Inhealth 11/28/2016

Choosing Health Care Wisely 15 | Healing Arts 33 | Rustic Bread 38

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ER E IN LA N D E N T TO TH M LE P P U S 17 S P EC IA L UARY 20 16 - JAN 0 2 R E B DECEM

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Life-changing EDUCATION AND RESEARCH

Health

SPOKANE • EASTERN WASHINGTON • NORTH IDAHO also at inlander.com/inhealth 1227 W. Summit Parkway, Spokane, Wash. 99201 PHONE: 509-325-0634

EDITOR Anne McGregor

annem@inlander.com

MANAGING EDITOR Jacob H. Fries CALENDAR EDITOR Chey Scott COPY EDITOR Michael Mahoney CONTRIBUTORS Jessica Joelle Alexander, Kristen Black, Robin Hamilton Brodt, Wilson Criscione, Young Kwak, Robert Maurer, Linda Hagen Miller, Haylee Millikan, Taryn Phaneuf, Sarah Philip, Iban Sandahl, Carrie Scozzaro, Matt Thompson, John H. White PRODUCTION MANAGER Wayne Hunt ADVERTISING DIRECTOR Kristi Gotzian DIRECTOR OF MARKETING Kristina Elverum ADVERTISING SALES Autumn Adrian, Mary Bookey, Gail Golden, Janet Pier, Claire Price, Carolyn Padgham-Walker, Wanda Tashoff, Emily Walden SALES COORDINATION Kati Bronson, Camryn Barker DESIGN AND PRODUCTION Tom Stover, Derrick King, Alissia Blackwood Mead, Jessie Hynes DISTRIBUTION MANAGER Justin Hynes BUSINESS MANAGER Dee Ann Cook

Helping to slow disease progression.

CREDIT MANAGER Kristin Wagner

Making health care more accessible.

PUBLISHER Ted S. McGregor Jr.

Advancing solutions that reduce costs.

GENERAL MANAGER Jeremy McGregor

InHealth is published every other month and is available free at more than 500 locations across the Inland Northwest.

One copy free per reader. Subscriptions are available at $2.50 per issue: call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x215. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2016. InHealth is locally owned and has been published since 2004.

spokane.wsu.edu SUPPLEMENT TO THE INLANDER

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Doing a Disservice 20 THE EMPOWERED PATIENT 15

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FROM THE EDITOR

Paperwork.

Do you have a story idea? Share it with Editor Anne McGregor at annem@inlander.com.

The Reset Button

F

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eeling a little overwhelmed by the prospect of the holidays, a divisive election that just keeps on giving or work responsibilities that never seem to end? Processing all the emotions surrounding life as 2016 ends and 2017 begins will take some work. Looking outward is important. Make time to volunteer and support causes you believe in, and consider donating to worthwhile charities (p.11).

But this is also a good time to take a look inward. It’s important to acknowledge the feelings that bubble up. Since our species began hashing out designs on the walls of caves, we’ve instinctively reached for the healing power of expression through art.

In Linda Hagen Miller’s story (p. 33), you’ll learn about an innovative program to help doctors-in-training learn skills, through art, that will help them cope with demanding future careers.

Art isn’t limited to observing others’ creations, though. The very act of creating something — moving paint around on paper, patiently crafting a loaf of artisanal bread (p.38) or gathering all your muscles to perfect a yoga pose (p.46) — is something that can bring its own insights and a sense of calm confidence. And with that insight, you may just feel refreshed and ready for anything 2017 has in store.

To your health!

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CHECK-IN

Washington State University President Kirk Schulz at the WSU-Spokane campus.

MILESTONE

Green Light for WSU

W

ashington State University is ready to accept applications for its new medical school opening in August 2017.

In October, the school earned preliminary accreditation from the Liaison Committee on Medical

STAY CONNECTED

Email InHealth Editor Anne McGregor at annem@inlander.com. The conversation continues on the Inlander Facebook page, and stay in touch with us at Inlander.com/InHealth.

Education. That meant WSU could begin recruiting students.

WSU expects about 60 students in the inaugural class of its Elson S. Floyd College of Medicine in Spokane.

“This is a significant moment in Washington State University’s 126-year history,” says WSU President Kirk Schulz.

Students will receive medical education across four of WSU’s campuses: Everett, Spokane, TriCities and Vancouver. John Tomkowiak, founding dean of the college of medicine, has said that the hope is that students remain in Washington state

LIFE COACHING

Tis the Season…

T

Robert Maurer is a Spokane psychologist, consultant and author of Mastering Fear.

he year-end holidays evoke powerful emotions in many of us. They can be a time of great joy and celebration, or may remind us of losses we have experienced. If this is a challenging time of year for you, I offer two suggestions. First, seek the companionship of others. This can take many forms, such as attending a class, participating in a religious service, joining a service organization such Kiwanis or Rotary. If your finances permit, a cruise is a wonderful place to escape the winter blues and meet friendly people.

Second, embrace the holidays as a time to focus on giving,

to practice medicine.

The preliminary accreditation also marks a shift in the rift between WSU and the University of Washington. The UW medical school program is now working with Gonzaga University, and welcomed 60 students this year.

Gonzaga president Thayne McCulloh says he’s happy to see WSU’s medical school add more future doctors to the area: “This is a wonderful step toward continued growth of health science education and related research for the Inland Northwest, and a significant milestone for Spokane.”

— WILSON CRISCIONE

rather than on perceived shortcomings. Small acts of kindness may enrich our lives as much as the recipients’ lives. Say “thank you” or write a thank-you note to the people who serve us all year long in coffee shops and stores, or who deliver our newspapers or packages. Volunteer to serve at a food bank or at a nursing home by reading to or visiting with patients. Write a “love letter” to family members or friends, thanking them for who they are and how they have contributed to your life. This may lift their spirits, and yours. Send a card with kind words to someone you have become distant from in the past year. Volunteer at an animal shelter. In addition to bringing happiness to the dogs and cats, you will meet other animal lovers.

Tis the season… to be kind to ourselves and others.

— ROBERT MAURER DECEMBER, 2016 - JANUARY, 2017

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YOUNG KWAK PHOTO

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CHECK-IN ASK DR. MATT

Helping Kids Feel Secure

H Matt Thompson is a pediatrician at Spokane’s Kids Clinic.

opefully, the many who voted for DJT did not do so as an endorsement of crassness, xenophobia or hatred — but rather as an an anti-same ol’, same ol’ action. It will be interesting to see how things go, once things get real ’round D.C. I expect like many successful business people, our President-elect will carefully choose a team comprised of individuals of high integrity who are experienced and dedicated to the success and future of all.

Since I am no expert regarding politics or the economy, I will not speculate about how or why the election results ended up the way that they did. Nor will I try to predict how

…I’ve heard of middle-school kids getting in arguments over the Affordable Care Act and NAFTA. I’m all for spirited debate, but I have to believe that these kids have been absorbing a lot of parental passion… or when the future state of our nation might change. But, as a pediatrician, husband, dad, neighbor and human, I can give my opinion about how we should try to manage the impact all of this has on our kids.

Following the election results, I couldn’t help but think of the American cinema classic Titanic. I was very touched by the scene toward the end when, as the water rushed in down the stairs and through the hallways of the grand vessel, a mother was calmly tucking her children in, telling them a last bedtime story. That was excruciating to watch, but I think it was an amazing demonstration of one of the most important things we do as parents. While not necessarily denying the realities at hand, we need to provide the solid, steady calm to help contain the anxieties and fears of our children during times of crisis and certain change.

Of late, I’ve heard of middle-school kids getting in arguments over the Affordable Care Act and NAFTA. I’m all for

spirited debate, but I have to believe that these kids have been absorbing a lot of parental passion, vitriol and fear. We have got to moderate our responses. If your toddler stumbles in her short pants, skinning her knees and dropping her lollipop in the dirt, you don’t want to shriek, wail and chastise her for wasting food. You want to say “Whoa, good thing you’re a professional stunt kid!” then help her up, give her a hug, wipe her lollipop off on your shirt, pop it in your mouth to give it a spit shine and hand it back to her.

Now is a great time for us as parents to demonstrate good emotional regulation and control. To quote the late, great child developmental Yoda, Stanley Greenspan, M.D., from his post-9/11 book The Secure Child: “We need to help our children cope with the frightening feelings that the media coverage of disasters and the anxieties of adults bring up.”

We needn’t avoid discussing our opinions in front of and with our children, but let’s watch the rants and tirades. This is an excellent opportunity to demonstrate leadership and promote resilience both in our children and our communities.

Greenspan suggests four principles that help our kids feel secure and protected. 1) Spending time together as a family: This provides the safe space for kids to share their uncertainty and fears. 2) Expressing feelings: This requires taking the time to listen, and holding off on a hurried reassurance. Listen closely, empathize and summarize back to them what you hear. Then, after a few minutes and hugs… 3) Providing reassurances in realistic terms (as challenging as that can be). 4) Contribute to and help others in need: This demonstrates that we are not alone, and we live in a world where people look out for each other and take steps to be part of solutions.

After a loss, good coaches don’t spend the precious postgame learning moment disparaging the referee, or the other coach’s questionable recruitment practices; they might point out strengths of the performance, as well as areas that could have been better. They tell the players to get a meal and some good rest and show up the next day, ready to give everything they’ve got to prepare for the next competition.

I think it’s time that as parents, we stop complaining about the referees and our disdain for the other team’s players and coaches, and move on to preparing for what’s next.

The ensuing family discussions should allow our children to better understand and feel empathy and hope. So come on, folks — let’s turn that wall into a bridge.

— MATT THOMSPON

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CHARITY CORNER

Flip the Script on Your 25 Days of Christmas

W

hile you’re out shopping for gifts or even groceries in December, don’t overlook all the people barely scraping by. A reverse Advent calendar is a fun and interactive way to help others this holiday season. The idea is simple — instead of taking something out each day, put something in. Choose one organization or more, and at the end of the month (or a few days before Dec. 25), you can donate all of the items you’ve collected. At the end of the 25 Days of Christmas, you’ll have given your family the gift of giving back to the community; and, most likely, you’ll also have given someone else the gift of a little joy for the holiday season. Below are some local organizations to consider; each also has a list of more ideas on their websites:

CROSSWALK

voaspokane.org/crosswalk, 838-6596 Crosswalk serves Spokane’s young homeless community, providing an emergency shelter and many other programs designed to keeps kids and teens safe, in school, fed and on their way to a better life.

Items to donate: socks, underwear, razors, body wash, hair care products, backpacks, clothes, shoes, bus passes and gift cards for food and entertainment.

TRANSITIONS

help4women.org, 328-6702 This nonprofit’s programs aim to end poverty and homelessness for women and children in Spokane.

