Inhealth 2/6/2017

Perils of Patient Care

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| The Lowdown on High Blood Pressure

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| Rub-on Relief

40

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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 Bret Bowers, Kristen Black, Robin Hamilton Brodt, Jennifer DeBarros, Raven Haynes, Young Kwak, Robert Maurer, Taryn Phaneuf, Mitch Ryals, Matt Thompson, Daniel Walters, John H. White PRODUCTION MANAGER Wayne Hunt ADVERTISING DIRECTOR Kristi Gotzian DIRECTOR OF MARKETING Kristina Elverum ADVERTISING SALES Autumn Adrian, Mary Bookey, Gail Golden, Jeanne Inman, 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. 2017. InHealth is locally owned and has been published since 2004.

spokane.wsu.edu SUPPLEMENT TO THE INLANDER

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INSIDE

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FIND OUT if you are harboring silent, potentially

FROM THE EDITOR

deadly vascular disease.

Dr. Amy L. Doneen DNP, ARNP

Medical Director, Heart Attack & Stroke Prevention Center, Adjunct Professor Texas Tech Health Sciences Center

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While a heart attack or stroke can cost thousands of dollars and rob your quality of life, this scan is less than a night out to dinner and is life-saving. Once you find out if you have vascular disease, we can do a complete work-up (as found in our book, Beat the Heart Attack Gene (Amazon. com) to determine the root causes.

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

Warming the Heart

P

olice officers clearly have dangerous jobs. But did you know that the most violent job in the state is being a nurse’s aide? That’s according to a 2011 investigation by KUOW public radio in Seattle, which also noted that jobs involved with providing care at one of the state’s two psychiatric hospitals, Eastern State and Western State, were especially dangerous.

In this issue, reporter Mitch Ryals considers the thorny problem of how caregivers’ rights to safe working conditions coexist with patients’ rights to receive the care they need.

We also have special sections on soup and heart health; sections that may not appear at first to be related. I think they are, and here’s why: One of my favorite evenings recently was going to the home of good friends to enjoy a big pot of delicious clam chowder. A cozy fire in the fireplace, crunchy bread, a crisp, cold salad and lots of laughter combined to work a little magic on my spirits. See the connection? Soup can deliver not only a delicious bounty of nutrition, just what your physical heart needs, but also offers up the chance to do a little something wonderful for your emotional heart. So gather your ingredients, put the pot on to simmer and invite someone who needs a boost to share in the goodness.

To your health!

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CHECK-IN

ASK DR. MATT

Getting to the Heart of Strep Throat

S

treptococcus is a name that describes many different round bacteria that cause human disease (I’ll just call it “strep” from here on out).

It’s like calling a vehicle “truck” when there are dump trucks, fire trucks, taco trucks, etc. Moms are Matt Thompson is a checked for Group B strep pediatrician at before delivering a baby; Spokane’s Kids Clinic. strep pneumonia is a type of bacteria that can cause sinusitis, ear infections, pneumonia, and some skin infections. The most notorious strep is the one that causes strep throat, Group A strep. In humans,

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.

Group A strep causes a number of mild to serious diseases, including skin infections, pharyngitis, kidney disease, heart disease and even shock.

Strep throat occurs when one infected individual passes the bacteria to another person’s mucous membranes through respiratory droplets, which are coughed, sneezed, slobbered or smeared. Symptoms, including fever, aches, throat pain, headache and possibly stomachache, follow.

Note that strep throat does not usually include a prominent runny nose or cough.

Fortunately, antibiotics are effective at treating strep and limiting its spread to others, and treatment might help one feel better about half a day sooner. The most important reason to treat strep is to prevent one of the serious complications that it can cause called acute rheumatic fever. ARF, which most commonly occurs in children between the ages of 3 and 15, continues to cause serious disease all over the world, affecting millions, mostly in developing regions without access to antibiotics.

Complications of ARF can include arthritis, skin infections, neurological disorders, and perhaps

the most serious complication, rheumatic heart disease. Rheumatic heart disease following ARF used to be the number one cause of heart valve replacement in the U.S., but is now far less common, due to routine use of antibiotics to treat acute infections over the past 50 years.

Even experienced clinicians are not very good at predicting who does and does not have strep without testing. Some of the viruses that mimic strep do not play nicely with antibiotics and can lead to unpleasant rashes and other interactions.

That’s why most clinicians will only treat for strep throat when there has been a positive rapid throat swab or throat culture. Fortunately, delaying treatment a day or two while awaiting a test result should not increase the risk of ARF. After about a day of antibiotic treatment, the infectious period is over. After two or three days of treatment, it is best to get a new toothbrush. So this Valentine’s Day, if your sweetheart has a sore throat, you may want to skip the kiss and stick with the box of chocolates.

— MATT THOMPSON FEBRUARY - MARCH, 2017

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CHECK-IN

FORUM

Tricky Ticks

H

SUPERFOOD

Fishing for Compliments

ATTRIBUTES: Rainbow trout’s flaky, mild meat makes it a palatable fish for kids and adults alike, even for those who might not ordinarily like fish.

SUPERPOWERS: Rainbow trout is a boon for protein seekers, containing 21 grams of protein in a serving, along with sky-high levels of the omega-3 fatty acids EPA and DHA, and no calories from carbohydrates. It’s also a very good source of B vitamins, phosphorus and niacin.

WEAKNESS: The Monterey Bay Aquarium recommends eating farmed rainbow trout due to water contamination that has impacted wild trout. Explicit instructions for eating fish caught in

Washington state are available at the Department of Health’s Fish Consumption Advisories webpage.

HOW TO USE IT: While it is tempting to fry up a trout, that’s not the best way to maximize nutrition. Instead, try this healthy Provençal “en papillote” preparation from the New York Times: Place trout, skin on, on a sheet of oiled foil. Open up the fish, and season with salt and pepper. Stuff with a medley of chopped tomatoes and garlic. Drizzle with olive oil. Lay a sprig of fresh thyme on top, then fold the trout halves back together. Crimp foil securely around the fish, place on a baking sheet and bake at 450 degrees for 10 to 15 minutes.

— ANNE McGREGOR

ere in the Northwest, we all like to spend time in the great outdoors. Yet with any outside activity comes some risk, including being bit by a pesky tick that could be carrying something nasty. While most cases of the tick-borne Lyme disease are centered in the upper Midwest and Northeastern U.S., there were seven to 22 cases per year in Washington and two to 14 cases per year in Idaho between 2005 and 2015, according to Centers for Disease Control data.

So besides it just being gross to be bitten by a blood-sucking tick — and seeing that reported cases in our region are not incredibly common — why should we be concerned?

That’s partly what attendees can learn at an upcoming seminar in Spokane that seeks to “unravel the mystery of Lyme disease,” hosted by Dr. Marty Ross of Seattle, who’s been treating Lyme disease patients for the past 12 years.

Lyme disease is treatable by antibiotics, but if left untreated its effects can be severe. Though there is some controversy in the medical community, some patients who’ve battled the infection report having lasting, chronic symptoms after treatment. At the seminar, hear from people who’ve been affected by the disease, including a young woman who battled a late stage case.

— RAVEN HAYNES NW Lyme Patient Workshop • Sat, March 25, from 10 am-4 pm • $5-$15 • Gonzaga University, Hemmingson Center • 702 E. Desmet • nwlymepatientworkshop.com • 206-962-9439

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100% LOCAL

Fitness in the Palm of Your Hand

E

The Rundles: Justin and Jessica

MILESTONE

The End of an Era

A

fter 31 years of serving HIV/AIDS clients, the Spokane AIDS Network (SAN) is no longer providing HIV care and prevention services due to loss of funding.

The Spokane Regional Health Department will be the new care provider to more than 200 former SAN clients, and HIV prevention and case management services will move there by March 31. Clients in Wenatchee, Chelan, Douglas and Okanogan counties will transition to Confluence Health, and SAN leader-

INFANT Reflux, Constipation, Nursing Difficulties, Birth Trauma, Colic, Motor Deficits, Torticollis PEDIATRICS ADHD, Sensory Integration, Bed Wetting, NDDs, Ear Infections, Constipation PRENATAL Sciatica, SPD, Back Pain, Headaches, VBAC, Better Birth Plan, Postnatal Care FAMILY CARE Headaches, Neck Pain, Back Pain, Reflux, Disc Injuries, Wellness Care

ver wanted a progressive, personal-trainer-style workout that you could just do in your own space, when you felt like it? The Workout Anywhere app, created by Spokane’s own Justin and Jessica Rundle, offers the opportunity to do just that. The couple have offered personal training services for years, says Justin. “We had a lot of clients who would come in, and we were training them in the gym, and they would tell us, ‘I would like to do this at home.’”

So he and his wife, both graduates of Mt. Spokane High School and both certified personal trainers (she graduated from EWU and he played football and graduated from Whitworth) developed the app to do just that. “It’s a proven training program that has worked for people over the years,” says Justin.

The app, which can link to popular fitness trackers, includes daily programs for all levels of fitness as well as interactive challenges, nutrition advice and an exercise directory. “The main feature that has become really popular is our boot camp,” says Justin, “and that lesson is on the site so they can follow along.”

Find the app at workoutanywhere.net.

— ANNE McGREGOR

ship is working closely with both clinics to mimic the wraparound services that clients have received for years.

The news came as a shock to both clients and the organization itself, says Gaye Weiss, SAN Executive Director. SAN suddenly lost 75 percent of its funding when the Washington State Department of Health chose not to award a contract in October, leaving the nonprofit to wonder how it would continue to be the resource — the care provider, the safe place, the hangout spot — it had always been for the HIV/AIDS community.

“We’re trying to recreate this,” says Weiss.

“You have camaraderie, you’re not being isolated, you’re with a like-minded community. There’s just so many more layers than medical care.”

SAN reached nearly 3,000 people in the Inland Northwest through HIV education, prevention and care programs, and many have stepped forward to share their story of SAN’s impact. At a bittersweet 31st anniversary party in December, Weiss says there were those who said they wouldn’t be alive if not for SAN, and “that’s what’s hard to walk away from.”

For now, SAN will focus on transitioning and supporting its clients, and selling off the tall, Victorian-style house that was a second home to many in the Inland Northwest.

“I’m still numb,” says Weiss, “but there’s being numb, and there’s being proactive and making it work the best we can.”

