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Health SPOKANE • EASTERN WASHINGTON • NORTH IDAHO 1227 W. Summit Parkway, Spokane, Wash. 99201 PHONE: 509-325-0634
EDITOR Anne McGregor
MANAGING EDITOR Jacob H. Fries ART DIRECTOR Chris Bovey CALENDAR EDITOR Chey Scott PHOTOGRAPHER Young Kwak CONTRIBUTORS Cat Carrel, Jennifer DeBarros, Jeff Drew, Heidi Groover, Clarke Humphrey, Jacob Jones, Meghan Kirk, Deanna Pan, Stephen Schlange, Carrie Scozzaro, Leah Sottile, Matt Thompson, Daniel Walters, Lisa Waanenen, John White, Sarah Wurtz Photos by Ariel Lewis of Designer With a Camera.
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InHealth is published every other month and is available free at more than 500 locations throughout the Inland Northwest. One copy free per reader. Subscriptions are available and cost $2.50 per issue. Call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x223. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2014. InHealth is locally owned and has been published every other month by Inland Publications, Inc. since 2004.
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FROM THE EDITOR
Your Therapy. Your Choice.
You’d never leave important health care decisions to chance. Take an active role in choosing a therapy option that is right for you. When you choose St. Luke’s Rehabilitation Institute you get teams specifically trained in rehabilitation and innovative therapies to help you conquer everyday tasks. Do your research, make an informed decision, and tell your doctor.
St. Luke’s is a division of Inland Northwest Health Services (INHS). INHS is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of the community.
Joint Commission accredited
Anne McGregor is the editor of InHealth. Email her at firstname.lastname@example.org.
always enjoy the pithy advice of our life coach, Cat Carrel. In this issue, she talks about finding your heart-based path — living life so that you don’t have major regrets about how you’ve spent your time (p. 12). That got me wondering: Is it just a little bit too easy to take good health for granted? I would imagine a moment of regret for many of us is when the doctor says we’ve reached an unhealthy weight, our blood pressure is too high or we’re nearing the threshold of developing diabetes. Dang! How did that happen? Although it’s never too late to change, and sometimes a diagnosis is just the kick in the pants we need to revamp our habits, most of us could benefit from a little preventive maintenance. Luckily, unlike the incomprehensible (to me) workings of our high-tech gadgets, our bodies just need the basics: restful sleep on a consistent basis; fruits and veggies and whole grains every day; the opportunity to move about for a while; and some supportive and nurturing relationships. The list of benefits appears nearly endless — from reduced risk for a slew of cancers to avoiding the nefarious effects of cardiovascular disease, diabetes and dementia. And the best news is that every day offers us a chance to take a step in the right direction. To your health!
These accreditations assure patients the highest quality care and results possible.
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HANDS TO HEAL. HEARTS TO SERVE. NURSING: ONLINE Enrolling Now
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the new health care law
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CHECK-IN STAY CONNECTED You can reach Editor Anne McGregor via email at email@example.com. The conversation continues on the InHealth Facebook page, and stay in touch with us at Inlander.com/InHealth.
ON OUR FACEBOOK
Do you worry about heart disease? What are you doing about it? KRISTIN IVERS-DUPONT: Not eat animal products. KATE POGUE RAU: I stay stress free and I run to mitigate the fact that I love onion rings. ROBERT FAIRFAX: Ride my bike! MICHELLE CALDWELL: Olive oil for most cooking, not a whole lot of meat. MAXIE RAY MILLS: No fast food, and sing a lot. BERRY ELLISON: Yes, I think about it. But I don’t do much about it; heart disease and cancer seems to be what kills U.S. citizens.
The Sweetest Part ATTRIBUTES: Chocolate really does grow on trees. Cocoa trees produce pods that are harvested twice a year. It takes a full year’s production from one tree to yield about a pound of chocolate. Chocolate gets its health benefits from a type of antioxidant called flavanols that in plants help repair damage and provide protection from environmental toxins. SUPER POWERS: The list is growing. Research shows those who indulge in chocolate more than once a week enjoy a lower risk of heart disease and stroke than those who eat it less frequently. The action of chocolate’s antioxidants may help protect arteries from plaque
BILL GEELAN: Quit just over a year ago and feeling pretty confident that I am officially that nonsmoker that every smoker hates. CINDY COLE VANHOFF: Quit 25 years ago. Still have a craving every once in awhile. Kind of weird! JIM ALMY: Yes. I quit 11-11-09. Cravings happen, but are pretty rare now. LAURA CHEATHAM: Quit 6 months ago! Just beginning but going to stay smoke free!
WEAKNESSES: Chocolate can be loaded with calories, and depending on the type, unhealthy fat. HOW TO USE IT: Choose chocolate in its most unprocessed form. Dark chocolate generally has the most flavanols, or you may choose cocoa powder that is not Dutch-processed. To harness the power of flavanols, experts suggest enjoying approximately one-ounce portions of dark chocolate several times a week. — ANNE McGREGOR
Status Report on Statins
RICK BOAL: Besides major diet changes, I had a series of chelation treatments.
Smoking contributes to heart disease. Have you quit smoking yet?
formation, lower blood pressure and improve blood flow to the brain and heart. Chocolate has also been shown to reduce levels of stress hormones.
John R. White is a pharmacy professor at WSU-Spokane.
levated cholesterol is associated with the number one cause of death in both males and females — cardiovascular disease. About 30 percent of our cholesterol comes from our diet, but about 70 percent is produced internally. Statins reduce cholesterol by blocking the body’s production of cholesterol. Those most likely to benefit from statins are people with preexisting heart disease. Others groups may benefit as well, such as people with diabetes or other risk factors for cardiovascular disease. Your provider should evaluate your overall risk for cardiovascular disease using an accepted method, such as the one promoted by the National Cholesterol Education Program, and determine whether the benefit of a statin outweighs the risk. Statins can be lifesaving, but they are not without potential risks. Statins can cause muscle aches, and on rare occasion may cause a potentially fatal form of muscle wasting called rhabdomyolysis. Statins are also associated with a very low risk of liver injury. Some studies have suggested that statins may be associated with a reduction in brain function (for example, memory), but other studies suggest they may actually be helpful in this regard. Lastly, there is a small risk of developing diabetes if you take statins. For example, one study reported that if 255 patients were treated with statins for four years, there would be one extra case of diabetes. Bottom line? Statins are not completely safe, but in many cases may help you to avoid cardiovascular disease, the number one killer in our country. — JOHN R. WHITE
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CHECK-IN ASK DR. MATT
I Matt Thompson is a pediatrician at Spokane’s Kids Clinic.
n 2009, we got our first taste of the H1N1 influenza virus, and it is back with vigor this year, with cases reported all over the country and in Spokane. But we were lucky to hit a home run with this year’s vaccine. Annually, a group of experts from around the world make a recommendation for the Northern Hemisphere flu vaccine. They recommend that the vaccine contain two type A strains, an H1N1 and an H3N2 strain, as well as a type B strain (two type B strains in a new quadrivalent vaccine). Amazingly, they are right half the time, and this year was a perfect match. Remember that there are always H1N1 and H3N2
strains circulating (not just the 2009 type). Those designations describe various features of the virus’ machinery — not unlike identifying a truck versus a passenger car, but also what brand, what color, what fuel, etc. I’m often asked for guidelines on when kids can return to school. In general, kids with viral illnesses, whether influenza or others, should not return to school until they are without fever above 100 degrees for at least 24 hours, while not getting any fever-reducing medicines. Children with GI symptoms (not typically seen with influenza, but with other viruses) should not return to school until they are having two or fewer episodes of diarrhea a day. Kids being treated for strep throat should not return to school until they have been on antibiotics for at least 24 hours. The best way to prevent catching and spreading these bugs? Good hand hygiene. So wash up! — DR. MATT THOMPSON
Homecoming for Camp Goodtimes
ack in March of 2013, the American Cancer Society announced it would focus mainly on its key mission of funding cancer research instead of camps across the nation, but locally, kids affected by cancer will continue to have the week of medically supervised fun known as Camp Goodtimes. After eight years at Ross Point Baptist Camp in Post Falls, the camp will return to its original home at Camp Reed. “We welcome the return of Camp Goodtimes to Camp Reed and are committed to a smooth transition for the families. Our number one priority is making sure these children have the best week of their summer,” says YMCA Camp Reed Executive Director Lisa Vogt. The American Cancer Society established an application process whereby campsites could still apply for endorsement, and approached Camp Reed to suggest it go through the process for the continuation of Camp Goodtimes. Thanks to support from community organizations like Coaches vs. Cancer, Ronald McDonald House Charities, Cancer Care Northwest and Providence Health Care, Camp Reed’s bid for endorsement and funding was a successful one. “Because Camp Reed is an established camp, we are able to serve more children than they’ve been able to in the past, and so the donor dollar will go farther because we already have so much of the framework in place for providing a camp,” Vogt says. “We’ll be able to serve almost twice as many kids with the same dollar amount as in previous years.” The camp will run from Aug. 3-9 and registration is now open. — CLARKE HUMPHREY
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THEIR OWN WORDS
Roberta Wilburn Roberta Wilburn is the Associate Dean of Graduate Studies in Education at Whitworth University. She holds doctorates in education and theology. Now she’s guiding the creation of the University’s Marriage and Family Therapy Wellness Center, where clinicians-in-training will provide services for $25 per hour.
