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Women’s Health Topics and Services Available in Kitsap County

wave of 2012

Women’s Health & Wellness Guide Presented by


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WAVE OF PINK

Wave of Pink 2012

September 28, 2012

Women’s Health & Wellness Guide

Welcome to this year’s edition of Wave of Pink!

With October and Breast Cancer Awareness Month just around the corner, the timing for this year’s annual women’s health and wellness publication couldn’t be better. Access to quality health care has become a critical topic of our socioeconomic discussions both nationally and locally. Women today have more opportunity than ever to seek preventive health screenings and services as well as receive treatment of the highest standards right here in Kitsap County. In this year’s Wave of Pink there are numerous articles and advice about cutting edge services in our local community as well as how to access vital health screenings, eating healthier for you, the positive impact of yoga and much more. We truly hope you enjoy this year’s Wave of Pink for a healthier you.

Thank you to the following whose expertise contributed to this publication: Stephanie Cline Harrison Medical Center Thomas Meeks, DO, FACOS Harrison HealthPartners Bremerton

Heather Denis, RD, CD, DCE, CPT Harrison Medical Center Matthew Shutske, MD Advanced Medical Imaging Dr. Manfred Henne InHealth Imaging

Eric Rasmussen, MD

Lisa J. Ballou, M.A., Ph. C. Expansions Yoga

Peggy Griffell, NP Silverdale Primary Care

Anita McIntyre, MD, FACOG OB/Gyn Associates

Lori Eakin, MD, FACS Harrison HealthPartners Silverdale

J Wesley Solze, MD Advanced Medical Imaging

PUBLISHER: Sean McDonald COORDINATOR: Wayne Nelson PRODUCTION: Bryon Kempf COVER DESIGN: Bryon Kempf GUEST COORDINATOR: Susan Phillips, Advanced Medical Imaging Copyright 2012 ©Sound Publishing Inc.

Because

We’re as close as your own backyard KPS Health Plans has offered quality health plans to residents of Kitsap County for more than 65 years. Our extensive provider network ensures that you will receive care through your choice of doctors, without a referral. In fact, the network includes more than 47,000 providers in the state of Washington alone. Choice bundled with award winning customer service, come see what KPS can offer you.

There’s When shopping for a health plan, think close to home. Think KPS.

www.kpshealthplans.com | (360) 377-5576 | (800) 552-7114


September 28, 2012

WAVE OF PINK

Harrison Women’s Health Screening Fund: Helping ensure annual screenings for all women Now through targeted fundraising, a new Women’s Health Screening Fund has been created at Harrison Medical Center Foundation. The fund will help fill the gaps that have prevented some women in our community from accessing potentially lifesaving screenings for breast and cervical cancer. In August, the Fund received its first charitable gift—a $6,000 donation from Soroptimist International of Greater North Kitsap, partial proceeds from their 2012 Bras for a Cause Event.

By Stephanie Cline

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Foundation Director, Harrison Medical Center

nyone can get breast cancer. And of the women who do, most have no known risk factors except for being a woman and getting older. Breast cancer is the most frequently diagnosed cancer among women in Washington state. The good news is that the five-year survival rate for all women diagnosed with breast cancer is 90 percent. Your chances for survival are better if the cancer is detected early before it spreads to other parts of your body. In fact, when breast cancer is found early and confined to the breast, the five-year survival rate is 98 percent. The key is to detect breast and other cancers in their earliest stages through important screening exams, such as mammograms and pap smears. Unfortunately, many women in our community are going without these

Stephanie Cline important screenings due to the lack of adequate health insurance. For these women, cancer is often diagnosed at later stages when it’s harder to treat and the risks to survival are much graver.

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Society, last year approximately 425 Kitsap women were served through the BCCHP Program, receiving screening and diagnostic exams, including mammograms and pap smears. Women who were then ultimately diagnosed with cancer were enrolled in the Medicaid Program to cover the costs of their treatment.

The intent of the fund is to extend the safety net that already exists in the community by working with the local contracted providers of the national Breast, Cervical and Colon Health Program (BCCHP), such as Peninsula Community Health, Kitsap Public Health, Advanced Medical Imaging, InHealth Imaging, and most recently Harrison HealthPartners.

While BCCHP has had a tremendous impact on women both locally and nationally, providers know that the funding is far from adequate. It is common for the program to run out of funds four-and-a-halfmonths into a six-month contract, leaving women on waiting lists and in the gap for potentially life-saving care. In Washington state, it’s estimated that BCCHP serves just 25 percent of the women who are eligible— underscoring both the need and opportunity to make a tremendous difference for women’s health care in our community.

Through current federal, state and some private funding, including Susan G. Komen for the Cure and the American Cancer

For more information about how you can help, call the Harrison Foundation at 360744-6761.

What you need to know about breast implant surgery By Thomas Meeks, DO, FACOS

filled with silicone gel.

major muscle

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Each type of implant has advantages and disadvantages. For example, silicone implants are considered more natural to the touch, but saline implants cost less. In addition, saline implants can be placed through the smaller incisions.

The breast placement for you will depend on several factors including lifestyle, the amount of natural breast tissue you have, the size of the implants, and desired appearance.

