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2 • Wednesday, February 8, 2012

Sequim Gazette

Thank you for

joining us at

Olympic Medic al Center Found ation’s

, Set, Go!

HEART LUNCHEON By Sara Maloney Red, Set, Go! Event Chair It is hard to believe that our annual Red, Set, Go! educational heart lunch is once again upon us and we have the opportunity to remind the community of the importance of taking care of our hearts. During the past four years our goal has remained the same as we continue to educate, encourage and empower women to take care of their hearts. The committed partners of Red, Set, Go! will once again provide the tools we need to take responsibility for our heart health. In conjunction with educating attendees and raising the awareness of heart disease we have also included an important fund raising component to this event. Since launching this campaign in 2008 we have raised an incredible $143,000 to benefit patients being treated in the cardiac services department at Olympic Medical Center.

Mission: The mission of Olympic Medical Center Foundation is simple: “To improve the quality of patients’ lives”. OMC is one of the best rural hospitals in the nation, and as such relies on the dedication of many volunteers of the foundation. This has been particularly true in recent years when we have all been experiencing

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financial uncertainties and the associated challenges that accompany these uncertainties. We have been fortunate over the past several years; the foundation’s endowment has increased to more than $1 million. In addition, the foundation gives yearly donations to provide state-of-the-art equipment and essential programs for patients.

Campaign: The launching of our annual heart lunch – Red, Set, Go! in 2008 was an important reminder that even in challenging economic times the need to support important causes does not go away. Staff at both Olympic Medical Center and the foundation felt it was vital to raise the awareness of the critical issue of heart disease on the Olympic Peninsula. Experts agree that raising awareness saves lives and that education is the key to eradicating this disease. Heart disease remains the #1 killer of both men and women so it is important that we continue our efforts to eradicate this disease.

Red, Set, Go! February 10, 2012 We have once again scheduled our event to take place in February – American Heart Month. We encourage members of the community to take a little time to attend, become inspired to improve their own heart health and reduce their risk factors. This year our keynote speaker is Paul Cunningham MD, Jamestown Family Health Clinic, and his focus will be on stroke – the warning signs, the causes, the effects, the diagnosis and treatments available. Our presenting sponsor is Jamestown S’Klallam Tribe. The Tribe is a valuable partner in recognizing the importance of providing quality health care in our community. Other corporate sponsors include at the silver level Sequim Gazette and Swedish Medical Center. At the bronze level Airlift Northwest, Astellas Pharma Inc. US, Avamere Olympic Rehabilitation of Sequim, Crestwood Convalescent Center, First Federal, John L Scott, Karen Rogers Consulting, Port Angeles Soroptimists, Sequim Health & Rehabilitation, Judy Tordini and Dr. Kara Kurtz Urnes. For more information contact OMC Foundation 417-7144 or visit www.omhf.org

Family Health Clinic Our physicians and nurse practitioners specialize in care of the whole family. We care for newborns, toddlers, adolescents, and adults of all ages. Each of our medical providers has a unique area of interest and expertise: • Preventive care • Geriatric care: including care in nursing home or assisted living setting • Disease management for chronic medical conditions • Procedures: cardiac stress testing, casting, gynecology, and minor surgery • Obstetric care for pregnant women • Osteopathic care

808 N. Fifth Ave., Sequim

360-683-5900

Jamestown S’Klallam Tribe

1033 Old Blyn Hwy •Sequim, WA 98382 • 360-683-1109


Wednesday, February 8, 2012 • 3

Sequim Gazette

FOUNDATION Approximately 800,000 Americans suffer a stroke each year, yet many regions lack access to expert neurological care. Fortunately for residents of the North Olympic Peninsula, specialty care is available at Olympic Medical Center, thanks to Swedish TeleStroke. In October 2010, OMC partnered with the Swedish Neuroscience Institute in Seattle to provide immediate, expert support for stroke victims. Known as TeleStroke, the program offers patients specialist assessment within the local community. The TeleStroke program links OMC’s emergency physicians to g y medicine p y