I was researching family and marriage counseling... Therapy. What’s the difference? Therapy deals with the systemic approach. Counseling is on an individual basis. We’re talking about looking at families and even individuals from a systemic point of view. Sort of a holistic model? Exactly. Even if you’re dealing with an individual, that individual is impacted by their family, by their environment, by a lot of things. We used to have a clinical mental health counseling program. We’ve switched to the marriage and family therapy, because it is aligned with Whitworth’s mission and vision… At Whitworth we believe in a mind-and-heart education. Aristotle said educating the mind without educating the heart is not education at all. So the heart is just really critical. Do you mean compassion or your actual heart? Your actual heart, absolutely. Even as we do research and we look at the relationship between the heart and the mind, the heart really is regulatory. It impacts a lot of things. Recent studies have shown that the heart communicates with the brain, therefore influencing information processing, perceptions, emotions, and health… All the research is showing that the heart communicates with the brain in ways that significantly affect how we perceive and react to the world. How would that be manifested? Well, just think. If you’re having problems with your heart, it affects how you feel, how you feel determines how you respond, and if you’re interacting with someone, then it impacts how you may react positively or negatively. So we have to take care of the mind and the heart. Our new Marriage and Family Therapy and Wellness Center — it’s about healing broken hearts and minds. Helping individuals and families find positive pathways. Because we want them to have a healthy life. — INTERVIEW BY ANNE McGREGOR
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efore we know it, spring will be here, and with it many anticipated Inland Northwest events, one of the first being the 38th Lilac Bloomsday Run, on Sunday, May 4. After registering for the race online (bloomsdayrun.org), head to Providence Health & Services site to register for its annual free BLOOMSDAY TRAINING CLINICS, hosted by Providence and Group Health. These clinics are a great way to stay committed to a program if you’re not a regular runner/jogger, which not all of us are. With meetings once a week on Saturday mornings, starting seven weeks before the race, the time invested offers a great return — you’ll be much less likely to wheeze up Doomsday or ache beyond belief the following Monday. Offering a gradual conditioning program, the first week’s route is one quick mile. Routes then increase by a mile each week, ending with a full 7-mile route the week before Bloomsday. Don’t let that intimidate you. Each clinic opens with a short presentation by a health or fitness expert, and medical assistance is available during the sessions just in case. It’s like a mini-Bloomsday every week — volunteers even man water stations to keep you hydrated. — CHEY SCOTT Bloomsday Training Clinics • Saturdays at 8:30 am from March 15-April 26 • Free, online registration required • Spokane Falls Community College, 3410 W. Fort George Wright Dr. • phc.org
Leading with the Heart
A Cat Carrel is a certified life coach in Spokane.
s the years go by, there may be something in the backs of our minds that we regret not doing; a path not taken. It might be something as simple as having a garden or as complex as an entirely different career. Whatever we find ourselves coming back to again and again, this message is our heart-based path. Often,
something blocks the way of that path. Whether it is family or friends telling us what we should do, a little voice in our heads that tells us we are not smart enough or good enough or whether it’s a fear of the unknown, these blocks cannot overpower the messages from our hearts. Our hearts guide us on our paths because we are meant to pursue these things that are meaningful to us. If we listen, our heart-based path will guide us to a most beautiful place: a place of authenticity, happiness, and fulfillment. And that is a place we will never regret living. — CAT CARREL
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9 8 6
7 1 7 6
RATINGS: Gentle (left), Tough (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.
1 8 1
Answers to all puzzles on page 39
9 8 9
6 2 1
PUZZLES BY JEFF WIDDERICH & ANDREW STUART www.syndicatedpuzzles.com
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 two-letter clue, turn to page 23. 4 19
7 9 9 6 3 5 8 4 2 7 6 5 7 6 2 3 4 1 7 8 7 2 9 6 1 8 2
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
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.
4 3 2 1
7 8 6 8 2 3
6 9 8
© 2014 Syndicated Puzzles, Inc.
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A Snapshot of Health The latest “Spokane Counts” report from the health district shows where local health is improving and where it’s lagging behind BY HEIDI GROOVER AND LISA WAANANEN
eet the average Spokanite: He’s partway through his 79 years, in good health and satisfied with his life. (Or so he tells the state Department of Health when asked.) But what are the chances he was bullied or suffered from depression as a child? Is he overweight? Insured? Did he get the flu shot? Data can help answer those questions, propelling certain issues to the forefront of public health policy and eventually improving the health of an entire region. A new report from the Spokane Regional Health District provides the latest snapshot of health in the county. The latest biannual “Spokane Counts” report details 61 “indicators” ranging from the rates at which we binge-drink and exercise to how many children are immunized or abused. The data comes from a variety of local, state and national records, like the Centers for
Disease Control and the U.S. and Washington state Departments of Health. A team from the Spokane Regional Health District analyzed disparities among races, genders, income groups and other demographics within each indicator and compared local data for each one to previous years’ measurements, state and national data and goals for 2020. A final score — the sum of each measurement and comparison — was assigned to each indicator. Those scores reveal stark successes and needs, which can, in turn, help guide public health policy and education programs in the community. “It wasn’t the intent of this report to identify what’s going on behind each indicator,” says Spokane Regional Health District epidemiologist Adrian Dominguez, who authored the report. “It’s just to identify what are the problem areas. ... It’s for
the entire county to look at, for us to work with one another to put our efforts together and address these problems.” This year’s results are stark: many indicators are improving steadily in our region, like physical activity and drug use among youth, smoking among adults and youth, and food security for children. Others, like youth depression and bullying, are worsening. “What we’ve seen is an increase in stuff that deals with mental health and things associated with youth as well,” Dominguez says. “Those are things that maybe [have] existed but we haven’t really focused in on them, because we didn’t have the information to support that.” Find the full report, including more detailed data about each indicator, at srhd. org/spokane-counts. ...continued on next page FEBRUARY-MARCH, 2014
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NEWS SNAPSHOT OF HEALTH
WHAT’S GETTING WORSE? Twenty indicators made the report’s “not meeting expectations” list, and some of them are especially startling because they haven’t progressed over previous years. Preschool immunizations, credited in public health with controlling diseases like measles and whooping cough, are down 17 percent since 2008. Among mental health and violence issues, bullying and youth depression are both up, with significant disparities between race and education groups.
Percentage of youth who said they had symptoms of depression
Percentage of young children with complete immunization records
Percentage of youth who said they were bullied in the past 30 days
s technology has emerged that enables bullies to torment their victims in new ways, the issue has come to the forefront nationwide, and Spokane is no exception. The percent of youth in grades 6, 8, 10 and 12 who say they’ve been bullied in the past month has been on the rise in Spokane County since 2008. Elaine Conley, community and family services director at the health district, says those numbers — and others, like higher rates of youth depression — may be indicative of family and community pressures bullies are facing outside the classroom. Poverty and low education levels in Spokane County can contribute to family stress, and as the economy has lagged in recent years and families have suffered even more financial strain, children are being exposed to more even more tension. “There are a lot of poor families in this community, and I don’t think the general public, for the most part, understands the stress these families are under,” Conley says. “Some of these parents are working two and three jobs just to keep a roof over their family’s head and to get them basic food. Stress is coming out in various ways. Smoking is one, drinking may be another, and certainly violence is part of that mix.”
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WHERE WE’RE LAGGING
Along with asking whether Spokane’s numbers are improving or worsening, measuring whether we’re keeping up with national and state progress can provide context. Even in some areas where we’re improving, like smoking among pregnant women, the region remains far behind.
Spokane County (2011):
Percentage of births in which the mother smoked during pregnancy
Spokane County (2011): 15.9% Washington state (2011): 8.9% United States (2010): 9.2%
mong Spokane’s biggest challenges highlighted in this set of data is smoking among pregnant women. It’s a practice that not only presents well-known dangers to the smoker, but can result in low birth weight or preterm birth, according to the health district. In Spokane in 2011,
Number of victims reported by Child Protective Services, per 1,000 children
48.1 Washington state (2011): 33.7 the rate of births to women who smoked during pregnancy was nearly twice the statewide rate. Again, says the health district’s Conley, Spokane’s lower rates of education and income are at play. Younger women with less education and lower incomes, often facing more stress just to survive than their richer or better educated peers, are more likely to smoke during pregnancy than women who are older than 25 or have some college education. In an effort to address the problem, the health district offers a program partnering nurses with low-income families and first-time pregnant women to educate them on healthy practices and help them set goals. Conley says empowering them to prepare for their new family can “create a sense of hope within these young women, who may have never been able to see a future for themselves, much less their unborn child.”