Programs include a number of transitional living centers, a childcare center, a job preparation program and a community center. Items to donate: diapers, feminine hygiene products, toilet paper, baby wipes, paper cups and plates, women’s underwear in smaller sizes, blankets, winter boots, art supplies, board games and more.

WORLD RELIEF SPOKANE

worldreliefspokane.org, 484-9829 A subset of World Relief, an international organization that aims to help those affected by war and natural disasters, the Spokane branch provides refugee resettlement assistance, employment services, micro-enterprise loans, immigration services and more. Items to donate: furniture of any kind, new hygiene products, household items (especially kitchenware), linens, cleaning supplies and electronics.

SPOKANIMAL

spokanimal.org, 534-8133 SpokAnimal’s adoption center and other animal welfare services it offers are now operated without any funding from the city of Spokane.

Items to donate: general office supplies, Purina One brand food for cats and dogs of all ages, toys, non-clumping litter, clippers, baby blankets and cleaning supplies.

— HAYLEE MILLIKAN

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CHECK-IN SUPERFOOD

Rocket Fuel ATTRIBUTES: Arugula, with its distinctive peppery-flavor, also goes by the alias “rocket.” Requiring just three hours of sunlight a day, arugula is perfect for a winter windowsill garden.

SUPER POWERS: Research shows dietary nitrates can lower blood pressure and improve muscle response during exercise. And arugula is loaded with nitrates, at more than 250 grams per 100-gram serving.

As a member of the cancer-fighting cruciferous family, which also includes broccoli and cabbage, arugula contains sulforaphane.

That’s the chemical that gives the family its distinctive odor when cooked, and inhibits an enzyme that cancer cells need to progress.

WEAKNESSES: At just 10 calories for a two-cup serving, arugula is not going to satisfy your hunger.

HOW TO USE IT: Spokane’s Chaps restaurant’s Gina Garcia offers this recipe for a perfect lunch for one: Toast a slice of hearty bread, and top it with a generous handful of arugula, followed by a poached or soft-cooked egg.

Dress lightly with a mild vinaigrette. Prepare to swoon!

— ANNE McGREGOR

PILL BOX

Alternatives to Ibuprofen?

I saw a story on the news that said Celebrex (celecoxib) was safer than either ibuprofen or naproxen. I take over-the-counter ibuprofen once or twice a week for headaches. Should I talk to my doctor about a prescription for Celebrex?

John R. White chairs WSU-Spokane’s Department of Pharmacotherapy.

T

here are a multitude of nonsteroidal antiinflammatory drugs (NSAIDs) on the market.

The three that you mention above are included in this category. One of the problems with most NSAIDs is that they can facilitate stomach upset, bleeding and ulcerations. Because of this, a new category of NSAIDs was developed that does not cause this effect. They are called COX-2 inhibitors. Unfortunately, one of the COX-2 inhibitors (Vioxx) was found to increase the incidence of heart attack and was removed from the market. This left concerns regarding the other COX-2 inhibitor, Celebrex.

The study that was recently published in the New England Journal of Medicine and presented at the American Heart Association meeting compared the safety of Celebrex (prescription only), ibuprofen (prescription and OTC) and naproxen (prescription and OTC). Prior to this study, most had assumed that Celebrex was the most dangerous and naproxen was the safest. This study evaluated

people who were at high risk for, or already had, heart disease and who were also taking one these meds every day for months or years. More people taking ibuprofen showed worsened kidney function than in the other two groups. An increased risk of hospitalization for high blood pressure or the development of gastrointestinal bleeding or ulcers was reported in those taking naproxen or ibuprofen.

Celebrex was not found to be riskier for heart health than the other two medications.

While it appears that Celebrex may be “safer,” this is only one study, and it was done in people who were at risk for heart disease who were chronically taking daily doses of NSAIDs. For someone who only occasionally uses ibuprofen, you should not be concerned about the findings of this study (as long as you do not have contraindications to the use of ibuprofen). If you are not sure, please consult with your pharmacist or medical care provider.

— JOHN R. WHITE

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BRAIN EXERCISE

3 4

Sudoku

RATINGS: Moderate (left), Diabolical (right) To complete Sudoku, fill the board by entering numbers 1 to 9 such that each row, column and 3x3 box contains every number uniquely.

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Answers to all puzzles on page 44

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4 8 7 5 2

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8 7

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PUZZLES BY JEFF WIDDERICH & ANDREW STUART www.syndicatedpuzzles.com

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7 1

9 3 8

Each letter has been replaced by with a number. Using the starter clues, work out the words that must go in each cell on the codeword grid. Some well-known phrases and names may also be found. For a three-letter clue, turn to page 21.

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6 17

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Saltroom of Spokane

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Codewords 20

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7 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

4 2

1 4

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Str8ts

RATING: Gentle Like Sudoku, no single number can repeat in any row or column. But rows and columns are divided by black squares into compartments.

These need to be filled in with numbers that complete a ‘straight’ — a set of numbers with no gaps but can be in any order. Clues in black cells remove that number as an option in that row and column, and are not part of any straight. Glance at the solution above to see how ‘straights’ are formed.

3

9 7 8 6 4 9

5 1 4 9 8 2 1 1 6 3 2

3

4 9 8

6

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NEWS

ALI BLACKWOOD ILLUSTRATION

THE EMPOWERED PATIENT

Choose Wisely Doctors and patients are teaming up to reduce unnecessary treatments — and to improve outcomes

BY WILSON CRISCIONE

T

he congestion, coughing and sore throat just won’t go away. You have to stay home from work, and you’re losing sleep. You schedule a visit with your doctor, thinking you have an upper respiratory infection and hoping to get some antibiotics for some relief at last.

But your doctor says no. Antibiotics, the doctor explains, are unlikely to help.

Not only could an unnecessary prescription be potentially harmful, but it will also cost money and increase the threat of resistance to antibiotics. You get it. Antibiotics aren’t the answer this time. Leaving the clinic, you have a better understanding of what

to do to get better and what to do in the future. In short, you’re now an empowered patient.

This is how the Choosing Wisely campaign should work. The campaign is a national initiative of the American Board of Internal Medicine that encourages physicians and patients to discuss necessary treatment based on evidence-based recommendations. The goal is for patients to get the best value out of health care spending, a balancing act that should lead to the most effective treatment to achieve the best possible quality of life, while creating the fewest negative side effects and complica-

tions, all at the best price.

Educating patients is key, but it takes time. “It turns out there’s a bunch of studies showing that if you provide information to patients, in the context of having empathy, then patients are satisfied without receiving those services,” says Matt Handley, chairman of the Washington state Choosing Wisely Task Force.

Handley says experts have known for years that there’s too much “low-value” care. The Washington Health Alliance sought to reduce overuses several years ago, and when the Choosing Wisely ...continued on next page DECEMBER, 2016 - JANUARY, 2017

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NEWS “CHOOSE WISELY,” CONTINUED...

both patient choices and physician reimbursement will need to be transformed. “If you’re trying to improve value,” Handley says, “you’ve got to do both.”

campaign launched, Washington Health Alliance became one of the few grantees in the nation to promote it in 2015. Handley, SHARED DECISIONS who’s also a medical director for quality Choosing Wisely recommends a number for Group Health, says the state is seeing of ways to cut down on patient visits and results, and that Group Health has reduced reduce the cost of health care for patients. the use of antibiotics for upper respiratory In addition to cutting antibiotic prescripinfections by 50 percent, with no change in tions when evidence patient satisfaction. shows they aren’t likely But there’s to be helpful — theoretianother push in the cally also cutting down movement for qualThe Choosing Wisely campaign recomon patient visits — the ity over quantity in mends that patients ask these five campaign recommends health care: physicians questions before any test or procedure: that certain procedures are now actually being be conducted more paid for the value of 4 Do I really need this? sparingly. the care they deliver, 4 What are the downsides?

Carl Olden, a physiinstead of payment 4 Are there simpler, safer options? cian at Pacific Crest based on the number 4 What happens if I do nothing?

Family Medicine in of tests ordered or 4 How much does it cost?

Yakima, says that the patient visits. common practice in Combined with the past has been for women to get a Pap the shared decision making in the Choossmear every year until women turned 65. ing Wisely campaign, it’s led to a changBut women don’t need a Pap smear every ing landscape in health care for both for year, according to a recommendation from patients and physicians. To reduce health the American Academy of Family Physicare costs, and achieve better outcomes,

WHEN YOU GO

cians and Consumer Reports. Since it takes 10 to 20 years for cervical cancer to develop, Choosing Wisely recommends that women in their 20s only get a Pap smear every three years. For women 30 to 65, it’s generally every five years, along with an HPV test.

“Most women are happy to hear that,” Olden says.

But while a recent national survey showed that many primary care physicians find Choosing Wisely recommendations easy for them to follow, doctors are wary that their patients will resist following the guidelines. The Journal of General Internal Medicine surveyed 2,000 primary care physicians and 2,500 primary care providers at the Department of Veterans Affairs about recommendations on four diagnostic tests, screening tests and medications that are likely to cause harm if overused. Of those who responded, 80 percent said advice on avoiding overscreening, or testing for colon cancer or cardiac problems, would not be difficult. But the study also found that physicians most consistently considered some recommendations difficult for patients to accept. Those included limiting the use of antibiotics for sinusitis, avoiding imaging

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“We need to fundamentally change the system to align what people are paid for…”

— KELLY STANFORD, Group Health VP of Clinical Operations

KRISTEN BLACK PHOTO

for low back pain, and not prescribing sedative-hypnotics to treat insomnia, agitation or delirium in older adults.

This is why it’s important for physicians to educate patients, says Olden, who adds that his patients understand that they may have to wait longer to see him because he spends more time discussing decisions with patients. He says physicians must talk to patients in a way that’s respectful and provides education, because it will ultimately lead to better outcomes in value and cost.

Reducing unnecessary treatment, says Olden, will clearly reduce costs.

Yet there’s one sometimes overwhelming barrier in convincing patients to avoid a treatment they may not need. What if there’s even a 1 percent chance they do need it? What if, even though Choosing Wisely recommends against most CT scans for a headache, that CT scan ends up revealing something serious that otherwise would have been ignored?

“That takes a long time to have that discussion. It’s easier to say, ‘Let’s go ahead and get it,’” Olden says. “We have to fight against that.”

It’s tough for a physician. Patients have ideas about what they want, and the

system is designed around the idea that satisfied patients become repeat customers.

If a patient doesn’t come back, doctors lose revenue. That’s why Olden says that health care reimbursement will need to change so doctors have incentives to value quality, evidence-based practices over quantity of visits.

“That’s wishful thinking,” Olden says.

“But that’s where we need to get if we want to bend cost curves and improve outcomes.”

