HEALTHY LIVING IN THE INLAND NORTHWEST • FREE
! g n i w o Gr den r a g r u o y in h lt a e h r e Find bet page 27
School Dangerous A P R I L - M AY, 2 0 1 3
Are They Making the Grade? PAGE 38
Alcohol and Adderall on Campus
SUPPLEMENT TO THE INLANDER
3/26/13 12:45 PM
75% of net proceeds raised stays in Eastern Washington to help continue to provide life-saving support in our community.
Susan G. Komen Eastern Washington
RACE FOR THE CURE® Sunday, April 21, 2013
Participate with us!
Form a team!
www.komeneasternwashington.org PrESEnTinG SPOnSOr
The Running Ribbon is a registered trademark of Susan G. Komen for the Cure®
Friday 5-8pm Saturday 10am-6pm Sunday 7:30-noon
Grab your girlfriends and head to the Convention Center. Your $5 admission provides a full weekend of fun, entertainment, beauty, health and fashion.
Race for the Cure participants get into the show FREE! • kids 12 & under free
2 Health APRIL-MaY, 2013 INH_CNTS_04_13.indd 2
3/26/13 12:44 PM
APRIL-MaY, 2013 INH_CNTS_04_13.indd 3
Health 3 3/26/13 12:44 PM
collaboration innovation collaboration drives innovative health care
At INHS collaboration drives everything we do. Through innovative health care technology, education and patient care solutions, INHS is reaching out to the region and creating tomorrow’s health care − today. St. Luke’s Rehabilitation Institute Information Resource Management (IRM) Northwest MedStar Northwest TeleHealth health@work
Community Health Education & Resources (CHER) Center of Occupational Health & Education (COHE) Health Training Network Center of Philanthropy
Health SPOKANE • EASTERN W ASHINGTON • NORTH IDAHO 9 S. Washington St., 4th Floor, Spokane, Wash. 99201 phone: 509-325-0634
editor Anne McGregor
managing editor Jacob H. Fries a r t DIRE C TOR Chris Bovey calendar editor Chey Scott photographer Young Kwak contributors Heather Caro, Cat Carrel, Nicholas Deshais, Lisa Fairbanks-Rossi, Eric Gavelin, Heidi Groover, E.J. Iannelli, Alexy Ilyashenko, Jacob Jones, Arah Munds, Stephen Schlange, Carrie Scozzaro, Matt Thompson, Daniel Walters, Lisa Waanenen, John R. White production manager Wayne Hunt a d v e r t i s i n g SALES MANAGER Kristi Gotzian director of marketing Kristina Elverum advertising sales Jann Harris-Terry, Tami Booey, Kristin Wagner, Carolyn Padgham-Walker, Bruce Deming, Emily Walden, Jamie Albertini, Jean Russell Sales coordination Raevyn West, Rebecca Rison, Angela Rendall design and production Tom Stover, Derrick King, Alissia Blackwood, Jessie Spaccia DISTRIBUTION MANAGER Trevor Rendall
We improve patient outcomes. We lead health care innovation. We create healthier communities.
business manager Dee Ann Cook credit manager Gail Golden publisher Ted S. McGregor Jr. general manager Jeremy McGregor
InHealth is published every other month and is available free at more than 500 locations throughout the Inland Northwest. One copy free per reader. Subscriptions are available and cost $2.50 per issue. Call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x223. copyright All contents copyrighted © Inland Publications, Inc. 2013. InHealth is locally owned and has been published every other month by Inland Publications, Inc. since 2004. Inland Northwest Health Services (INHS) is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of the community and its member organizations Providence Health Care and Empire Health Foundation.
S U PP L E M E N T TO T H E I N L A N D E R
4 Health APRIL-MaY, 2013 INH_CNTS_04_13.indd 4
3/27/13 3:45 PM
INSIDE APRIL-MAY, 2013
Preserve Your Health Now! ON THE COVER | ALEXY ILYASHENKO PHOTO
CHECK-IN We are a functional medicine clinic specializing in balancing your metabolism for optimal health... Rather than giving you a prescription to treat a symptom.
PILL BOX Q-AND-A
12 13 Deaconess Medical Building 801 W. 5th Ave. Suite 104 Spokane, WA 99204
Substantive Discussion EMERGENCY CANCER DOCTORS
FREE Community Health Forums posted on our website www.themetabolic-institute.com
20 22 22 Beautiful wool rugs personally hand-selected, manufactured and direct imported from around the world. Our rugs cost less, look better and are in all price ranges.
Our only business is rugs and servicing rugs.
Seeds of Good Health COOKING 55-PLUS PARENTING EVENTS PEOPLE
34 36 38 40 42
Brings your rug’s color and beauty back to life! Spokane’s only Deep Water Rug Washing facility. Featuring a 6 Step Hand Wash Process and a 7 Step Inspection Process with a 15% cash and carry discount.