Swedish’s nationally recognized stroke team experts 24 hours a day, seven days a week through real-time, secure videoconferencing technology. “We have excellent emergency medicine physicians who do a very good job of diagnosing stroke and initiating treatment. The TeleStroke program adds another level of opportunity for our stroke patients by giving access to neurology specialists, while eliminating or minimizing the need to travel to Seattle or Tacoma,” said Lorraine Wall, assistant administrator and chief chief nursing officer of Olympic Medical Center. “In the past, we had to send more severe stroke patients to Seattle,” Wall said. “Now, we can treat them here. Unless there’s a serious complication, patients can stay right here and recover in our intensive care unit.” How the TeleStroke Program works The Swedish Stroke Program hub is located on the Cherry Hill campus in Seattle. When a patient arrives in the emergency department at Olympic Medical Center with stroke symptoms, day or night, the Swedish stroke team is paged. Members of the team — which includes a stroke team physician in coordination with a specially trained stroke nurse practitioner, physician assistant or registered nurse — can log in on their home or office computers to complete a TeleStroke examination and determine if a patient might qualify for available rescue therapies in an attempt to “stop” the stroke. The most common rescue therapy that the stroke team would use is an FDA-approved medicine called tissue plasminogen activator, or tPA. This medicine can reverse the devastating effects of stroke for some patients if it is administered within four and a half hours of the onset of a stroke. But the key to the successful use of tPA — or other clot-busting thrombolytic drugs — lies in the rapid and correct diagnosis because as every minute passes, more brain cells die if the blood clot causing the stroke is not destroyed (“Time is Brain”).

“Four Swedish campuses — First Hill, Cherry Hill, Ballard and Issaquah — are certified as Primary Stroke Centers by the Joint Commission,” said Tammy Cress, RN, Swedish’s director of TeleHealth. “TeleStroke is another important tool in our arsenal against the third-leading cause of death in the United States and the No. 1 cause of adult disability.” TeleStroke consultation also ensures that high-quality, in-hospital and post-acute interventions are in place to prevent recurrent stroke and future disability. About ischemic stroke An ischemic stroke is a stroke associated with the blockage of a blood vessel that feeds areas of the brain. This type of stroke normally is due to a blood clot in an artery that feeds an area of brain with oxygen. When that is compromised, the affected area of brain starts to die. “The TeleStroke program helps us target this kind of stroke quickly and efficiently,

providing improved opportunity for recovery for our patients,” said Wall. About 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds. Stroke kills more than 137,000 people a year. That’s about 1 of every 18 deaths. It’s the No. 3 cause of death behind diseases of the heart and cancer. For more information about Olympic Medical services to diagnose, treat and rehabilitate stroke patients, visit www. olympicmedical.org and search keyword “stroke.” Information courtesy of Olympic Medical Center.


4 • Wednesday, February 8, 2012

By Tammy Cress, MSN, Director of TeleHealth; and Sherene Schlegel, BSN, FAHA, Manager Stroke and TeleStroke Programs Across the United States many small and/or rural hospitals lack the medical staff or expertise to provide timely stroke care that ensures the best possible outcomes. According to a Washington State Department of Health survey completed in 2007: • Only 50.7 percent of hospitals that admit stroke patients have a neurologist available • Only 18.3 percent of hospitals have a stroke team in place to respond to patients having an acute stroke

Leveraging technology to improve access Swedish began implementing its Acute TeleStroke Program in 2007 in response to the identified need to ensure stroke expertise is

... helping people live better Health Care Services 24-Hour Skilled Nursing Care Post Operative Care Palliative Care Services

Sequim Gazette

available wherever a patient presents for acute stroke care. TeleStroke is a form of telemedicine that uses technology to provide remote clinical consultations. TeleStroke has allowed Swedish to efficiently extend advanced stroke care capabilities to all of its emergency departments and to nonSwedish hospitals that previously have been unable or inconsistently capable of providing this level of care. Olympic Medical Center became a TeleStroke partner with Swedish in October 2010. Historically, stroke patients presenting at one of these hospitals — even those arriving well within the rescue window — have not been guaranteed immediate access to stroke specialists and critically important treatment that could improve their positively impact their chances of a meaningful recovery. Because of that, sometimes these patients were transported to a facility that could provide the care, during which time additional brain cells died unnecessarily. Since the inception of these TeleStroke relationships, some of Swedish’s TeleStroke partner sites have seen an increase in the number of patients appropriately treated with rtPA (a clot-busting drug for stroke). In addition to this first-line acute rescue therapy, Swedish also has been able to offer additional tertiary care, such as neurointerventional therapies, as part of a system of care.