Harrison HealthPartners Bremerton Plastic & Reconstructive Surgery

ach year, hundreds of thousands of women undergo breast augmentation surgery, a plastic surgery procedure designed to improve the appearance of the breasts. Most women undergo the procedure to enlarge breasts that are naturally small, though some have it to correct disproportionate breasts or repair congenital deformities. Breast implants can also be combined with breast lift surgery (mastopexy), in which sagging, drooping breasts are repositioned higher on the chest. Combining mastopexy with implants allows the surgeon to add volume as well as create perkier, more youthful breasts. In addition, women undergoing breast reconstruction following a mastectomy or trauma to the chest may have implants placed in near chest as part of that reconstructive procedure. Silicone versus saline breast implants If you are considering breast implant surgery, one of the first questions to ask is, which breast implant is right for me? There are two main types of breast implants: saline and silicone. Each type has the same basic anatomy—a silicone shell with filling. The difference is in the filling. Saline implants are filled with a salt and water solution, while silicone implants are

Placement of surgical incisions The location of surgical incisions is also an important decision that must be made prior to surgery. There are four options for your breast implant incisions:

Potential side effects of the two implant types also differ. For example, if the shell of the saline implant ruptures, the result is in an obvious “flat tire” on the ruptured side. However, if the silicone implant ruptures, the result may not be noticeable right away. Although the saline is harmless to the body, in either case surgery is necessary to remove and replace the ruptured implant.

Inframammary incision (under the breast)—an incision is made in the inframammary fold where the breast meets the chest wall. Periareolar incision (around the nipple)— an incision is made along the areolar border

The safety of silicone breast implants In the past, concerns emerged that silicone implants posed health risks, including increased risk of systemic diseases such as lupus and arthritis. The Food and Drug Administration (FDA) placed a moratorium on silicone implants in 1992 so the safety of these devices could be studied. The moratorium was lifted in November 2006 when the agency concluded there was no evidence of risk. In fact, in March 2012, following years of breast implant clinical trials, the FDA approved a new type of silicone implant. Known as “gummy bear” implants, these are filled with a cohesive, forearm-stable silicone gel that has the consistency of gummy bear candies (hence the nick name).

Thomas Meeks, DO, FACOS Placement of breast implants

Transaxillary incision (in the armpit)—an incision is made in the armpit area to access the subpectoral space.

Another important decision to be made prior to surgery is where to place the implant in relation to your breast tissue and chest muscles. The basic implant placement options are:

Trans-umbilical (TUBA, around the belly button)—an incision is made around the belly button and a tunnel is created up to the breast pocket via the abdominal wall and chest. The implant is then placed through a tube.

Subglandular (above the pectoralis muscle)—implants are placed behind the breast tissue but above the pectoralis major muscle

Only a fully trained, board-certified plastic surgeon can properly evaluate you to determine if you are an appropriate candidate for breast implants, as well as help you make the important decisions about which types of implant, placement, and incision are right for you.

Submuscular (behind the pectoralis muscle)—implants are placed either completely behind the pectoralis major muscle or partially behind the pectoralis


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WAVE OF PINK

Protecting your skin from Seattle skies are best pursued at times other than the highest risk midday window of 10 AM to 4 PM. Be aware of surfaces that will increase reflective UV exposure such as water, snow and ice, glass, metal and sand. Always try to seek shade when UV risk is maximal. Incidental, casual sun exposure adds up.

BY Eric Rasmussen, MD

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o, this is not a discussion of the latest Nordstrom rainwear attire! We really do have sun and ultraviolet (UV) light exposure risks in the Northwest. Granted, we have factors that help mitigate our risks such as clouds and fog, as well as the latitude and altitude at which we live. However, we are a vibrant community with many outdoor activities and hobbies that increase our risk from cumulative UV exposure. Skin cancer and premature photoaging of the skin are the most feared sequelae resulting fromUV exposure. Lighter skin types are at greatest risk. Other risks include immunosuppression and photoinduced skin disease such as lupus and drug photosensitivity. Proper protection from solar radiation will help us avoid these problems.

Eric Rasmussen, MD When planning protective strategies, it is best to start with simple, common sense measures such as being aware of the UV risk each day, the UV index. Outdoor activities

Clothing is an important component of UV protection. Regular use of broad brim hats, and tightly woven fabrics are highly protective. Fabrics such as cotton and linen may only give an ultraviolet protection factor (UPF) of 5 to 9, and are even less protective when wet. Darker fabrics are more protective than lighter fabrics. Many recreational clothes are commercially available which clearly indicate their UPF. We must also not forget the need for sunglasses to avoid UV damage to the lens, cornea, and conjunctiva of our eyes. Use of broad-spectrum sunscreens remains an essential part of the UV protection plan. These products need

Why do women have more headaches? BY Peggy Griffell, NP

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Silverdale Primary Care

hy do women have more headaches - - the answer is twofold. First, is the unique fluctuation of hormones women experience on a monthly basis from the time of menses to menopause. Second, women are also unique in the stress burden they carry as they attempt to be everything for everyone … juggling the many roles of motherhood, wife, career woman in addition to financial pressures can add to daily stresses which can then trigger headaches. There are multiple types of headaches including: tension, sinus, cluster and migraine that we treat in primary care. For the purposes of this article, I will be focusing on migraine headaches. Migraine headaches affect 29.5 million Americans and are the most common form of disabling headache that will send women to their primary care providers. Three out of four people who have migraines are women, and commonly occur between the ages of 20 and 45. Women also tend to report more painful headaches that last longer and often include associative symptoms including nausea and vomiting. How can you tell if you are having a migraine headache? Often you will have at least two out of the following three symptoms including: moderate to severe headache, nausea, and sensitivity to light. Sinus headaches tend to also include nasal congestion and thick nasal secretions. Tension headaches do not cause nausea, are usually mild to moderate in pain intensity and rarely cause any sensitivity to light (photosensitivity).

