; we heal in connection with others,” Hoffman says. “Here in this community, people are finding healing.”—J.S.

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Do you suffer from  ANDRIS KAZMERS, MD

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CORINNE H. TRUSOCK, PA-C TERESA KERSTING, PA-C At Integrative Cardiovascular Health and Wellness we provide state-of-the-art 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 and loving care which takes into account the uniqueness and needs of each individual. Vascular lab onsite.

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Expert Shoulder Replacement Surgeons Work Here Northern Michigan’s only fellowship-trained shoulder replacement surgeons practice in Traverse City. Orthopedic Surgeons Christopher Chuinard, MD, and John Reineck, MD, have been trained by the top experts in their field. They use their additional education and training to diagnose and treat complicated shoulder and elbow disorders. Christopher Chuinard, MD

Drs. Chuinard and Reineck also specialize in reverse total shoulder replacement for people with a severely damaged rotator cuff, arthritis, or complex fractures. Together, they have performed more than 1,000 shoulder replacements for people in northern Michigan. If you have debilitating shoulder pain, you can get expert help right here. For more information about orthopedic services in northern Michigan, call 800-533-5520.

John Reineck, MD

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Drs. Jack Reineck (L) and Christopher Chuinard (R)

Shoulder Surgery

PHOTO BY MICHAEL POEHLMAN

Innovative Shoulder Procedures Reduce Pain, Improve Mobility The shoulder is the most complex joint in the body, admired by physiologists for its remarkable dual achievements in both strength and range of motion. But that complexity comes with a cost when the shoulder is injured or shows wear and tear, because surgery on the shoulder can be equally complex. Residents of Northern Michigan are fortunate to have two fellowship-trained shoulder surgeons nearby, with Dr. Christopher Chuinard and Dr. Jack Reineck, of Great Lakes Orthopaedic Center. As shoulder specialists, they perform several times more shoulder surgeries than general orthopaedic surgeons. “Our complication rate is very low, and study after study shows the complication rate is lower the more surgeries you do.” Reineck says. National respect for the two can be seen in their participation in early stage trials

for innovative shoulder surgery procedures. Currently, Chuinard is involved in trials of a technology called pyrolytic carbon humeral replacement, which replaces a portion of the “ball” part of a patient’s shoulder joint with a high-tech carbon material shaped into a hemisphere to fit the socket. The material is extremely hard and durable, but it is also slightly fl xible and thus presents less wear and tear on the patient’s cartilage and other tissues than standard metal shoulder replacement parts, Chuinard explains. Reineck is trained in an innovative procedure that just 15 clinics in the United States are approved for implementation. During the procedure, called augmented glenoid for challenging anatomy, the physician uses specialized plastic material to replace bone that is missing from a patient’s socket, which then allows the patient’s

socket to be reconstructed—reducing pain and offering freedom of movement. In some cases, Chuinard and Reineck have been involved even further upstream in the product development cycle. “We get together with engineers to identify issues, weaknesses with components,” Reineck says. “Or we might say, ‘I’d like to do some particular procedure, but not remove as much bone.” Thinking about their work with innovative procedures, Chuinard sees three great things happening at Munson Medical Center. “With our research we are contributing to the overall health of people across the country. The work we’ve done has helped provide a new option for one device here, and our current work is set to provide yet another option,” he says.—J.S.

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Telemedicine

PHOTO BY MICHAEL POEHLMAN

Improving Rural Health Care

Providing top quality medical care in rural areas has always been a challenge for the health care system—either patients have had to travel long distances to get care, or doctors, nurses and other health care providers have had to travel long distances to reach patients. Neither of those solutions is optimal, especially in places like Northern Michigan, where winter snow and ice can make travel especially difficult for people already compromised by health issues. For poor, rural populations, travel is documented as one of the biggest obstacles to seeking healthcare services. Medical providers are turning to telemedicine as a way to offer quality care while eliminating the travel barriers, and earlier this year, Munson Healthcare received a $407,676 grant to help speed the deployment of telemedicine to 19 rural medical clinics in Northern Michigan.