MORE INCENTIVE

Physicians generally don’t object to Choosing Wisely recommendations, says Kelly Stanford, Group Health’s vice president of clinical operations and market integration.

It supports the way they’d like to work every day anyway, she says.

“The challenge is the gap between getting from one payment methodology to another,” she says.

Right now, Stanford explains, physicians largely are compensated every time they do something — perform a procedure or order a test — a “fee-for-service” system.

But for the amount of money we’re spend...continued on next page

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DECEMBER, 2016 - JANUARY, 2017 NEWS inhealth 11-28-2016.indd 17

Health 17 11/17/16 3:14 PM

NEWS “CHOOSE WISELY,” CONTINUED...

are following Choosing Wisely recomknow. It’s not something we want to hapmendations. For example, Rockwood tries pen, and we’re not planning to do that in ing nationally on health care, the results of not to treat sore throats with antibiotics our system.” the current system are lacking, she says. without first conducting a test for strep According to a 2015 analysis by the POWER TO THE PATIENT throat. Rockwood can check if physicians Commonwealth Fund, the U.S. spent The Choosing Wisely campaign and a are meeting the threshold. If so, the doctor almost 50 percent more on health care as a value-based approach both ultimately receives a bonus, Knox says. percentage of GDP than the next highest depend on patient cooperation. “I think Knox says that in most health care spender, France, and it’s key in making this shift to value-based organizations he’s almost twice as much care,” Stanford says. “You have to have the aware of, those kinds as the United Kingpatient engaged and involved.” If patients of bonuses make up dom. But the report know they have some control in making about 10 to 20 percent The Washington Health Alliance says notes, “Despite spenddecisions, they may take more ownership of physician compensathese tests, procedures or medications ing more on health and be better informed. tion. That’s enough to are commonly overprescribed: care, Americans had But the shift may take a while. Aceffect some change in poor health outcomes, cording to a study from the Journal of how physicians behave, 4 Pap smears including shorter the American Medical Association released in Knox says. However, 4 Antibiotics life expectancy and October, the number of some unnecessary moving even further 4 Cardiac imaging greater prevalence of medical treatments — like antibiotics for the toward a pay-per4 MRIs or CT scans chronic conditions.” flu or bronchitis — actually increased from value system most 4 Early elective birthing “We need to 2002 to 2013, around the time Choosing likely would not happen fundamentally change Wisely was launched. In response to the quickly. And it brings the system to align what people are paid study, Elizabeth McGlynn, vice president up a thorny issue: Will a value-based payfor and what they’re working on,” Stanford at Kaiser Permanente Research, told NBC ment system ultimately mean less overall says.

News that “the take-home message for papay for physicians?

That means moving toward support of tients is that they should take an active role “I don’t know the answer to that yet,” a value-based health care system, where in identifying the important components of Knox says. “It could be that physician physicians are compensated for the value their care and advocating for themselves — salaries will go down. But I don’t really of care provided to patients. Defining and quantifying health care “value” can be a challenge, but it is crucial. In 2013, Bill Gates had this to say: “I have been struck by how important measurement is to improving the human condition. You can achieve incredible progress if you set a clear goal and find a measure that will drive progress toward that goal.”

Broadly, health care “value” can be understood as a simple equation: health outcomes divided by the cost of delivering Seeing an elderly relative for care. Health outcomes include things like the first time in a while? whether the patient survived, any disabilities they may face in the future, how long it Now could be the time to call took patients to recover enough to resume Spokane’s Aging and Disabilities their regular lives, how long the improveHelpline. ment in health will last, and whether Providing FREE referrals to long-term side effects of treatment might be services in Spokane County. anticipated.

• Housing Stanford says that Group Health, soon • Meals to be part of Kaiser Permanente, a non• Legal Support profit that refers to itself as an “integrated • Transportation managed care consortium,” has always paid • Long Term Care attention to health care value because it • Insurance operates under a system in which care is integrated with the patient’s coverage.

Call us at: (509) 960-7281 It works a bit differently in other health care systems. Gary Knox, chief medical officer for Rockwood Clinic and a member of the Washington Choosing Wisely Task Force, says Rockwood physicians still mostly rely on a fee-for-service model. But they are given incentive pay if they meet certain quality metrics or demonstrate they 222 W Mission Ave, Suite 120, Spokane, WA 99201 | Mon-Fri 8am-5pm

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11/17/16 3:14 PM

GARY KNOX, Chief Medical Officer for Rockwood Clinic and a member of the Washington Choosing Wisely Task Force, says physicians are working hard to follow Choosing Wisely recommendations where appropriate — no antibiotics for a sore throat without a positive strep test, for example.

KRISTEN BLACK PHOTO

being actively engaged is important.”

For Robin Shapiro, president of Seattle-based Allied Health Advocates, the Choosing Wisely campaign is a good thing.

It means that health care organizations will need to be more transparent about how much medical care will cost, and providers may be more willing to talk to patients about the cost of a surgery because of the

campaign.

“That campaign has done a really nice job of making the discussion about things that really matter to patients in a way that patients understand,” Shapiro says.

Handley, chairman of the Choosing Wisely task force, says the campaign is more aligned with patient preferences. As a side effect, care will get safer. He says that

using evidence-based medicine and shareddecision making is important, and Choosing Wisely marries those two things.

“We think this is about patient empowerment,” Handley says. “Let’s get patients more empowered, so they can make decisions with their health care.” n To learn more, visit choosingwisely.org.

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Health 19 11/17/16 3:14 PM

NEWS

Katrina and Ryan Strickland with their service dogs, Madison and Huntley, at Franklin Park in Spokane.

SPECIAL NEEDS

Doing a Disservice Bringing pets to public places can have unintended consequences for those who rely on service animals

BY CHEY SCOTT

C

hihuahuas in purses, puppies in shopping carts, blue heelers off leash in a home improvement store.

Pet dogs seem to be appearing more often in public places — sometimes by owners willfully ignoring no-pets rules, or passed off by their fibbing owners as service animals. For most people, pets showing up in strange places is not much more than a curiosity. But for people who depend on service animals, the worry is that unexpected encounters with poorly trained pets may endanger the health and safety of both service animals and their owners.

Spokane resident Laura Renz worries about what could happen every time she leaves home. Renz has been using a service dog to aid with her mobility for the past three years as a result of injuries she suffered after a major motorcycle accident in

2012. Her trained service dog, a 1-year-old, female chocolate Lab named Little One, is the third service dog she’s had, and offers physical support to Renz as she gets up from a chair. Little One also helps Renz up from the ground when she sometimes falls.

About two months ago while shopping at the North Spokane Costco warehouse, Renz was minding her own business when, she says, all of a sudden another customer’s dog, sitting in a child stroller, unexpectedly launched itself toward Little One. According to Renz’s account, the dog’s owner said it was his service animal. Based on her prior experiences with service animals, and the fact that the dog was in a stroller, Renz doubts this, explaining that a trained service dog should never show aggression toward other animals or people — especially unprovoked.

SARAH PHILIP PHOTO

“It really upset me, and scared me,” Renz recalls, as Little One, wearing a black vest with “service dog” embroidered in white, reclines on the floor next to her chair. “These dogs, even if they perform a service, they can’t be jerks — that is where the problems come in.”

Costco wouldn’t comment on the incident involving Renz and her dog, but the company’s policy regarding service animals animals follows guidelines of the Americans with Disabilities Act stating that its employees will only approach customers with animals if it’s not visually apparent that it’s indeed a service animal.

Renz is concerned that businesses of all types are doing little to educate their employees on what the law stipulates, or requiring them to enforce it.

Though the ADA protects the disabled community against discrimination, the law outlines two specific questions that businesses may ask of a person with an animal: Is this dog required because of a disability? What work or task has the dog been trained to perform? Staff may not, however, ask a person to disclose the nature of a disability or to reveal any other health information. State and federal laws currently do not require any type of registration or licensing for service animals.

Only if the handler voluntarily admits an animal is not a service dog, and this violates a store policy regarding pets, can staff

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can ask for the dog to leave the premises.

Under the ADA, only dogs (and oddly enough, miniature horses) qualify to be service animals. The law doesn’t recognize emotional support animals that might assist a person with social anxieties in staying calm, though there is a provision that defines psychiatric support animals, which might support a veteran with post-traumatic stress disorder, or remind a person with a psychiatric disorder to take medication.

Renz says owners of legitimate service dogs are happy to answer store employees’ questions. “Anyone who says ‘You can’t ask me that,’ that’s a fake, I guarantee,” Renz asserts. “We go through all this training and are glad to say it’s a service dog, and what the dog does for us.”

voice her concerns that local businesses are not educating their employees on what is and isn’t a service animal, and why pets that could interfere with service animals shouldn’t be allowed in areas where dogs usually aren’t present.

Madison is Katrina Strickland’s second guide dog. Her first, Vannie, had to be retired after being attacked by a pet dog in downtown Spokane. Vannie was traumatized and could no longer safely work as a guide dog.

“It frightened [Vannie] as much as it frightened me,” Strickland recalls. “The woman said she was sorry, but that doesn’t do anything when you’re messing with someone’s eyes. It was a really scary incident.”

Both Strickland and everal area businesses her husband Ryan use from the puzzle on page 13 have started posting their trained guide dogs to get service animal policies around.

5 = T; 15 = M; 23 = A near entrances. Some Spokane“It allows you a sense area Rosauers stores have recently placed of freedom that a cane doesn’t,” Katrina paper flyers by these signs that list the explains. “It allows you a sense of comstores’ ADA-compliant rules regarding pets. panionship, independence and freedom. It Renz has approached both the Spobreaks down barriers between you and the kane and Spokane Valley city councils to sighted world.”

S

CODEWORDS: HINT

The couple feel threatened by people trying to pass off pets as service animals.

“I think it happens a lot more now that there are websites that allow people to purchase supposed certifications and vests for their dogs — a little jacket that claims they’re a service dog, or they can print a certificate for $100,” Ryan says.

Katrina adds, “We see it more and more. Riding the buses, you see people and they have a big dog and they’re like, ‘Well, this is my service dog,’ and they say that to the bus driver. But then the dog turns out to be aggressive and causes a distraction” to other riders’ guide dogs.

Ill-mannered pets passed off as service animals not only endanger real service animals and their handlers, but also make it harder for legitimate service animals to get the respect they deserve. “I just ask that people really think about what it’s doing to people with disabilities who need the dogs to live a life like any other sighted person or someone without a disability,” Ryan says. “It becomes 10 times harder for us, as legitimate service dog users, to educate more people that when going to businesses we should be able to bring our animals.” n

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n

FOCUS

G N I C N A L A B S S E N T I F & IL FE S TNES

& FI RCISE

EXE

ar yet e y t s e t t your fi 7 1 0 2 e o mak t u ANEUF o H y P N e r Y i R p A s T BY ho’ll in w s l a c o l Meet six

I

n end-of-year twinkling lights and parties, it’s easy to get caught up in the festivities, feeding off their energy — or stress — and paying little mind to workout routines, food pyramids and regular bedtimes. But come Jan. 1, that perspective will change. Resolutions inevitably include a revolutionized lifestyle that expertly balances commitments and transforms the body into a well-oiled machine.