So now that you have determined that you probably are experiencing migraine headaches, what do you do next? First of all, I would always recommend consulting with your primary care provider to determine if you would be a candidate for any diagnostic testing like a CT scan or MRI of the head. These types of diagnostic testing can rule out any possible causes of secondary headaches which can include brain tumors and brain aneurysms (bulge in the artery in your brain). Assuming that the scan was negative, you might be wondering exactly what a migraine headache is. This is one of those grey areas in medicine, where we don’t know specifically what causes a person to experience these headaches. It is thought to be due to imbalances in brain chemicals that cause an inflammatory response which causes blood vessels in the brain to swell and press on nearby nerves, causing pain. What we do know about migraines is that they are very genetic. If your mom had migraines, you are likely to experience them yourself. Migraines are often caused by a variety of environmental and physical triggers. Hormonal fluctuations that occur just prior to getting your period account for more than half of all migraines in women. This is thought to be related to the sudden decrease of estrogen and progesterone levels prior to menses. For these people, menopause can be a blessing as it can significantly decrease migraines. However, women who are in their 40’s and starting to approach menopause can sometimes develop migraines for the first time in their life. Stress whether it is “good stress” or “bad

Peggy Griffell, NP stress” can trigger migraines. Women often put unrealistic timelines or expectations of oneself in an attempt again to be everything for everyone. Making time for oneself and finding healthy ways to deal with stress are important, including, but not limited to, eating well, regular exercise, alone time and 7-8 hours of sleep nightly. Other common migraine triggers are dietary which can include but are not limited to: MSG (monosodium glutamate) – found in many Asian foods as well as canned soups; alcohol – especially red wine; overuse of caffeine; foods containing tyramine or nitrates including aged cheese, processed meats, soy products and fava beans; chocolate and foods containing aspartame (Nutrasweet). Pharmaceutical treatment options for migraines are broken into two categories,

September 28, 2012

to protect us from both UVB and UVA irradiation by using mixes of organic absorbing/filtering and inorganic absorbing/ reflecting compounds. The Sun Protection Factor (SPF) of each product appears on the label. Generally a broad-spectrum sunscreen of 30 will block 97% of UV rays. Protection can be less if the sunscreen is applied sparsely, not reapplied, the product washes or is rubbed off, or if the product is applied less than 20 minutes before UV exposure. A tan is the body’s response to UV injury. Tanned skin only provides a potential maximum SPF of 3 and sunless tanners only provide a SPF of 2. An international study has shown a strong association between regular tanning bed use and increased melanoma risk. In our office, we say, “Light is alright”. Please enjoy our Northwest summer weather, but please start a regular program of UV protection for yourselves and your children.

abortive therapy and prophylactic therapy. Abortive therapy encompasses treatment for the acute migraine and typically includes: OTC combination meds with caffeine, Tylenol, and aspirin – think Excedrin, Anacin, etc; Triptans which are prescription meds and include Imitrex, Maxalt, Zomig, to name a few; and Ergot deriviative meds which includes Fioricet. The key to abortive therapy is to take the medication immediately at onset of migraine symptoms. The sooner you can treat it, the more likely the migraine will respond to the medications. Sleep, quiet dark room, and ice bag on your head can also be effective. Prophylactic therapy is indicated for patients who experience two or more migraines per month with disability lasting three or more hours, failures of acute treatments, or use of pain relief drugs more than twice weekly. The first line medications recommended for prophylactic therapy include: Amitriptyline (Elavil), Depakote, Propranolol (Inderal) and Topiramate (Topamax). For women with menstrual migraines, often starting Naproxyn (Aleve) several days before their period and continuing until its completion can be successful in not only avoiding a menstrual migraine but also decreasing painful cramps and decreasing blood flow. Oral birth control pills given continuously, thus stopping the normal decline of estrogen and progesterone before menses, can also be successful. Overall, the key to migraines is finding your triggers, decreasing your stress, and working with your health care provider to determine if diagnostic testing is necessary and if medications will be helpful. Before coming to see your health care provider, keep a headache diary. Note the time of day, the duration of the headache, associative symptoms, food eaten for past 24 hours and approximate time in menstrual cycle to assist in the diagnostic process.


September 28, 2012

WAVE OF PINK

New breast care center in Silverdale T medical and radiation oncologists, physical and lymphedema therapists, patient navigators, pathologists, social workers, community resources, and plastic surgeons. And while it would be ideal to have all of these caregivers in one building, with good communication and shared concern for the patient, together we are able to guide the patient through the treatments and care he or she needs. My goal as a breast surgeon is to be a caregiver in the true sense of the word, providing seamless care for my patients with breast cancer so they move from a potentially life threatening situation to restored health and overall wellbeing. Long term follow-up care leads to a comprehensive relationship with patients.