RugSpa.com 220 E. 2nd Ave | Spokane, WA 99202 509.624.8084
APRIL-MAY, 2013 INH_CNTS_04_13.indd 5
Health 5 3/26/13 12:44 PM
FROM THE EDITOR
Lead Safe Spokane program Anne McGregor is the editor of InHealth. Email her at firstname.lastname@example.org.
3% IntereSt LoanS up to $13,000 per unIt to addreSS Lead BaSed paInt hazardS. 75% oF the Loan IS ForgIven over 3 YearS. owner occupIed hoMeS and rentaL propertIeS Located In Spokane countY are eLIgIBLe to appLY. hoMe MuSt Be BuILt BeFore 1978.
occupantS MuSt earn LeSS than 80% area MedIan IncoMe. a FaMILY oF Four can QuaLIFY IF theY Make under $50,300 per Year. owner occupIed hoMeS MuSt have chILdren under 6 YearS oF age that LIve In the hoMe, vISIt More than SIx hourS a week, or a pregnant woMan In the hoMe. Program administered by
For More InForMatIon on Lead SaFe Spokane and other prograMS: 509.755.7555 or khco.coM
Simple and Real
he last few months have brought a slew of reports on a lot of things that are apparently bad for us. I got a newsletter from a nutrition organization telling me to eat rice no more than twice a week — the arsenic in there is bad news. And stay away from canned foods — BPA in the lining may disrupt our hormones. Sugar is demonized — “It’s toxic,” declared the New York Times’ Mark Bittman. Salt consumption? It’s now linked to autoimmune disorders. Sometimes I feel like a toddler in a fine china shop when I go to the grocery store — there are just too many ways to mess up. So instead of focusing on what not to eat, I’m thinking it’s much easier to focus on what to eat. As my kids learned in school, it’s better to eat foods with fewer ingredients. Have an apple or a handful walnuts. Peel a juicy grapefruit and eat it. A hardboiled egg makes a nice snack. In short, the less your food has been processed, the better it is for you. And what better way to make sure your food is wholesome than to grow it yourself? I hope you’ll enjoy our cover feature on gardening — whether your plants are in a big sunny spot in the yard, growing up the wall on your porch or in a little herb pot by the kitchen windowsill, it is both healthy and satisfying to eat what you grow. To your health!
6 Health APRIL-MAY, 2013 INH_CNTS_04_13.indd 6
3/27/13 2:26 PM
GonzaGa MBa In Healthcare Management
Better business means better care » Learn alongside industry peers » Focused on the business of healthcare management » Structured to fit the schedules of working professionals “The curriculum allows students to look at real world cases from across the country. I’ve been able to apply what I’ve learned directly to my work.” - Stuart Prey ‘13
Learn more at an upcoming information meeting:
MBA & MACC PROGRAMS
APRIL-MAY, 2013 INH_CNTS_04_13.indd 7
Health 7 3/26/13 12:45 PM
8 Health APRIL-MaY, 2013 INH_CNTS_04_13.indd 8
3/26/13 12:45 PM
STAY CONNECTED Send letters and story ideas to InHealth Editor Anne McGregor at email@example.com. Join the conversation on the InHealth Facebook page and at InHealthNW.com.
ON OUR FACEBOOK
With the availability of alcohol and potent drugs, do you think college is more dangerous than ever? Mike Green: More dangerous now because of the society we live in, but not specifically from drugs or alcohol... Since, of course, drugs and alcohol have always been readily available and easy to obtain.
Kathy Grabicki Sackett: No. People are more educated about the consequences of addiction than in the past. There’s also more professional people ready to help if a problem does arise. William D Wright: Yes! Still, there was nothing like rolling a keg up the stairs at Pearce or Dressler Halls at EWU and then when empty rolling it down. Troy Martz: Old or new, the substances have always been dangerous. I wonder how much the culture has changed in terms of violence and crime? Michaél Davey Alegria: I have two kids in college. They have been raised to know the consequences and while they aren’t perfect angels, I don’t lose sleep worrying about them in their dorms. They’ve done mama proud. Heather Ann: I think the bigger issue is that we have told children about the dangers of alcohol and illegal drugs, but we then turn around and give them a pill whenever they are hurt. Headache? Stomach ache? Can’t sleep? There is a pill for that. We have become a society that wants a quick fix, and thinks that there really is a pill to fix everything.