The challenge comes later in trying to make the changes stick when January’s resolve gives way.

Forming new habits is difficult, says Cindy Bourgoin, a Spokane-based certified fitness trainer and nutrition specialist. But she and other trainers agree it’s possible through setting goals, taking incremental steps and enlisting others to help you stick to your commitments.

For nearly 20 years, Bourgoin has worked with clients who are trying to lose weight, train for a sport or stay active as they get older. As she nears 60, Bourgoin has transitioned her business online, helping her clients over FaceTime or Skype sessions. She begins each person’s journey in the same way: Asking a set of questions geared toward identifying their starting point and uncovering their reason for seeking help.

People have different reasons for wanting to get or stay fit. They may be competitive. They may have children or grandchildren they want to run around with. Whatever it is, it’s important, she says, because it’s what will keep a person on track.

“What we value — our belief system — is what we act on,” she says. The process may be long and difficult. Willpower falters. But those core values are powerful. “That’s what we go back to.”

But what happens next? Does working out have to include mind-numbing hours on a treadmill in your basement? Luckily, the Inland Northwest is filled with inspiring ways to stay active, as well as individuals whose passion for sports and outdoor recreation has provided them with wisdom to share.

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LISA GERBER

SKIER, RUNNER, OWNER OF MARKETING BUSINESS

L

The caption goes here.

FULL NAME PHOTO

isa Gerber’s activity levels fluctuate throughout the year, hitting a peak as she gears up for a big trail-running event at the end of the summer and slowing down in the fall. But there’s one constant: A Wednesday night running group.

“It’s pouring rain and 43 degrees out and we’re all going running at 5:30. And we’ll get a glass of wine afterward,” she says. “We’ve been doing this for I don’t FAVORITE POST-WORKOUT FOOD know how many years — more than five, Strawberry-flavored Recoverite drink for sure. We have become such close and cheddar cheese Kettle Chips friends.”

TOP FIVE WORKOUT SONGS She says staying active is vital to her “Moves Like Jagger” by Maroon 5 well-being. She also prioritizes a full night “Applause” by Lady Gaga of sleep, keeping video screens out of “So Happy I Could Die” by Lady Gaga her bedroom, and keeps her diet free of “Animals” by Maroon 5 processed food. She loves to read books, “Vocal” by Pet Shop Boys watch movies and plan her next trip with her husband.

She maintains a full regimen of yoga, massage, strength training, running and skiing all while building her own business, Big Leap Creative, through which she helps entrepreneurs and business executives craft and market their stories: “I also speak nationally not only on storytelling but also on taking big leaps — overcoming hurdles that keep us from bringing ideas to life.

Being fit and taking care of oneself is one part of that of course.”

Having her own business allows her to set her own hours, including taking her work with her when she needs to. “I work a lot of hours, but they don’t have to be at a set time,” she says. She schedules in fitness classes or a few minutes to go for a hike in the middle of the day, knowing it helps rejuvenate her creativity and focus.

She’s balanced work and recreation long enough to know they’re two critical parts of a whole life. “I’ve always done those things and had to set them around work stuff. … They’re pretty integral to my peace of mind and happiness and groundedness.”

Still, Gerber admits there are days when she just doesn’t want to exercise. That’s where her dog Pepper comes in. “When it comes to motivation, if all else fails, Pepper needs her exercise, too, and any tendency to slack off will be quickly met with her eager nudging and tail wagging. It’s pretty hard to deny her. And she sets a YOUNG KWAK PHOTO …continues on next page solid pace!”

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FOCUS: EXERCISE & FITNESS

JEFF YATES

When the season is right, Jeff Yates and his snowboard are never far apart.

BOB LEGASA PHOTO

MULTI-BOARD ATHLETE, CAR SALESMAN

R

ather than naming a particular sport, Jeff Yates says his primary focus is “not sitting still.” He proves it by puttering around his yard in Coeur d’Alene on his day off while talking about his commitment to a range of action sports.

Yates, 48, started competing as a snowboarder in the 1990s. For 20 years, he oscillated between snowboarding in the winter and wakeboarding in the summer, taking advantage of sponsorships and chances to make extra money by teaching younger athletes.

Sometimes he’d mountain bike. And then there were triathlons and road cycling.

“Then I got into car sales. And once you get into car sales, you work. And you work and you work and you work,” he says.

He’s worked his way into a new kind of fame as Parker Subaru’s top salesman three years in a row — “Well, still two months to go for the third year, but I got it,” he says.

Seven years ago, he took up kiteboarding, finding a sport that didn’t require the same podium-centric mindset of his early days.

When he’s not selling cars, he’s ambling up and down the Columbia River corridor “chasing wind.” He extends his season on the water as long as he can before following the seasons to any of his other pursuits.

“The great thing about living in North Idaho is it’s really hard to burn out when you have four seasons,” he says in early November. “Your sport lasts about six months at the most. Right now,

STARTED...

Snowboarding at age 16; wakeboarding at age 17; kiteboarding at age 40 WHAT DO YOU DO TO STAY WELL IN THE WINTER? Snowshoe and hike in the backcountry with a snowboard on my back.

FAVORITE EXERCISE Biking and hiking with my pup. I also love working in the yard — it’s my place to get away when I can’t recreate.

I’m out on the water as much as possible, and I can’t wait to go snowboarding.”

His passion for these various sports is what keeps him fit. He relies on his wife to keep an eye on how he eats to make sure he doesn’t overdo it on fast food. He goes to bed early each night. And he stays limber for his outings by exercising alone in his home or going to the gym, but not on a strict schedule.

“There’s no real method to my madness. I’m lucky that I live a pretty mellow life for as much as I do. I get a lot of rest,” he says.

“I’m just... enjoying life.” …continues on page 26

24 Health DECEMBER, 2016 - JANUARY, 2017 INFOCUS inhealth 11-28-2016.indd 24

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FOCUS: EXERCISE & FITNESS

JAMIE REDMAN

Jamie Redman had to dial things back a bit from her time as an Olympian in London — and that’s OK.

OLYMPIC ROWER, PHYSICAL THERAPIST

S

tanding 6 feet tall, Jamie Redman remembers feeling out of After years training for the Olympics, Redman depends on place on the cross country team in high school. When she setting a plan for her fitness. She signs up for events and sets small went to Yale at 18 and joined the rowing goals, like besting her race time, to keep herteam, she no longer towered over the women self motivated. She sticks to a schedule that standing around her. keeps her active five or six days a week.

FAVORITE POST-WORKOUT FOOD “I found my people,” she recounts.

“I have to give myself a goal or I’ll go PANCAKES! And for those especially taxing Four years after competing on the world crazy,” she says. “If I don’t have a plan now, I workouts, I love those pink cookies from stage at the London Olympics, Redman is back just feel like I’m drifting aimlessly.”

Rocket Bakery. in Spokane, trying to balance work and play She’s not immune to the struggle of stickFAVORITE EXERCISE like most other people. After years of 30-houring with the plan. She gets busy or worn out Planks — an amazing exercise for core per-week training schedules and high-stakes at work, until the last thing she wants to do strength and injury prevention. And you can competition, she’s learning to enjoy the lighter is hit the gym or plan healthy meals for the don’t need special workout clothes to do side of sports. She earned a graduate degree week. But she’s practical in her approach. them! and works as a physical therapist at U-District She sets small goals, like setting aside time on TOP FIVE WORKOUT SONGS in Spokane. a weekend to prepare food for the week or “Kryptonite” by 3 Doors Down She’s still competitive, but now it’s in trail eating two green things at each meal. If she “Everytime We Touch” by Cascada running and skiing instead of rowing. Redman needs more sleep, she focuses on going to bed “Somebody Told Me” by The Killers says she’s embraced the lower stakes that acjust five minutes earlier for a week, and then “Wake Me Up” by Avicii company amateur athleticism. adding another five minutes the next week.

“Remember the Name” by Fort Minor “You can still fulfill your competitive urges,” Years of team sports have taught her the she says. “My first winter back, I signed up for value of a supportive community filled with a ski racing circuit. It was a way for me to test my fitness and push people who count on her to show up. my boundaries. … I think, as athletes, we’re striving to challenge “If I tell a friend I’m going to meet them,” she says, “sometimes ourselves.” that’s the only thing that gets me there.”

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Mike Overby carries his competitive athletic spirit over to his business.

MIKE OVERBY

SKIER, PARTNER IN THE COEUR D’ALENE ART AUCTION

F

or most of his life, Mike Overby stayed in shape for skiing by skiing. He competed in his youth, spent winters in Utah in his 20s and still goes on heli skiing trips with a Hayden, Idaho, production company.

But as he’s aged, he’s realized he can’t ski at the same level without extra training. Now 47, he runs, trains at the gym and pays attention to his diet, so he can keep up with the sport he lives for.

Of course, he doesn’t just run — a sport he took up in his 30s to rehabilitate a knee injury. He took up marathons.

As his workouts move him toward a successful ski season each year, his career revolves around an annual art auction. Overby is a partner at the Coeur d’Alene Art Auction — a premier auction house that sold 300 pieces for a total of $18.5 million last year. Auctioning art is a competitive industry that requires years of building relationships with collectors.

“I think that’s why my skiing — my competitive background in that — it does help in business, too,” he says. “I’m pretty competitive at whatever I do.”

FAVORITE POST-WORKOUT FOOD Chocolate milk FAVORITE EXERCISE Spinning class, because it packs a huge leg workout into an hour. I can put a big hill on a stationary bike and run it for an hour, which is impossible to do outside on the bike; there aren’t any climbs that long around here!

TOP FIVE WORKOUT SONGS “It’s a Long Way to the Top (If You Wanna Rock ’n’ Roll)” by AC/DC “Interstate Love Song” by Stone Temple Pilots “Pedestrian at Best” by Courtney Barnett “What Are You Waiting For?” by Nickelback “Party in the U.S.A.” by Miley Cyrus

Working for himself at the auction house over the past 20 years has provided the flexibility that Overby needs for annual ski trips. He pencils in a couple of gym sessions each week, because having it on the calendar ensures that he’ll go.

With age has come a new assessment of risk. He doesn’t shy away from big mountains, making regular trips to world-class skiing destinations.

But he no longer opts for an 80-foot drop on the descent.