United States (2010): 44.5
Percentage of young children with complete immunization records
Spokane County (2012): 40% Washington state (2011): 68.1% United States (2011): 68.5% ...continued on next page
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NEWS SNAPSHOT OF HEALTH
WHAT’S GETTING BETTER? Many of the indicators show progress, but even among those are challenges. Binge drinking by youth (grades 6-12) fell 7 percent between 2006 and 2012, but still exceeds the state rate and includes major disparities depending on gender, race and how well educated the child’s mother is. Similarly, nearly 14 percent more young people are physically active than in 2006, but racial disparities show there’s still work to be done. Among adults, smoking rates are decreasing and flu shot rates are increasing over the long term, but from 2010 to 2011 both took a step back, showing the opposite results (increased smoking, decreased flu shot rates).
Youth Binge Drinking
Percentage of youth who had 5 or more drinks in a row sometime in the past two weeks
Youth Physical Activity
Percentage of youth who are active for at least an hour five days a week
Adult Flu Shot
Percentage of adults who received a flu shot in the past year
Percentage of adults who smoked every day or some days in the past month
Youth Food Insecurity
Percentage of youth who had to skip or reduce a meal in the past year for lack of money to buy food
common thread in public health is the focus on children. Even through high school they’re still developing, which means they’re ripe for starting good health habits — or bad ones. Helping youth develop healthy habits can have positive effects into adulthood, not just on their health but on their cost to the health system as a whole. Children who are food-insecure — those “who had to skip or cut the size of a meal in the last year because there wasn’t enough money for food” — not only risk poor health, but the establishment of poor eating habits, like low fruit and vegetable intake. This year’s Spokane Counts report shows a continuing decrease in food insecurity among youth (grades 8-12), though disparities exist: The
percent of black children who had experienced food insecurity was twice that of white respondents, and the rate among children whose mothers had not graduated high school was more than three times that of children whose mothers were college graduates. In her role as a “healthy communities specialist” at the health district, Natalie Tauzin focuses on preventing chronic disease in various ways, including by improving eating habits. She credits multiple efforts for increasing children’s access to food: local food banks, backpack programs, which send food home with children over the weekend, and school breakfast programs, which are encouraging more students to make breakfast a daily habit. Looking to the future, Tauzin is hopeful a new food policy council made up of local leaders can create “policy priorities” that address food security for the entire county. “As a community, many, many nonprofits are addressing food insecurity in lots of different ways,” she says. “Smaller programs continue to try to chip away at this, but ideally it will be something that comes on multiple levels.” n
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NEWS WOMEN’S HEALTH
Expanded Options Millions of women now have access to birth control with no out-of-pocket costs; here’s what you need to know BY DEANNA PAN
he average American woman spends about five years pregnant, postpartum or attempting to conceive, according to the Guttmacher Institute. But she spends significantly more time — three decades — trying to avoid having a child. In the United States, more than half of all pregnancies are unintended, and unintended pregnancies are often associated with negative health outcomes like poor prenatal care and premature birth. Better family planning, on the other hand, is linked to improved health for babies and their mothers. Now, under the Affordable Care Act, more than 27 million American women can access birth control without being charged a copayment or having the costs applied to their deductible. And it’s not just “the pill” that insurance companies are required to cover. The rule ensures that women have access to the whole gamut of FDA-approved contraceptive methods — including hormonal injections, vaginal rings, contraceptive implants, diaphragms, cervical caps, the morning-after pill and permanent sterilization procedures, like tubal ligation — without cost-sharing. “Every woman is different and every woman responds differently to various forms of birth control,” says Leila Abolfazli, legal counsel with the Washington, D.C.-based National Women’s Law Center. “What this rule really recognizes is for women to get the right health care they need, they need the coverage of the full range of methods.” By mandating coverage with no outof-pocket costs, the rule removes hefty
Dr. Jason Reuter displays various contraceptives available at Spokane OBGYN. STEPHEN SCHLANGE PHOTO financial barriers that keep women from consistently using contraceptives or choosing the method that makes the most sense for them, Abolfazli says. An IUD, for example, can set a woman back by as much as $1,000 up-front. But over time, using long-term contraceptives, like IUDs, can actually save women money. “In the long term, when you think about what [monthly] birth control can cost over three to five years, the math oftentimes works in favor of these long-term
methods,” says Karl Eastlund, CEO of Planned Parenthood of Greater Washington and North Idaho. Eastlund says providers have seen a rise in popularity of IUDs and contraceptive implants over the past two years. These long-term contraceptives are highly effective, says Dr. Jason Reuter of Spokane Obstetrics and Gynecology. According to one study, the IUD, or intrauterine device, is 20 times more effective than the birth control pill, ring or patch.
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“The patch is only once every week; the vaginal ring is once every three weeks; there’s an injection that’s once every three months,” Reuter says. “Having options just allows people to individualize what works best for them.” The rule, unfortunately, only applies to women’s contraceptives, so vasectomies aren’t covered. Neither are condoms, for that matter. Drugs that induce abortions also aren’t covered. Almost all employers are required to provide birth control coverage in their company insurance plans. Only houses of worship, such as churches, are exempt. The federal government has also issued an “accommodation” for religious nonprofits, like charities and hospitals, that object to the birth control mandate. At these organizations, employers can avoid paying for contraceptive coverage by authorizing the insurance company to provide those benefits directly to employees. So-called “grandfathered” health insurance plans that existed before March 2010 are also exempt from providing coverage for preventative health care, which includes birth control, but according to the National Women’s Law Center, 90 percent of these
health plans will lose their grandfathered status by 2014. Despite the government’s compromise for religious employers, controversy surrounding the mandate threatens to take this health care benefit away. More than 100 lawsuits have been filed in federal courts challenging the contraceptive mandate under the Affordable Care Act. In March, the U.S. Supreme Court will hear lawsuits from two for-profit companies suing the federal government under the Religious Freedom Restoration Act and the First Amendment. If the court rules in favor of the companies, Hobby Lobby and Conestoga Wood, “the ramifications could be far and wide,” Abolfazli says. Citing religious objections, businesses, for instance, could refuse to provide coverage for immunizations or prescription drugs they object to. They could deny insurance to LGBT people, AIDS patients or single mothers. “This could really open up a huge hole in protections for a variety of health and services and beyond,” she says. “It would give employers license to discriminate against employees in a variety of ways — both in the health coverage they provide their employees and beyond.” n
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Physician’s Assistant Rita Warner offers care for minor conditions at the Walk-In Clinic in Spokane Valley. MEGHAN KIRK PHOTOS
A New Approach As more gain access to health care, mid-level practitioners step in to meet that demand BY CHEY SCOTT
ow that millions of Americans have health insurance through the Affordable Care Act, some providers remain wary about how it could affect the nation’s health care system — mostly how already strained providers will be able to provide quality care for the burgeoning number of newly insured patients. Those are the main concerns held by Janice Jordan and her husband Kevin Bichler, both certified physicians’ assistants who in December opened a new primary care clinic, Optimal Healthcare, in Spokane Valley. As more and more formerly uninsured patients gain access to medical care, the couple worry that already busy clinics across the Inland Northwest and beyond will become even harder to get into. At the same time, though, they follow the widely held prediction that more physicians’ assistants and nurse practitioners — often referred to as mid-level practitioners — will begin opening private practices similar to theirs. While nurse practitioners can own
and operate an autonomous practice, state regulations for physician assistant-owned clinics like Optimal require that a consulting physician be included on the facility’s license. “There’s a growing following [of patients] to mid-levels, and we hear people comment and say they like having a PA or nurse practitioner; they treat patients more like people than a number,” says Jordan, who’s also a registered nurse. “That is actually one of the many reasons why we took on this huge endeavor. We were so sick and tired of what we call the ‘cattle-prod’ medicine… it doesn’t matter what you’re being seen for; you only get 15 minutes, and too bad if you have more [concerns] than that,” she adds. Both Bichler and Jordan have held positions at high-volume clinics where they say the standard was for providers to see 20 to 25 patients a day. Bichler says that often meant working on patients’ medical charts at home after work each day for several hours, to avoid rushing to document a visit
in between appointments. With their new practice, the pair hope to spend as much time with patients as needed. So far they’ve been able to, while the clinic is still establishing a primary patient base. Even when the pace picks up, though, both will continue to make themselves available in as many ways possible for patients who might have a concern, through email and phone contact.