Peter Marinoff, president of Paul Oliver Hospital, in Frankfort, has led Munson’s telemedicine efforts, and offers an example. “A patient can be in Frankfort, and the infectious disease doctor they need is in Traverse City. The patient can go into a room, get checked in by a nurse, and then the physician appears on a screen instead of walking into the room,” he says. A system of two monitors and two cameras provides the flow of information between the patient and the doctor. A high-definition camera and screen allow the physician to carefully inspect the patient, with the in-room nurse operating the camera. The telemedicine team demonstrated the equipment to Marinoff, using the dermatology camera, and the clarity and magnification of the skin image was remarkable, he says. “And when they hook the stethoscope up, the quality of

the sound that the physician hears on the other end is amazing.” “Think of the remoteness of Beaver Island,” Marinoff says. “If somebody has a health issue in the summer, access is pretty reliable. “In winter, though, patients might not be able to be transported because of the weather, but now we have a way to connect to a provider on the mainland,” Marinoff says. Are further advances fast approaching? “We are only in the beginning stages,” he says.—J.S.

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Advances in

Northern Michigan

Dental Care

Medical Insider MyNorth Medical Insider

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MYNORTH MEDICAL INSIDER

Advertorial

Associates in Family Dentistry 10850 E. Traverse Hwy Ste 2250

Traverse City, MI 49684 231-946-9644 • www.smiletc.com

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 Treatment • TMJ Treatment & Management • Periodontal Therapy • Digital X-Rays • •

Dr. Michael Hutchison

Our Specialty: Breathtaking First Impressions Nestled in the beautiful surroundings of Northern Michigan, in the heart of Traverse City,

you will find a dental office unlike any oth-

er. Amidst the relaxing view of West Grand Traverse Bay, a dental team committed to the endless pursuit of excellence is waiting to welcome you. From same-day crowns to exceptional laser dentistry, dental implants to routine cleanings, our team is committed to providing the highest quality dental healthcare. Whether you are new to the area or simply seeking the best dental care in Traverse City, Dr. Michael Hutchison is ready to help you turn your smile into something worth smiling about. Dr. Michael Hutchison, along with his entire team, invite you to experience the difference today. Welcome!

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Dental Hygiene

A Flap About Flossing? A news article about flossing teeth, how controversial could that be, right? Well, quite controversial, it turns out. Earlier this year the Associated Press wrote a story explaining how there had never been a scientific basis for the federal health recommendation that people should floss regularly, and since federal law stipulates that such guidelines must be based in science, the recommendation was removed. Dentists across the nation could barely believe what they were reading, since they see the positive effect of flossing every day in their dental chairs. We checked in with Dr. Phillip Yancho to hear his reaction and advice. Can you recall your first reaction when you read the article? The team and I were at the office when we heard about it, and we just thought, Oh, boy. Now we have to spend time dismantling the impacts of this misleading article.

And a lot of people think bleeding gums are normal. Right. People have come to accept that as normal. But it is a dangerous sign of infection that can lead to periodontal disease, and there is no cure for periodontal disease. If you bumped your fingernail and blood started oozing out, you’d go to the doctor right away and ask what is wrong. Well, bleeding gums should be viewed the same way—you should work to stop that. And flossing is a very powerful tool in stopping that bleeding. How is the dental industry reacting to the article? The American Academy of Periodontology jumped in and said you still need to floss. And I’m sure there will be a study, but a really well-designed study will take years to show the results. In the meantime, the AP has done a lot of damage with this article. So just keep flossing!—J.S

How do you think it went so wrong? Well, it’s true there is not a good scientific article proving that flossing teeth is beneficial. But I tell my patients there’s also not a scientific study showing if you step out of an airplane without a parachute you are going to be hurt. Some things are just self evident. We see the benefits of flossing every single day. I can tell you who flosses just by looking in their mouth. The positive effects are that obvious. What happens if you don’t floss? The main thing that can happen is a periodontal gum infection. You end up with bleeding gums and increasing pocket depths, and that all leads to bone loss and eventually could cause a loss of teeth. Here’s a convincing way to look at it. I have seen elderly patients who have flossed for years and their teeth and gums are in great shape. But then as they get older, they might have dexterity and movement issues, and they can’t floss as well. And suddenly they show up with a big cavity between their teeth and bleeding gums.