“As you get older,” he says, “you just have to manage everything.” …continues on next page DECEMBER, 2016 - JANUARY, 2017

INFOCUS inhealth 11-28-2016.indd 27

YOUNG KWAK PHOTO

Health 27 11/17/16 11:53 AM

FOCUS: EXERCISE & FITNESS

Even with a hectic schedule, Megan Lindsay squeezes in workout time as she reaches for her goals.

MEGAN LINDSAY

PROFESSIONAL SOCCER HOPEFUL, SALES CLERK, RESTAURANT HOSTESS, ASSISTANT COACH

A

t an early morning fitness class, ing since she was 4 or 5 years old. But it’s Megan Lindsay of Spokane gathdifferent than when she was in college, ered around a tire with a small or the two years she spending playing group of women. Their objective: Flip the professionally for European teams. Soccer tire end-over-end up used to be her and down a field. By job — and she FAVORITE POST-WORKOUT FOOD the end, the tire has hopes it will be At the moment, a peanut butter and banana traveled a mile. again — but for sandwich with Ezekiel bread.

The early mornnow she’s fitFAVORITE EXERCISE ing sessions keep ting in training At the gym, tire flips. I love tire flips! On the Lindsay’s athletic around family, pitch, I love crossing and finishing drills. I love aspirations as the top two part-time scoring and practicing my shots. I could do priority. The 25-yearjobs and an asthese for hours! old soccer player has sistant coaching TOP FIVE WORKOUT SONGS spent the past year gig at her alma “Get Me Bodied” by Beyonce training on her own mater, Gonzaga “Gold Guns Girls” by Metric in Spokane, working Prep.

“Farewell To the Fairground” by White Lies toward a spring tryout “Since I’ve “Tiptoe” by Imagine Dragons with the Seattle Reign, been back, it’s “Once in a While” by Timeflies a professional team in been harder the National Women’s just because Soccer League. my time is not as flexible as it was Thanks to classes at U-District, she’s overseas. Overseas you just had to focus found a way to maintain the competitive on practice ... you had the whole day to team atmosphere that has kept her playdo whatever you want,” she says. “It’s

hard because I’m working two jobs, so my time is very limited as far as working out, but it’s nice because classes are in the mornings when everyone else is sleeping.”

Lindsay says that a lifetime of school and outside commitments, like soccer, have prepared her for this balancing act, but ultimately it’s her dedication to her goal that keeps her going. She wakes at 5 am to fit in a U-District athletic fitness class before she heads to work downtown at Athleta, a clothing store. She has a three-hour break after her retail shift when she can work on ball handling and technique. Then she heads to Waddell’s Neighborhood Pub & Grille, where she works as a hostess.

She may not have much time for Netflix, but she’s happy with the opportunities she’s been given that allow her to pursue her dream.

“It’s something I can look back on and say, ‘I tried. I gave it my best shot. I was prepared and I was ready for it,’” she says. …continues on page 30

28 Health DECEMBER, 2016 - JANUARY, 2017 INFOCUS inhealth 11-28-2016.indd 28

11/17/16 11:53 AM

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FOCUS: EXERCISE & FITNESS

LARRY KRAFT

TENNIS PLAYER, RETIRED EWU PROFESSOR

I

There’s no handicap in tennis, and 91-year-old Larry Kraft wouldn’t take one if there was.

SARAH PHILIP PHOTO

n a city of racquetball players, Larry Kraft most enjoyed handball, until one day a friend pushed him to try tennis.

“I just simply got hooked,” he says.

Nearly 40 years later, at age 91, he still plays several times a week at the Spokane Club.

When Kraft taught communications at Eastern Washington University, he and his colleagues would play tennis on courts reserved for faculty over lunch. Since retiring in 1991, he still plays at noon, reserving a court for about an hour and a half to play doubles or singles. He’s always been fairly active, though not a star, he says, failing to mention that he and a partner won the 75-to-79 age bracket of the men’s tennis doubles at the Washington State Senior Games in 2002.

He has days when he doesn’t play up to his own standards. During a recent match, he was in a funk until the third set.

“I get disgusted with myself,” he says.

But he’s learned to accept the speed or agility he’s lost over the years. His teammates can attest that he still covers the court well.

“You just have to face facts. I think I face them. I fight it all the way, but we’re going to lose in the end,” he laughs.

Still, he thrives on the competition. “We all want to win when we play against each other,” he says. “I feel lucky that I can still enjoy it so much. People ask me that sometimes, you know, ‘How long are you going to play tennis?’ And I tell them, ‘As long as I’m enjoying myself, I’m still playing,’ I just simply enjoy it — even times when I don’t even feel really good. Some of it’s probably mental, but I get out on the tennis court and I feel just great.” 

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LIVING

EDUCATION

The Arts of Medicine

Doctors and med students in Spokane gather before rounds to contemplate art, from the music of Neil Young (top) and Neko Case (above) to Dick Ket’s selfportrait (left) and med student Ashton Kilgore’s sketch from the Congo (below).

How music, literature and visual art are humanizing health care

BY LINDA HAGEN MILLER

D

arryl Potyk, M.D., queues his phone to a song, presses play and deposits the phone in an empty, grande-sized paper coffee cup. He slides the now amplified phone to the center of a table and three people lean forward, intently listening to Neko Case’s smoky

voice, whisper-singing her cover of Tom Waits’ “Christmas Card from a Hooker in Minneapolis.”

The song ends. The group leans back in their chairs, and Potyk asks the two men and one woman, “What did that song mean to you?”

It’s sad and bluesy,” Jessica Lundgren offers. “She’s pregnant, she’s broke, then we find out she’s in prison… ” “I hear poverty and struggle, something I don’t know a lot about firsthand,” says Dan Rona-Hartzog. ...continued on next page DECEMBER, 2016 - JANUARY, 2017

LIVING-MAIN inhealth 11-28-2016.indd 33

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LIVING

“THE ARTS OF MEDICINE,” CONTINUED...

“I hear the Western perspective coming through,” Mark Joseph Torres says, reflecting on his upbringing in the Philippines.

“She’s worrying about the future, thinking ahead.”

We are not in a high school literature class, group rehab or college seminar on music appreciation. And these are not typical students. We’re in the physician’s breakroom at Sacred Heart Medical Center, and today the participants are a senior and junior resident, a third-year medical student and an attending physician. Dubbed “A Daily Dose of the Humanities,” the innovative exercise incorporates art, music and literature into medical education at the University of Washington School of Medicine regional campus in Spokane.

H

umanities classes are rarely offered in medical curricula; as electives, if they’re available at all. Most medical coursework is so intense and packed

Dr. Darryl Potyk leads a discussion about the music of Neil Young prior to setting out on rounds with residents, attending physicians and students (including Pamela Schultz, pictured), at Providence Sacred Heart. YOUNG KWAK PHOTO with science and medicine, the last thing a fledgling physician will choose to do is sit in on a class involving art, literature or philosophy. But years ago, as medical school course developers realized that an education focusing only on the nuts and bolts of medicine could end up producing technically proficient but robotic physicians, humanities course offerings in medical school began to gain traction.

On a daily basis in clinics and hospitals across the country, electronic medical records have served to further widen the disconnect between patients and their health care providers. EMRs require doctors to spend precious appointment time on the keyboard of their laptops documenting the visit. Patients say they feel disconnected, unheard and dismissed when physicians are constantly looking at screens, busily typing chart notes.

A Daily Dose of the Humanities offers a way to help medical professionals

reconnect with their patients, their peers and themselves. It differs from traditional coursework in two important ways: it’s short and it’s daily. Prior to patient rounds at Sacred Heart, the internal medicine rounding team (usually an attending physician, residents, medical students and occasionally pharmacists) meets for about 10 to 15 minutes, and one member shares a piece of music, art or literature. The exercise is the catalyst for a group discussion as each team member reflects on how they personally feel the art or music applies to medicine, patients or themselves.

The innovative program, which began two years ago, is the brainchild of Potyk, Assistant Dean for Regional Affairs and Clinical Professor at the University of Washington School of Medicine in Spokane. Potyk is quick to share credit with Judy Swanson, M.D., Internal Medicine Clerkship Director and Clinical Associate Professor; Judy Benson, M.D., Providence

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Internal Medicine Residency Program Diheavy. Molly Knox, a fourth-year medirector and Clinical Associate Professor; and cal student entering the field of neurology, Jeremy Graham, D.O., Clinical Assistant presented four songs during her four-week Professor, all at the UW School of Medirotation, but one stands out. cine. Potyk’s medium is music, Benson and “I was in the fourth week of my first Graham focus on literature and Swanson rotation of medical school and the residents concentrates on visual were finishing their art. very first block of “The short, inpatient service,” intense humanities Knox says. “It had sessions allow everybeen a long week with one to take a breath, challenging cases and look at the big picture late hours. So far that and reflect for a moweek, we had serious ment on why they discussions following became doctors,” says mainly sad songs.

Potyk, an instructor To lighten the mood at the UW School and celebrate the end of Medicine since of our first block, I 1994. “Discussing a brought in a pumppiece of art, a song or up rap song (often literature lowers barplayed during hockey riers and allows us to “THE NEEDLE AND THE DAMAGE DONE” games). It had the glimpse into another desired effect — laughperson and discover ter — but also began I caught you knockin’ other lives. We ask a short discussion on At my cellar door each other, ‘How does coping with stress.”

I love you, baby, this speak to you, to “Songs have the what we do every ability to say what Can I have some more day?’ ” we sometimes can’t Oh, oh, the damage done.

One of Potyk’s — that we are sad, I hit the city and Daily Dose exercises having a bad day, revolved around the confused or upbeat,” I lost my band Neil Young song “The she continues. “TakI watched the needle Needle and the Daming a few minutes Take another man age Done,” a poignant before rounds to relax Gone, gone, the damage done. lament of heroin and express ourselves addiction. was therapeutic and I’ve seen the needle Potyk notes that led to team bonding.

And the damage done even though the song The humanities proA little part of it in everyone is 45 years old, it has gram also facilitated But every junkie’s a timeless message the team to process about the compelpatient cases: if there Like a settin’ sun. ling lure of drugs in was a difficult case — NEIL YOUNG, 1972 today’s society. When keeping you up at he presented the song night, the scheduled to the internal medicine rounding team he time prior to rounds was a great time to was leading, he says it opened the door debrief.” to discussing the tug and pull of treating When Galia Deitz, a third-year medical patients who use illegal drugs, the need for student, first learned they would discuss compassion on the part of their medical artwork every day before rounds, she was providers and the physician’s responsibility ambivalent. to prescribe appropriately and limit narcotic “I didn’t realize this was not something prescriptions. every team did until we had a different “Additionally, some took note of the attending physician,” says Deitz, who parline, a little part of it in everyone,” Potyk says, ticipated in the Daily Dose for one week on “highlighting our own vulnerability, which Dr. Swanson’s team. led to a discussion of impaired physicians, “Much of medicine is built on laws the incidence of substance abuse and what and universal understandings of science, to do if you suspect a colleague is imand that is what guides clinical judgment paired.” and decision-making,” Deitz says. “How...continued on next page Not all musical discussions are quite so

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LIVING “THE ARTS OF MEDICINE,” CONTINUED... ever, there is also an important, intangible component to medicine that extends beyond science and can also be influential in driving medical decisions. A lot of art interpretation is just that: interpretation.

tests that will be ordered, and the diagnoses that will be included in our differentials.