stablishing a regular patient portfolio also has been the focus of another local clinic with a similar care philosophy. Open just over a year ago, the appropriately named Walk-In Clinic is located in an unexpected setting: a leased space inside a Rosauers supermarket on East Sprague in Spokane Valley. Billing itself as a minor care clinic, Walk-In Clinic also offers primary care and is staffed full-time by certified physicians’ assistant Rita Warner. The clinic’s overseeing physician, John Torquato, owns a family practice in Hayden and occasionally sees
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Interior Design... Your Way patients at the Spokane Valley office. Warner stresses that Walk-In isn’t an urgent care facility, although it accepts patients for many minor ailments people often seek treatment for at urgent care clinics: common colds, sinus infections, urinary tract infections, minor muscle injuries and strains and other minor infections. Walk-In offers a flat-fee pricing menu for most visits, based on what the patient is being seen for and if he or she has any underlying conditions that may be related to or affect the visit. “The whole idea is to make inexpensive medical care inexpensive,” Warner says. “A very simple problem on a very healthy individual is less work, so we can do it at [a lower] price,” she adds. Because of its pricing model, combined with the fact that many patients are newly insured, Warner says many people are choosing to return to the clinic as their primary care provider. “Constantly, that is how we’re building the primary care side; seeing people the first time for a minor issue. We’re getting busier all the time,” Warner says. “People are having trouble finding a [primary care provider] that’s not a full practice.”
hough it’s only been open for a few months, Optimal’s owners have already heard from past colleagues asking if they’re hiring or expanding. The couple believe more mid-level providers will branch out like they’ve done, opening private family practices out of frustration with the bureaucracy of institutional medicine. “We’d like to see less patients and give more quality care,” Bichler says. “That also increases our own satisfaction,” chimes in Jordan. If anything indicates the couple’s commitment to providing the level of personalized care they so firmly believe in, it’s the time and financial investment into Optimal’s physical space. With help from friends and the clinic’s medical assistant Colleen Clure, the couple completely remodeled a 1970s-era former dental office off Pines Road that sat vacant for more than a decade before they bought it. Bichler is eager to share the “before” photos, a stark contrast to how it looks now, from the puzzle on page 13 with all-new carpet, 2 = N; 17 = A fixtures, windows, doors, lights — even walls — and paint, of which the scent still lingers. n
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Health 23 1/22/14 3:59 PM
Building a Team Coordinated care is the goal of a new providers’ alliance BY ANNE McGREGOR
he fight against cancer can engage an army of health care providers — from front-line family physicians to the most cutting-edge surgical specialists. Navigating the battlefield, though, can be frustrating and expensive for patients and their families. “How can we knit together a delivery system for cancer patients in the Inland Northwest that better meets their needs?” says Scott O’Brien, Providence Health Care’s Chief Strategy Officer. Taking a cue from the Seattle Cancer Alliance, which includes the Fred Hutchinson Cancer Research Center and other entities, Providence Health Care, Kootenai Health and Cancer Care Northwest have formed an
alliance in which they’ve agreed to collaborate on providing better cancer treatment in the region. For patients, the alliance ultimately should offer a more streamlined experience. Members of the care team of will work out the logistics of planning and scheduling treatment and make sure that the patient’s medical record information is passed along to the correct parties. “Our hope would be that once we know where your next step is, the person in the office will say, ‘Here’s where you’re gonna go, I know so and so, and this is what you can expect,’” says O’Brien. Better management of records should help reduce costs from unneeded or duplicated procedures and testing. Even
better, patients often may be able to access multiple services at one location. One thing the alliance won’t include is a unique brick-and-mortar location. “Putting the services out into the community where people can access them has been an important part of our planning,” says Warren Benincosa, chief executive officer of Cancer Care Northwest. He notes that CCNW sites will double from four to eight with the alliance. On a broader level, the alliance may make it possible for new services to be offered in the region. “We’re hoping that by coming together, we have enough critical mass to provide some of that care locally, so those patients don’t have to leave [for treatment],” O’Brien says. Radiation therapy will be the first service to fall under the alliance, scheduled to be up and running this spring, with more to follow. “This is a huge undertaking by all parties to bring this all together,” says Benincosa. “However, we know that we are doing it for the right reasons, and that is to bring the highest level of quality cancer care in radiation to the people living in the region.”
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LIVING HEALTHY HEARTS
Get To Know Your Heart From diet and exercise to pills and procedures, how do you keep it pumping? BY JACOB JONES
omplicated networks of arteries wind and branch throughout our bodies, constantly cycling oxygen-rich blood to our hearts, limbs and vital organs. As we age, these blood vessels accumulate plaque, restricting blood flow and increasing the risk of heart attack. Heart disease, the blanket term for such problems, kills more Americans each year than any other affliction â€” more than all cancers combined, all strokes, all accidents. In 2010, nearly 600,000 people died from heart disease across the United States, according to data from the Centers for Disease Control. But despite its broad prevalence and relative preventability, heart disease continues to be
widely misunderstood. Cardiologists sometimes describe heart disease as a plumbing problem, likening blocked arteries to plugged-up pipes in need of a Roto-Rooter. But recent studies indicate that comparison tells only part of the story, and may compel patients to seek unnecessarily invasive treatments. Dr. Michael Ring, an interventional cardiologist with Providence Spokane Heart Institute, says an oversimplified understanding of heart disease can sometimes cause a bias in patients toward excessive medical procedures. If they see heart disease as primarily a physical problem, they may assume it is best fixed with a physical procedure to clear the arteries. ...continued on next page
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LIVING HEALTHY HEARTS
Patients of Dr. Michael Ring, a cardiologist with the Providence Spokane Heart Institute, may undergo diagnostic imaging to locate blockages in their hearts. JACOB JONES PHOTO
“GET TO KNOW YOUR HEART,” CONTINUED... “There’s the perception that if you have anything wrong with your arteries you need to get it cleaned out or fixed,” he says. “[Many patients] tend, if anything, to be inappropriately overly aggressive with taking care of their blockages.” Percutaneous Coronary Interventions, known as PCIs, have become the most common procedure for physically clearing arteries, pushing them open with a tiny balloon or propping them open with a metal mesh tube called a stent. More than a half-million
patients undergo stent-placement procedures each year, thousands in the Inland Northwest. Medical experts agree PCIs and stents can be lifesaving for patients with severe blockages, but some researchers, like Dr. Michael Rothberg of the Cleveland Clinic, suggest as many as half of such procedures may be unnecessary. In a recent study, he argues the plumbing analogy perpetuates a popular myth of the stent as a quick cure-all. “Although the image of coronary arteries
as kitchen pipes clogged with fat is simple, familiar, and evocative,” he writes, “it is also wrong.”
tents come in a variety of sizes and designs, but most consist of a tiny metal mesh tube that collapses like compressed chain-link fencing. Implanting a stent involves snaking a balloon-tipped catheter up into an artery, usually entering through the wrist or groin area. A stent is threaded up the catheter wire to the blockage
MIND YOUR DIET
ou heart what you eat. Registered dietitian and nutritionist Kerry Scott says a healthy diet serves as one of the best, surest ways to prevent heart disease. With so many fad diets and misconceptions, it can be easy to lose track of the essential basics of a well-balanced approach. Heart-healthy and responsible foods can take a little more thoughtfulness or preparation, but the extra time and effort pays off in the long run. “It’s not like there’s broccoli at the takeout window,” she says. “To eat well and to eat more whole foods takes more planning.” Eating whole foods, primarily fruits and vegetables, is one of the easiest steps. Everyone, even people in their 20s and 30s, should be aware of their cholesterol and lipid levels. Reduce saturated fats by cooking with olive oil or other plant-based oils instead of butter. Limit egg servings to less than one a day. Two specific diets come highly recommended: the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) plan. Both plans promote diets high in fresh produce and seafood as well as moderate alcohol intake of less than two drinks a day.