Getting Back Up Again
Bonnie St. John
t takes plenty of characters to build a LAW AND ORDER: SPECIAL VICTIMS UNIT plot: good guys, bad guys, cops, the bartender who saw the crime go down. But it could be some of the most minor roles that make the biggest difference to the viewer, according to new research from Washington State University communications professor Stacey Hust. People who watch shows like Law and Order or CSI are more likely to step in if they see someone being sexually assaulted, according to Hust’s study, funded by WSU, co-authored with Emily Garrigues Marett of Mississippi State University and published in the Journal of Health Communication. Crime dramas are among the most common shows in prime-time lineups, and often emphasize the importance of witnesses stepping in to help, Hust says. The theory is that, “These programs expose people to incidents of sexual assault, and they are able to identify that it’s a crime,” Hust says. “Exposure to crime dramas tells us there’s something wrong with this, and that it’s not appropriate behavior.” If researchers can identify what it is about TV plots that encourages people to intervene, advocates could use those techniques in educating the public, Hust says. And, she adds, TV writers could drop more interventions into their scripts. “If we see on television that doing this behavior is going to get us praise, acceptance and value among our peers, we’re more likely to do it in our own life,” says Hust. “Bystander intervention is key to sexual assault reduction because it creates an environment where [assault] is not tolerated.” — HEIDI GROOVER
he’s a Harvard graduate. She’s a mom. She’s a celebrated author and speaker. At age 5, BONNIE ST. JOHN’s leg was amputated, but that didn’t stop her from going on to win three medals in ski racing at the 1984 Winter Paralympics in Innsbruck, Austria. In the years that followed, she has faced divorce and disability, times of hardship and times of prosperity. Through it all, St. John has striven to share the message of falling down… and getting back up again. She’s even been named one of the “five most inspiring women in America.” Join her for a special presentation at the Women Helping Women Fund’s 21st annual luncheon, a fundraiser that has highlighted some of the most inspiring women in the nation over the years. For the past two decades, this annual gathering has helped raise more than $5 million to fund more than 370 programs that help women and children overcome hardship across the Spokane area. — SARAH MUNDS Women Helping Women Fund Luncheon • Mon, May 20, at 11:30 am • $125 • Spokane Convention Center • whwfspokane.org • 328-8285 APRIL-MAY, 2013
Health 9 3/27/13 2:25 PM
Another Take on Tylenol
inter’s over! Invigorate weary-looking skin with this exfoliating scrub by Spokane simple-living advocate Monique Kovalenko. “I strongly suggest using organic ingredients for all products that are applied to the skin,” she says, “in order to avoid toxins and dangerous chemicals.”
John R. White is a pharmacy professor at WSU-Spokane.
¼ cup fine-ground coffee, organic/fair trade ½ cup unrefined granulated sugar ½ cup baking soda Slowly add water to a scoopful of mix, stopping when you have a pasty consistency. Gently rub into skin in circular motions. Rinse with warm water. To use on your face, add olive oil instead of water to a tablespoonful of mix. — ANNE McGREGOR
n the past few years, several studies have demonstrated a possible association between asthma and the use of acetaminophen (Tylenol). There are two concerns raised by these studies. First, there may be an association between exposure to acetaminophen in utero or during the first year of life and the later development of asthma. Second, acetaminophen may have a detrimental effect (increased wheezing, etc.) in those children who have asthma. There are several reasons acetaminophen is currently widely used for children. A strong correlation between the use of aspirin and the development of a potentially fatal condition called Reye’s Syndrome was discovered in the 1980s. Since then, aspirin has not been recommended for fever in people under the age of 19. Aspirin also may cause stomach and bleeding problems, among other things. These factors together have led to the widespread use of acetaminophen in children. But at this point, it may be best to avoid acetaminophen for children who have asthma or are at risk for asthma. While you might give ibuprofen to your child for pain or fever, you should never use aspirin. It’s best to ask your pediatrician for a suggested plan to treat your child for fever or pain. — JOHN R. WHITE
ASK DR. MATT
Babies Really Suck
Matt Thompson is a pediatrician at Spokane’s Kids Clinic.
hile some babies seem content to do most of their sucking to obtain nourishment, others just can’t seem to get enough, even being born with a “suckle knuckle” — a blister on the hand from vigorous in-the-womb suckling. Evidence of “pacifiers” to placate babies goes back at least 3,000 years. Historically, there have been concerns about safety (pacifiers have not always had the safety ring preventing choking), hygiene (a discarded rag may have been wrapped around a chunk of meat, bread or a sachet of sugar dipped in wine), morality (thanks in part to Freud, sexualizing the pacifier along with everything else), malocclusion (crooked teeth) and impact on breastfeeding. So what is the evidence? Babies tend to kick a binky quicker than a thumb, but they both have about the same
impact on the structure of the mouth. The idea of “nipple confusion” from pacifier use is a notion from popular opinion, not empiric evidence. A recent review of the best research available found that for healthy term babies, pacifier use had no significant impact on the duration of breastfeeding up to four months following birth. Quality research is lacking to evaluate the impact of pacifier use on the duration of breastfeeding beyond four months. The most compelling evidence supporting the use of a pacifier is the observed reduction of risk of sudden infant death syndrome. Why is not entirely clear; some theorize it may lower the threshold for arousal during critical events such as arrhythmia, or cessation of breathing. My take on the evidence? If an otherwise healthy, thriving, successfully feeding super-suckler is more content between feedings with a clean, safe binky — two thumbs up! — DR. MATT THOMPSON
Need Cataract Surgery? Have Glaucoma? If you are in need of cataract surgery and have been diagnosed with glaucoma you may be eligible to participate in an investigational device research study. If you qualify for the study, you will receive study-related eye exams at no cost and you may even be eligible for reimbursement up to $1000 for your time and travel expenses.