— RAVEN HAYNES

What Does Your Family Deserve?

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Health 11 1/25/17 5:18 PM

CHECK-IN LIFE COACHING

Let It Go!

W

Robert Maurer is a Spokane psychologist, consultant and author.

e all know that the heart is a muscle, and that muscles require exercise. It is also an organ, so good nutrition is essential. What is less well known is that the heart is equally impacted by the quality of our social interactions.

Physicians have long believed that emotions greatly affect our health and longevity. Cardiologists Ray Rosenman and Meyer Friedman began identifying the dramatic influence of our moods and relationships on heart health when they discovered the Type A personality. Among the key traits of this personality type, anger has been identified as the major risk factor linked to cardiac disease and death. Being short-tempered in traffic, at stores, at work, or with family and friends can cause severe damage to the heart. Hostility puts us at risk for higher cholesterol as well.

On the other hand, a feeling of connectedness has been repeatedly associated with improved heart health. This means not just having family and friends, but feeling appreciated, loved

and valued by them. A willingness to ask for help from others who are non-judgmental can significantly reduce the risk of heart disease. For example, patients who confide in others have dramatically lower levels of cholesterol, and lower risks of hypertension as well.

After more than 40 years of research in the field, it appears that seeking out friendships and practicing compassion — two highly effective antidotes to anger — are as important to our lives as good food and exercise.

— ROBERT MAURER

Maurer’s book, One Small Step Can Change Your Life, was named a Google Top 100 book for 2016.

PILL BOX

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

I went to my doctor last week with a cough and runny nose that had been going on for about a week. I was hoping to get some antibiotics, but the doctor only gave me a recommendation for some OTC cough medicine and a decongestant. Why didn’t she just give me the antibiotics?

W

ell, first of all, kudos to your doctor. She almost certainly made the right decision. It sounds like you have a simple and uncomplicated cold. Antibiotics are very useful for bacterial infections (such as some types of pneumonia) but do not have an impact on viral infections such as the common cold. As the old adage says, “A cold will go away in two weeks if you see your doctor, and in 14 days if you don’t.”

Not only that, but antibiotics are not benign, and taking them can at times cause complications. First, exposure to an

antibiotic could result in an allergic reaction. These can range from being mild to life-threatening. It is not prudent to take this chance if there is not a likely strong benefit.

Second, every time any of us takes an antibiotic we expose the many types of bacteria in our bodies (good and bad) to it, and this exposure can facilitate the development of resistance to the antibiotic by those bacteria.

Third, we are learning more and more about our normal microbiome — the many non-disease-causing and helpful bacteria that live in and on our bodies and their functions. When we give antibiotics we wipe out both good and bad (if they are present) bacteria, and this can lead to problems. One example is a very severe form of diarrhea that can be caused by the overgrowth of a problematic bacteria after antibiotic therapy has wiped out the normal populations.

So hang in there and expect to get better soon. If you get worse or develop a fever, go back to your provider again.

— JOHN R. WHITE

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BRAIN EXERCISE

5 6 8

Sudoku

RATINGS: Gentle (left), Moderate (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.

4 9

7

Answers to all puzzles on page 44

3 2 7 4 5 3 6

5 1

2 3 8 8 2 7

Codewords

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.

23

23 2

12

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23 23

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1 4 7

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

7

4 8

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

8 1 2

3

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1 9 6

5 2 9 3 9 6 4

19 21 24 4

1 to 25

8

9 16

18 21 20 18 17 16 17

To solve 1 to 25, move the 15 22 19 6 7 15 numbers from the outer 23 23 24 5 8 14 ring onto the board in the 25 25 1 4 13 9 directions of the arrows. The number must appear on the 11 2 3 12 11 10 line — up, down or diagonal 2 22 20 12 7 14 — that the arrow indicates. As you place them, they must snake together vertically, horizontally or diagonally so they link in sequence from 1 to 25. We started you out with a number to work from. A solved puzzle will look like the one above. There is only one solution.

21 2

4

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6 5 13 3 10

8 10 11

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9 17 16 14 6

FEBRUARY - MARCH, 2017 CHECK-IN inhealth 02-06-2017.indd 13

3 4

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Health 13 1/25/17 5:18 PM

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NEWS

Do No Harm

WORKPLACE

Questions of patients’ rights are pitted against the safety of health care workers on a daily basis locally, and throughout the country

BY MITCH RYALS

C

helsea Shanda can take a punch. When she applied to work as a mental health technician at Eastern State Hospital, she was prepared to do so. She knew that attacks from patients were a part of the job.

“I acknowledged before I even applied to the hospital that I would get hit eventually,” she says. “It was not a question of if, but when was it going to happen.”

The first time the 27-year-old was assaulted by a patient was in May 2016, about a year and a half after she started working at the state-run psychiatric hospital. That patient had lost the privilege to go outside and smoke a cigarette because he refused to comply with his treatment plan. Despite this, the patient pushed his way past staff and other patients to the yard, Shanda says. She was telling him to go back inside when he punched her in the face multiple times. The back of her head crashed against a window and her nose gushed with blood.

She curled up in a ball on the floor, but the man, who Shanda describes as a “UFC fighter” weighing more than 300 pounds, continued to hit her until patients pulled him off. Staff stood by and watched, Shanda says. Intervening could put their jobs in jeopardy. ...continued on next page

Chelsea Shanda endured two assaults while working at Eastern State Hospital.

KRISTEN BLACK PHOTO

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Health 15 1/26/17 4:36 PM

NEWS constantly walk the thin line between a moral and legal obligation to provide care and holding patients accountable for acts of violence, says Kelly McGinty, a nurse practitioner in a local emergency room.

“This is a very sensitive topic,” McGinty says. “Are we violating their civil rights by restraining them in order to provide care when they are actively violent or psychotic? Do we allow them to assault us because they’re mentally ill or high on meth?”

Research shows that the risk of assault is highest at mental hospitals and in emergency rooms.

“DO NO HARM,” CONTINUED...

Shanda returned to work about two weeks later, and was on the receiving end of another patient’s punch within a month.

This time, her eye turned black and blue and swelled shut.

She missed two months of work, and was told to get a psychiatric evaluation.

A psychologist determined that she had post-traumatic stress disorder and postconcussion syndrome. The doctor ordered

counseling.

Assaults perpetrated against those in the health care industry are nothing new, especially in a mental health or emergency care setting.

Yet it’s a problem that raises serious questions about patients’ rights to treatment and workers’ rights to be safe. Health care employees who treat mentally ill, drug-addicted and psychotic patients must

D

errick Alexander was detained at Sacred Heart Medical Center following attempts to end his own life. Shortly after, in September 2015, he was transferred to Eastern State Hospital because of a “grave disability” and diagnoses for multiple mental illnesses, according to a psychologist’s report in his court file.

Alexander, who was not available for an interview, has a documented history of auditory and visual hallucinations of “shadow people” who tell him to end his life, public documents say. He has attempted suicide before and has cycled in and out of psychiatric treatment.

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He was arrested at Eastern State Hospital in March 2016 after allegedly assaulting four staff members. According to court documents, Alexander became agitated when staff would not allow him to have his blanket. He is accused of punching, kicking and biting three staff members and spitting in the face of another.

He’s been sitting in the Spokane County Jail ever since as attorneys argue whether he is able to understand the charges against him and can stand trial. Two psychologists have evaluated Alexander recently and came to opposite conclusions.

“A trial would occur all around Mr. Alexander while he focuses on issues not relevant to his case,” his public defender writes in court documents.

The incident with Alexander is not an unusual scene for emergency rooms or psychiatric wards.

Spokane Deputy Prosecuting Attorney John Grasso says that, on average, he files charges against patients for assaulting a health care worker about once per week.

“We get these cases regularly,” he says.

“We see them quite often.”

Patients can be charged with a felony-

level assault for anything from spitting to slapping to biting to shoving to punching to kicking employees. Grasso adds that he tries to avoid charging patients who accidentally hit a nurse because they’re flailing in pain.

“Do we allow them to assault us because they’re mentally ill or high on meth?”

— KELLY McGINTY, ARNP “It has to be an intentional act to assault,” he says. “That’s what I’m looking for. It’s not uncommon to have a case with mental health issues or drug issues. Some of them are just angry and don’t like the treatment they’re receiving.”

Still, attorneys and some health care providers struggle with the decision to charge someone criminally for an assault ...continued on next page

FEBRUARY - MARCH, 2017 NEWS inhealth 02-06-2017.indd 17

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NEWS

Health care workers at Eastern State Hospital are 60 times more likely to be assaulted at work than other state workers, according to KUOW of Seattle.

“DO NO HARM,” CONTINUED... committed while they’re drunk or high, or that can be attributable to severe mental illness.

Andrew Biviano, a local attorney and a former mental health caseworker, has represented patients and employees of Eastern State Hospital on a variety of issues. As a caseworker, he’s also been assaulted by patients himself.

“I do know it’s an issue among staff at Eastern State Hospital in particular,” he says of the difficult decision to press charges against patients. “They maybe want charges and someone taken to jail, but there’s a clinical question of whether we can hold it against this person and treat it as a criminal or clinical matter. That’s why they’re here, for psychotic issues, and we shouldn’t hold that against them.”

R

eports at the state and national levels support the notion that this is a significant problem in the United

States.

A 2011 investigative report by Seattle public radio station KUOW found that the most violent job in Washington state is a nurse’s aide. Specifically, the report says employees in psychiatric hospitals, such as Eastern and Western State hospitals, are assaulted while working 60 times more than the average worker in the state.

The Associated Press in 2015 found

that attacks on Western State Hospital em“This is unacceptable,” Murray said ployees contributed to millions in medical then. “These professionals do vital work in costs and worker shortages — to say nothhospitals and other health settings to care ing of the concussions, fractures, bruises for our loved ones, our neighbors and our and cuts suffered by workers. communities.”

A 2016 review article in the New EngThat report also concluded that there land Journal of Medicine are currently no determined that federal standards violence in a health for violence prevencare setting is undertion, only voluntary In general, health care workers have the right reported, ubiquitous guidelines. Murray to request not to treat a person they do not and persistent. called for the Ocfeel safe around; however, the hospital can And last April, cupational Safety and not refuse to treat a person.