Scott recommends combining those ingredients with exercise or other activities. Even making your meals more social, such as having dinner with friends, can slow down your eating and help justify some of the investment in quality foods. — JACOB JONES
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and fits around the balloon. When the balloon inflates, it expands the mesh stent until it locks open, propping out the walls of the blood vessel. For patients suffering from severe ischemia, the suffocation of tissue due to low blood flow, stent and angioplasty procedures can provide dramatic benefits. Physically opening up the artery restores blood and oxygen immediately. Even Rothberg acknowledges stents and PCI procedures can be lifesaving in many critical cases. Ring says the majority of local stent recipients have shown dangerous signs of poor blood flow or symptoms of angina (chest pains or tightening). A national health care survey found the Inland Northwest region has a “low usage” rate of just 5.7 PCI procedures per 1,000 Medicare patients. But the area has a higher than normal rate of PCIs on patients who have been previously screened through vascular image testing known as angiography. “We’re not going hog-wild and doing a lot of procedures,” Ring explains. “We tend to be more selective. … I think that means good care.” Critics say stents become more questionable when a patient does not suffer from life-threatening blockages or persistent symptoms. Studies have shown the elective use of stents on artery blockages of less than about 70 percent results in no significant benefit over less invasive treatments like medication, combined with healthy lifestyle changes. While the use of stents has declined in recent years since those findings came to light, Rothberg argues the stubborn plumbing analogy creates a false impression that stents proactively prevent heart attack-causing blood clots or blockages. That assumption largely ignores the realities of inflammation and data on heart attack risks. Ring agrees with some of those concerns. Studies suggest stents provide minimal benefit in preventing heart attacks because
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Myocardial infarction: Commonly known as a heart attack. Angiography: An imaging technique, like an X-ray, that shows blood flow through arteries to pinpoint blockages or other problems. The resulting image is called an angiogram. Stent: A tiny metal mesh tube that fits inside an artery and expands to hold open a section of a narrow or blocked artery. Angioplasty: Procedure to open or widen an artery by threading a balloon inside an artery, compressing plaque against the blood vessel walls. PCI: Stands for percutaneous coronary intervention, a catheter procedure such as angioplasty or placing a stent to treat blockages. — JACOB JONES work with their doctors to make informed decisions. “There are many, many factors that are involved,” he says, noting, “There is some disagreement even among equally qualified, well-meaning physicians.” n
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Acute Coronary Syndrome: A significant or sudden artery blockage that dangerously reduces blood flow and may result in a heart attack.
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Ischemia: The suffocation of tissue resulting when low blood flow cuts off the supply of oxygen to a muscle or organ.
*The 2013 Media Audit
Angina: Chest pain, tightening or discomfort, a common symptom of narrow or blocked arteries.
InHealth is read by more adult women than any other locally produced magazine.*
Atherosclerosis: The buildup of plaque along coronary arteries, leading to narrowing of blood vessels and blockages.
for Women in the Inland Northwest
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tudies from last year indicate stents may still be overused in treating heart disease nationally, but the public seems to be accepting a more nuanced understanding. Ring, who serves with the Clinical Outcomes Assessment Program for Washington state, says cardiologists have introduced new guidelines and safeguards to prevent unnecessary procedures. National organizations have also developed an Appropriate Use Criteria, setting out the optimal conditions for implanting stents. Data shows the number of stent procedures continues to drop each year, along with the number of more invasive bypass surgeries. In recent years, Ring says the statistics have started to turn against heart disease as procedures improve and physicians stress the importance of prevention. Annual heart-related deaths in Washington state have dropped below those from cancer, and national rates may soon follow. “It is one of the big success stories in medicine over the past three decades,” he says. “If you look at the drop in what’s called age-adjusted cardiovascular mortality, it’s dropped by about two-thirds.” Ring emphasizes that any diagnosis or treatment of heart disease should involve frank consultations with a cardiologist on options, outcomes and potential alternatives. Patients should read up on procedures and
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life-threatening blood clots often arise in sections of artery with little or no previous signs of blockage. You can’t place a stent if you can’t see a problem, Ring says, but patients still tend to assume a stent will ward off any future issues. “There’s that kind of inherent bias of the public, and it’s a misconception,” Ring says, “that being aggressive and preemptive will actually prevent a heart attack. … [But] most heart attacks occur in areas that were not predictable.”
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FEBRUARY-MARCH, 2014 LIVING LEAD inhealth 1-28-2014.indd 29
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LIVING HEALTHY HEARTS
A Women’s Issue
Dr. Enkhtuyaa “Ellie” Mueller, a cardiologist with Rockwood Clinic, uses “stress testing” to help diagnose cardiovascular disease. JACOB JONES PHOTO
Long considered a man’s problem, heart disease proves just as deadly for women BY JACOB JONES
hink of the words “heart attack.” You might picture a guy, late middle-aged, hair going gray. He probably has a bit of a gut. Maybe he’s chomping a bacon double-cheeseburger when he suddenly clutches his chest or grabs his left arm. He collapses to the floor. Heart attack victims and family members have a much more realistic perspective on the medical condition, but this popular stereotype still has an outsized effect on health care education, risk awareness, research and prevention efforts. Dr. Enkhtuyaa “Ellie” Mueller, a cardiologist with the Rockwood Heart and Vascular Center, says many people tend to overlook the risks of heart disease for women, despite the fact the American Heart Association reports heart disease now kills one in every three women. “There’s all sorts of myths,” Mueller says. “The general perception is that heart disease is for men. … It is really a silent killer in women.” More than 290,000 women died from
heart disease in the United States in 2010, according to the Centers for Disease Control. That’s more than seven times the number of women expected to die from breast cancer each year, but many physicians and health outreach campaigns fail to convey the risks and challenges facing women with heart disease. Mueller says doctors often emphasize the importance of mammograms, but they also need to start talking more about the heart. “Everybody thinks, ‘Breast cancer is the killer. Breast cancer is the killer,’” she says. “It doesn’t even come close.”
uch of the disparity between how men and women view heart disease may stem from how both sexes show symptoms. People expect heart disease to come with dramatic chest tightening, arm pains or heartbeat irregularities. For men that is often true, but women often present different, much more subtle symptoms.
Mueller clenches her left arm to her chest, mimicking the common heart attack warning sign, saying, “Women hardly ever get that symptom.” Many women might just feel nauseous, fatigued or short of breath. They could experience sweating or jaw pain, but the milder symptoms can be easily confused with a cold or flu. By the time more serious symptoms arise, heart problems could be much further along. Research shows 64 percent of women who died suddenly from heart disease did not show symptoms ahead of time. Mueller says women also have a harder time recovering. After a heart attack, the Heart Foundation reports 42 percent of women died during the next year, compared to just 24 percent of men. “Nobody talks about that,” she says. Approximately 435,000 women suffer heart attacks each year in the United States, according to the Heart Foundation. About 35,000 of those women were younger than 55.
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Dr. Michael Ring, a cardiologist with the Providence Spokane Heart Institute, agrees that women face significant discrepancies in preventative care and outcomes in regard to heart disease. With research often focused on heart disease in men, the risks and warning signs for women tend to be harder to recognize. “Their symptoms just seem to be less easy to diagnose” he says. “It may be confused with other things. … Clearly women, during their lifetimes, are just as likely to develop heart disease as men.”
n recent years, new resources have started to emerge for women. The American Heart Association now has a Go Red For Women campaign with outreach efforts each February. Heart disease rates for both men and women have declined, but approximately 8 million women still live with heart disease in the U.S. Mueller says the Rockwood Heart and Vascular Center can conduct comprehensive cardiac assessments. She has also started working with other cardiologists and hospital administrators in hopes of opening a dedicated Women’s Heart
TOP CAUSES OF WOMEN’S DEATHS Heart disease, the top cause of death for American women, kills seven times as many women as breast cancer. Here are the top causes of death in 2010, according to the Centers for Disease Control and Prevention:
Stroke and Aneurysm 77,110 Chronic Lung Diseases 72,660 Lung Cancer
SOURCE: National Vital Statistics Program, CDC. Stroke and aneurysm category includes other cerebrovascular causes of death; chronic lung diseases includes emphysema, chronic bronchitis and other chronic lower respiratory diseases.
Clinic at Valley Hospital. “We are working up proposals,” she says, expecting more details to be available in the coming months. The most important thing, Mueller says, is still personal awareness and reducing your individual risk factors. Women should track their cholesterol and lipid
levels. They should manage their diet and abstain from smoking or excessive alcohol. They should exercise. “Coronary artery disease is really, really preventable,” she says, adding, “It’s really simple. There’s nothing complicated and there’s no shortcut. You just exercise and you eat healthy.” n
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Wild Sage Executive Chef Charlie Connor with his Leek, Potato and Kale Chowder. YOUNG KWAK PHOTOS COOKING
Sage Advice Special-needs diets are a welcome challenge at Wild Sage American Bistro BY CARRIE SCOZZARO
harlie Connor wants you to enjoy your meal at Wild Sage American Bistro, but he also has a personal interest in giving you healthy options. An insulin-dependent diabetic who was diagnosed with celiac disease as a youngster, Connor knows all too well how food
impacts your daily life. “If any restaurant knows gluten-free, it’s us,” says Connor, noting that Wild Sage has spent the past seven years perfecting their gluten-free menu, including bread. He relishes “knowing that I am creating a memorable experience for someone on a
daily basis.” It’s a commitment to quality that has consistently earned Wild Sage top ratings on customer-driven websites such as Yelp and Urbanspoon. “I want people to enjoy our food with minimal processing. Let the quality of our ingredients and consistent
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execution speak for itself,” Connor says. As much as possible, those ingredients are local and regional foods: Washington’s Double R Ranch beef, sustainably raised steelhead from the Columbia River, and C&S Hydro-Huts greens; and Idaho’s Snake River Farms beef, Silver Creek Farms golden trout, and Deerfield Farms tomatoes. Wild Sage even grows some of their own vegetables and fruits. “I’ve designed a menu that allows me to be creative on a daily basis, and work within the limits of what is in season and available,” says Connor, who describes the menu as eclectic — featuring items as diverse as quinoablack lentil cakes, goat cheese-stuffed chicken breast, coconut curry pasta, bouillabaisse, a kale Caesar salad, Yukon gold potato taquitos, and even steaks and burgers. “There is a range of influences on our menu, with known flavors that go well together,” says the 33-year-old executive chef, who started working in the industry as a teenager. “Just enough cutting-edge not to scare you.” Since graduating from Spokane Community College’s Inland Northwest Culinary Academy in 2001, Connor has worked his way through a high-profile roster of local restaurants, including Beverly’s at the Coeur d’Alene Resort, Max at Mirabeau Park Hotel and P.F. Chang’s. Acknowledging that the food industry is not without sacrifice, Connor credits his parents for some of his success. “My father’s work ethic rubs off on me daily,” he says, while his mom’s “ability to worry and over-plan” has been a real plus. “Another excitement about cooking,” says Connor, “is that there is always more than one way to do it. I can learn something new on a daily basis from my crew, my bosses, my mentors, my mistakes.” Connor says that he also continues to learn from his guests, especially those like himself who have special dietary needs. What’s next for this energetic chef? When he’s not cooking, life’s about enjoying the beauty of the Inland Northwest — fishing, camping, barbecue, time with family and friends. But most days, he’s in the kitchen. “I just want to make a little impact in this world,” says Connor, “and leave an impression where I have put my heart and soul.”