How Acute TeleStroke works for patients Case study: A 36-year-old woman experiences an abrupt onset of neurologic symp-

The Swedish Neuroscience Institute Acute Telestroke Network

Jefferson Healthcare (Port Townsend) Lake Chelan Community Hospital (Chelan) Olympic Medical Center (Port Angeles)

toms. Her husband takes her to a Swedish TeleStroke-affiliated hospital such as Olympic Medical Center. As part of its arrangement with Swedish, OMC’s emergency department contacts the Swedish Stroke Team and requests a TeleStroke consultation. Physicians in OMC’s emergency department collaborate with the Swedish TeleStroke Team via secure videoconferencing connections to evaluate the patient. Together they decide if the patient would benefit from the administration of rtPA or other rescue options. Sometimes, despite receiving the clot-buster, some patients still will have residual clot in their brain. Together the two teams of physi-

www.sisequim.org

Live, interactive videoconferencing allows the Swedish Stroke Team to be available virtu-

98 82

60 40

28

20

60+ years of service to Sequim

Making the connection

Correct treatment decisions made (P=0.009) Thrombolytics used

80 Patients (%)

360.582.2400 650 West Hemlock St., Sequim www.sequimskillednursing.com

cians next would decide on whether the patient should be urgently transported to Swedish for interventions only available at this type of hospital or if the patient’s care needs can be met at OMC. Due to the dual-facility collaboration, and a well-coordinated system of care, patients are benefitting from time-sensitive expert care locally, as well immediate access to needed specialty care that only is available in a tertiary medical center such as Swedish.

Telemedicine vs telephone consulation in STRokE DOC 100

Comprehensive Rehabilitation Program Physical Therapy Occupational Therapy Speech Pathology

Skagit Valley Hosptial (Mount Vernon) Swedish/Ballard Swedish/Edmonds Swedish/Issaquah Swedish/Mill Creek Swedish/Redmond Whidbey General Hospital (Coupeville) Walla Walla General Hosptial (Walla Walla) Yakima Valley Memorial Hosptial (Yakima)

Swedish Health Services CentralWashington Hospital (Wenatchee) IslandHospital (Anacortes)

0 Randomized telemedicine (real-time audio/video and digital imaginge n=111)

23

Randomized to telephone consulation n=111


Wednesday, February 8, 2012 • 5

Sequim Gazette

Dr. Paul Cunningham is a 1999 graduate of the University of Washington School of Medicine and completed his residency in Family Medicine and Fellowship in Geriatrics in 2003 at Swedish Medical Center, Seattle. He is board certified in Family Medicine with added qualifications in Geriatrics and Hospice and Palliative Care. Dr. Cunningham cares for patients of all ages, with a focus on older adults, at the Jamestown Family Health Center in Sequim, nursing homes and other care facilities in the community. When not working, Dr. Cunningham enjoys spending time with his wife, Pam, a nurse for the Sequim School District, and his daughters Poppy and Fiona, ages 7 and 8, both students at Franklin Elementary School in Port Angeles.

For “starred” offerings below, check-in at OMC Cardiac Services in Port Angeles: Olympic Medical Center, 939 Caroline St. – 1st Floor East or in Sequim: Medical Services Building, 840 N. Fifth Ave. – 2nd Floor North. Sodium and Heart Failure.” Speaker: Judy Tordini, Feb. 8 • 2:30 p.m. Working on Wellness Forum RN, OMC Cardiac Services Director. OMC, Port “The Heart of the Matter” Speaker: Pat McCollum, Angeles. MS, OMC Cardiac Rehab Coordinator. Medical Feb. 27 • Noon* “Keep Your Heart Healthy Services Building, Sequim. with Regular Cardio Exercise.” Feb. 10 • 11:30-2 p.m. Red, Set, Go! Heart Speaker: Pat McCollum, MS. Luncheon. All proceeds to benefit OMC Cardiac Medical Services Building, Sequim. Services. Call OMC Foundation at 417-7144. Feb. 29• Noon* Heart Disease: “Differences Keynote address: Dr. Paul Cunningham, Sequim. Between Men and Women.” Feb. 13 • Noon* “Can’t Breathe? Learn How to Help Speaker: Judy Tordini, RN, OMC Cardiac Services Your Lungs and Heart Too.” Speaker: Leonard Director. Olympic Medical Center, Port Angeles. Anderson, M.Ed., OMC Pulmonary Rehab Wednesdays • 9-11:30 a.m. Free Blood Pressure Coordinator. OMC, Port Angeles. Checks at Sequim site. Feb. 22 • Noon* “The Link of High Blood Pressure,