By Lori Eakin, MD, FACS

Harrison HealthPartners Silverdale Breast Care

wo years ago, an article appeared in the New York Times titled, “Wanted: Mammologists.” The authors felt that “the breast is something of an orphan” in our health system of increasing specialization, and that patients needed someone who had learned how to diagnose breast cancers and “breast care specialists devoted to shepherding them through surgery, therapy and healing.” The authors were obviously not inquiring about the existence of people devoted to the study of mammals (the true definition of a mammalogist), but rather someone well-versed in diseases of the breast who can provide reassurance and emotional support in addition to surgical skills. Not only does a specialist of this variety exist, but that specialist is called a breast surgeon and I am one! At Harrison HealthPartners Silverdale Breast Care, I see both women and men with all forms of breast concerns. From assessing the

Lori Eakin, MD, FACS potential risk for developing cancer and evaluating non-cancerous and benign disorders to performing biopsies and treating cancer, we believe in a team approach. This means bringing together primary care providers and gynecologists,

Centrally located in Silverdale, our office is equipped for minor procedures under local anesthetic and needle biopsies using ultrasound guidance. A patient navigator is on site to assist patients with needs related to their treatments. Onsite, I have access to radiology expertise at Advance Medical Imaging (AMI)

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Nothing stops breast cancer like a team. Introducing Survive and Thrive—a new program designed by Peninsula Breast Center to help women reach their health and fitness goals and at the same time, reduce the chance of breast cancer returning. When cancer strikes, you want to know that you have the team on your side. Now, you can find that team on this side of the water.

PeninsulaBreastCenter.com

360.697.8024

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and the Harrison Medical Center laboratory. Close proximity to pathologists who have special expertise in breast diagnoses is also a benefit. In- and outpatient surgical procedures are performed using advanced surgical techniques at Harrison Medical Center in Bremerton or Silverdale. I bring with me the experience of working in a nationally accredited breast center (NAPBC) in Pennsylvania, and have high hopes for such a center here in Kitsap County. As my husband and I get to know our new community, I have been fortunate to get involved in one of my dream charities—a fund newly established through the Harrison Foundation that helps provide screening mammograms for women who would otherwise be unable to obtain them. Women’s health care is my passion, and I am excited to be able to do my part to contribute to the health of women in Kitsap County.


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Eating for a brand new you By Heather Denis, RD, CD, DCE, CPT

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Harrison Medical Center Diabetes Educator/Clinical Dietitian

3. Legumes, such as black beans, pinto beans, lentils, kidney beans, lima beans, soy beans, and cannellini beans, help remove waste from the body, and therefore help lower cholesterol and promote healthier blood vessels in both the heart and brain. They are also a great source of iron.

hat if there was such a thing as a magic pill that could reverse the aging process and prevent certain diseases such as heart disease and cancer? While there may not be a pill, there are certain foods that come very close to doing just that. The human body is in a constant state of change. In fact, some scientists believe the body renews itself about every seven years. We need to eat nutrient rich foods to help these new cells be as healthy as possible. That’s where a certain group of foods known as “super foods” comes in. What makes these foods “super”

A super food is a food that contains high amounts of vitamins, minerals, or phytochemicals (non-nutrient compounds found in plant based foods). It is the phytochemicals that give food their character, taste, color, and aroma; they also serve as antioxidants, enhance the immune system, reduce inflammation, kill cancer cells, and protect DNA from being damaged. Super foods fall into a list of nine,

and strawberries, contain antioxidant compounds called anthocyanins. These reduce free radicals in the body, which have been shown to accelerate the aging process. A diet high in berries also helps with memory and the prevention of urinary tract infections.

Heather Denis, RD, CD, DCE, CPT healthy food groups: 1. Dark green vegetables, such as spinach, broccoli, collard greens, bok choy, kale, and Swiss chard, are a good source of calcium; magnesium; folate; polyphenols; fiber; vitamins A, C, and K. Spinach is also high in zeaxanthin and lutein, which helps support eye health and may reduce the risk of age-related disorders. 2. Berries, including blueberries, raspberries, cranberries, blackberries,

4. Orange fruits and vegetables, including sweet potatoes, carrots, pumpkins, orange bell peppers, and winter squash, contain beta carotene, which helps protect the eyes and promotes the immune system. The deeper orange colored fruits and vegetables may also help promote cardiovascular health. 5. Whole grains, such as brown rice, wheat, barley, oats, and rye are rich in complex carbohydrates and help reduce the risk of heart disease and certain types of cancer. Unlike refined grains (white rice, white bread, etc.), they have not been through the milling process that removes many of the nutrients. 6. Cold water fish, including salmon, halibut, tuna, trout, sardines, and mackerel, contains the highest level of omega 3 fatty acids. Omega 3s reduce triglyceride levels, which have been shown to reduce the risk