Whether this helps us come to the correct diagnosis, or simply establish rapport with a patient, it is an invaluable art.”

Swanson, who has been teaching since 1998, uses art to generate discussions with

“Medicine is learned by the bedside and not in the classroom.

Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”

— WILLIAM OSLER, Canadian physician, pathologist, educator and author We use visual cues to help us gain a better understanding of what message or meaning we think the artist is trying to convey.

The same is true with medicine. We use observational skills, a large one of which is visual, to help guide patient interviews, the

her care delivery team. “I am big on observation and physical diagnosis,” she says, “and my goal using visual artwork in this program is to reinforce physical examination skills and help students see the whole patient, not just the ailment.”

Swanson presented a Dick Ket painting to open the discussion of looking for visual cues. In the Dutch magic realist’s self-portrait, you see a thin, dark-haired man holding a bottle filled with flowers.

He wears a black beret, a white shirt unbuttoned below his chest and a dark coat slung over one shoulder. His head is turned away, but he looks at the viewer from the corner of his eyes.

“The portrait seems fairly straightforward, but when I asked the group to look closer, they realized his bluish nails and clubbed fingers demonstrated that Ket probably suffered from uncorrected Tetralogy of Fallot, a congenital heart defect which is present at birth,” says Swanson.

“The ensuing discussion emphasized the importance of including observation along with routine physical examination.

“Talking about what we see in an image,” she continues, “opens up discussions on patient care. In our work, we see a lot of suffering, and sometimes what we experience working with patients is too raw to discuss outright. Daily Dose is a way we can let others know they are not alone in feelings of despair.”

Empathy, despair, bonding. And

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sometimes perspective. During Ashton Kilgore’s internal medicine rotation, she contributed an oil painting of a foot by Adolph Menzel. The appendage is seen from above, as if the viewer is looking down on their own foot.

“I like this piece for its skillful portrayal, the way it maintains the physicality and process of painting, and also because of the perspective from which the foot is painted,” says Kilgore, a fourthyear medical student. “While medical studies are largely focused on pathologies, physiology, diagnoses and treatment, seeing this foot from a patient’s perspective served as a good reminder for me to consider the emotional and social concerns of my patients.”

P

articipants are also invited to contribute their own artwork to the Daily Dose. Kilgore, who grew up in the Congo, Kenya, Morocco and Haiti as the daughter of a bush pilot, offered a sketch of Congolese pygmy children that she had drawn when she was 22 years old. Her time spent in povertystricken areas of Africa and the Caribbean largely influenced her decision to go

into medicine, as she witnessed firsthand the disparities in health care between the United States and developing countries.

Her sketch not only spurred a conversation about the types of illnesses and disease she witnessed in Africa, it also gave the other students and residents a portal into Kilgore’s talent as an artist, and helped round her out as an individual as well as a fellow medical professional.

The residents and students interviewed unanimously agreed that the Daily Dose is a welcome respite to their hectic schedules, an enlightening team-building exercise and an eye-opening opportunity to examine their own philosophy on the practice of medicine.

“The Daily Dose of Humanities is a great way to remind young doctors and doctors-to-be that with all things in medicine, never stop learning how to be a compassionate human,” says Knox. 

Resident physician Joshua Gruhl (above) and Dinesh Ratti, an attending physician, have joined in Dr. Potyk’s Daily Dose of the Humanities sessions. YOUNG KWAK PHOTOS

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LIVING

COOKING

Grains of Truth Shaun Thompson Duffy goes from mill to oven

BY CARRIE SCOZZARO

B

read has gotten a bad rap, says Shaun Thompson Duffy, who bakes bread, consults with bakeries, teaches classes and, most recently, mills his own flour.

“Gluten-intolerance people have tons of theories about it,” says the 36-year-old chef-turned-baker, who has dedicated his career to exploring artisanal breadmaking.

In particular, he wondered why people with gluten intolerance reported that they could eat the breads he creates. Duffy, who owns Culture Breads, offers a monthly subscription service featuring bread and freshmilled flours.

Was there something about modern bread that was inherently different from his bread? Was it the modern wheat, Duffy wondered? Was it pesticides, lack of fermentation, the milling method, or even the type of yeast used in commercial breadmaking? Or maybe a combination?

“What I do is just hit the reset button and go back to baking, basically, before industrialization,” says Duffy, who does not claim medical expertise but has earned his chops in the culinary world. He’s cooked in some of the America’s most distinguished restaurants: at the Houston Country Club

under certified master chef Fritz Gitschner; in Las Vegas at the Bellagio’s Picasso restaurant under James Beard Foundation award winner Julian Serrano; and at various Texas locations under an adventurous Randy Rucker, who pioneered molecular gastronomy in the Lone Star State.

Around 2001, Duffy noticed an increase in restaurant specialization. There were programs focused on desserts, charcuterie and bread. He recalls making what he thought was a clever brioche using goat whey. It inspired him to think of specializing in bread. “How can I stay on the cutting edge, still have a family and do my own thing?” he says he asked himself at the time. Bread intrigued him, in part because there wasn’t a lot of information on artisanal breadmaking or alternative grains at the time.

Duffy’s research led him to seek out and learn from small-batch bakers who were often working in obscurity, then to experiment on his own. Wild yeast fermentation became an essential part of his approach. He uses the time-honored process of creating a sourdough starter that allows yeasts and bacteria that occur naturally in flour to develop. Bread baked

Shaun Duffy tending to his loaves.

YOUNG KWAK PHOTOS

with sourdough does not need to have commercial yeast added to it, and takes on a tangy flavor.

At Tabor Bread, the first Portland baker to mill its own flour, Duffy finetuned his techniques. He relocated to Spokane in 2012, partially for his wife’s job but also because of the region’s wheatbased agricultural history. After working a few years with Spokane’s Bouzies Bakery, Duffy struck out on his own in 2015 to build Culture Breads.

Duffy recently found kindred spirits in DOMA Coffee’s Terry and Rebecca Hurlen Patano, whose Post Falls, Idaho, business specializes in economic and environmental sustainability. The plan, says Duffy, is to mill flour at DOMA’s facility using a newly installed granite stone mill.

Built by New American Stone Mills, Duffy’s new mill weighs about 2,500 pounds and cost more than $18,000.

It will allow him to mill his own flour, particularly the soft wheat variety he gets from Palouse Heritage’s Palouse Colony Farm, located between the Whitman County towns of St. John and Endicott.

Duffy says the new mill will allow him to continue making bread the old way, creating a product that is “digestible, nutritious, flavorful.” He appreciates bread’s lengthy history as part of the human diet: “Cooking with fire made our brains bigger; fermentation allowed us the energy to sustain our daily activities.” 

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RECIPE • Cover, leave on counter at room temperature in between stretching and folding.

• Stretch and fold every 20 minutes for the first hour only, flipping the dough every time.

• For next TWO hours, fold and stretch every 30 minutes.

• After the third hour let the dough rise, covered.

Heritage Spelt and White Wheat Bread The most complex thing in this recipe is adjusting for fresh-milled flour. Commercial flour is designed to be predictable, so this recipe includes a small amount of organic, all-purpose flour to help beginning bakers get started. As your comfort level working with freshmilled flour increases, transition to all fresh-milled flour. Measure by weight with a kitchen scale. This recipe also uses white wheat, not to be confused with white flour, and requires a culture, also known as a starter. You can find lots of starter recipes online, or check out Shaun Thompson Duffy’s starter recipe at Inlander.com/inhealth.

INGREDIENTS • 250g whole spelt flour (Culture Breads, Lentz Spelt Farms or Fairhaven Mill) • 200g whole, hard spring white wheat flour (Culture Breads, Bluebird Grains or Central Milling) • 50g organic all-purpose flour, ideally stone-milled • 100g starter (more accurately called sourdough, culture, leaven or levain) • 475g water (80˚F depending on ambient temperature; warmer temperatures expedite fermentation) • 12g sea salt INSTRUCTIONS MIXING Mix flours, starter and water by hand. Once there is no more visible dry flour, let mixture sit, covered and

undisturbed so the water can work its way into the tiny starch molecules.

• After an hour, add salt and mix by hand until salt is dissolved and dough feels homogenous, and ideally is 75˚ F. • Let rest five minutes, then “claw” the dough and mix till it comes back together.

• Let rest five minutes, repeat clawing.

PRESHAPE • Flip your dough on a lightly floured surface.

• Fold sides together into center, then repeat with top and bottom to create a square.

• Fold the opposite corners over each other; repeat with the top left and bottom right corners.

• Flip the dough over so the seam is on the bottom.

• Cover with a towel and let relax about 20 minutes (longer if it’s colder than 70˚ to 75˚ F).

FINAL SHAPE • Lightly dust top of dough with flour, then gently flip over and repeat the shaping technique from Steps 2-4 above.

• Lightly flour a kitchen towel and lay it inside a bowl.

• Gently lift the shaped dough into the bowl and place into refrigerator overnight, uncovered.

BAKING • Preheat oven to 550˚ F. • Place a dutch oven or lidded cast-iron pan in oven and preheat pan for at least an hour.

• Remove dough from fridge and sprinkle with a little whole grain flour to keep the bottom from scorching.

• Unmold dough into pan, “score” the dough with either STRETCH AND FOLD scissors or a knife in a decoraBULK FERMENTATION Bakers tive pattern. stretch and fold the dough to • Lower temperature to 500˚ strengthen it. Lift up one corner F and bake with lid on for 20 or side of your dough (as if it minutes. were a square shape), stretching • After 20 minutes, remove lid, it gently as you fold it in toward lower temperature to 450˚F the center of the dough. and bake another 20 minutes.

• Repeat with the other three • The bread should have a dark sides. mahogany crust when you take • Flip the dough over. it out to rest on a rack. n

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LIVING

EMPATHY CAKE

W

PARENTING

Play Well A new book about how they parent in Denmark offers lessons for overprogrammed American kids

BY JESSICA JOELLE ALEXANDER AND IBEN SANDAHL

I

n Denmark, dating back to 1871, husband and wife Niels and Erna JuelHansen came up with the first pedagogy based on educational theory, which incorporated play. They discovered that free play is crucial for a child’s development. In fact, for many years, Danish children weren’t even allowed to start school before they were 7. Educators and people who set the agenda for children’s schooling didn’t want them to engage in education because they felt that children should first and foremost be children, and simply play.