Leek, Potato, and Kale Chowder Heart-healthy, easily converted to gluten-free/vegetarian, this soup is perfect for a chilly afternoon. 2 tablespoons butter or butter substitute 2 cups leeks, white part only, small dice ¾ cup celery, small dice 3 garlic cloves, sliced thin 1 teaspoon kosher salt 2 tablespoons gluten-free all-purpose flour 6 ounces sweet white wine Pinch nutmeg 2 cups Yukon or russet potatoes, small dice 2½ cups water 1 cup lacinato, or black kale, rinsed and chopped 1½ cup whole milk Salt and pepper, to taste Lemon juice or white wine vinegar, to taste 1. “Sweat” leeks, celery, and garlic with butter and salt on medium-low heat until softened. 2. Stir in flour and cook a few minutes. 3. Add wine and nutmeg and stir. 4. Bring to a low boil to cook out the alcohol. 5. Add diced potato and cold water; increase heat to medium high and bring to a simmer. 6. Cook until potatoes are tender (not mushy), approximately 15-20 minutes. 7. Add kale and milk and warm through, as to not overcook the kale. 8. Season to your taste with salt and pepper. 9. Finish with a dash of vinegar or lemon juice. Makes approximately 5 cups FEBRUARY-MARCH, 2014
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Ava, 5, and her sister Aubrey, 2, put their hot pink Peltor earmuffs to good use. YOUNG KWAK PHOTO
Protecting Little Ears
Preventing hearing loss doesn’t have to mean leaving the young ones at home BY LISA WAANANEN
osie attended her first Spokane Shock game a week after she was born. At 6 weeks old, she’d gone to multiple concerts. Now 21 months, she’s gone to see monster trucks, the Harlem Globetrotters, outdoor concerts at Northern Quest and countless other Shock games. Each time, her tiny ears are covered by a pink pair of earmuffs designed to protect her hearing from the booming sound systems. She’s the ninth baby in the family, so her mom and dad know how to balance parenting with living life. Her mother, Pamala Phelps, says the hearing protection isn’t so different from putting your child in a car seat. “Having a little one doesn’t mean staying home and missing events,” she says. “It means take precautions to protect their little ears.”
A growing number of babies and children have been sporting ear protection at loud events; the market for children’s earplugs and earmuffs has exploded in the past couple of years. Back in 1999 when Tom and Kathy Bergman opened Ear Plug Superstore, an Oklahoma-based purveyor of hearing protection products, there were no child-specific hearing protection products in the United States. Tom recalls that unless the sound actually hurt, as with firing a gun, no one was even thinking about it. “Demand today for child hearing protection is thousands of times greater than it was when we began in the business,” he says. It all started with Apple, the daughter of Gwyneth Paltrow and Chris Martin, who was photographed wearing a pair of pink hearing protection earmuffs at a Cold-
play concert in 2006. Ear Plug Superstore started selling the Peltor kids’ version in the U.S., and for about two years they were the only company selling them. The kids’ earmuffs became their most popular product by a factor of 10. Interest skyrocketed again in 2010 after 1-year-old Baylen, son of New Orleans Saints quarterback Drew Brees, sported a pair during the televised Super Bowl celebration. More recently, Jay-Z and Beyoncé’s baby, Blue Ivy, has been spotted with a blue pair of Baby Banz earmuffs while taking a helicopter ride with her dad. Parents now have dozens of brands, colors and styles to choose from. EveryCasa, a brand of Spokane-based etailz, inc., carries Em’s 4 Kids infant earmuffs in styles that range from camp to pink polka-dot. Pro Ears, maker of ReVO headphones for kids,
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reports that their most popular design is Skulls. Fashion statement aside, experts have welcomed the trend. The risk of loud noise in young ears is real — the American Academy of Audiology estimates that 12 percent of kids ages 6 to 9 have some noiseinduced hearing loss. And the damage can’t be reversed. A surprising number of family-friendly venues, from sports arenas to surroundsound movie theaters, are loud enough to pose a risk. Kami Fehlig, doctor of audiology at Spokane Ear, Nose & Throat, says parents shouldn’t bring babies unprotected to racetracks and air shows where noise levels can be extreme. “It bothers me to no end to see these little ones out there with no hearing protection,” she says. A lot of factors determine how much protection is enough, she says. Most products include a decibel rating that indicates what level of noise they protect against, but they won’t be as effective if they don’t fit properly. An extreme situation like an indoor shooting range requires double protection, with headphones layered over earplugs. Hearing loss can happen from one sudden sound, like a firecracker, or from gradual and repetitive exposure. Some people may like it loud, but an iPod at full volume or a stereo system with a thumping bass will cause damage over time. “A lot of these people don’t have hearing loss yet, but they will,” Fehlig says. Families with a tradition of loud recreation — shooting competitions, boating, truck pulls — have been ahead of the curve, often after witnessing older relatives deal with the effects of hearing loss. Jennifer Bocook grew up around motorsports, wearing ear protection, and her daughters, 5-yearold Ava and 2-year-old Aubrey, know that getting ready for an event means putting on their hot pink Peltor earmuffs. “I had them start wearing them from a very early age,” she says. “They don’t know any different.” Of course, some kids just won’t keep them on, no matter what. But other children end up wearing theirs a lot — their earmuffs empower them to control their own sound environment, even when the volume isn’t loud enough to endanger their hearing. Benjamin Drake’s two young children have worn ear protection at Dave Matthews concerts and even got to attend the Seahawks game in December when fans set the official Guinness World Record for loudest crowd (137.6 decibels). But his 3-year-old daughter, Frankie, likes to wear
ARE YOU LISTENING?