Cardiovascular screenings

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Advanced Medical Imaging

ardiovascular disease is the leading cause of death in women. It is a more common cause of death than all cancers combined including but not limited to the most common cancers such as breast cancer, colon cancer, and lung cancer. One-third of women

Phone: (360) 633-3725

Lori Nelson, ARNP Women’s Health Nurse Practitioner 20700 Bond Rd NW • Poulsbo

8. Cultured dairy products, such as live active cultured yogurt, kefir milk, and buttermilk, contain friendly bacteria called probiotics, which aid in digestion, boost the immune system, break down cholesterol, and shield against harmful substances that travel through the intestines. 9. Chocolate (yes, chocolate!). Cocoa is rich in flavonols which reduce the risk of blood clots and lower cholesterol. The higher the cocoa solids content, the higher the antioxidant effects, so look for dark chocolate made with at least 40 percent cacoa. The recommended amount of dark chocolate is 1.5 oz per day. Getting started To increase the amount of super foods you eat, begin by substituting or adding some of these nutrient-packed foods into your regular meals and snacks. Replace chips with whole grain crackers; add berries to a spinach salad. As you add these super foods into your diet, you will find that eventually there is not as much room for the non-nutritious foods. Building a whole new you may be as close as your refrigerator.

Matthew Shutske, MD, Radiologist Calcium Score. This non-invasive CT scan calculates the total amount of calcified plaque in a patient’s coronary arteries. The test is a very fast CT scan, taking less than 30 seconds, and does not require an intravenous line or intravenous contrast. The coronary arteries are the arteries that supply blood to the heart which, if blocked, may result in a heart attack. Knowing how much calcified plaque is in the arteries helps determine how much risk a patient has for a heart attack. The total calcium score is an independent predictor of coronary heart events. In other words, a calcium score can help

Disease prevention is the key to a healthy life. We at AMI are here to work with you and your doctors to help prevent and detect disease before it becomes a serious problem for you and your family, and to help you achieve the happiest, healthiest life possible.

One test we offer is Coronary Artery

www.lorinelsonNP.com

7. Tomatoes are rich in vitamin C and carotenes, are great immune boosters, and support prostate heath in men.

Another test we offer is Carotid Intima-media Thickening (CIMT). This non-invasive ultrasound scan measures the thickness of the carotid arterial wall in the neck, and has been shown to strongly correlate with atherosclerosis elsewhere in the body as a predictor for cardiovascular events. After a brief scan, the patient is provided with information of their “vascular age” to help your doctor assess their risk for adverse cardiovascular events. This test requires no IV and does not involve radiation.

The key to preventing early death due to any disease is prevention, early detection, and early and effective treatment. At Advanced Medical Imaging, we provide imaging services to help detect cardiovascular disease as early as possible in order for your doctor to begin early and effective therapy.

Health Care for Women

of heart disease, protect from irregular heartbeats, and decrease inflammation. If you follow a vegetarian diet, you can get omega 3s from flaxseeds, pumpkin seeds, soybeans, walnuts, and canola oil.

your doctor determine your risk for heart attack and help them determine what types of further testing or therapy you may need.

will die of cardiovascular disease and stroke.

BY Matthew Shutske, MD, Radiologist

September 28, 2012

We also offer CT coronary artery angiography and cardiac MRI in terms of cardiovascular disease diagnosis. These tests are not commonly used as screening tests, but are other imaging tests usually done on symptomatic patients that can help your doctor determine of you need cardiovascular therapy based on the results of the test.


September 28, 2012

WAVE OF PINK

Meet Marsha Gartrell, RN >

Committed to her fa ith and family

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Known to indulge grandchildren

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Registered nurse and Harrison pa tient

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Brings a unique perspective to the development of electron ic medical records technolog y

Harrison is well underway using electronic medical records technology, which we call HERO. Since launching in 2008, we’ve created nearly a million distinct electronic records for our patients to enhance the quality of your care, your safety, and the portability and security of your medical record.

I promise

to protect your privacy while pro viding your doctor’s real-time a ccess to your electronic medical record.

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WAVE OF PINK

September 28, 2012

F R A N C I S C A N H E A LT H S Y S T E M

St. Anthony Mammography Clinic Milgard Medical Pavilion 11511 Canterwood Blvd. N.W. Suite 230 Gig Harbor 253-530-2170 Hours: 7 a.m. – 6 p.m. Monday through Friday Walk-ins welcome!

Wave goodbye to breast cancer With highly accurate screening and early detection St. Anthony Mammography Clinic offers convenient access to topquality digital mammography. Because we believe you deserve the most advanced breast screening technology available, in a safe and comfortable setting.

St. Anthony Mammography Clinic has been awarded the highest quality rating possible for adhering to the rigorous quality and safety standards as set forth by the Mammography Quality Standards Act (MQSA).

Have you had yours? Get your mammogram during October and receive a free gift! Call 253-530-2170 to schedule your appointment today.

FOR ADVANCED MEDICINE AND TRUSTED CARE, CHOOSE ST. ANTHONY. www.FHShealth.org


September 28, 2012

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InHealth Imaging—Blazing the trail for 3D mammography

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into thin layers or “slices”. These images allow radiologists to find the smallest of cancers sooner. Plus, InHealth Imaging radiologists meet with you following your mammogram to review your films—you don’t have to wait for a letter or a call, you leave with peace of mind.