Washington Sen. Health AdministraPatients have a right to treatment and to Patty Murray antion to change that. a minimum standard of care. nounced the release In January 2017, Patients also have the right to refuse of a report from the OSHA announced treatment in some cases. In Washington U.S. Government that it will develop an state, a person can be civilly committed to a Accountability Office enforceable violence hospital for mental health treatment if that finding that health prevention standard. person is deemed a threat to themselves or care workers throughWashington is others, as determined by a qualified expert. out the country expeone of only a few Initially, a person can be detained for up to 72 rience “substantially states to install hours. Any longer than that requires a judge’s higher estimated rates preventative policies signature. of nonfatal injury due in hospitals, such — MITCH RYALS to workplace violence as recordkeeping, compared to workers worksite analysis and overall.” training.

According to the Bureau of Labor StaFor McGinty, the nurse practitioner, tistics, incidents of violence in a health care training and the presence of security guards setting that caused workers to take time off are big reasons she believes she’s personwork increased by 12 percent from 2011 to ally avoided physical attacks, though she 2013. says she is verbally assaulted several times

KNOW YOUR RIGHTS

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Family Owned and Operated

a week.

The training teaches nurses how to de-escalate agitated patients, McGinty says, and how to respond if a patient tries to physically assault them.

“Basically, the provider must feel the patient is a danger to themselves or others, and there are no other alternatives, before we place them in restraints,” she says.

The situation is slightly different for mental health technicians like Shanda, who says that generally, employees are taught how to escape from a patient’s attack, but must walk a fine line, because using too much force can put their jobs in jeopardy.

Kelly Stowe, a spokeswoman for the Department of Social and Health Services, which runs Eastern and Western State hospitals, says that Eastern State has formed a special team to respond to violent situations.

Those people are “trained to provide a safe, effective and immediate plan of response for individuals in a psychiatric crisis, particularly when danger exists for the patient or staff,” Stowe writes via email.

“Verbal intervention tools are used prior to physical interventions, which are only applied when able to be performed safety.”

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S

handa says she had a good rapport with the man who attacked her last May. They would talk casually and bonded over a shared appreciation for the band Ace of Bass. Now, the scar on the bridge of her nose is a constant reminder of the day that left her rattled.

Shanda says she has trouble sleeping and forgets things. When she returned to work, she didn’t feel safe. Not for fear of the patients, she says, but because no staff came to help her. In December, Shanda says she was fired without being told why.

She was heartbroken.

It was her own experience with mental illness that fueled her desire to work with people struggling with similar issues. As a teenager, doctors told her that she might have borderline personality disorder, bipolar disorder or major depression.

“Then I had my daughter and flipped my life around,” she says. “I haven’t been on medication since, but I know what it’s like to feel like a lab rat, and for people to call you crazy and say you’re messed up.”

Now, she wants to continue working with people struggling with a mental illness.

She’s thinking about becoming a nurse, despite the dicey situations health care workers can face.

“It’s difficult,” she says, “Because it’s somebody you’re caring for.” n FEBRUARY - MARCH, 2017

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NEWS

Deaconess is on its third owner in a decade.

BUSINESS

The MultiCare Difference Nine years after Deaconess and Valley Hospitals were sold to the for-profit Community Health Systems, they’re going nonprofit again

T

wo other health systems tried to run Deaconess and Valley hospitals — and struggled to balance the books — before it was MultiCare Health System’s turn to take a crack at it.

Nearly a decade ago, Community Health Systems, a big health care conglomerate from Tennessee, came to Spokane with its eye on Empire Health — a nonprofit on the edge of bankruptcy that had just seen a $7 million loss and laid off 130 employees. The community was wary of a conversion of a nonprofit to a for-profit hospital, but after a deal that included the creation of the private Empire Health Foundation, it went through.

For a while, CHS seemed to be flourishing. It expanded even further in 2010, gobbling up Rockwood Clinic and its 32 locations, and then gathering up the entire

BY DANIEL WALTERS collection under the name Rockwood Health System.

But then, CHS, too ran into trouble: Nationally, the company had become too big, too unwieldy, and the purchase of yet another hospital system had left the CHS staggering under a hefty load of debt. The CHS empire was widespread, but much of that territory, according to an analysis in Modern Healthcare, was like its business in Spokane: still second place behind a market leader. The only choice was to retreat, selling off pieces of its business.

And that’s how Deaconess and Valley hospitals ended up, once again, as part of a nonprofit. This time, it was MultiCare.

“We are always looking for an opportunity to expand our geographic footprint,” says MultiCare spokeswoman Marce Edwards.

Bob Crittenden, Gov. Jay Inslee’s special advisor for health reform, says that it makes sense for MultiCare, as a nonprofit based in Tacoma, to want to expand to the eastern side of the state. A large company, or even the Washington state government, may prefer to negotiate with a health system that has a wider presence throughout the state.

“MultiCare can start working with other groups statewide,” Crittenden says.

“We purchase a lot of health care for our employees. It’s better for the sellers and the state for a large system to go statewide, to provide care for more people.”

F

or now, the impact of the MultiCare purchase remains unclear. In response to a series of questions from the Inlander, Rockwood Health System

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marketing director George Hampton sent only this statement in response: “We look forward to deepening the impact we can have as part of a larger regional network.

Patient care is continuing across Rockwood Health System without interruption as the transition work is done behind-the-scenes.

More information about future plans will be available once the transaction is complete.”

Similarly, MultiCare’s Edwards says there haven’t been any major changes yet.

“We’re still in the exploratory phase,” she says. “They’re learning who we are, and we’re learning who they are.”

One major upcoming change? MultiCare will bring a new electronic medical record system to the Spokane region.

Edwards also describes a significant emphasis on urgent care centers, 24/7 minor emergency rooms where patients can go at any time.

“We have 30 urgent cares in the Puget Sound region,” Edwards says. “We believe that they’re a really important part of the health care system.”

In one sense, MultiCare has already been a part of the region.

questions about their symptoms. At the end of the virtual exam, if the treatment requires a prescription, patients can send the prescription directly to the pharmacy of their choice.

B

eyond the patients, the question is what sort of impact MultiCare will have on staff. Three years ago, Deaconess and Valley hospitals were locked in the middle of a dispute with the Service Employees International Union, complaining that staffing cuts had resulted in far too few nurses for far too many patients.

Here, MultiCare can relate. It spent a year in the midst of intense negotiations, and strike threats, with the Washington State Nurses Association over staffing levels at MultiCare Tacoma General Hospital.

But the ultimate deal they struck left the nurses pleased — for the first time in state history, patient ratios were defined in the nurse’s contract.

Also pleased? Antony Chiang, president of the Empire Health Foundation, the nonprofit formed out of the sale of Empire Health nearly a decade ago. He can’t talk about details yet, but he says the founda-

Tacoma General is operated by MultiCare, which traces its roots back to 1882.

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“It’s our first physical presence,” Edtion has already been meeting with Mulwards says. “We had a few virtual health tiCare, discussing potential partnerships presences.” centered on topics like graduate medical She’s referring to two programs: One education. is “Doctor on Demand,” a $49-per-visit “Our engagement from them so far… video chat service that allows patients to has been nothing short of phenomenal or ask a doctor medical questions at any hour amazing,” Chiang says. And in his experiof any day. (If a condition ence, the fact that they’re a can’t be assessed over nonprofit makes a difference. the phone, patients aren’t “Nonprofit health systems, from the puzzle on page 13 charged anything.) because they have an underly3 = K; 8 = Q; 17 = E “Access a doctor iming set of driving principles mediately, and get medical and values beside a responinformation and diagnose and treatment sibility for return to shareholders, make information,” Edwards says. choices to invest in the community for a The second is eCare, a web-based much more meaningful rate and commitprogram from a company called Zipnoment level,” Chiang says. “I think this will sis that leads patients through a series of be the case here.” n

CODEWORDS: HINT

Weight Loss/ Hormones Genetics

Never miss an issue. Find more local stories on topics important to you: parenting, health trends, super foods and much more!

Inlander.com/Inhealth FEBRUARY - MARCH, 2017

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FOCUS

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UNDER PRESSURE HEALTHY HEART

Is your blood pressure silently sabotaging your health?

STORY BY ROBIN HAMILTON BRODT  ART BY ALI BLACKWOOD

T

wo years ago, Mark Lanz, a 65-year-old Vietnam veteran from Spokane, was diagnosed with high blood pressure. “It wasn’t something I was even aware of,” Lanz says. During a routine exam with his primary care physician, Lanz had a blood pressure reading of 160/100 — clearly hypertensive. Lanz had no symptoms that he could recall: “It’s like that story about cooking a frog. If you put him in a pan and slowly heat the water, he’ll never notice it.”

Blood pressure is called the silent killer for a reason — like Lanz, most people never experience symptoms.

But high blood pressure can lead to a myriad of health problems, including heart attack and stroke, as well as

kidney disease, eye disease and sexual dysfunction.

That’s why those blood pressure readings in your doctor’s office are so important. But experts caution that a single reading in the office does not really create a full picture of your heart health. That’s because blood pressure varies so much — it can change related to whether you’ve been sick or are in pain, how well you’ve slept, what you’ve been eating, and even how nervous you are about having your blood pressure measured.

Like Lanz, says family practice physician Douglas Hammerstrom, many of his patients discover their ...continued page 26

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More Than a Run

The funds raised by our first Pink Ribbon Run and other fundraisers stay local in the Inland Northwest and get granted out to our loved ones and neighbors right here at home.

The Pink Ribbon Run is Presented By: Avista Development | Citizens for Community Action DoubleTree by Hilton Spokane City Center | Fred Meyer | Inland Imaging | The Inlander Special thanks to Inland Imaging for its continued community support

Mammograms Save Lives Mammography is the gold standard for screening for breast cancer in women age 40 and older.

At present, there are no tests to replace mammography.

•

Mammography has helped reduce mortality rates due to breast cancer in the U.S. by nearly 1/3 since 1990.

•

For those that a mammogram helped save a life, 40% were in their 40s. 1 in 5 breast cancers occur in women aged 40-49.

•

3 in 4 women diagnosed with breast cancer have no family history.

•

For women over 50, skipping a mammogram every other year can miss up to 30% of cancers.

Annual mammograms can detect cancer early — when it is most treatable. Mammograms can also prevent the need for extensive treatment for advanced cancers and improve chances of breast conservation.

Current guidelines from the American College of Radiology and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40 — even if they have no symptoms or family history of breast cancer.