To qualify, • Have mild to moderate open-angle glaucoma you must: • Use from 1 to 3 glaucoma medications • Need cataract surgery in the next 1-2 months • Meet all other study-related criteria
For more information, please contact Eileen with Spokane Eye Clinical Research at (509) 623-9768
10 Health APRIL-MAY, 2013 INH_DIGEST_04_13.indd 10
3/27/13 2:25 PM
THEIR OWN WORDS
Dr. Craig Panos
U.S. SKI TEAM PHYSICIAN AND A SPORTS AND CONCUSSION MEDICINE SPECIALIST AT KOOTENAI HEALTH.
Why is it hard to get people to buy into concussion treatment? Part of the stigma is you’ve got coaches saying, “I played through my concussion, and I’m fine.” And you’re like, “Really? Did you always slur? You can’t even remember to bring the footballs to practice, and you’re telling me you’re good?” You run into that… If you don’t spend that time explaining why we’re doing what we’re doing, the way the brain functions, it’s easy to kind of write it off… Here’s the deal: When you are a kid, it is completely opposite of your nature to sit around, play no video games, watch very little TV, no texting, little computer time, basically go to bed at 8 o’clock. We’ve got to get them to buy into what they need to do and why. I feel like I did everything wrong when my son had a concussion. That’s okay. I tell parents this first visit’s gonna be an hour and a half, but when you come out I want you to be a resource for the next parent who says, “Hey, my kid got hit. What should I do?” What about sports other than football? Women’s soccer is the second busiest group for me. There is no group worse than the soccer mom. Don’t dare tell a soccer mom her daughter isn’t going to play freshman soccer on Saturday, ’cause you got somethin’ comin’… I tell them, “I’m sorry the schools charge me with keeping your kids safe.” What are people with concussions supposed to do? They’re supposed to rest their brains. Don’t exercise your brain. What does your brain do? It thinks, and it has emotions. Those are the two things we’re trying to rest. Don’t go watch Brian’s Song. And you want to get good sleep. — INTERVIEW BY ANNE McGREGOR
ids have been confounding their parents since forever. What’s relatively new is book after book claiming to explain it all. Recently we’ve had titles-turned-sensations like Outliers, Bringing Up Bébé, Quiet and anything with the words “Tiger Mother” in it. Of course all that invites an everything-you’veread-is-wrong response, and the biggest has been NutureShock by Po Bronson and Ashley Merryman. Now they’re back, this time taking on Malcolm
Gladwell’s Outliers — you know, the book that says your kid needs 10,000 hours of practice to become the next Bill Gates. In TOP DOG: THE SCIENCE OF WINNING AND LOSING, Bronson and Merryman say it’s one thing to practice, but it’s more important to perform — to compete under pressure. The book studies Wall Street and NASCAR to find out why only some kids grow up to be warriors instead of worriers. Top Dog delves into other questions, too, from high-stakes testing to sibling rivalries. In the end, Bronson and Merryman say competition is good: “Competition doesn’t kill creativity,” Bronson says, “it facilitates creative output by supplying motivational drive.” — TED S. McGREGOR JR.
June 13 - 22 July 5 - 14
July 25 - Aug 4
Aug 15 - 25
for tickets: cdasummertheatre.com or 208-769-7780 APRIL-MAY, 2013 INH_DIGEST_04_13.indd 11
Health 11 3/27/13 3:54 PM
check-in Life Coaching
Let Growth Bloom
Cat Carrel is a certified life coach in Spokane.