Think it’s expensive? Think again. Most insurance companies cover annual screening mammograms at 100% and InHealth Imaging is the only practice to offer 3D Mammography to all patients at no additional charge to the patient, plus no referral is needed.

Last year, InHealth Imaging blazed the trail for 3D Mammography as the first imaging center in the Western United States

“I cannot stress enough the importance of annual 3D Mammograms”, explains Dr. Manfred Henne, Radiologist at InHealth Imaging. “Early detection of breast cancer by 3D Mammography improves the chances that breast cancer can be diagnosed at an early stage and treated successfully, many times without the use of chemotherapy,” Dr. Henne continues.

“We meet many people in the community who are over 40 and are not having annual mammograms, or have never had a mammogram, says Tami Bloom, Director of Marketing and Communications for InHealth Imaging, “with so much information literally at our fingertips, the facts are right in front of us—annual 3D mammograms save lives,” Bloom says.

CONTRIBUTED

ou know you should do it, but you put it off—or maybe you heard you don’t need to do it every year. Sound familiar? Annual mammograms for women over 40 are recommended by The American Cancer Society, and if you haven’t had one in a while, 3D Mammography technology offers the benefit of increased cancer visibility with less compression. Before you book your appointment, there is more.

Dr. Manfred Henne and patient. to offer this advanced detection. 3D Mammography, or Breast

Tomosynthesis, uses high-powered computing to convert digital images

Yoga’s Health Formula: Breath + Movement = Balance + Energy By Lisa J. Ballou, M.A., Ph. C.

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Co-owner Expansions Yoga

ecause many Americans misunderstand what yoga is, they miss out on its benefits. It has been my experience that Americans define yoga in one of two extremes. Either they define it solely as the extreme version of the various poses. Or, they define it as an extreme form of ascetic, esoteric spirituality. They tend to think that one must be a contortionist to practice yoga or that doing so is tantamount to drinking some cult belief infused “kool-aid.” In actuality, yoga seeks to establish balance -- balance between the physical and the cerebral, balance between strength and flexibility, balance between external stimuli and internal focus. Yoga is primarily defined by its purposes: to coordinate breath and movement; to increase self awareness; to channel energy. Given that yoga is a 5,000 year old practice, almost anything else we do is really a version of yoga. My triathlete 18-year-old son and baseball playing 13-year-old son tire of me watching their team practices and arrogantly commenting, “you DO know that stretch your coach made you do was REALLY just Uttanasana.” (Such arrogance on my part almost always elicits either sullen silence or a justified, “whatever, Mother.”) What makes something “yoga” is not so much what is done as how that something is done. If the exercise or stretch in question is done with an attention to subtle adjustment, with an attempt to use the breath to gain a deeper version of the physical activity, with an understanding that no matter how well one does the pose, one could always make an incremental improvement,

with a curiosity about the systemic effects of any given pose on the mind and the psyche, then one is doing yoga. If one is not doing any of these things, one is simply bending over and trying to touch one’s toes! Ironically, without this type of yogic awareness, most people experience “stretching” as either uselessly “easy” or downright painful; with this type of yogic awareness, “stretching” can become a satisfying and beneficial challenge. One of the first beneficial “epiphanies” most people have after attending a yoga class is that it isn’t just stretching. I believe that yoga helps me achieve one of the most basic markers of health -- “balance.” Each and every yoga pose asks us to stretch certain parts of our body while strengthening others. By performing yoga, we come to learn how one muscle group needs to be strong and stable in order for another to yield and open. Many injuries, both acute and chronic, are created due to the lack of this essential balance. We need a certain type of range of motion in order to perform our daily activities, but often, we lack the fundamental strength to support that range of motion. Therefore, we injure ourselves either by over stretching a muscle group or by over burdening a joint. One of the main benefits of yoga is that it creates the necessary balance between strength and flexibility which allows us to perform daily activities more effortlessly. When we are young and/or healthy, we tend to take this balance for granted. However, as we age, this balance is imperative to offset the natural orthopedic degeneration that occurs over time. With age comes a tendency toward muscular weakness and structural rigidity. These two factors significantly increase the risk of acute joint injury and chronic joint

body parts and systems can be a powerful antidote to these very common secondary complaints by restoring the balance necessary to minimize them.

Lisa J. Ballou, M.A., Ph. C. deterioration. A consistent yoga practice helps to maintain muscle strength and structural mobility which, in turn, makes our joints less vulnerable to injury and which retards the natural “wear and tear” processes. As 96-year-old marathoner Jack Kirk claimed, “we don’t stop running because we get old, we get old because we stop running.” Continued movement is critical for continued health. Additionally, yoga can be beneficial when one’s movement is compromised after an illness or surgery. Often times the illness or surgery diminishes one’s muscle strength and one’s range of motion such that, in addition to being plagued by the primary problem, the patient also develops secondary problems as a direct result of the “imbalance” that the illness/surgery has thrust them into. Yoga’s focus on increasing the practitioner’s awareness of the interrelationship between multiple