Above: Remote Emergency Department. At right: Swedish Stroke Team in Seattle ally in a moment’s notice. This secure video-conferencing solution allows the remote ED team and the patient (figure 1) to see and hear the Swedish neurologist (figure 2) in real time. It also allows the neurologist to examine the patient — doing everything except actually touching the patient — and to come to a treatment recommendation. Both teams use one set of protocols to perform the evaluation and begin treatment. The neurologist also reviews brain images as part of the consultation. In the world of acute stroke, time is brain. The more time it takes to treat a patient experiencing stroke, the more brain cells die and the potential for long-term disability increases. With TeleStroke, patients benefit from immediate access in their local emergency departments with the specialists coming to them via technology. This model of care ensures a stroke patient’s window of opportunity does not close before receiving critical treatment. This window, during which treatment can be offered, is narrow. In just a few hours, the patient needs to be evaluated, diagnosed and treated with clotbusting medications if he or she going to have the best chance of recovering from the effects of a stroke. Additional therapies, which are available at specialized medical centers, like Swedish, can be used after an initial treatment with rtPA.

Olympic Rehabilitation of Sequim Results fuel TeleStroke network growth In other parts of the country, some programs have adopted a model that supports remote emergency departments for acute stroke events with only a telephone consultation, instead of using live, interactive video conferencing. At least one study shows this approach is less promising. The study demonstrated that support provided via video better assists in ensuring an accurate diagnosis and promotes the increased use of the clot-busting treatment. Because of these documented results, multiple hospitals in Washington have made commitments to their communities to improve access to stroke care by becoming part of the Swedish Acute Stroke Telemedicine Network. Each network hospital has TeleStroke technology that links their emergency department physicians and nurses directly with a Swedish Acute Stroke Telemedicine Team at the Swedish Neuroscience Institute in Seattle. This team of experts is available 24 hours a day, seven days a week — always ready to support partner emergency departments that are caring for stroke patients.

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6 • Wednesday, February 8, 2012

Sequim Gazette

Judy Tordini, RN Director of Cardiac Services, Olympic Medical Center Q. If you had to point out to a woman what a single greatest risk factor for stroke is (on average), what would it be and why? A. First and foremost, women deny time and care for themselves over family and friends. We are caregivers who balance the world and those in it, but don’t always think to care for ourselves. We are not good at prioritizing time for ourselves until an acute event happens. Q. What is the single biggest thing a woman can do to help minimize her risk for a stroke or heart attack? A. Healthy lifestyle: How that looks on each woman depends upon her particular risk. Is it blood pressure, is it inactivity or is it all with managing stress in a healthy, consistent way? Q. Is a specific “type” of woman more at risk for stroke? A. Yes, a woman with high blood pressure and an irregular heart rate called atrial fibrillation. Q. Does the risk span the age continuum? A. Yes, it’s the risk not the age that matters – irregular heart rate happens at any age, high blood pressure at any age.

Together, We Are Better. Swedish and Olympic Medical Center have partnered to enhance the care available in Clallam County. This partnership allows Olympic Medical to continue providing you quality medical care, close to home. It will also bring more specialty services to the area in the future. And, it will provide seamless access to the resources of Swedish in Greater Seattle, should you need them. Learn more at www.olympicmedical.org