Ancient Rhubarb Secrets ATTRIBUTES: This hardy, cold-season perennial is one of spring’s first edible harvests in the Inland Northwest. An ancient vegetable that is more like a fruit, rhubarb has been used in Chinese medicine since 2700 BC. Rhubarb’s tart, astringent taste invigorates the palate. SUPER POWERS: One cup has just 26 calories but contains 2 grams of fiber, 16 percent of the recommended dietary allowance of vitamin C and 45 percent of vitamin K — also known as the “clotting vitamin” because it helps prevent abnormal bleeding. WEAKNESSES: Rhubarb leaves aren’t edible — in fact, their high content of oxalic acid makes them poisonous. Cooking stalks in aluminum, iron or copper pans can turn your cookware and rhubarb an unappealing brown color. HOW TO USE IT: Try Alice Waters’ Rhubarb Compote from Chez Panisse Fruit. Start with one pound of rhubarb, peeled. Trim ends and discard leaves. Cut lengthwise into thirds, then into two-inch pieces. You should have about six cups. Grate the zest of one orange into a 10-inch non-reactive baking dish, squeeze in three tablespoons of juice from your orange. Add rhubarb and a half-cup of sugar, toss till the rhubarb is well-coated. Cover and bake at 350° for 25 minutes. Remove cover and bake five or 10 more minutes, till tender. Try it with a little sweetened cream for dessert or even as a side dish with pork. — Anne McGregor
ust as a seed may struggle to sprout and take root in the crack of a sidewalk, we may struggle with challenges that seem determined to keep us from blossoming. But what if instead of being stymied, we looked at every challenge as an opportunity to help us grow? Regardless of the outcome, the key is to make sure we face challenges, head on. So address your challenge in a space of empowerment, rather than in powerlessness. And just like the seed taking hold in the crack of the sidewalk, you’ll find that facing challenges creates powerful, even unexpected, momentum. Don’t forget, without nutrients — food and water — the sprouted seed will wither and never blossom. Similarly, we need to nurture ourselves, foster expansion and capitalize on our momentum. Growth is as important to our minds as it is to other living organisms, and without proper attention and feeding, we may never blossom into our full potential. For this spring, think what it would be like to take a powerful look at all of your challenges; instead of dreading them, think of them as opportunities to grow. — Cat Carrel
Finally... A Dream Come True If you’re suffering from the psychological and physical effects of hair loss, you’re not alone. 50,000,000 Americans cope with serious hair loss each year.
• • • • • •
Non Invasive Medical Procedures Custom Designed Hair Pieces Master Stylist Color Correction Specialist Celebrity Status Clients! Award Winning Salon
The procedure was developed by Pamala Jabote using premium european human hair, custom designed for each clients new look.
Jabote Hair Dreams
CALL FOR YOUR APPOINTMENT TODAY 208.215.1523 | www.jabote.com 103 S. 4th. Coeur d’Alene, ID
GRAND OPENING SPECIAL!
$50 Off First Visit
12 Health APRIL-MaY, 2013 INH_DIGEST_04_13.indd 12
3/27/13 2:25 PM
9 5 4 3 2 1 3 9 2 8
2 5 4
1 7 3 6 2 8 6 1 4 7 2 3 5 3 8 3 8 9
9 8 1 7
5 2 6 1 3
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 one-letter clue, turn to page 21. 12
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
RatingS: Gentle (left), Tough (right) To complete Sudoku, fill the board by entering numbers 1 to 9 such that each row, column and 3x3 box contains every number uniquely. Answers to all puzzles on page 41
puzzles by jeff widderich & andrew stuart www.syndicatedpuzzles.com
Rating: Gentle Like Sudoku, no single number can repeat in any row or column. But rows and columns are divided by black squares into compartments. These need to be filled in with numbers that complete a ‘straight’ — a set of numbers with no gaps but can be in any order. Clues in black cells remove that number as an option in that row and column, and are not part of any straight. Glance at the solution above to see how ‘straights’ are formed.
8 7 7
7 1 2 6 4 5 7 6 4 9 1 3
TIME FOR NEW GLASSES? Appointments Available at theeyecareteam.com
Downtown at Main and Washington | 509.747.6581 EyeCareTeam_InHealth_SPEC_Qtr.indd 1
Health 5:10 PM13
3/27/13 2:25 PM
Own it! Get the home of your dreams. Our home loan experts make it easy. numericacu.com • (800) 433-1837
One of these women is terminally ill. The other is 84. Life is unpredictable. That’s why Hospice of Spokane provides holistic end-of-life care to people of all ages. Learn more about how we can help you and your loved ones when you need it most.
Learn more at hospiceofspokane.org Spokane’s only nonprofit hospice
14 Health APRIL-MAY, 2013 INH_DIGEST_04_13.indd 14
3/27/13 2:25 PM
College students today face a wide range of drug and alcohol challenges, from mixing energy drinks with hard alcohol to Adderall.
STEPHEN SCHALNGE PHOTO
Substantive Discussion Teens face a complicated world of prescription drugs, alcohol and marijuana — how well are we preparing them? By Daniel Walters
t Washington State University, Kenny Hummel was only a freshman. But Hummel was found in a WSU dorm room last fall, passed out, with his blood-alcohol content at 0.40, five times what is considered legally intoxicated. He died of acute alcohol poisoning.