Even now, children age 10 and under finish regular school at 2 pm and then have the option to go to what is called “free-time school” (skolefritidsordning) for the rest of the day, where they are mainly encouraged to play. Amazing, but true!

In a pilot study conducted on preschool children in a child development center in Massachusetts, researchers wanted to measure whether there was a positive cor-

relation between the level of playfulness in preschoolers and their coping skills. Using a test of playfulness and a coping inventory, the researchers cross-checked the children’s playfulness and the quality of their coping skills. They found a direct positive correlation between children’s playfulness level and their ability to cope. The more they played — that is, the better they became at learning social skills and engaging in social/ play contexts — the better they were at coping. This led the researchers to believe that play had a direct effect on all of their life adaptability skills.

Another study, conducted by occupational therapy professor Louise Hess and colleagues at a health institute in Palo Alto, California, sought to investigate the relationship between playfulness and coping skills in adolescent boys. They studied both normally developing boys and those with emotional problems. As in the preschool study, for both groups of boys there was a

e all know what a Danish pastry is — that delightful caloric bomb of glazed breakfast deliciousness. But what about a Danish classroom cake? And moreover, how can this help teach empathy?

While researching our book, The Danish Way of Parenting, my co-author and I interviewed numerous teachers and students across Denmark to learn how they incorporate empathy in schools and at home.

The Danes’ highly developed sense of empathy is one of the main reasons Denmark is consistently voted one of the happiest countries in the world. Empathy plays a key role in improving our social connections, which is a major factor in our overall happiness. What many don’t realize is that empathy is a learned skill that many of us miss out on in America.

We describe several empathy programs for younger kids in our book, but one of the most interesting programs, that starts on the first day of school at six years old and continues until graduation at age 16, is called “Klassen Time” or “the Class’s Hour.”

“The Class’s Hour” is set for a special time once a week, and it is a core part of the curriculum. The purpose is for all the students to come together in a comfortable setting to talk about any problems they may be having. Together, the class tries to find a solution. And this is where the “Klassen Time kage,” or “the Class’s Hour cake,” comes in.

It’s a simple cake that students take turns baking every week for the occasion.

It’s interesting to think what implementing the Class’s Hour in the U.S. school system could do for our future. By dedicating an hour a week to teaching kids to put themselves in someone else’s shoes, what kind of changes could we bring about? Looking to the world happiness reports year after year, I can’t help but think that incorporating a version of the Danish Class’s Hour in our schools and improving empathy could literally be a piece of cake.

— JESSICA JOELLE ALEXANDER

direct and significant correlation between the level of playfulness and their ability to cope. The researchers concluded that play could be employed to improve coping skills, particularly the abilities to adapt and to approach problems and goals in a more flexible way.

Play is so central to the Danish view of childhood that many Danish schools have programs in place to promote learn...continued on page 42

40 Health DECEMBER, 2016 - JANUARY, 2017 LIVING inhealth 11-28-2016.indd 40

11/17/16 3:43 PM

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LIVING “PLAY WELL,” CONTINUED... ing through sports, play and exercise for all students. Play Patrol, for example, is focused on the youngest elementary school students and is facilitated by the older ones. These student-led programs encourage both young and older students to play various activities such as hide-andseek, firefighter or family pet — and to encourage shy, lonely kids to join in the game, too. This type of fun and imaginative play, with mixed age groups, encourages kids to test themselves in a way they wouldn’t with their parents or teachers.

It greatly reduces bullying and further fosters social skills and self-control.

Almost everyone has heard of Lego and played with the famous colorful building blocks at least once in their lives. One of the most popular toys in history, Lego was dubbed “the toy of the century” by Fortune magazine at the start of the millennium. Originally made from wood, Lego has never lost its fundamental building-block concept. Like the zone of proximal development, Lego can work for all ages. When a child is ready to take the next step toward a more challenging construction, there are Legos made

Co-authors Jessica Alexander (left) and Iben Sandahl for doing so. It’s a wonderful way to play with your child to gently help them master a new level. They can play on her own or with friends; countless hours have been spent playing with Lego all over the world.

The interesting fact that most people don’t know about Lego is that it comes from Denmark. Created by a Danish carpenter in his workshop in 1932, it was called Lego as a contraction of the words leg godt, which means “play well.” Even then, the idea of using your imagination to play freely was in full bloom.

So the next time you see your children swinging from the branches, jumping off some rocks or play-fighting with their friends and you want to intervene to save them, remember that this is their way of

learning how much stress they can endure.

When they are playing in a group with some difficult children and you want to protect them, remember that they are learning self-control and negotiation skills with all kinds of different personalities to keep the game alive. This is their way of testing their own abilities and developing adaptability skills in the process. The more they play, the more resilient and socially adept they will become. It’s a very natural process. Being able to leg godt, or “play well,” is the building block to creating an empire of future happiness.  Excerpted from The Danish Way of Parenting by Jessica Joelle Alexander and Iben Sandahl. For more information, visit thedanishway.com.

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LIVING DECEMBER - JANUARY EVENTS BLOOD DONATION | Give blood at the Inland Northwest Blood Center, which requires up to 200 donors each day to ensure that the blood bank is adequately stocked. Donors can schedule an appointment online or donate during walk-in hours. Spokane office: Mon, Fri-Sun from 7 am-3 pm; Tue-Thu, 11 am-6 pm. Coeur d’Alene office: Mon, Fri, Sat, from 7 am-3 pm; Tue-Thu, 11 am-6 pm. inbcsaves.org (423-0151) SECOND HARVEST FOOD SORTING | Join other volunteers to sort and pack produce and other bulk food items for delivery to local emergency food outlets. Ages 14+. Shift dates and times vary; sign up at inland.volunteerhub.com/events.

Second Harvest Food Bank, 1234 E. Front (252-6267) TREE OF SHARING | The 34th annual program collects and distributes requested items to regional nonprofits and social service agencies serving low-income, disabled and elderly members of the community. Pick up a tag and drop off items by Monday, Dec. 12. Tags available at NorthTown, River Park Square and Spokane Valley malls. treeofsharing. org (808-4919) SANTA EXPRESS | The 24th annual holiday store offers items at allowance-friendly prices (50 cents to $8) for area children (ages 4-12) to purchase for their friends and family, with proceeds supporting the Vanessa Behan Crisis Nursery. Open through Dec. 23. Mon-Fri, from 11 am-8 pm; Sat, from 10 am-8 pm; Sun, from 11 am-6 pm. At 707 W. Main (skywalk level). vanessabehan.org (340-0479)

INTRO TO YOGA | An instructor leads beginners or new practicers of yoga in a gentle class, and explains the benefits of this form of exercise. Wear comfortable clothes, and bring a water bottle and mat, if you have one. Free. Dec. 6, from 6-7 pm. Free. South Hill Library, 3324 S. Perry. spokanelibrary.org (444-5385) CAR SEAT INSPECTIONS | On-site technicians will make sure families’ car seats are safely installed, offer safety tips and discuss passenger safety laws. Appointments available on Dec. 7 and 14. Free. Before your appt, email Renee.Witmer@providence.org with your child’s age, weight, height, your vehicle year and model, and the reason for your check.

Sacred Heart Children’s Hospital, parking garage, Seventh and Division. (844-1854) HOLIDAYS AT THE HEARTH | Members of the community are invited to join staff and clients served by local nonprofit Women’s Hearth for an afternoon of sugar cookie decorating, carol singing, facility tours and more. Thu, Dec. 8, from 4:30-5:30 pm. RSVP requested. Women’s Hearth, 920 W. Second. Help4women.org

INBODY 570 TESTS | INHS Community Wellness has a machine available to the public which provides a complete picture of body composition, including weight, body mass index, basal metabolic rate and more. Appointments on Dec. 14 and 30, and Jan. 3, 12 and 25. $20/test. INHS Wellness Center, 501 N. Riverpoint Blvd. wellness.inhs.org …continues on page 45

More Than a Story

COMMUNITY CANCER FUND HOLIDAY BASH | The second annual event benefits the fund’s mission of fighting cancer in the Northwest. Includes complimentary food, beverage, live music by Kelley James and dancing to music from DJ Patrick. Fri, Dec. 2, at 7 pm. $125-$350. Davenport Grand Hotel, 333 W. Spokane Falls Blvd. communitycancerfund. org JINGLE BELL RUN | This annual event is a fundraiser run for the Arthritis Foundation, with holiday-themed costumes strongly encouraged. Sat, Dec. 3, at 8 am. Riverfront Park, Northbank Shelter. kintera.org (263-0193)

PAJAMA STORYTIME | Hear local authors read their favorite picture books at a special pajama storytime. Includes 30 minutes of stories, fingerplays, and songs followed by a 30-minute play and learn session. Pajamas encouraged, but not required. Featured authors: Chris Cook, Kris Dinnison, Rachel Toor and Ellen Welcker. Tue, Dec. 6, from 6:307:30 pm. Free. Spokane Valley Library, 12004 E. Main. scld. org (893-8400)

UNION GOSPEL MISSION VOLUNTEER ORIENTATION | Learn about volunteer opportunities and services offered at monthly orientations. Dec. 13 and Jan. 10, at 6 pm, at both UGM locations: Coeur d’Alene (Center for Women & Children), 196 W. Haycraft, and Spokane, 1224 E. Trent. Sessions on Dec. 27 and Jan. 24, from 10 am-noon in CdA, and from 6-8 pm at Anna Ogden Hall, 2828 W. Mallon. uniongospelmission.org/events (535-8510 x 2 or 208-665-4673)

JUST FOR KIDS

BODIES HUMAN: ANATOMY IN MOTION | Mobius’ blockbuster science exhibit includes six whole bodies, more than 100 individual organs, and transparent body slices that have been preserved through plastination, a technique that replaces bodily fluids with reactive plastics. Exhibit runs through Dec. 31; open Tue-Sat, 10 am-5 pm; Sun, 11 am-5 pm. (Recommended for ages 10+.) $15 admission. Mobius Science Center, 331 N. Post. mobiusspokane.org (321-7137)

EXCHANGE CLUB CRAB FEED & AUCTION | The 50th annual event raises funds for nonprofits that work to prevent child abuse: Vanessa Behan Crisis Nursery, Children’s Home Society of Washington and Partners with Families and Children. The event includes a social hour, dinner and silent and live auctions. Sat, Dec. 3, at 4:30 pm. $75/person; table sponsorships available. Spokane Convention Center, 334 W. Spokane Falls Blvd. downtownspokaneexchangeclub. org (226-2448)

CHRIST KITCHEN GINGERBREAD BUILD-OFF | The annual gingerbread house build-off features teams competing to build the most elaborate gingerbread house, as voted by the public. Families and kids can also make their own gingerbread houses ($7), take photos with the Gingerbread Man and watch the houses being constructed. Sun, Dec. 11, from 10 am-4 pm. Free to watch. Davenport Grand Hotel, 333 W. Spokane Falls Blvd. ccckministry.org (325-4343)

S

itting on the floor, cross-legged, listening to a friendly librarian read aloud from a picture book has been an element of public libraries since their inception. And with increased focus on the importance of early childhood education and literacy, libraries have adopted new ways to sneak optimal learning experiences into these fun story sessions. At the 10-branch Spokane County Library District, weekly “Play and Learn Storytime” sessions for the littlest learners among us intentionally incorporate elements of the STEM (science, technology, engineering, math) philosophy while children listen and engage during the story.