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HEALTHY HEART “UNDER PRESSURE,” CONTINUED... hypertension during a routine visit to his office, or after an emergency room visit.

The advent of home blood pressure monitors has made keeping track of a patient’s hypertension much easier.

“The widespread availability of those monitors has been the biggest boon to helping patients manage their high blood pressure,” Hammerstrom says.

“The one caveat is that the patients need to bring their monitors into their doctor’s office to be checked against the clinical monitor, which is more reliable than an electronic cuff.”

Getting back to normal

Mark Lanz says not knowing your blood pressure is “like that story about cooking a frog.

If you put him in a pan and slowly heat the water, he’ll never notice it.” BRET BOWERS PHOTO, VA MEDICAL CENTER

understanding Exercise

WSU researcher Susan Marsh’s lab mice have gym privileges. Researchers at her lab study the effects of exercise on the hearts of mice who have high blood pressure or diabetes.

She says the field of mouse heart research has revealed intriguing possibilities about exercise. For example, a single bout of exercise at a “comfortable running speed” protects mice against heart injury for up to 10 days. The research isn’t really replicable in humans. “You can’t predict precisely when someone is going to have a heart attack and tell them to exercise 10 days before that,” says Marsh. “The question always comes, ‘Then does that mean I only have to exercise three days a month?’ The answer to that, I think, is no.”

Although Marsh says there’s ample evidence that exercise is absolutely beneficial to the heart, exactly how it works isn’t clear. Researchers once thought that elevated body heat that arose with exercise was the key. That turned out not to be the case, says Marsh. The effect of exercise on free radicals in the body also turned out to be a nonstarter: “There’s a lot of evidence showing that [exercise] does help, that it does work… but how is one of those questions that is still really hanging out there.”

— ANNE McGREGOR

The first step for patients who want to reduce high blood pressure is to take an honest look at their lifestyle. Despite all the momentous achievements in cardiology and pharmacology, “nothing will replace having the patient’s involvement in weight loss, exercise and salt restriction,” says Providence cardiologist Guy Katz.

Hammerstrom agrees. “It depends a great deal on how reliable [patients] are and how committed they are to getting better.”

At the VA, Lanz takes part in a peer counseling program designed to help patients make lifestyle changes, like achieving a healthy weight or quitting smoking, It’s part of a program to take “a holistic approach to hypertension as it relates to other diseases, such as diabetes,” says Peer Support group leader Matt Hoff. “We help people understand what’s in it for them… say we have a vet who likes to go fishing, but he can’t get out in the woods anymore because of his health. We set goals for him.”

Emphasizing a diet that is high in fruits and veggies — but more important, low in salt — is key to reducing blood pressure.

The DASH (Dietary Approaches to Stop Hypertension) diet includes:  six daily servings of grains;  four to five servings each of fruits and vegetables;  two to three servings of dairy;  six or fewer servings of lean protein;  two to three servings of oils;  four to five servings of nuts, seeds and legumes per week;  five or fewer servings of sweets per week.

Additionally, and perhaps most important, people with hypertension need to limit salt intake to no more than 2,300 milligrams per day for the standard DASH diet, 1,500 for the low-sodium version. The American Heart Association estimates that

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Do we know the best numbers?

Hypertension is now defined as readings that are persistently at or above 140/90, so treatment focuses on reducing blood pressure to that level.

Results of a recent trial called the Systolic Blood Pressure Intervention Trial (SPRINT), reported in the New England Journal of Medicine, questioned whether that’s low enough.

“The appropriate targets for blood-pressure lowering have long been debated,” the Journal states, but the bottom line seemed to be that patients encouraged to work toward a lower BP measurement (less than 120/80) had a significantly lower risk of fatal and non-fatal cardiovascular events and death from any cause.”

— ANNE McGREGOR

the average American diet contains 3,400 or more milligrams of sodium daily.

Exercising for at least 30 minutes most days of the week is also key, but it doesn’t mean you need to join a gym. Those 30 minutes can be broken down into 10-minute chunks. “You have to challenge the heart to protect the heart,” says WSU exercise researcher Susan Marsh, who notes that resistance exercise is often neglected.

You don’t have to lift weights; just moving items from shelves or loading and unloading groceries offers benefits.

The National Center for Complementary and Integrative Health compiled research on hypertension and alternative treatment approaches and found limited evidence that yoga, qi gong and Transcendental Meditation may offer some benefit in reducing high blood pressure. As far as possible benefits from supplements and foods such as cocoa, coenzyme Q10, fish oil and garlic go, the report notes, “The evidence is very limited and sometimes conflicting.”

Medications are the next step toward controlling blood pressure. Getting the

best combination can take some time.

Among the most commonly prescribed are diuretics that help the body shed excess water and sodium; beta-blockers which slow the heart rate, reducing the heart’s workload; and ACE inhibitors and ARBs which help to relax the arteries and allow blood to flow more freely.

For a small subset of patients, surgi-

Lanz is grateful to his medical team — his primary care physician, a pharmacist and a nurse — at the VA for helping him get his hypertension under control. Originally prescribed an ACE inhibitor called lisinopril, Lanz developed a dry cough, which is a common side effect. He was switched to a calcium channel blocker.

“That did the trick,” he says. When his

“It depends on how committed they are to getting better.” cal intervention may offer help. In people whose blood pressure is elevated by narrowing of the arteries that supply the kidney with blood, or in cases in which there’s a plaque-like build up in the renal arteries, treatment with renal angioplasty and stenting is possible. Studies of renal denervation in patients whose blood pressure doesn’t respond to other treatment have been disappointing, says cardiologist Katz.

home monitor showed his blood pressure was beginning to rise, his team at the VA was able to download and record his data, adjusting his medication accordingly. Lanz, who works at the VA as a nuclear medicine technician, praises the comprehensive approach his care team took toward controlling his high blood pressure: “What they do for us vets is phenomenal.” 

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HEALTHY HEART

A Heart-to-Heart with Amy Doneen

BY ANNE McGREGOR

“A

lot of people wonder how that could have happened to Princess Leia?’ says Amy Doneen. “Why did Tim Russert have a stress test and die a week later?” asks the medical director of the Heart Attack & Stroke Prevention center and adjunct professor at Texas Tech Health Sciences Center.

She thinks she knows the answer. They, and millions of other Americans, suffer from cardiovascular disease that hasn’t been effectively diagnosed and managed.

As an example, she notes that while cardiac stress testing has good diagnostic value, it may create a false sense of security.

That’s because stress tests are considered “normal’ unless there’s evidence that blood vessels are 70 percent or more occluded.

Yet, she says 86 percent of heart attacks occur in people whose vessels are less than 70 percent occluded.

“If you are told you are OK, are you

really OK?” she asks. “I don’t think the [risk factor] guidelines are good enough. They lag about 20 years behind the research.”

Moreover, because insurance reimbursement follows current risk factor guidelines, simple tests to find out if you are silently developing cardiovascular problems, “subclinical disease,” probably aren’t covered, and may not even be offered to you by your physician as a result. But assembling a better picture of your health is something that, together with your doctor, you can tackle.

Doneen recommends first getting educated about cardiovascular disease. Here are the basics: Imagine that your blood vessels are like a garden hose. Plaques form inside the rubber itself, not on the inner wall of the vessel, says Doneen. Over

Is your reading accurate?

Some clinics and most home blood pressure monitors are digital devices that may use manual or automatic inflation.

Digital instruments may use a cuff placed around the upper arm, the wrist or a finger. A 2014 study of more than 200 patients at an Ottawa nephrology clinic revealed the home devices’ significant limitations. “An important proportion of home blood pressure monitors used by patients seen in our nephrology clinic were inaccurate. A re-validation of the accuracy and safety of the devices already in use is prudent before relying on these measurements for clinical decisions,” write the study’s authors.

Even in-office measurements using manually inflated monitors can be thrown off if the cuff isn’t placed correctly, over bare skin. If the cuff is deflated too rapidly, or if talking or other noice occurs during the reading, it can also skew the results.

— ROBIN HAMILTON BRODT

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the years, plaques, often incited by various inflammatory processes, grow and begin to protrude into the vessel wall, and may eventually rupture. The body recognizes the injury and “scabs” over the protruded area, forming clots. If a clot dislodges and ends up in your heart, it can cause a heart attack; in your brain, it can cause a stroke.

The good news? “It is very treatable.

There’s lots that can be done,” she says.

So are you at risk? Here are six things to consider:

1

Inflammation anywhere in your body is your enemy. That means if you suffer from chronic inflammation, as a result of conditions like rheumatoid arthritis, psoriasis or even tooth and gum disease, you face an increased risk for plaque development in blood vessels.

2

Your family history offers clues. But don’t just look for family members who have had heart attacks or strokes. Dementia, diabetes and kidney disease can also be a sign of potential cardiovascular trouble in your family tree. To get even more information, Doneen recommends genetic testing (ranging from $40 to $100) that will reveal your individual risks.

Doneen uses five genetic tests, which only need to be done once in your life, to better understand your risk factors and, importantly, reveal optimal treatment strategies, including which medications and diets are uniquely suited to you.

3

What’s your blood pressure? High blood pressure, now classified as an average greater than 140/90, inflicts a battering on vessel walls. But new studies show that aiming to reduce blood pressure even more, to 120/80 or lower, may be optimal. Monitoring your own blood pressure, and providing your health care provider with your numbers, is critical.

4

Is there evidence of plaque growing in your vessel walls? Two tests are available to assess that. One is a test called “coronary artery calcium scoring” — it’s a CT exam of the heart that requires a doctor’s order. During the month of February, Inland Imaging offers the test at a special rate of $100 (it’s $281 normally). The other test is an ultrasound scan

total cholesterol by the good cholesterol (HDL).

It is best to have a ratio less than three.

Your LDL level should be less than 100, or less than 70 if you’ve had a prior heart issue.

6

Are you insulin-resistant? “About 70 percent of people who have had a heart attack or have plaque in the arteries have this,” says Doneen, and the condition is often not identified until someone receives a diagnosis of type 2 diabetes, meaning years of damage may have already been done. But it’s not hard to find out if you are insulin-resistant, long before symptoms surface. You just need a glucose tolerance test, which Doneen says costs about $20 and requires a couple of hours of your time. Your fast-

“If you are told you are OK, are you really OK?” called a carotid intima media thickness test (CIMT) that looks for evidence of plaques in the vessels in your neck.