At the University of Idaho, Joseph Wiederrick was also only a freshman. But he was found under a small bridge several miles from campus this winter, dead of hypothermia. He’d left a fraternity party at midnight, wandered aimlessly through Moscow for hours, knocking on a few doors,
before slipping on a creek bed and soaking his clothes. Toxicology reports indicated alcohol and marijuana in his bloodstream. Illegal drugs have long been an issue in college. But now legal — or mostly legal — substances are adding to the temptations ...continued on next page APRIL-MAY 2013
Health 15 3/27/13 2:19 PM
news “Substantive Discussion,” continued... faced by students. Energy drinks, prescription medications, and marijuana are easily available to underage students. Mix with alcohol, and chug liberally. “Students think they’re invincible,” says Kyle Erdman, a student representative on WSU’s alcohol and drug task force. “We think we could drink as much as we want and wake up and have a good story to tell,” he says. “With freshmen, they think this is what Washington State is about.” “It’s not that more students are drinking, it’s what students are drinking. When I was in college we drank beer mostly,” said Bruce Wright, WSU Health and Wellness Services Director, in an interview last fall. “Now, there seems to be a shift. Students are drinking hard alcohol.” Unfortunately, the problem isn’t just alcohol or drugs. It’s the combination. Alcohol is a depressant. Prescriptions like Ritalin and Adderall (see “Big Pill on Campus,” page 19) as well energy drinks like Red Bull and Monster are all stimulants. When they’re mixed together — as in a Vodka Rockstar, a common drink at
Cassandra Nichols directs WSU’s counseling services; they’ve made a big push recently to work with freshmen, who are at greatest risk from dangerous behavior.
A weekly email for food lovers SIGN UP AT
T here should be more to life than maintenance-free living. To join us for a free lunch and learn about our caring community, call Claudia at (509) 924-6161.
To advertise, call 509.325.0624 x216 or email firstname.lastname@example.org
16 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 16
3/27/13 2:20 PM
local bars at WSU — the effects can be deceiving, and deadly. “They mask the effects of intoxication,” says Wright. “They contribute to the disinhibition of judgment.” With a stimulant, a drinker doesn’t get as sleepy, and doesn’t know how drunk he or she is.
The Search for Solutions
For the 2012-13 school year, WSU launched “Booze, Sex and Reality Checks,” a mandatory education program targeting freshmen. It teaches things as simple as what constitutes “a drink.” (Hint: Those red Solo cups hold more than just “one drink.”) WSU has a counseling employee dedicated entirely to helping students with drug and alcohol problems. If it seems like freshmen are more vulnerable to making bad decisions, that’s because they are. Adnan Amin, a psychiatrist at Spokane’s Sacred Heart Medical Center, says the college kid’s brain is physically immature — it’s uniquely wired to discount the riskiness of behavior while glamorizing the benefits. “We have more alcohol problems with incoming freshmen,” says Cassandra
Early Exposure S
hould parents defuse the “forbidden” and let kids try alcohol in the protected environment of home? In a University of North Carolina study, researchers examined that question. About a quarter of parents of third-grade children in the study said they let their young children taste alcohol in an attempt to keep them from abusing it later on. Forty percent of parents believed that not allowing children to have alcohol would just make them desire it more. Some academics have bought into the notion that large-scale prohibition just leads to more recklessness. In 2008, 135 college presidents, including the presidents of Pacific Lutheran University and the College of Idaho, signed a petition to lower the drinking age to 18. Binge drinking, they believed, was exacerbated because it happened in private. “The idea is generally based on common sense,” says Haske van der Vorst, author of a Dutch study examining exposing kids to alcohol at home published in the Journal of Alcohol and Drugs. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it.” But in reality, van der Vorst’s study found the opposite occurred: those children exposed to alcohol by their parents were more likely to develop alcohol-related problems later. — Daniel Walters
Nichols, director of counseling services at WSU. “We also have more problems with sexual assaults, because of the alcohol problems.” Nichols is also seeing more students enter WSU struggling with existing addictions, and not just with alcohol. Still, she thinks the school’s efforts are paying off. “The effectiveness of that program is more successful than we would have
suspected,” Nichols says. Several recent surveys, she says, indicated they’ve changed student attitudes. But Dick Mandeville, Whitworth University’s vice president for student life, is skeptical. “Schools have been doing alcohol programming for probably 25 years,” Mandeville says. “There is very little data ...continued on next page