Finally, many people are surprised by how wide reaching the benefits of yoga are. I recently had the privilege of working with a woman who claimed “not to like yoga.” “Fine,” I said, “let’s just do what we are going to do and not call it ‘yoga.’ Let’s just call it breathing and moving.” I had her start out by assessing how she was feeling on a scale of 1-10. I then told her, “when we are done, we will have you re-assess how you are feeling. If your number improves, then we will call what we just did a success.” After our hour of “breathing and moving” was completed, I asked her if her number had improved. She was adamant that it had and noted that it felt like she “had taken a vacation.” I believe that the reason for this lies mainly in yoga’s ability to affect the energy. How one breathes is very much correlated to how one feel energetically: if one gets nervous, one takes quicker more shallow breaths; as one relaxes, one takes slower, quieter breaths. When a person is practicing yoga, that person is deliberately controlling, focusing, and coordinating the breath. In so doing, one powerfully and positively affects one’s energetic state. Personally, I think this is the most beneficial aspect of yoga – not only does it make one physically fitter, not only does it extend one’s ability to perform healthful movement, it also allows one to control one’s energetic state. When I practice yoga, my mood is not at the mercy of whatever the day throws at me. Instead, I am able to decide which energetic state of being would most serve my current needs and then construct a yoga practice to create the very energy which I need to function optimally.


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ly t n ce ed e R ard Aw

September 28, 2012

Breast Imaging Center of Excellence

SILVERDALE

1780 NW Myhre Rd., #1220

AMI is proud to announce our Silverdale Women’s Diagnostic Center has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR) – the only center awarded this distinction on the Olympic and Kitsap Peninsulas. This award recognizes the hard work of our radiologists and mammography staff for the rigorous, voluntary testing this requires. We are also the only imaging center on the peninsulas accredited by the ACR in Breast MRI, Breast Ultrasound, Mammography, Stereotactic and Ultrasound-guided Breast Biopsies.

POULSBO

Our Women’s Diagnostic Center was established over 26 years ago. We offer the latest technology in digital mammograms at three locations with 3D mammograms available in Silverdale. Walk-in Screening Mammograms are available in Silverdale every day. DEXA Bone Density Scans are also offered at our locations for convenience.

PORT ORCHARD

Our Comprehensive Breast Diagnostic Center in Silverdale offers a full complement of imaging and interventional technology to detect breast cancer. Our radiologists interpret over 22,000 mammograms annually and experts agree that the more images read, the more accurate the reading. One radiologist is solely focused on breast imaging every day and available for immediate consultation. For continuum of care, two Harrison breast surgeons are now located in the same Silverdale office suite.

22180 Olympic College Way, #101 450 South Kitsap Blvd., #110

Appointments: 360-337-6550 or 1-800-972-9264 www.amiradiology.com Accredited by the American College of Radiology in CT, MRI, Ultrasound and Mammography

State-of-the-art Technology includes: • 3D (Tomosynthesis) and 2D Digital Mammography • 3D Elastography Breast Ultrasound • Breast MRI • Three types of Image-guided Biopsies Stereotactic Core Biopsy Ultrasound-guided Biopsy MRI-guided Biopsy We welcome new patients. Subscribe to our quarterly Especially for Women e-newsletter at contact@amiradiology.com


September 28, 2012

WAVE OF PINK

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Women’s robotic surgeries By Anita McIntyre, MD, FACOG

D

OB/Gyn Associates

uring the lifetime of a woman, 1 in 7 is likely to undergo a hysterectomy for a variety of reasons. It is the second most common major surgery a woman will undergo in her lifetime. Reasons for a hysterectomy are fibroid tumors, bleeding, prolapse or cancer. The most likely route of hysterectomy nationwide currently is still the abdominal hysterectomy with a large incision on the abdomen. During the 1990s with more widespread use of laparoscopy, the Laparoscopic Assisted Vaginal Hysterectomy (LAVH) rates doubled as the technology spread. Though less invasive than the open approach we still were performing the majority of hysterectomies open. During my residency there were many exciting laparoscopic advances including the total laparoscopic hysterectomy and the laparoscopic supracervical hysterectomy. This was only for those who could perform the more advanced

Anita McIntyre, MD, FACOG laparoscopic procedures so were not widely adopted. Since then the Davinci Robotic System has revolutionized GYN surgery. The Davinci Robotic System has allowed us to perform these more advanced laparoscopic procedures more easily and safely. Davinci is a robotic system which is attached to laparoscopic

instruments and which is controlled by the surgeon who sits remotely at a console. The Davinci laparoscopic instruments can bend and rotate at the tips allowing for a full range of motion. The view the surgeon sees at the console is 3-D and the surgeon can magnify or adjust the view easily. Control of the instruments can be extremely precise as you can adjust the movements of the robot according to the procedure. So for more delicate procedures you might have a 5 to 1 ratio on each movement. This allows us to not only see better but to be able to separate scar tissue involving the intestines which in the past was only safely done with an open procedure. This also helps prevent future scar tissue formation. In addition more advanced electronic morcellators can help us to remove large specimens through a small laparoscopic port. So now we have technology which can allow us to do most of our hysterectomies with minimally invasive surgery. In the field of GYN Oncology, it has enabled us to remove lymph nodes as well as other delicate procedures

laparoscopically. This has greatly reduced the length of hospital stays as well as the complications. Most women go home within 24 hours. In addition to hysterectomy and cancer staging procedures, the Davinci has allowed us to perform vaginal suspension procedures for prolapse. Harrison Medical Center purchased a Davinci Robotic System in June of 2008. Since the start of the Davinci program 4 years ago, I have not had to do any open hysterectomies with the exception of one whom had a contraindication to the laparoscopic approach. With these advances in laparoscopy we should start to see a trend toward minimally invasive surgery for the majority of cases and only for the most advances cases have to resort to an open procedure. Although ideally we try to manage our patients medically and not have to resort to surgery, the Davinci offers us a safe, minimally invasive tool which allows for speedier recovery with less blood loss, fewer complications and minimal pain.