5

Know your lipid numbers. It’s not total blood cholesterol that matters so much as your ratio, says Doneen.

To figure out your crucial ratio, divide your

ing blood sugar should be less than 100.

Blood vessels take a beating when blood sugar is chronically high, although not everyone agrees what “high” is. “In Europe, your blood sugar has to be over 115 to be diagnosed with type 2 diabetes,” Doneen notes. “Fly to the United States, you have to be 126 to be diagnosed.” 

Sleep Apnea and Blood Pressure

Not sleeping? Your blood pressure could be part of the problem. A small study published in September 2016 in the American Journal of Physiology by researchers at the University of British Columbia at Okanagan shed light on the issue.

In the study, 10 healthy volunteers wore breathing masks allowing researchers to manipulate oxygen levels while the volunteers slept, mimicking sleep apnea. After just one night, the body’s ability to regulate blood pressure was impaired.

The American College of Cardiology calls sleep apnea and high blood pressure a “dangerous pair.” Estimates indicate that as many as 50 percent of people with hypertension may also have sleep apnea. Diagnosing and treating sleep apnea can be especially helpful for patients with resistant hypertension — those who find that medications and lifestyle changes aren’t enough to lower their blood pressure.

— ANNE McGREGOR

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LIVING

Soup, Glorious Soup COOKING

Clover chef Travis Dickinson (front) and sous chef Cody Geurin. YOUNG KWAK PHOTO

Step aside, juicing: Soup is the new way to pack nutrients into your meals

BY TARYN PHANEUF

W

ithout a doubt, a hot bowl of soup comforts and warms us when the weather is less than optimal. But even more than being an inexpensive and quick option for meals, soup can help meet important health goals without sacrificing flavor or variety.

Easily loaded up with vegetables, soup can deliciously incorporate a variety of ingredients to combat diet-related diseases. And it can help you lose weight — studies indicate that people who eat broth-based soup end up consuming about 20 percent fewer calories, says Terry Perry, director of kitchen programs at Second Harvest in Spokane.

“Soup has always had really great benefits,” she says. “It’s inexpensive, it provides so many nutrients. I think it’s great.”

Whether you’re trying to lose weight or simply approach food more thoughtfully, soup is a good option, adds Nikki Strong, a Spokane-based nutrition coach and registered dietitian.

“I think it gives people an opportunity to mix in some extra vegetables.

One of my favorite aspects of soup is it encourages mindfulness while you’re eating,” she says. “Because it’s hot, it slows you down, which is a key component for people who are trying to lose weight.

“So much of what we do is graband-go, so we end up eating a bunch of calories without really thinking about it. Eating something slower makes you check in and be more aware of what you’re putting into your body.”

The Healthiest Diet ?

While diet fads come and go, one thing that seems persistent is the drumbeat to increase the number of servings of vegetables and fruits we consume each day. Recent research into the healthiest diet for the heart, called the OmniHeart (Optimal Macronutrient intake) diet ...continued on next page FEBRUARY - MARCH, 2017

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LIVING “SOUP, GLORIOUS SOUP,” CONTINUED... study found that adherents lowered blood pressure and improved blood lipids by following any of the three diets studied — one emphasized carbohydrates, one emphasized protein, and one emphasized unsaturated fats. The protein and unsaturated fat diets both produced longer-term cardiac risk reduction. But all three diets included generous amounts of vegetables and fruit each day — ranging from 9 to 11 servings.

Getting in the recommended servings of fruits and vegetables — not to mention whole grains, nuts, beans and other food groups — can be challenging, especially when coupled with efforts to reduce sodium, sugar and saturated fats.

Soup, however, offers a foolproof way to pack in macronutrients. Using vegetables, herbs and spices, legumes and grains, it’s possible to create enjoyable flavors in a dish packed with nutrients.

It’s not magic: “If you hate a vegetable,

I wouldn’t put that in your soup,” says Strong. “Make it so you’ll actually want to eat it. Look for a variety — things with a lot of color, such as spinach and dark carrots and things like that,” Strong adds. “The more you can add in there, the better.”

With practice, soup can be an easy way to use leftovers or pantry staples, Perry adds. Smaller servings of meat and vegetables that are starting to look a little sad are revived when mixed with broth and a can of beans. Just keep the rice, noodles or barley in balance, so the soup doesn’t go overboard on carbohydrates, crowding out other ingredients.

Whatever combination, whether following a recipe or relying on instincts, homemade soup is almost certainly better than the canned varieties.

“A lot of the soups you’re going to buy out of a can have a lot of extra sodium and preservatives that your body doesn’t really need,” Strong says.

Soup isn’t solely about vegetables,

Hope You’re Hungry!

Dan Dan Noodles from Blackbird — one of more than 100 restaurants participating in Inlander Restaurant Week. YOUNG KWAK PHOTO

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nland Northwest chefs have been busy envisioning, creating and taste-testing hundreds of dishes to dazzle the palates of area diners during the 10 days that make up Inlander Restaurant Week, Feb. 23 to March 4.

Pick up the Inlander on Feb. 23, or visit inlanderrestaurantweek.com, and then settle in to make some tough decisions as you peruse the three-course dinner menu options from more than 100 restaurants, priced at $19 or $29, depending on the restaurant. Don’t miss

the drink specials on locally crafted beer, wine, cider, spirits and coffee.

From Coeur d’Alene to Liberty Lake to Spokane Valley to every corner of Spokane itself, transformative meals await diners during this special event that benefits Second Harvest food bank.

— ANNE McGREGOR

though. Strong and Perry recommend broth-based soups to add flavor and avoid the extra fat and calories of cream. Even more, they recommend making your broth from scratch — an easy technique that involves simmering roasted animal bones in water with some vegetables and seasonings.

The process draws out nutrients from the bones, and combined with the flavors from the vegetables, creates a perfect substitution in any recipe that calls for water.

Homemade broth has the added benefit of containing less sodium and being less expensive than store-bought versions.

“It’s so simple to make your own broth,” Perry says. Throw in onion, celery, and carrots to simmer with the bones for extra flavor. “And there you have the same base as expensive restaurants.”

Good Bones

Coeur d’Alene’s Astrid Rial (aka, the Cycling Chef) started making bone broth just two years ago but she loves talking about it so much — and inspires the friends she talks to so effectively — that she’s considered a local expert on the subject.

From September to April, she has a crock pot full of liquid simmering at all times. She stockpiles bones from whole chickens barbecued in summer, ventures to the butcher shop to ask for the pieces that would normally be tossed out, or culls bones from wild game hunted by friends.

Bags of surplus pork, beef and chicken broth are labeled and stacked in her freezer.

At first, she followed recipes for broths that simmered for a few hours. But as her interest expanded, her research took on greater depth, including a book published in 2014 called Nourishing Broth: An OldFashioned Remedy for the Modern World, which included a recipe that called for leaving the bones simmering for four to five days. She didn’t even know if her crock pot could handle cooking overnight, but she decided to try making a broth with lamb bones.

“I put them in around 6 o’clock at night. We woke up in the morning and we came downstairs and my kitchen smelled medieval,” she says. “The smell was just amazing, and that had just been after it cooked for about 12 hours. It was creamy and the texture of it was amazing. I let it go for three days the first time. The flavor is just very deep when you let it go for a long time.”

The method is known as perpetual broth. She leaves a ladle and a strainer next to the crock pot to scoop out and use ...continued on page 34

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RECIPE

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Clover’s Italian Wedding Soup This soup is a versatile and delicious way to include any seasonal vegetable, with or without meat. Clover sous-chef Cody Geurin says he has also made this soup with a variety of beans, grains or noodles.

4 ounces bacon, diced 8 ounces Italian sausage 2 medium leeks, whites only 1 medium parsnip 1 medium carrot 3 ribs celery ½ head fennel 6 cloves of garlic, sliced thin 1 medium poblano chile 1 medium red bell pepper 4 ounces tomato paste 4 ounces sherry 24 ounces tomato juice 3 quarts stock, chicken or veggie 2 medium Yukon gold potatoes, peeled and diced 1 Delicata squash 1 cup garbanzo beans, soaked and cooked separately 1 bunch kale 1 tablespoon cumin 3 bay leaves

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1 teaspoon smoked paprika ½ teaspoon mustard powder In a separate pot, cook soaked garbanzo beans in salted water to desired texture. Al dente is perfect, as they will continue to cook in the soup. Dice all veggies to half-inch. In a heavy bottom pot, render bacon over medium heat, until halfway cooked. Add sausage, brown. Add mirepoix (leek, celery, carrot, parsnip); cook till the mix begins to soften. Add fennel, peppers and garlic and cook till softened. Stir in tomato paste and continue to cook for 2 minutes, stirring to avoid scorching. Deglaze with sherry and cook until thickened by the paste. Add stock and tomato juice; bring to simmer. Add dry spices, cooked beans, potatoes and squash; cook until potatoes are soft but not mushy (about 20 minutes). Add kale, cook for an additional 5 minutes. Season with fresh herbs, kosher salt, and pepper.

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LIVING-MAIN inhealth 02-06-2017.indd 33

Health 33 1/25/17 5:28 PM

LIVING RECIPE

Second Harvest’s One Pot Bean Lentil Chili

Want to learn to make soup at home? Second Harvest is offering a Hearty Homemade Soup class on Thursday, Feb. 23. Register online at secondharvestkitchen.org.

1 can beans (pinto, black, kidney, red or

black-eyed) not drained ½ cup cooked lentils ½ 15-ounce can diced tomatoes ½ cup vegetable or chicken stock 1 tablespoon chili powder 1 tablespoon ground cumin 1 teaspoon dried oregano ¼ teaspoon salt ¼ onion, diced ½ bell pepper, diced ½ zucchini, diced ½ carrot ½ cup corn, frozen or fresh ½ cup shredded cheddar cheese Combine all ingredients in a medium-sized saucepan over medium heat. Bring to a simmer. Stir often, keeping on a simmer for 30 minutes, allowing the flavors to develop

and the chili to thicken. Top with shredded cheese and tortilla strips. Serves 3 TORTILLA STRIPS 6 tortillas Pan spray Preheat oven to 350 degrees. Cut tortillas into ¼-inch by 2-inch strips and place on a sheet pan lined with parchment paper.