For the Finest Quality Carpeting & Area Rugs PLAN YOUR
WEEKEND with the help of The Inlander’s Award-Winning Editorial Staff
DELIVERED TO YOUR INBOX EVERY FRIDAY KARASTAN SALE ON NOW! Up to $3/Yard Rebate SIGN UP AT
INLANDER.COM/NEWSLETTER 509.534.5064 | email@example.com | wallflowerdesigns.com Mon-Fri 9-5:30 | Saturday 10-3 | 2820 E. 30th Ave, Spokane All Major Credit Cards Welcome or Financing is Available
a product of
To advertise, call 509.325.0624 x216 or email firstname.lastname@example.org
APRIL-MAY 2013 INH_NEWS_04_13.indd 17
Health 17 3/27/13 2:20 PM
news “Substantive Discussion,” continued... to indicate that it’s made any difference between levels of drinking or the use of [alcohol].” After all, the most famous anti-drug program, DARE’s “Just Say No” campaign, became the most high-profile failure. It spread a scary message: Drugs are everywhere, and they’re deadly. But a follow-up study in 1999 examined more than 1,000 students who’d had a DARE education. The results were revealing: Those who’d had DARE and those who hadn’t didn’t have a single difference in their beliefs about drug use, their attitudes toward drugs, or their self-esteem. In fact, some worried that it had an opposite sort of effect: It was normalizing. It made the stereotypical everybody’s-doin’-it argument directly to students. Whitworth, a small, private Christian campus in Spokane that is officially “dry,” is taking a different tack. Rather than aiming at the students likely to binge drink or use drugs, they’re aiming at those standing on the sidelines. A recent grant provided for 11 Whitworth faculty members to be trained in “The Green Dot” campaign, teaching bystanders how to stop sexual assault and violence. Alcohol can fuel both. “You can be direct and go up to somebody and say, ‘I think you’ve had too much, can I take you home?’ ” Mandeville
Bruce Wright, WSU’s Health and Wellness Services director, says drinks like a Vodka Rockstar are new and dangerous. “They mask the effects of intoxication.” says, or you can delegate, asking friends to help you intervene with someone exhibiting risky behavior. Erdman says WSU needs that sort of community. “My definition for a ‘Cougar
What’s a Parent to Do? Y ou’ve seen PSAs haranguing you to talk to your kid about drugs and alcohol. But those commercials don’t do a very good job telling you exactly how to talk to your kids. “You have to have a good relationship with your child,” advises Dr. Adnan Amin of Spokane’s Sacred Heart. That requires learning how to get a teen to talk. Don’t just ask how the day was. (“Fine,” goes the reply.) Instead, ask questions like, “Are there a lot of cliques in your school?” and “How’d your essay turn out?” Text with them regularly. (Contrary to some guides, don’t feel obligated to use dumb TXT abbreviations — that can just seem corny.) That sets the groundwork for more serious conversations. Use Lindsay Lohan’s latest stint in rehab or an uncle who struggles with alcoholism as a jumping-off point. One thing you’ll want to underscore is how few kids regularly use drugs or alcohol. Even at state colleges, there’s a sizable number who choose not to drink at all. Peer
pressure, research shows, is rarely overt. It often is simply a child being in an environment where alcohol is consumed, and not knowing what to do. Some guides recommend role-playing various scenarios with your child. And if you used drugs when you were their age? Most experts recommend being honest, without getting into specifics. That gives you an opportunity to talk about why you used drugs, and how you view your own behavior now. If you suspect a child is already using alcohol or drugs, it’s best to simply ask them directly. But think through how you’ll respond beforehand. While you want and need to learn more about the situation, refrain from being accusatory. “You shouldn’t blame the kids,” Amin says. Asking “Well, what did you think would happen if you went to the party at Tyler’s house?” is probably not helpful. Instead, try something like “You must have been really confused,” or “Do you understand what happened?” It’s important not to
family’ is to do anything for the safety and well-being for the students,” he says. “It’s upperclassmen saying ‘This a mistake I made,’ or ‘Don’t mix energy drinks with alcohol.’ ”
TimeToTalk.org and DrugFree.org offer information for parents wanting to advise their kids on drug and alcohol abuse. WSU offers statistics and advice for parents on alcohol use by students at adcaps.wsu.edu/parents get angry. If you think you’re going to lose control, leave the room. And don’t be reluctant to seek help from a mental health professional. Sometimes drug use speaks to an underlying condition — depression, bipolar syndrome or anxiety. Sadly, “a lot of kids who need treatment are not getting the treatment,” Amin says. “Therefore, they’re using the substances in the form of self-medication.” — Daniel Walters
18 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 18
3/27/13 2:20 PM
Reaching out to fellow students is key. “I think there’s a large group of students that go through college in isolation,” Erdman says. “That alone is a big problem with alcohol.”