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MYNORTH MEDICAL INSIDER

Advertorial

AcmeL Dental Care to R: Dr.Health Trevor Kay, Dr. Dennis Spillane, Dr. Shawn Spillane Acme Dental Health Care

Acme Dental Health Care

Dental Health Care, PC

Dennis Spillane, DDS, Shawn Spillane, DDS & Trevor Kay DDS Bellaire Dental Health Care:638 Willow Drive • Bellaire, MI 49615 • 231-533-5001 Acme Dental Health Care: 4480 Mt. Hope Road, Suite A • Williamsburg, MI 49690 • 231.486.6878

Acme Dental Health Care

The fresh air and warm hospitality of Northern Michigan certainly have been a wonderful welcome for brothers Dr. Dennis Spillane and Dr. Shawn Spillane. The duo opened Bellaire Dental Health Care in June of 2014 and haven’t slowed down since. We are happy to announce the new changes coming to our Dental Health Care family! The support and referrals from our wonderful patients and the caring atmosphere our great team at Bellaire Dental Health Care has provided, has allowed us to thrive and grow. Very soon, in November of 2016, we will be opening an additional dental practice in the Village of Acme at US-31 and M-72. Keeping patient satisfaction and convenience in mind, it seemed a perfect spot for our new dental practice with the rapid growth that has been happening in the area. With our growth and adding a new location we are also excited to introduce our new associate: Dr. Trevor Kay. It was with great care we handpicked Dr. Kay to work with us to serve you. We have no reservations in saying you will come to love and trust him. He is a very laid-back, easy-to-talk-to doctor with

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extensive dental training. Dr. Kay is a graduate of the University of Detroit Mercy Dental School and grew up in metropolitan Detroit but always knew Northern Michigan was where he wanted to practice dentistry. He feels honored to be able to work and live in this community and is looking forward to developing meaningful relationships with his new patients. Acme Dental Health Care will be committed to providing the same high level of care as Bellaire Dental Health Care for you and your family members. The 30-years plus of experience that both Dr. Dennis and Dr. Shawn each have brings a level of expertise to the practice which is second to none. For a complete list of what we have to offer & to learn more about our offi e, we encourage you to call us today!

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Dental Advances

The Technological Array in Today’s Dental Offices

Advances in Dental Crown Technology

CEREC Systems Continue to Improve As with other areas of technology, dental technology tends to advance with a breakthrough followed by a period of refinement, then another breakthrough and another period of refinement. Such is the case with the CEREC technology (Chairside Economical Restoration of Esthetic Ceramics). CEREC began to gain popularity in dentistry in the last decade as it allows dentists to make crowns in one appointment. In recent years this technology, including the software, the digital imaging system, and the bonding agents to keep crowns permanently in place have drastically improved. The office of Dr. Jason Mantey incorporates the latest CEREC technology including the most recent camera and digital imaging system, crown milling unit, and cements and bonding agents. Mantey recently moved to Traverse City, taking over the dental practice of Dr. Robert Howard.

Traditionally, dentists took impressions for crowns with a rubber-like material, which was sent to a laboratory that fabricated the crown. The patient would wear a temporary crown until the lab sent the permanent crown, which typically took about two weeks. Traditional crown fabrication is still commonplace, but more and more dental offices offer CEREC technology as it is much more convenient for patients. The process usually takes a couple of hours and begins with using a digital camera to capture a highly detailed 3D image of the tooth being crowned. The image is sent to the in-office milling machine, which makes the crown from a ceramic block using diamond burs. The milled crown is then put in a porcelain-firing oven and cooked at 1,500 degrees Fahrenheit to harden it. The material used for CEREC crowns is extremely dense and wear resistant, Mantey says.—J.S.