Lightly spray the strips with pan spray and bake until golden brown.

“SOUP, GLORIOUS SOUP,” CONTINUED... some whenever she needs it. After a wet afternoon at soccer practice, her 13-year-old son requests a cup when he gets home. He also likes it as a savory cup of tea with his breakfast in the mornings, says Rial, who uses it to cook soups, stews and chowders during the cold months.

“As you take broth out of the pot, you add more water and it just keeps simmering,” she says. At the end of the week, she strains and freezes whatever is left over.

“When you let it go for four or five days, the intensity of the flavor and the color of it becomes this beautiful, rich brown broth.”

Teri McKenzie, founder of the Inland Northwest Food Network, most appreciates the lightness of bone broth during a time of year that is often known for heavy foods.

Her interest in making her own broth grew with her work with local ranchers. As she met more people raising animals in the way that fit with her values, she was willing to expand her diet to include red meat for the first time in more than 25 years.

“I love soup, it’s really nourishing and nurturing,” she says. “Obviously soup is a ...continued on page 37

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RECIPE

The Cycling Chef ’s Bone Broth

Astrid Rial of Coeur d’Alene is known locally as “The Cycling Chef.” She’s been experimenting with long-simmering broths — measured in days, not hours — and recommends this recipe, which offers plenty of ways to make it all your own.

1 chicken or turkey carcass (organic, pasture-raised) or 2-3 marrow bones (beef, pork, lamb, elk, goat, etc. (preferably organic and/or pasture-raised)

Optional vegetables: 1 onion, quartered; 1-2+ large carrots; 2-3 celery sticks (roughly chopped); ¼ cabbage (roughly chopped); 4-5 cloves of garlic

2 tablespoons of apple cider vinegar

Filtered cold water (enough to cover contents + more for evaporation losses)

1-2 bay leaves 1-2 tablespoons of peppercorns Salt, to taste Fresh or dried herbs, to taste: thyme, rosemary, parsley, sage, etc.

Whole spices of your choice (as many as you like): galangal, black peppercorns, allspice, juniper berries, whole dried turmeric root (or fresh), fresh ginger root, mustard seeds, etc.

Roast bones for 30 to 45 minutes in 350° oven. Cover ingredients with cold/room-temperature water in a crock pot. Simmer on low for 1 to 5 days. Remove from heat and strain and use as a base for any soup or sip by itself.

Add fresh herbs like parsley, dill or cilantro just before serving.

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Health 35 1/25/17 5:28 PM

LIVING RECIPE

The Kitchen Counter’s Ginger Curry Carrot Soup “This is a simple but flavorful soup that is perfect for a cold winter day,” says Patty Brehm, owner and chef at the Kitchen Counter in Moscow, Idaho. “The ginger and other spices in the curry are good immune boosters. It’s also a great way to clean out your fridge. Throw in any spare vegetables you have!”

2 tablespoons coconut oil 1 onion, diced 1 tablespoon grated ginger 1 tablespoon yellow curry (whichever curry blend you prefer) 1 tablespoon sea salt 4 pounds carrots, peeled and chopped in 1-inch rounds 2 pounds Yukon gold potatoes, 1-inch diced Sauté onion in coconut oil on medium-low heat until soft, but not browned. Add ginger and sauté until fragrant. Add curry powder and cook for a minute or so, allowing the oils in the powder to come out (or “bloom” in culinary terms). Add carrots and salt, cook until the carrots start to sweat and soften (that’s when they release all their sugar, giving you a more flavorful soup). Add potatoes and water to cover by an inch or so. Bring to a low boil, then simmer until potatoes and carrots are cooked through. Blend and season to taste. If you prefer a thinner soup, add water or milk. The soup will continue to thicken as it sits. For a spicier soup, add red pepper flakes when you add the curry powder. Serves 8

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“SOUP, GLORIOUS SOUP,” CONTINUED... key food for this time of year here. Bone broth is one of those types of food I’d recommend people eat and … use our local meat — elk or venison. Or beef or chicken.

And I love the idea that it’s not wasting.

Nothing is wasted in the animal, then.

That’s another reason to support it.”

She uses her broth in soups with beans and vegetables that change with the season.

In winter, she relies on root vegetables and kale. Or she goes another direction, using the broth to make pho — a meal her family has used as a cold-weather superfood for a long time.

“If somebody got the flu or got the bad cold, we would go and buy it,” she says.

“It was such a cure-all. It seemed to be so healing.”

But is it? Some nutritionists and food scientists are skeptical of any claims that bone broth is, in fact, healing. But it does provide a source of nutrients, including amino acids, calcium and protein, that may be lacking in someone’s diet.

Perry says broth packs in extra nutrients, but it’s really just one piece of a well-built meal.

“That broth is beneficial,” she says.

“But the more veggies you add to it, the more beneficial it’s going to be.”

Humble to Haute

At Clover in Spokane, soup can be a nostalgic affair or an $8 adventure in fine dining — from a cup of traditional tomato soup with a grilled cheese sandwich for lunch to a creamy mushroom soup garnished with goat cheese and duxelles (a deliciously fancy term for chopped mushrooms, shallots and herbs sauteed in butter).

Clover chef Travis Dickinson says soup is an easy, rotating item on the menu because it leaves so much room for experimentation, while also relying on the quality, seasonal ingredients that the restaurant is known for.

He likes simple recipes focused on a single puréed vegetable, like cauliflower, just as much as a chunky soup with a variety of veggies. Putting something new together is fun and easy when all it takes is rummaging through a stock of beautiful foods.

“The big focus is keeping it seasonal — keeping it exciting,” he says.

Home cooks can take a similar ap-

SCHEDULE A LITTLE FACE TIME.

proach, using soup as a menu item that changes with the seasons and moods of the meal. The point is that soup can be easy. Many grocery stores offer prechopped ingredients that can be thrown right into the pot, and frozen vegetables work just as well as fresh ones.

For busy families, cooking from scratch can be daunting. But making it a team effort, using tools like a crock pot, and keeping a few servings in the freezer to pull out at the end of a long day can make it less intimidating and impact more than a family’s health. It can be difficult to get children to eat vegetables, but when they have a hand in preparing dinner, they are usually more excited to eat it, Perry says. Spending time together in the kitchen often gives way to conversation and socializing that feeds the soul as much as the stomach.

“I think that sometimes the adult in the family gets a little overwhelmed coming home and thinking about making dinner and doing it all themselves. We’ve forgotten about including other members of the family,” she says. “By sharing the responsibility, it’s not so much work and it becomes an enjoyable experience.” n

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FEBRUARY - MARCH, 2017 LIVING-MAIN inhealth 02-06-2017.indd 37

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LIVING

PARENTING

Gaming Strategy Help for kids who can’t seem to shake video gaming

BY TARYN PHANEUF

O

ver the years she’s worked specifically with people addicted to digital technology, Cosette Rae, a social worker, has noticed a troubling pattern. In the hundreds of calls answered daily at reSTART, the technology addiction center near Seattle she helped start in 2009, the people seeking help keep getting younger.

“Instead of college-age students, we’re getting calls from parents with kids as young as 8 and 6,” Rae says. “When we had started, the problem was starting to emerge with late high school and collegeage kids. Now we’re introducing technology to younger and younger children. The problem is starting to emerge earlier in the psychological development of childhood.”

Rae is CEO of reSTART, where a staff of mental health professionals works to meet the challenges of treating adolescents ages 13 to 17 who show signs of addiction to the internet, video games and other digital technology. In November, reSTART launched the first adolescent treatment program at its Serenity Mountain campus —

32 acres in Startup, Washington, with two residential care homes staffed with professionally trained clinicians.

The program was sought by parents for years, Rae says. They call with questions about children who, for example, have lost interest in all their usual activities, stopped eating dinner with the family and fallen behind and lost interest at school where they used to excel. Instead, parents battle outbursts at the slightest suggestion that it’s time to set aside the gaming console or cellphone.

“I don’t get calls from parents who are saying, ‘He just spends too much time online.’ It’s a whole group of things,” she says.

“It becomes a big battle. They become policemen. It becomes kind of the meltdown of the family.”

Known as “internet gaming disorder,” this kind of addiction is not included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM. But the APA has indicated it is a “condition for further study.”

Rae believes it will be officially recognized

within the next couple of years.

The unofficial disorder is most common among males ages 12 to 20, according to the latest edition of the APA’s manual.

Under the definition, internet gaming becomes a disorder when use starts to impact basic human functions. Rae says that could mean it’s affecting academics, health or relationships.

Daisy O’Dell, a marriage and family therapist in Spokane who has seen this disorder show up as a symptom in families experiencing other issues, says that gaming dependency looks and acts like other forms of addiction. She explains how it can develop.

“Because of the way gaming activates the reward center of the brain, anyone can be susceptible in creating a dependency when engaged in excessive amounts,” O’Dell says. “Video gaming has the ability to release the ‘feel good’ chemicals, dopamine and serotonin, in the brain.

Anytime we experience a release of these chemicals, we want more of whatever we experienced.”

These chemicals are released all the time through exercise, learning and connecting with others.

“What is tricky about how video games release feel-good chemicals, is that they introduce an intermittent reward process while in play. Meaning that our brain doesn’t know exactly when we will reach our goal or complete our task, therefore the pursuit and anticipation of reward becomes a part of the excitement,” she continues.

“This process mirrors that of gambling behaviors. The brain is engaged in a way that solicits more play, more risk, more investment in pursuit of the reward.”

T

here are certain indicators of a problem: The person grows preoccupied or obsessed with gaming.

They have withdrawal symptoms when they’re not playing. They need to play more and more to get the same thrill, because they develop a tolerance. It’s become the thing in their lives — more important than relationships or other obligations, even when they recognize its impact.

O’Dell says some people are at higher risk of developing dependency because of other mental health issues, including anxiety, depression or ADHD. Rae says parents are made to believe the solution is as simple as unplugging the device.

“What many of us don’t understand is that [gaming addictions] change the brain.

They change the brain in a very powerful way,” she says, referring to building toler-

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1/25/17 5:30 PM

GETTING HELP

Worried that your child is overusing digital media? ReSTART lists a number of behaviors to look for to recognize computer or screen addiction. If a person exhibits three to four of these behaviors, that may suggest abuse. If five or more apply, it may suggest addiction.