t used to be that parents could at least tell if their kids had the volume up too high. With the profusion of iPods, earbuds and headphones, it’s harder than ever to know whether adolescents may be permanently damaging their hearing. But experts who’ve traditionally studied job-related hearing loss have recognized the problem and turned attention toward educating younger audiences. Here are ways parents can help: Talk to them. A 2013 study by Dr. Deepa L. Sekhar, a pediatrician at Penn State College of Medicine, found that 70 percent of the parents surveyed had never talked to their teens about noise exposure. The study concluded that most parents were open to taking steps to prevent hearing loss, but underestimated the threat and assumed their child was not at risk. Use volume-limiting settings. Many devices, like iPods and phones, have settings that allow parents to set a maximum volume (and then lock down that setting). But keep in mind that different types of headphones can also affect how much sound reaches the eardrums. If you can hear it, it’s too loud. Earbuds and headphones vary widely in quality, but it a rule of thumb is that if any sound can be heard by someone nearby, it’s time to turn the volume down. Avoid competing sounds. Volumes get loudest when sounds are competing with each other. Don’t let kids drown out one loud sound with another loud sound — for example, no cranking up the music while mowing the lawn. Make hearing protection easy. Most kids aren’t going to track down earplugs before they head out to the next concert or sporting event. But offer a pair on the way out the door, just in case, and they may very well decide to use them. For your teen musicians or frequent concertgoers, an inconspicuous pair of custom-fitted earplugs — the type professional musicians use — could be a worthwhile gift. — LISA WAANENEN
hers at other times, he says, like when they can hear fireworks from their home in Coeur d’Alene. “She always asks if she can wear them 5.0 h during the fireworks,” he says. Tom Bergman of Ear Plug Superstore says they’ve seen increasing interest from educators who’ve found that earmuffs often help children with ADD, ADHD and autism-spectrum disorders concentrate and remain calm in the classroom. They got an order from one school superintendent who wanted to order enough pairs of earmuffs that every student could opt to wear them during test-taking sessions. “Children who find the world too noisy for comfort often fall in love with their earmuffs, choosing to wear them a lot,” he says. n
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Jack Bunton works on his recovery at home after knee replacement surgery in December. STEPHEN SCHLANGE PHOTO
Take some time to prepare for post-surgery recovery BY DANIEL WALTERS
or 71-year-old Jack Bunton, osteoarthritis in his knee had become so bad that bone was rubbing against bone. “It’s very, very painful when you walk,” Bunton says. “My left leg was an inch and a half shorter than the right.” Fortunately for the retired auto mechanic, there was a solution: A full knee replacement. In the same way he used to rebuild engines, he could have a new knee. Long before he went into surgery, he knew that a successful operation didn’t begin with the anesthesia. And he knew it didn’t end when he woke up, or even when the hospital sent him back home. “You’re trying to get over that insult to your body from your surgery,” says Debbie Rappuchi, director of Providence Visiting Nursing Association Home Health Care
Services, about orthopedic surgery. “But you’re also trying to get over the insult of the surgery and anesthesia.” Whether it’s a knee surgery, a hip replacement or a back operation, your body needs to repair the wear and tear on the area around the incision. It needs to flush out the anesthetic. You may be on a regimen of painkillers. For some surgeries, that could mean waiting four to six weeks before you’re well enough to drive. In other words, big lifestyle changes may be in store. “It’s really fortunate when people have an opportunity to prepare,” Rappuchi says.
PREPARING YOUR MIND AND BODY
“The stronger you go into surgery, the stronger you come out of surgery,” says Jan
Collins, a St. Luke’s physical therapist with 23 years of experience. Your primary care physician and a physical therapist can help you get a head start long before the operating room. “I had a therapist working with me,” Bunton says. “They gave me some exercises before I even had the surgery, to build up the muscle around the knee. Because you’re up and walking as soon as they’re done with you.” Each type of surgery carries unique challenges. Local hospitals offer highly recommended classes on surgeries. Michelle Egan, orthopedic care coordinator, teaches pre-surgery classes at Sacred Heart Medical Center. “They need to get themselves ready: What to expect from the minute you come in the hospital door, through
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your pre-operative period,” Egan says. “We also talk to them about making the mental commitment to having a good recovery and a good outcome.” Don’t discount the psychological: Nurses and therapists repeatedly emphasize that preparing yourself to do the hard work in therapy to recover afterward — seeing yourself as just as crucial to the medical team as the surgeon, therapist, and anesthesiologist — can make a major difference. Research your surgery. Attend classes. Ask questions. All that preparation will pay off once you begin your recovery.
A FEW CHANGES AT HOME
For a time, walking around may be difficult after surgery. You may have to use a walker. You may not be able to bend over or easily stand up after using the toilet. In some cases, getting your house ready for returning home can be as simple as moving furniture and improving lighting to make navigation easier. “We picked up all of our throw rugs, moved sharp edges out of the way — the end tables,” Bunton says. In other cases, needs can be more complicated. “We had a woman who had a total hip replacement,” Rappuchi says.
“She was brought home by her friends. She sat down on her couch with her coffee. But when her friends left, she couldn’t get up because her couch was too low.” So just to be safe, check the height of furniture you plan to use. Can a walker fit through your doorways? Will you be able to climb stairs to get to your bedroom? In some cases, getting in and out of bed can be a challenge, or it may be difficult to get into a good position — equipment is available to help with that. Similarly, you may need a toilet riser or grab bars in your bathroom. Consider other simple changes, like moving important items to low shelves within easy reach. Have an idea what you’ll want to wear post-surgery — pick out soft, comfortable clothes that are easy to put on.
FOOD AND TRANSPORTATION
Most likely, you’ll be expected to be up and on your feet quickly after surgery. But just because you can walk doesn’t mean you’re able to drive. Be prepared to ask for help getting places for four to six weeks. If you’re married or living with your family, you have a big advantage: someone to help with the cooking and transporta-
tion. If you live alone, Miriam Frost, a physical therapist with Rockwood Home Health, recommends having some others lined up to help take you to appointments, get groceries, cook, and take out the garbage. It’s always easier to recruit volunteers before you really need them. Stock up on foods you like that you can easily prepare — the easiest are things that can be thawed and microwaved. Frost recommends gathering lots of prune juice to fight the inevitable post-surgical constipation, as well as lip balm for chapped lips, and suckers, hard candies and Biotene gum to combat dry mouth. Focus on simple foods and small portions first, Frost says, ones that are easy to digest with pain medication. Fill all your regular medications before your surgery, and a bring a list to the doctor so they can double-check for problematic interactions with your newly prescribed pain medications. If all goes as planned, you’ll reap the benefits of a better knee, hip or back before you know it. “We’re going on a cruise at the end of February,” Bunton says. Last time he went on a cruise he could barely walk. This time, he’s certain he’ll enjoy himself.
Andrew Boulet, MD, Cardiologist Providence Spokane Heart Institute
when my wife had a cardiac arrest because everything for her complex care was available.
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LIVING session) or March 10 and 17 from 5:30-7:30 pm. $30/ session; online registration available. INHS Community Wellness Center, 501 N. Riverpoint Blvd., Ste. 245. cherspokane.org (232-8145)
Be a Kid for the Kids
HEALTHY COOKING CLASS Monthly classes are taught by registered dietician Joan Milton and include recipes to take home with you. Offered on Feb. 12 and March 12 from 5:30-7 pm. $10; online registration available. INHS Community Wellness Center, 501 N. Riverpoint Blvd., Ste. 245. cherspokane.org (232-8145)
Tom Sherry and Joyce Cameron at last year’s Kids at Heart luncheon.
he Sacred Heart Children’s Hospital in Spokane is celebrating its 10th anniversary this year, a big milestone for the facility that was once just a dream of pediatric specialists across the Inland Northwest. To ensure the the hospital continues its mission of serving kids with special medical needs, the Providence Health Care Foundation began hosting its annual KIDS AT HEART charity luncheon eight years ago. Providence special events director Kathy Maurer says, “We want everyone who attends to tap into their inner ‘kid at heart’ while learning about the work the hospital does for the community. We’re gathered for a serious purpose, but the luncheon is all about having fun.” That fun comes in the form of kid-inspired group activities, table décor, games and prizes — even the menu centers around classic kid-favorite foods, Maurer says. Recipients of the Sacred Heart Children’s Hospital Advocates of the Year award also will be honored. Past honorees include the Rypien Foundation’s Mark Rypien and WSU Spokane Chancellor Lisa Brown, among others. Touching success stories of local children who’ve overcome illness through treatment at the hospital will be presented. Over the years, the Kids at Heart Luncheon has raised a cumulative $625,000 to support the hospital’s mission and continued expansion of pediatric services. The funds raised this year are designated to support pediatric cardiology care. In conjunction with that, the event’s keynote presenter is Dr. Neil Worrall, a pediatric cardiologist at the hospital. — CHEY SCOTT Kids at Heart • Tue, Feb. 25, 11:30 am • By donation, reservations requested • Spokane Convention Center • 334 W. Spokane Falls • kidsatheartcharitylunch.org • 474-2819