Improving with one new, innovative piece of technology at a time, dental care has undergone a dramatic evolution in recent years. We asked Steve Hall, D.D.S., of Suttons Bay Dental Center, to take us through some of the most important advances that make dental diagnosis and treatment so much more effective today. Cone beam imaging: This X-ray technology renders an accurate 3-dimensional image of bone underneath a patient’s gums. “You can have severe bone defects under the gum, but they are not always apparent,” Hall says. Cone imaging exposes those defects, which is especially important with device implants, because an accurate picture of the bone allows the surgeon to anchor the device into solid bone. Also, the radiation exposure is just 10 percent that of a CT scan. Electronic dental medical records: Though not a technology applied directly to the patient’s teeth and mouth, electronic records “make everything run a lot smoother,” Hall says. One key benefit: Dentists are able to easily compare a patient’s dental check-up results to those of six months or a year prior to accurately track the patient’s status. “The images are super clear and you can do side-by-side comparisons to see changes,” he says. Electronic Appointment Systems: Another one that doesn’t affect teeth and gums directly, but Hall says the easy-touse appointment systems make a dramatic difference because people are so much more likely to make and keep dental appointments, and thereby maintain oral health. “It’s all text and email and my patients love it,” he says. Invisible Braces: A low-impact way to straighten teeth that are not dramatically misaligned, invisible braces involve applying a series of retainers, each shifting the teeth ever so slightly more into correct placement. The retainers are computer designed and 20 separate retainers might be needed to complete the process. The braces are especially popular with adults looking to straighten slightly crowded teeth.—J.S.

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MYNORTH MEDICAL INSIDER

Advertorial

Dr. John Holcombe Dr. Steve Hall 1299 South West Bayshore Drive • Suttons Bay, MI 49682 231-271-6700 • suttonsbaydental.com Dr. John Holcombe, Dr. Steve Hall

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 have 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. 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

A Team Approach to Dentistry Drs. David Swan, Macare Lumbrezer, Chris Mazzola, Josh Van Horn, and Christina Mazzola are all graduates of the University of Michigan School of Dentistry. The greatest advantage of working in a practice with five doctors is the ability to collaborate on patient care. This team approach gives patients the benefit of all their advanced training and collective skills. We are so thankful for the talented and dedicated team of hygienists, dental assistants, and business staff. In 2016, our office was certified as a Great Place to Work®, named a Top 10 Business by

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the Traverse City Chamber of Commerce, and named to Fortune’s Top 100 Best Places to Work for Women. Every day we hear patients comment on the care they receive; complementing our team as happy, eager to help, and, of course, smiling. Whether you are a new patient or one of the many patients that have been in our office for decades, our goal is to exceed your expectations at every visit. Learn more about our office at: www.traversedental.com or call us at 231.947.0210.

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Dental Advances

Saliva Testing Can Provide Essential Information About Your Health “Your mouth is a window to your body. That is becoming more and more obvious every day with research that links the condition of your mouth to the health of the rest of you,” says Melissa Makowski, D.D.S., of Lakeview Dentistry of Charlevoix. As part of trying to see ever more through that window, medical researchers are turning to saliva tests to track a number of health indicators: levels of especially problematic bacteria that can cause damage to your heart or brain, a genetic predisposition to periodontal disease, and oral HPV, which can cause mouth and throat cancer. “In 2013, researchers found bacteria from the mouth in the brain tissue of Alzheimer’s patients,” Makowski says.

“They have found mouth bacteria in the artherosclerotic plaques of stroke patients.” There are about 700 bacterial species that live in the mouth, and today’s test can report back on 11 of the worst actors. “It’s simple to have a salivary test done,” Makowski says. “You just spit into a tube.” When the results come back, the dentist will determine if any action is needed. “If, say, two bacteria are high, maybe we would recommend antibiotics and a deep clean in addition to typical therapy,” she says. If genetic predisposition to periodontal disease is confirmed, the dentist will know to pay extra attention to that issue, possibly suggesting more frequent cleanings, like three or four a year instead of two. A

dentist might also discuss diet and exercise with the patient. If oral HPV is found, dentists can increase surveillance for tumors that can be caused by that disease. “We have special lights that can indicate a change in tissues,” Makowski says. Such testing and a broader view of how the mouth and general health are so closely linked is leading to more and better communication between dentists and physicians. “Patients generally see their dentist more frequently than their physician,” Makowski says. “So we can tell them, ‘It’s time to see your doctor.’ ”—J.S.

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The New Cancer Wellness: Yoga. Meditation. Cooking. The changing face of cancer support. / On the leading edge of cardiac device research. /...

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