Spends increasing amounts of time on computer and internet activities Fails attempts to control behavior Experiences a heightened sense of euphoria while involved in computer and internet activities Craves more time on the computer and internet

ance and feeling withdrawal. “Parents don’t see that that’s what they’re dealing with. It acts like a substance.”

But it’s a substance that everyone is using and few people are thinking critically about. Combine that with the place digital technology has come to occupy in society, and it’s not really feasible to tell someone

Neglects friends and family Feels restless when not engaged in the activity Is dishonest with others Computer use interferes with job or school performance Feels guilty, ashamed, anxious, or depressed as a result of behavior Sleep patterns change Experiences physical changes, such as weight gain or loss, backaches, headaches or carpal tunnel syndrome Withdraws from other pleasurable activities For more information, go to netaddictionrecovery.com.

who overuses to just quit. That’s why mental health professionals at reSTART focus on education to help patients develop the knowledge about themselves to better regulate their use of technology. Rae’s aim is to see this kind of curriculum used to prevent overuse.

“We all face this,” she says. “We need

to find strategies and ways to understand what we’re dealing with. A problem understood is half-solved.”

Adolescent services include a short-term intensive assessment program and a longterm therapeutic program. During the first phase, clinicians use assessments to get to know the person and understand the problem. Treatment means being completely unplugged for a while to address health issues like poor sleep and eating habits. Education on addiction — including its biological and societal impacts, and lessons on big data and privacy issues — fill kids’ days. They also work with a therapist to address other mental health issues, such as depression or aggression. Throughout the process, clients work toward building a plan to establish a healthier relationship with digital media.

“We’re excited because we feel that the missing piece is this: As a society, tech has slowly been emerging over decades. We didn’t see it and say, ‘Let’s analyze how this affects us.’ We just fell in love with it and embraced it, and ran with it at the expense of many children with our family,” Rae says. “Now we’re seeing the effects of embracing tech without understanding the risks and the benefits.” n

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FEBRUARY - MARCH, 2017 LIVING inhealth 02-06-2017.indd 39

Health 39 1/25/17 5:30 PM

LIVING ALT MEDICINE

Rub-on Pain Relief Topical CBD offers relief users swear by

BY ROBIN HAMILTON BRODT

Some of the CBD oils currently on the market

S

tep aside, Ben-Gay. Move on, Arnica gel. There’s a new rub-on pain reliever around. If you’re just hearing about cannabidiol – also known as CBD — but are still on the fence because of its connection to marijuana, fitness guru Ben Greenfield would like to put your mind at rest.

“The regular customers are chronic pain sufferers, and they say CBDs really help.”

Greenfield, who makes his home in Spokane Valley, is the author of the New York Times bestseller Beyond Training: Mastering Endurance, Health & Life, and, in 2008, was voted the National Strength and Conditioning Association’s Personal Trainer of the Year.

“I recommend CBDs to reduce inflammation postworkout, to reduce any toxin-related inflammation and to improve hormonal balance in the body,” Greenfield says, noting he’s also rubbing CBD on his sore shoulder at the time. “In higher doses it’s very useful for sleep, stress and managing depression.”

Because topical CBD preparations may be manufactured so that they contain little or no THC (the chemical compound that produces a “high” in marijuana), Washington state law permits them to be be sold outside of marijuana dispensaries.

“We’ve been carrying CBDs at Main Market for quite a while. But I think customers are just beginning to hear about its benefits and are seeking it out,” says Jill Herrera, the wellness manager at Spokane’s Main Market Co-op.

“I see a lot of people in their 40s and older — also people in their 20s — but more of those who have chronic back pain, foot pain, sciatica, headaches, definitely chronic pain. A lot of people are first-timers, interested in getting off of conventional meds. But the regular customers are chronic pain sufferers, and they say CBDs really help,” says Herrera. ...continued on page 42

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1/25/17 5:30 PM

INDISPENSABLE INLANDERS know that no story is one-sided — no issue is cut and dried. That’s why we believe great journalism makes a great community. But we also believe that no weekend should go unfilled. So we get the word out about where good times can be had, all over the region.

With nearly 200,000 of the most loyal readers in the country counting on us every week, we know this is a big job.

But we’re up for it, because we’re Inlanders, too. And it’s our mission to keep pumping out a must-read newspaper that helps cultivate the informed, creative community we call home.

I N L A N D E R .CO M / I N D I S P E N S I B L E

FEBRUARY - MARCH, 2017 LIVING inhealth 02-06-2017.indd 41

Health 41 1/25/17 5:48 PM

LIVING “RUB-ON PAIN RELIEF,” CONTINUED...

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She’s using a CBD tincture herself these days due to an ankle injury. “I rolled my ankle badly while I was dancing,” she says sheepishly. “It was totally black and blue and really swollen.”

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Spokane Valley trainer Ben Greenfield: CBD is “very useful for sleep, stress and managing depression.”

She started out using ibuprofen, she says, but worried about its long-term effects on her stomach.

“I still wanted some relief from the swelling and the pain. I take the CBD tincture several times a day — and that’s key. As with any herbal medicine, you have to follow the directions and, if you’re in an acute state, take it several times a day.”

In addition to Main Market, marijuana dispensaries and other cannabis retail stores sell CBDs in topical form, as a tincture or as a transdermal patch.

At The Source CBD, a Spokane CBDonly store, owner Shaun McHenry sees people of all ages buying CBD oil and tinctures, while topicals seem especially appealing to boomers.

“They use it for conditions like eczema and restless leg syndrome,” McHenry says.

“And I see more older people using topicals as a monthly medicine.”

So is there much science to back up CBD as an topical treatment? As with most claims related to marijuana or hemp-based products, although anecdotal reports and testimonials abound, rigorous research about the products is still scant. 

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LIVING FEBRUARY - MARCH EVENTS BLOOD DONATION | Give blood at the Inland North-

west 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; TueThu, 11 am-6 pm. inbcsaves.org (423-0151)

safety tips and discuss passenger safety laws. Appointments available on Feb. 1, 8, 15, 22 and March 1, 8, 15, and 22. Free. Before your appointment, email Renee.Witmer@providence.org with your child’s age, weight, height, your vehicle year and model, and the reason for your check. Checks provided at the Sacred Heart Children’s Hospital, parking garage, Seventh and Division. (844-1854)

SECOND HARVEST FOOD SORTING | Join other volun-

PAIRING WITH PARASPORT | Join the local nonprofit

teers 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)

CAR SEAT INSPECTIONS | On-site technicians make sure that families’ car seats are safely installed, offer

Coming up in the

providing professional coaching and athletic opportunities for local para-athletes for its inaugural auction fundraiser, featuring Barrister Wineries wine and heavy hors d’oeuvres during an evening of celebration and storytelling. Sat, Feb. 4. $45/person, $80/ pair. Barrister Winery, 1213 W. Railroad Ave. parasportspokane.org/events/pairing …continues on next page

INLANDER RESTAURANT WEEK GUIDE | February 23rd

BEST OF THE INLAND NW READER’S POLL RESULTS March 23rd CHARITY CORNER

Will Run For Food

G

et your legs and lungs ready for the Inland Northwest’s busy running season — including Bloomsday — by participating in the second annual 5K Hunger Run supporting the Union Gospel Mission and Second Harvest. Back for a second time after an incredibly successful inaugural year in which more than 700 participants turned out, the Hunger Run also features a new 10K route for the more motivated athletes out there.

“This is designed to again promote hunger awareness in the community, and it shows two charities with different organizational structure working together in collaboration to address a common issue prevalent in our community,” explains UGM development director Wil Wilhem.

Runners and walkers of all ages and fitness levels can choose from a 5K (3.1 miles) or 10K (6.2 miles) route that starts and ends at Plante’s Ferry Park, a new location this year that allows for the addition of a longer route.

“Our hope is that this run continues to grow, and draw attention in the community about hunger and the solutions that our agencies do to address that. It’s an opportunity for individuals to come out and do their best time in a 5K or 10K, but also to get people who might not otherwise exercise or run to come out and experience,” Wilhelm says.

Registration for the event is now open, offering discounted rates if you register before March 15.

— CHEY SCOTT The Hunger Run • Sat, April 1, at 9 am • 5K: $30$40; 10K: $40-$50 • Plante’s Ferry Park • 12308 E. Upriver Dr., Spokane Valley • thehungerrun.org

THE ECO ISSUE April 20th PICK IT UP FREE EVERY THURSDAY! FEBRUARY - MARCH, 2017

CAL-DIR-PEEPS inhealth 02-06-2017.indd 43

Health 43 1/26/17 4:41 PM

LIVING FEBRUARY - MARCH EVENTS INBODY 570 TESTS | INHS Community Wellness has

A HEALTHY START TO A HEALTHY HEART | A session offering information on foods and other wellness practices to keep your heart healthy in the long run, facilitated by diabetes educator and registered nurse Debbie Belknap. Online course on Feb. 16, at noon. Free. Register at wellness.inhs.org.

a machine available to the public which provides a complete picture of body composition, including weight, body mass index, body fat mass, basal metabolic rate and more. Appointments available on Feb. 6 and 21, March 8 and 23, April 4 and 19. $20/test. INHS Community Wellness Center, 501 N. Riverpoint Blvd., Suite 245. wellness.inhs.org

ADULT HEARTSAVER CPR & AED CLASS | A session

covering how to provide CPR to adults and children, how to use an Automated External Defibrillator, and how to help a choking victim. Offered on Feb. 17 and March 17, from 9 am-1 pm. $40. Providence Medical Park, conference room, 16528 E. Desmet Ct. washington.providence.org (474-2400)

ADVANCED CARE PLANNING | This session offers

tips and advice for completing an advance directive in the case of a sudden illness or injury that may leave you unable to speak for yourself. Sessions offered Feb. 7 and March 7, from 11:30-noon. Sacred Heart Medical Center (6 North Day Room), 101 W. Eighth. washington.providence.org (474-2296)

GO RED FOR WOMEN | The American Heart Asso-

ciation’s annual awareness campaign brings attention to heart disease, the leading cause of death in women. The luncheon includes an auction, health screenings, an expo, fashion show and keynote by educator and registered nurse Joey Traywick. Wed, Feb. 22, at 10 am. $125/person. Spokane Convention Center, 334 W. Spokane Falls Blvd. bit.ly/2jltDeA

A TASTE OF HOPE | The ISAAC Foundation’s ninth

annual benefit event features samplings of wines, beers, spirits, chocolates and specialty foods, while raising money to fund therapy grants for local children diagnosed with autism. This year features a Harry Potter theme. Fri, Feb. 10, at 6 pm. $65/person or $650/table of 10. Center Place, 2426 N. Discovery Pl., Spokane Valley. theisaacfoundation.org

SALAD LAB | In this hands-on class, experiment with a wide range of greens — from iceberg to arugula — and sample oils and vinegar for making quick, versatile dressings. Learn how to mix with other taste and textural components to create new salads with every season. Thu, Feb. 23, at 5:30 pm. $45/person.