Latest technologies in detecting breast cancer By J Wesley Solze, MD, Radiologist

T

Advanced Medical Imaging

he best weapon against breast cancer is early detection. It is so important for every woman over the age of 40 to have an annual mammogram. Participating in annual screening mammography has been shown to reduce the risk of dying from breast cancer by as much as 30%. If detected early with only one year or less tumor growth, the woman has a 90% chance of surviving breast cancer – IF detected early. New imaging technology is constantly being developed, tested and approved. In 2011, a huge step in breast cancer detection was approved by the FDA and now available at some radiology centers throughout the US. Tomosynthesis or 3D Mammography is a new and exciting diagnostic tool for detecting breast lesions, especially in women with dense breast tissue. 3D Elastography Breast Ultrasound is another excellent modality which gives new information on breast pathology. 3D converts digital mammographic images into a stack of very thin layers, building what is essentially a 3-dimensional mammogram. 3D mammograms can be used for annual screenings or as a diagnostic tool to

lesion is better characterized with 3D, whereas with 2D, the flattened images can hide this information.

further investigate areas of concern found in a 2D/digital mammogram. 3D is especially effective for women with dense breast tissue which affects about one-half of all US women that undergo screening mammograms. It has been proven to increase the detection rate of early breast cancer and reduce the number of false positive exams. At AMI, 3D hasn’t replaced digital mammography but is done in addition to 2D. 2D and 3D low-dose images are taken at the same time with the same scanner. The breast is under compression while the x-ray arm makes a quick arc over the breast, taking the series of images in about 4 seconds. 2D takes an image of the entire breast in one exposure. In 2D imaging, abnormalities can be hidden by overlapping breast tissue. 3D takes images from multiple angles, and through the use of computer processing, the images are digitally reconstructed into a series of high-resolution, one millimeter slices that can be viewed individually or played back in a cine loop. Images are sent electronically to the radiologist in the reading room, where the radiologist can manipulate and examine each slice individually. They can look through and around these single slices which reduces the confusion of superimposed tissue or overlap.

Some insurance is covering 3D, while others not yet. Because this is still a new technology, patients should check with their insurance plans to see if it will be covered.

J Wesley Solze, MD Benefits of 3D include: • Improved lesion visualization and characterization - distinguishes harmless abnormalities from actual tumors • Increased accuracy in detecting early breast cancers in women with dense breast tissue, which is about 75% of women in their forties • Reduces the need for additional views which can lower the overall radiation dose • Fewer recalls and fewer biopsies • The size, shape and location of a

3D Elastography Breast Ultrasound can help distinguish complex cysts from solid breast lesions, and can detect/ characterize palpable and non-palpable masses. This quick, 2 minute exam uses no radiation or needles, and is excellent to determine if a breast biopsy will be needed. Using an ultrasound probe, an “elastogram” is created in a color-coded elasticity map of the tissue stiffness – inside and around the breast lesion. If it is cancer, the tissue will appear larger with abnormal color, while benign lesions appear unchanged with little or no color on the elastogram. It gives new information on breast pathology. This technique can help reduce the number of biopsies. It also increases women’s confidence that a detected lesion is truly benign. Dr. Solze is the Medical Director for the Women’s Diagnostic Centers at AMI. Under his guidance, the centers recently received the award of “Breast Imaging Center of Excellence.” It is the only breast imaging center on the great Olympic Peninsula to have this distinction.


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September 28, 2012

Women are great at compromise. Don’t compromise on your mammograms. InHealth Imaging is the only provider in Kitsap County to offer screening 3D Mammography to every patient, every time, at no additional cost. Experience the Difference at InHealth Imaging: Greater clarity for earlier diagnosis Reduced call backs Reduced compression discomfort Immediate radiologist consultation No physician referral needed Most insurance plans cover 100% Early detection of breast cancer by 3D Mammography improves the chances that breast cancer can be diagnosed at an early stage and treated successfully without the use of chemotherapy. 3D Mammography (Tomosynthesis) is breakthrough technology allowing radiologists to view breast tissue with much greater clarity. The detailed images reduce the need, added stress and expense of call-backs. This technology uses very low x-ray energy and is safely below the American College of Radiology (ACR) guidelines.

Schedule Your Appointment Today (360) 598-3141

20700 Bond Road, Building B, Poulsbo, WA 98370 with satellite X-Ray offices in Silverdale & Bainbridge Island

www.inhealthimaging.com (360) 598-3141


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