A nonprofit organization

Stroke is a type of cardiovascular disease. It affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. What are the types of stroke? Stroke can be caused either by a clot obstructing the flow of blood to the brain (ischemic strokes) or by a blood vessel rupturing and preventing blood flow to the brain (hemorrhagic or bleeding strokes). Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations. Often called a “mini stroke,” a transient ischemic attack or TIA is a warning stroke that should be taken very seriously. TIA is caused by a temporary clot. Diagnosis of stroke When someone has shown symptoms of a stroke or a TIA (transient ischemic attack), a doctor will gather information and make a diagnosis. A doctor may use many different tests. He or she will review the events that have occurred and will get a medical history; do a physical and neurological examination; have certain laboratory (blood) tests done; get a CT or MRI scan of the patient; study the results of other diagnostic tests that might be needed. Impact of stroke Stroke is the No. 3 cause of death in the United States, behind diseases of the heart and cancer. Warning signs prior to a stroke Prior to a stroke, many people experience a TIA, which can occur days, weeks or even months before a major stroke. TIAs occur when a blood clot temporarily clogs an artery and part of the brain doesn’t get the blood it needs. The warning signs are the same as for stroke but they occur and disappear relatively quickly, usually in less than five minutes. Unlike a stroke, when a TIA occurs, the blood clot resolves itself and there’s no permanent injury. When a stroke occurs and part of your brain dies from lack of blood flow, the part of the body it controls is affected. Strokes can cause paralysis, affect language and vision and cause other problems. Recognize the warning signs of a stroke. Stroke is a medical emergency. Every second counts! Do not minimize symptoms.

Respond by calling 9-1-1 immediately if you or someone close to you is having warning signs of stroke. Then check the time. When did the first symptom start? You’ll be asked this important question later. Acute & preventative treatments of stroke Because their mechanisms are different, the treatments for the types of stroke are different. The most promising treatment for ischemic stroke is the FDA-approved clot-busting drug tPA (tissue plasminogen activator), which must be administered within a three-hour window from the onset of symptoms to work best. Administering tPA or other clot-dissolving agents is complex and is done through an intravenous (IV) line in the arm by hospital personnel. If given promptly, tPA can significantly reduce the effects of stroke and reduce permanent disability. Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment. For hemorrhagic stroke, specifically for a subarachnoid hemorrhage, surgical treatment often is recommended to either place a metal clip at the base, called the neck, of the aneurysm or to remove the abnormal vessels comprising an arteriovenous malformation. Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm, guided to the aneurysm or AVM where it deposits a mechanical agent, such as a coil, to prevent rupture. What are the effects of stroke? The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can’t reach the region that controls a particular body function, that part of the body won’t work as it should. If the stroke occurs toward the back of the brain, for instance, it’s likely that some disability involving vision will result. The effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected. Right brain The effects of a stroke depend on several factors, including the location of the obstruction


Wednesday, February 8, 2012 • 7

Sequim Gazette and how much brain tissue is affected. However, because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the side of the body it affects. For example, if the stroke occurs in the brain’s right side, the left side of the body (and the right side of the face) will be affected, which could produce any or all of the following: paralysis on the left side of the body; vision problems; quick, inquisitive behavioral style and memory loss. Left brain If the stroke occurs in the left side of the brain,

the right side of the body will be affected, producing some or all of the following: paralysis on the right side of the body; speech/language problems; slow, cautious behavioral style and memory loss. Brain stem When stroke occurs in the brain stem, depending on the severity of the injury, it can affect both sides of the body and may leave someone in a “locked-in” state. When a locked-in state occurs, the patient is generally unable to speak or achieve any movement below the neck. Information courtesy of the American Stroke Association at www.strokeassociation.org.

80% of Strokes are Preventable. Learn the signs and save a life.

Weakness • More than 500,000 people in the United States experience a new or recurrent stroke each year. • Stroke is the third-leading cause of death in the United States and the leading cause of disability. • Stroke kills about 160,000 Americans each year or almost one out of three stroke victims. • 3 million Americans currently are permanently disabled from stroke.

• In the United States, stroke costs about $30 billion per year in direct costs and loss of productivity. • Two-thirds of strokes occur in people over age 65 but they can occur at any age. • Strokes affect men more often than women, although women are more likely to die from a stroke. • Strokes affect black people more often and are more likely to be fatal.

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Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.

Trouble Speaking Sudden difficulty speaking or understanding or sudden confusion, even if temporary.

Vision problems Sudden trouble with vision, even if temporary.

Headache

Sudden severe and unusual headache.

Dizziness

Sudden loss of balance, especially with any of the above signs.

If you think you m maay be hhaaving a stro strokke, call 9-1-1 and seek immediate medical attention.

www.OlympicMedical.org


8 • Wednesday, February 8, 2012

Sequim Gazette

We take your health to heart.

Olympic Medical Center is proud to care for the hearts in our community. (360) 417-7486 | www.OlympicMedical.org


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