The Kitchen Engine, 621 W. Mallon. (328-3335)

INFANT/CHILD CPR CLASS | A class to teach steps

that could be lifesaving, including CPR and how to save a choking child. Also covers basic first aid for children, when to call 911 and basic newborn care. $30/two attendees. Offered Feb. 11, Feb. 25, March 11 and March 25, from 1-4 pm at Providence Sacred Heart Medical Center (101 W. Eighth; in the Avista Classroom), and on Feb. 15 and March 15, from 5:30-8:30 pm at Providence Medical Park, 16528 E. Desmet Ct. washington.providence.org (474-2400)

TASTE SPOKANE | The annual event benefiting the

UNION GOSPEL MISSION VOLUNTEER ORIENTATION

| Learn about opportunities and services offered at monthly orientation events. Feb. 14 and March 14, at 6 pm, at the Spokane and CdA shelters; Feb. 28 and March 28, at 6 pm, at the Spokane shelter only.

UGM Coeur d’Alene (Center for Women & Children) is located at 196 W. Haycraft Ave. UGM Spokane is located at 1224 E. Trent. Volunteer sessions for Anna Ogden Hall, 2828 W. Mallon, on Feb. 10 and 24, March 10 and 24, at 1 pm. uniongospelmission. org/events (535-8510 x 2 or 208-665-4673)

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Spokane Convention Center, 334 W. Spokane Falls Blvd. kidsatheartcharitylunch.org (474-4643)

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time for the 41st running of the Lilac Bloomsday Run with hosted community training clinics, offering graduated conditioning and supported training courses. March 18-April 29, Saturdays at 8:30 am.

Free. Meets at Spokane Community College Gym, 1810 N. Greene. bloomsdayrun.org (474-3081)

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, March 25, at 9 am. $40. St. Luke’s Rehabilitation Institute, 711 S. Cowley. Wellness.inhs.org

HONORING CHOICES | A class to help attendees through the process of advanced care planning, including how to have effective conversations about your values and beliefs for future health care. Tue, March 28, at noon. Free. INHS Community Wellness Center, 501 N. Riverpoint, Ste 245. wellness.inhs.org SPOKANE BIKE SWAP & EXPO | Community members can sell their used bikes and gear, shop for used bikes and from booths hosted by local vendors. Donate a bike and get free admission. Sat, April 8, from 9 am-5 pm. $5 registration per bike to sell at the event. Spokane County Fair & Expo Center, 404 N. Havana. spokanebikeswap.com

KIDS AT HEART | The annual luncheon, hosted by

NEGATIVE SPLIT HALF MARATHON | The annual, locally organized race is back, offering half marathon, 5K and 10K distances. A portion of proceeds benefit the Spokane HOPE School’s programs and services.

Sun, April 9, at 9 am. $30-$85. Route starts/ends at Kendall Yards. nsplit.com

the Providence Health Care Foundation, raises funds to support Sacred Heart Children’s Hospital’s mission in a fun format, and recognizes local advocates of the hospital. This year’s event supports the psychiatric treatment unit. Tue, Feb. 28, at 11:30 am.

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BLOOMSDAY TRAINING CLINICS | Get in shape in

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 children with life-threatening conditions, and to support their families. Fri, Feb. 24, from 6-10 pm. Northern Quest Resort & Casino, 100 N. Hayford Rd., Airway Heights. wishingstar.org

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LIVING WELL WITH DIABETES | This ongoing community program offered by INHS takes place through interactive, group-based workshops that cover how to deal with symptoms, eat healthy, incorporate regular exercise, proper use of medication and how to work effectively with health care providers. The next six-week sessions begins on March 14. Free. Meets at St. Luke’s Rehabilitation Institute, 711 S. Cowley. wellness.inhs.org

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CHOCOLATE & CHAMPAGNE GALA | Lutheran Com-

munity Services Northwest’s annual gala features tastings of champagne, chocolate and a gourmet dinner, with silent and live auctions. The evening also highlights the local nonprofit’s work with victims of child abuse, with proceeds benefiting the Sexual Assault and Family Trauma Response Center.

Sat, April 22, at 6 pm. $95/person. Davenport Hotel, 10 S. Post. lcsnw.org/spokane (343-5078)

LIGHT THE WAY DINNER AUCTION | An evening of

fun to benefit local children with cancer and their families. Includes dinner and an auction, with all

proceeds benefiting the American Childhood Cancer Organization Inland Northwest. Fri, April 28, from 6-11 pm. $80/person. Lincoln Center, 1316 N. Lincoln St. acco.org/inlandnw HEARTS FOR HOMES | The eighth annual dinner and auction generates funds to support North Idaho Habitat for Humanity’s Home Building Program and A Brush With Kindness, the nonprofit’s home repair program. Sat, April 29, from 5-9 pm. $45/person.

Best Western Coeur d’Alene, 506 W. Appleway Ave. northidahohabitat.org

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MARMOT MARCH | The 12th annual kids’ run is a 1-mile walk/run/jog for kids in third grade or under. An adult must accompany a child through the course, and strollers are welcome. Sat, May 6, at 9 am. Riverfront Park, Spokane. $10/child. Register at bloomsdayrun.org/marmot-march. n The calendar is a free service, on a space-available basis.

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LIVING

“We need to take a deeper look at the role religion takes in perpetuating abuses,” says Mable Dunbar.

PEOPLE

Keeping the Faith Mable Dunbar founded a local nonprofit that focuses on supporting Christian victims of domestic violence

BY CHEY SCOTT

H

elping other women heal has long been Mable Dunbar’s calling. As the founder of the Spokane-based nonprofit Women’s Healing and Empowerment Network (WHEN), Dunbar has over the years supported hundreds of women trying to break free from the cycle of domestic violence and abuse.

WHEN stands apart from other local groups supporting battered women because of its mission as a nondenominational, faith-based nonprofit focused on serving clients who identify as Christian. Dunbar explains that these women of faith are more likely than non-religious people to justify

the abuse they’re receiving because of their beliefs.

“In my experience, religion has been one of the greatest perpetrators of domestic violence,” she says. “I have seen women beaten and stabbed by their Christian husbands... I believed, and I felt strongly, there needed to be an organization that let these women know that the God they serve doesn’t condone this abuse.”

Often, she says, Christian abusers hide behind misinterpretations or out-of-context phrases from the Bible’s scripture to justify their abusive behavior, and to hold power over the victim.

JENNIFER DEBARROS PHOTO

In turn, abused women of faith are more likely to stay in an abusive relationship because they’ve been misled to believe it’s their duty as a good Christian wife and/ or mother to obey and accept the mental or physical abuse from their partner. Some of these women also are fearful of the moral repercussions of breaking up a marriage or a family, Dunbar says.

“We use the same Bible to show women that the text is not interpreted correctly, or is being partially quoted, and we show them where God says that he really loves them, and wants them to be in an environment where they are safe and can worship freely,” Dunbar says of the healing process.

Founded in Spokane in 2008, WHEN offers a shelter and recovery center for women from the Inland Northwest, and even outside of the region, to come and stay a minimum of two months to recover and heal. There, they participate in daily counseling sessions and workshops, in groups or individually. Mothers are able to bring their children; girls of any age and boys under the age of 10. Some of the women work or attend school while staying at the healing center, which has space for five families. Women in the community

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who choose to stay in their homes but need additional support and advice can also attend support group sessions at the center.

Because of its designation as a faithbased nonprofit, WHEN is solely supported by donations, rather than federally funded grants, and the healing center is staffed by an all-volunteer staff.

D

unbar first was called to the cause of aiding domestic violence victims while fulfilling internship requirements for her master’s degree by working at a domestic violence shelter in Michigan.

“We were sheltering Christian women, and I realized there was a need to have a shelter that catered to that population,” she says.

Dunbar first opened a healing center in Michigan after a wealthy donor offered a rural property to be used as a shelter facility. WHEN moved to Spokane in 2008 when Dunbar’s husband, Colin, was asked to work as a pastor here.

Most women learn of WHEN’s services by word of mouth, from their church or friends. The nonprofit also partners with the YWCA and other community organizations for client referrals; women must

first apply to the healing center because of limited space.

Continuing WHEN’s work to aid abused women is close to Dunbar’s heart for another reason.

“Prior to doing that internship at the shelter, as I was learning about domestic violence, I had to look at my own background. My mother was raped by a Christian, and when I understood what was happening, I realized that my mother had to deal with that traumatic situation,” she says, continuing, “I realized how that could have impacted me, and I had to go through my own healing... dealing with the ideology of being a product of rape.”

Though she’s not been a victim of domestic abuse herself, Dunbar says she often shares this story with her clients to help find common ground.

Of the women served by WHEN, Dunbar estimates that as many as 65 percent are able to break the cycle of abuse, either by leaving their abuser or working with their partner to overcome underlying issues leading to harmful behavior. Other women, however, do choose to go back to their partners and allow themselves to be victimized again.

“We don’t force a woman to leave her abuser. If she decides to go back, we support her, but we let her know the dangers.

If we have space available, she can come back and repeat the program,” Dunbar says.

Although WHEN’s main focus is supporting women who have been abused, the organization also hosts an annual conference in the fall that offers workshops to support male domestic violence victims, and to educate male abusers who are aware of their ways and seek to make a change.

Though domestic violence touches all social and cultural demographics, Dunbar believes such abuse is much worse in religious communities than the general population.

“It’s not only a cultural or community thing — it’s combined with religious beliefs, and that’s dangerous. Most people who are religious, that is their life, and that’s why as a community, we need to take a deeper look at the role religion plays in perpetuating abuse, domestic or sexual.”  For more information on the Women’s Healing and Empowerment Network, visit whenetwork.com.

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