“Usually books are chosen because they have some sort of subject or topic of interest to kids

that uses imagination,” explains SCLD’s Jane Baker. “But it’s not just the reading — kids are learning to recognize letters and words, and it brings in counting and fine and large motor skills.”

The hour-long storytimes offered as regular events on the library’s calendar are organized by age group, with sessions for ages 0 to 18 months, ages 1½ to 3, ages 2 to 5, ages 3 to 5 and family storytimes for all ages.

Baker says besides offering weekly sessions at all branches, the library has developed an outreach program to bring Play and Learn sessions to dozens of childcare centers in the region. Organizations or parents can also check out kits that include all the books and activity materials needed to host their own sessions.

“Storytime is very important to kids and early literacy, but it’s become more sophisticated as time goes on,” Baker says. “Early childhood learning is still one of the hallmarks of our strategies in reaching out.”

— CHEY SCOTT For details on Play and Learn Storytime at your closest branch, visit scld.org and click “events.”

DECEMBER, 2016 - JANUARY, 2017

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LIVING

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DEC. - JAN. EVENTS BLESSINGS UNDER THE BRIDGE WINTER EVENT | The local nonprofit hosts its 10th annual event to serve the community’s homeless, offering a free hot brunch, hot drinks, holiday treats, distributions of winter clothing, blankets and gifts. Sat, Dec. 17, from noon-3 pm. At Fourth Avenue and McClellan Street. See Facebook page (facebook.com/ BlessingsUTB) for a list of needed donations and for information on how to sponsor a table at the event.

E-BOOK BOOT CAMP | Just got a new Kindle, Nook or other device? Want to set it up to get free ebooks and audiobooks from the library? Bring your charged device, library card, and your Apple ID or Amazon password, if applicable, and learn how in an interactive session. Registration recommended. Free. Sat, Jan. 7, from 10:30 amnoon. Hillyard Library, 4005 N. Cook St. spokanelibrary. org (444-5380) HEALTHY WEIGHT MANAGEMENT | Learn five essentials to harness the power of your thoughts and emotions to improve your New Year’s resolution success. Free. Sat, Jan. 7, from 1-2 pm. South Hill Library, 3324 S. Perry. spokanelibrary.org (444-5385) SPOKANE HEALTH & FITNESS EXPO | Attendees can meet exhibitors, hear guest speakers, participate in fitness classes like barre, Zumba, CrossFit, jiu jitsu and more.

Sat, Jan. 14, from 10 am-6 pm and Sun, Jan. 15, from 10 am-4 pm. $8/adults, $4/ages 6-12; admission (cash only) good all weekend. Spokane County Fair & Expo Center, 404 N. Havana. spokanehealthfitexpo.com NEXT STEPS IN LIFE’S JOURNEY | This six-session series of classes shares the importance of advanced life planning and why it’s needed. Free. Mondays, from 6-7 pm, Jan. 16-Feb. 20. South Hill Library, 3324 S. Perry. spokanelibrary.org (444-5385) LEADERSHIP LIGHTS THE WAY GALA | The annual gala celebrates local leaders, and raises funds to support scholarships for local youth and adult programs. Evening includes a champagne reception, networking, auctions, award presentations and more. Sat, Jan. 21, from 6-9 pm. $65+/person. Northern Quest Resort & Casino, 100 N. Hayford Rd., Airway Heights. leadershipspokane.org CHILD PROTECTION PLAN | Local attorney and mother Randi Johnson covers what parents need to know about making sure your kids are taken care of by the people you want, in the way you want, no matter what. Free. Tue, Jan. 24, from 6-7:30 pm. South Hill Library, 3324 S. Perry. spokanelibrary.org (444-5385) BABYSITTING BASICS | Youths ages 10 to 15 can learn skills to be safe and successful babysitters in this course covering how to care for infants, CPR and first aid, personal safety, discipline issues and more. Sat, Jan. 28, at 9 am. $40. St. Luke’s Rehabilitation Institute, 711 S. Cowley. wellness.inhs.org TASTE SPOKANE | The annual event benefiting the Wishing Star Foundation hosts local food and drink purveyors, sharing samples of food, beer, wine and cider. Proceeds support Wishing Star’s mission to grant wishes to area kids with life-threatening conditions, and to support their families. Fri, Feb. 24, from 6-10 pm. Northern Quest, 100 N. Hayford Rd., Airway Heights. wishingstar.org n The calendar is a free service, on a space-available basis.

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LIVING

Shelley Enlow (left): Ashtanga helps you discover, “what your life is really about.”

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PEOPLE

The Yoga of Yes At the Ashtanga Yoga School of Spokane, teacher Shelley Enlow leads students toward self-knowledge

BY ROBIN HAMILTON BRODT

I

t’s 6:30 am at the Ashtanga Yoga School of Spokane, and the members of the early morning yoga crew are quietly, purposefully working on their individual practices under the watchful eye of teacher Shelley Enlow.

Some are more advanced, doing forearm balances that turn into upside-down lotus postures; others are struggling to balance in tree pose.

Sixty-something women and men practice side-by-side with much younger, stronger and more flexible counterparts.

Everyone seems to get the same attention and encouragement, regardless of their abilities.

Nancy Enz Lill, a dark-haired, lithe 56-year-old who has practiced with Enlow for five years, is 30 minutes into her practice as she gets ready to do a deep

backbend.

She kneels, takes a breath and prepares to arch backward, bringing her head to the floor.

Enlow supports Lill as her head touches down and her hands find her feet. The two begin to breathe together. Lill changes her hand position, and with the top of her head still on the floor, takes another five breaths.

“Yes, Nancy, good job!” Enlow tells her.

In these classes, known as Mysore, or self-practice, Enlow offers the yoga equivalent of personal training. “Yes” is the word she uses most often.

E

nlow is tiny — barely 5 feet tall — but, at age 45, is so strong that she can assist men three times her size.

Her own practice is quite advanced — she is a senior apprentice to David

Garrigues, one of the few yoga teachers certified to teach the Ashtanga method by its late founder, Sri K. Pattabhi Jois. She recently assisted Garrigues at an advanced Ashtanga workshop in London. In turn, Garrigues has taught several workshops at AYS Spokane, as has another star in the Ashtanga yoga firmament, Tim Miller, both of whom have national and international followers. That was unusual, and a treat for Spokane’s yoga community.

As a wife and mother of two, Enlow divides her time between mom duties, managing the studio and teaching the majority of the classes along with her husband, Brett, an emergency room physician. The studio is dedicated solely to the practice of Ashtanga, which is rare in the age of “yoga plus” — yoga and spinning, yoga and Pilates, yoga and weight training, not to mention yoga and pot, beer and chocolate.

“The Ashtanga method is so complete,” Enlow says. “Yes, you can get a leaner, stronger and more flexible body by doing Ashtanga, but those are just by-products of the physical practice.

“Ashtanga yoga is an exploration of your entire being — body, mind, spirit. It’s a practice of going inward and learning to still the mind (or at least becoming aware of the way you think), so that you can begin to see your own truth, what your life is re-

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WHAT TO EXPECT

T

aking an ashtanga class may sound intimidating. Fear not, new yogi. Here’s how you can show up and unroll your mat with confidence.

Come in, set up your mat and begin doing the primary series. If you don’t know it, the teacher will help you. There are also plenty of videos of the sequence on YouTube, and tons of downloadable cheat sheets. The series always starts with the sun salutations.

The teacher leads the students through the entire primary series. New students are invited to watch the poses they’re unfamiliar with. A class usually takes 90 minutes, including a nice long rest at the end.

Everyone does the final, closing postures and gets the cherry on the top — savasana, or corpse pose. It’s a dire name for something you will love. By the time you get to it, you’ll be tired, calm and happy.

— ROBIN HAMILTON BRODT ally about, and how you have a connection to everything and everyone.”

The students, whose professional and personal lives are varied enough to include medical doctors, artists, homemakers, professors and college students, come to the practice with a variety of yoga experience.

Bridget Gies, a former U.S. Navy pilot, has been practicing with Enlow for three years. Gies describes Ashtanga as “a demanding physical practice that integrates breath and focus to reduce the mental clutter that often keeps us from being our best selves.” It’s a skill, she says, that transfers to all aspects of life, “even landing on an aircraft carrier.”

Clark Karoses, 42, is a certified nursing assistant at Kootenai Health in Coeur d’Alene. He says Enlow “consistently challenges my limits — in body, mind and spirit — and shows me a path that allows me to transcend them, if my will is steadfast.”

For those working with injuries, the practice can be a great teacher. Students learn to be patient and kind to themselves.

Longtime student Connie Ramsey has seen her share of physical challenges, including a torn ACL, rotator cuff surgery and back pain. Enlow has helped her not only continue to practice, but to thrive.

“I am a better practitioner — and person — because of Shelley’s influence,” Ramsey says. “And she has this great laugh!”

Karoses seconds that assessment.

“She shows me my heart,” he says, “and demands that I use it.” n

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JULY 28-29, 2017 Save the date

Join us for the fourth annual Showcase, a weekend of spectacular festivities, golf and entertainment all for the local fight against cancer. To date, Showcase festivities have raised over $5.7 million for cancer patients and the Inland Northwest organizations that serve them.

Our 2017 event promises to be the best yet.

To learn more about the Community Cancer Fund and our mission of fighting local cancer, visit communitycancerfund.org.

Benefitting:

communitycancerfund.org Local. Collaborative. Innovative. Dynamic.

DECEMBER, 2016 - JANUARY, 2017 CAL-DIR-PEEPS inhealth 11-28-2016_TM.indd 47

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SPECIALIZED CANCER TREATMENT

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Dr. Aaron Wagner Radiation Oncologist

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