FEBRUARY-APRIL EVENTS BLOOD DONATION Give blood at the Inland Northwest Blood Center, which requires up to 200 donors each day to ensure the blood bank is adequately stocked. Donors can schedule an appointment online or donate during walk-in hours. Spokane office: Mon, Fri, Sat from 7 am-3 pm, Tue-Thu 11 am-6 pm. Coeur d’Alene office: Mon and Fri 7 am-3 pm, Tue-Thu 11 am-6 pm. inbcsaves.org (423-0151) UNION GOSPEL MISSION VOLUNTEER ORIENTATION Learn about volunteer opportunities and services offered through the ministry at monthly orientations. Dates and times vary; orientations offered at both the Spokane UGM (1224 E. Trent Ave.) and the Center for Women & Children, (196 W. Haycraft Ave., CdA). Full
schedule online at uniongospelmission.org or call 208665-4673 (CdA) or 535-8510 (Spokane). DOG PEOPLE BLOOD DRIVE This event returns for its second year, offering dog owners the chance to see if their pet is eligible to donate blood to the Pet Emergency Clinic. Criteria for dogs: must be between 1-6 years, over 60 lbs. and in good health. Inland Northwest Blood Center is also on site accepting human blood donations. Feb. 8 from 1-5 pm. Lincoln Heights Veterinary Clinic, 2829 E. 27th Ave. lhvetclinic.com (535-3551) PRE-DIABETES CLASS This two-part class is designed for people who are at risk or have been diagnosed with pre-diabetes, which affects more than 79 million Americans. Feb. 10 and 17 from 5:30-7:30 pm (one
GSI HEALTH CARE FORUM The 2014 event, hosted by Greater Spokane Inc. and the Spokane Journal of Business, is titled “The Affordable Care Act & Health Care Reform - What You Need to Know Now.” The forum is intended to engage the Spokane business community in a discussion about local employees’ health and wellness. Thurs, Feb. 13 from 7:30-9:30 am. $25-$30. Davenport Hotel, Grand Pennington Ballroom, 10 S. Post St. greaterspokane.org (624-1393) GO RED FOR WOMEN The local chapter of the American Heart Association hosts its annual fundraising and educational luncheon to raise awareness of heart disease, which is the leading cause of death in women. The event features a keynote speaker (TBA) and the option for participants to attend workshops. Wed, Feb. 19, at 10:30 am. Tickets $125/person. Spokane Convention Center, 334 W. Spokane Falls Blvd. spokanegoredluncheon.org (536-1500) LUNCH & LEARN In conjunction with February being heart health month, INHS hosts a mid-day educational session on the most important things to remember about heart health. Thurs, Feb. 20 from noon-1 pm. Free, register online to reserve a spot. INHS Community Wellness Center, 501 N. Riverpoint Blvd., Ste. 245. cherspokane.org (232-8145) WOMEN’S CANCER SURVIVOR RETREAT This retreat for women who have or are experiencing cancer offers a weekend of bonding, reflection, sharing, presentations and more. Feb. 21-23. $195 (fee assistance available). The Franciscan Place, 1016 N. Superior St. sjfconline.org (483-6495) BABYSITTING BASICS This course is designed for youth ages 10-15 to prepare them to become successful babysitters, and includes instruction in infant care, CPR, discipline issues, safety and more. Feb. 22 from 9 am-2 pm. $40; online registration available. Providence Sacred Heart Hospital Auditorium, 20 W. Ninth Ave. cherspokane.org (232-8138) A NIGHT OF GLAM The Spokane Aids Network (SAN) hosts its 16th annual Oscar Night gala fundraiser, this year themed “Welcome to the Emerald City,” including dinner and an auction held throughout the evening. Sun, March 2 at 4:30 pm. Tickets $125/person. Northern Quest Resort & Casino, 100 N. Hayford Rd., Airway Heights. san-nw.org (455-8993) MOVIN’ & GROOVIN’ FAIR The Corbin Senior Center hosts a health and wellness fair, with blood glucose and cholesterol screenings, as well as information from local businesses and vendors including Avista and others. Sat, March 8 starting at 8 am. Free admission. Corbin Senior Center, 827 W. Cleveland Ave. (327-1584)
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CHOCOLATE & CHAMPAGNE GALA Lutheran Community Services Northwest hosts its 30th annual fundraiser gala, featuring decadent dessert and bubbly as well as a steak dinner. Proceeds from the formal event benefit the organization’s Sexual Assault and Family Trauma Response Center. Sat, April 12. Ticket price TBA. Mirabeau Park Hotel, 1100 N. Sullivan Rd., Spokane Valley. lcsnw.org (343-5078)
sentations and live entertainment. April 25-26, Friday from 1-9 pm and Saturday from 10 am-6 pm. $5 admission, free for race participants. Spokane Convention Center, 334 W. Spokane Falls Blvd. spokanewomensshow.com MARCH FOR BABIES This annual team-based 3-mile walk/run supports March of Dimes’ programs for babies born premature or with a compromising health condition. April 26 at 10 am, registration begins at 9 am race day. Race entry by donation. Gonzaga University, Jundt Art Museum, 202 E. Cataldo Ave. marchforbabies.org (328-1920)
SPOKANE WOMEN’S SHOW This annual vendor show precedes the Susan G. Komen Race for the Cure, and features information and products from beauty, fashion, health, cooking and other vendors, as well as pre-
RACE FOR THE CURE The annual fundraiser and awareness walk offers a 1-mile survivors walk and a 3-mile walk/run, with proceeds benefiting the mission of Susan G. Komen’s Eastern Washington affiliate. April 27. Registration fees $15-$35. Starts at Spokane Convention Center, 334 W. Spokane Falls Blvd. komeneasternwashington.org (315-5940) n The calendar is a free service, on a space-available basis. Mark submissions “InHealth Calendar” and include the time, date, address, cost and a contact phone number. Mail: 1227 W. Summit Parkway, Spokane, WA 99201; Fax: 325-0638; or E-mail: firstname.lastname@example.org.
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Health 41 1/22/14 4:11 PM
“You’re a saint!” says Jimbo, a homeless Spokane man, as Joan Medina, serves a warm cup of coffee to him. PEOPLE
Taking it to the Streets Joan Medina is helping the hungry, one cup at a time BY LEAH SOTTILE
ne year ago, Joan Medina’s life changed forever — and it started with a piece of ham. Medina is a busy woman, and on one particularly busy day last January, she looked in her fridge and saw a piece of smoked ham she didn’t want to eat. Her husband Ted had just left for a six-week trip abroad, and had never gotten around
to cooking it. Before she left for work that day, she chopped up the ham, threw it in a crock pot with split peas, vegetables and spices, and left. When she got home, after a day of meetings and groups and an impromptu visit over coffee and dinner with friends, her house smelled like soup. She had forgotten all about it.
JENNIFER DEBARROS PHOTO
“It was, like, 7:30 by the time I got home. I’m thinking a) I don’t really want this soup, and b) what am I going to do with all of this stuff?” she says, seated at her kitchen table. “So I’m thinking to myself, ‘I wonder if I can take this out and share it with some people who don’t have any food?’ Because I don’t want to throw it away.” Medina, 44, jumped on Facebook and asked her friends what they thought. Within an hour, she and a friend had handed out plastic containers of split pea soup to people around downtown Spokane. Medina was hooked on how happy it made people, and the rush she felt from just giving without asking anything in return. The very next day she cooked up a new batch of soup, and her friend brought along a box of hand-knitted hats and scarves.
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They couldn’t stop. By March, when Ted returned from his trip, Medina had established a full-fledged homeless relief organization out of her kitchen, spending around $1,000 of her own money in supplies each month. That one pot of soup turned into sandwiches piled two inches high with meat, hand warmers and thick, brand-name socks. She gave out soft snacks that someone with bad teeth could chew. She handed out cough drops to soothe the rumbling coughs she kept hearing. She handed out paperback books with battery-operated book lights. The people would ask: What church was she a part of? What did they need to do in return? And she’d always say the same thing: no church, no obligation. “We wanted people to know there are people out there like us, who will just help you without requiring anything of you. Because I don’t think that’s right.” Along the way, Medina would look everyone in the eye and ask two questions: How are you doing? What do you need? “I was finding out that nobody is talking to them. No one is having conversations, no one’s treating them like a f---ing human being. I wanted that to change.”
y December, Joan Medina was pissed off. The rosy-cheeked woman stood before Spokane’s City Council and told the stories of the people she had met over the past year in order to dissuade them from expanding the sit-lie ordinance. “It is clear that a war has effectively been declared on these people,” she said. “A war declared by certain business owners and city leaders who would like downtown cleansed of all ‘undesirables.’” That first pot of soup wasn’t just a good deed for Medina. It was the spark that lit a fire inside of her. She wanted to feed homeless people in Spokane and keep them warm, but she wanted to defend them, too. She wanted them to know that even if it seemed like no else cared about them, she did. In one year, her passion has taken her in front of the city council, to meetings with police officers. It’s made her apply for a nonprofit status and name her group Brigid’s Cloak. And it’s opened up a whole new world to her. Tonight, you can feel the joy that it brings Medina. At her stove, she pours a gallon of organic milk into a stockpot and carefully whisks in a bag of Ghirardelli
chocolate. Ted brews coffee — organic, shade-grown — and pours it into a carafe. Jordan Hilker, who also works at the downtown library, packs tangerines and granola bars into baggies. At 9 pm, they load up the car and drive downtown. Just before they cross the Monroe Street Bridge, Joan spots a pair of guys with big backpacks and rolls down her window: “Do you want some hot coffee or a sandwich?” They look at each other and nod their heads. After a few minutes, the men have reusable Rosauers shopping totes stuffed with food and supplies. They’re holding mochas Joan has made for them, and they’re smiling. “It’s not every day a car pulls up and they say, ‘Do you want some hot coffee or hot chocolate,” one of them says to Joan. He pauses and points to his chest: “It just warms you right here.” She tells them to be safe, to stay warm. And she hops back into her car and continues her search for the people who might need her most. n Learn more about Brigid’s Cloak at facebook.com/BrigidsCloak
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