Surprisingly, even for kids at college, peer groups aren’t the most powerful influence on behavior. “Parents really are the primary influences,” Nichols says. She says surveys at WSU show that while students say they turn to peers first if they have a problem, they value parental advice above all. When campus police pick up students in trouble, she says one of the first questions is, “Are you going to call my parents?” Yet Nichols says parents of incoming freshmen often call her office asking how to have the conversation with students about drugs and alcohol. A part of her, Nichols says, wants to tell them that they should have been having these conversations for the past 10 years. What are the family’s values regarding drugs, alcohol, and sexual behavior? Whitworth’s Mandeville says when his son came back from Notre Dame his freshman year, even he was surprised by
big PILL on campus
f alcohol abuse represents the dark side of playing too hard, Adderall represents the dark side of working too hard. A prescription amphetamine prescribed to help kids with ADHD focus on schoolwork, its effects include dramatically increased ability to concentrate for lengthy periods of time. Those effects make it an appealing choice for students struggling with their academic load. According to a 2013 National Public Radio report, up to 35 percent of all college students say they have used stimulant pills to improve school performance. And abuse is worse during highstress periods. At the University of Puget Sound, a researcher analyzed the campus wastewater in 2011-12 and found that residue from the drugs increased to a level seven times higher during finals. Adnan Amin, a psychiatrist at Spokane’s Sacred Heart Medical Center, says parents have come to him, urging him to put their non-ADHD kids on medication, which he declined to do. They
may have seen another child improve with ADHD medication and want the same for their teen. “Some of them think that it’s unfair, that another kid has medication,” says Amin. A recent New York Times article describes Adderall pills being popped open and snorted like cocaine at high-stakes private high schools. Although Amin says in his inpatient care he sees more problems with kids addicted to opiates like Oxycontin — extremely dangerous to mix with alcohol — he says ADHD medications raise concerns as well. Like energy drinks, Adderall may dramatically mask the effects of intoxication. “Abuse has skyrocketed… There are reported deaths because of kids underestimating the seriousness,” Amin says. “An overdose can kill you.” For those who already have heart conditions, the drugs can be lethal. For those with bipolar disorder, using adderall may lead to aggression. — Daniel Walters
the amount of alcohol on campus. But ultimately, his son said they did a good job preparing him. “We also bribed him,” Mandeville says. “If you make it to 21 before your first
drink, you’ll get x amount of money.” That may sound unorthodox. But for his son, it changed the cost-benefit question. Is that beer, in other words, really worth losing $1,000? n
LIVE HEALTHY SHOP FRESH FROM THE FARM
APRIL-MAY 2013 INH_NEWS_04_13.indd 19
Health 19 3/27/13 2:20 PM
Ever-Ready What happens after you dial 911? By nicholas deshais
MedStar makes the trip as far as Montana, if need be. Two crews at the scene of a massive pileup (above), and alongside the remote St. Joe River (below). MEDSTAR PHOTOS
hangar at Felts Field holds many movable hospitals. One helicopter sits fueled up, the pilot and medical crew just a few steps away. Another has its casing removed and a mechanic fiddles with its innards. On the other side of the building, an ambulance just pulled in after transferring a patient from one hospital to another; its driver heads to the break room with a Subway sandwich in his hand. A fixed-wing takes up the most space in the hangar, ready to fly someone in need as far
as Seattle. The communications center sits in the middle of all this, the staff set to scramble at a moment’s notice if a far-flung emergency arises. This is the home of MedStar, the Inland Northwest’s only ambulance service that flies. “If the patient is sick enough, they call us. They just need some therapeutic jet fuel,” says Eveline Bisson, MedStar’s director. The helicopters lift off when someone’s bleeding far from a hospital, or there’s a
broken spine from a car wreck deep in rural Washington, Idaho or even Montana. “There’s got to be a clear benefit for the patient. It’s not just a joyride. It really comes down to speed.” MedStar is just one of the organizations ready to help when someone in the region calls 911. Beside the dispatchers, there are first responders, police officers, firefighters, EMTs, paramedics and volunteers. There are the folks at American Medical Response, the ambulance provider for both the city and county. There is MedStar. Washington State Patrol automatically gets notified if there’s an accident on the highway. “There are a lot of people,” says Lori Markham, operations manager for Spokane County Fire Dispatch. “It would impossible to count them.”
t begins, of course, when you dial 911. The first person to answer works for the police department. “If it’s medical, they’ll ask if it was
20 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 20
3/27/13 2:20 PM
Invest in Your Health violent,” says Kim Blashill, supervisor for Spokane police dispatch. “If it’s not, we’ll send you over to fire dispatch,” which is a separate entity located in the same building. “The combined communications building houses 911, sheriff dispatch, SPD dispatch and fire dispatch,” says Brian Schaeffer, assistant chief for the Spokane
other $44. Beyond city limits, the base rate jumps to $900, plus a per-mile fee. These rates can be shocking, but Jernstrom likes to remind people that it’s a service to save lives, not mass transit. “If we don’t transport you, we don’t charge you,” she says. If someone else calls 911 and the first responder determines that
“Sometimes you just go into savior mode… You buy somebody some time, that golden hour.” Fire Department. “Fire is the only agency you have the capacity to make decisions, that is truly consolidated. We dispatch for you can turn the ambulance away. all 15 fire agencies throughout Spokane MedStar’s rates are a whole different County. It is odd that the law agencies thing. Base rate for emergency transport in aren’t consolidated together, but that’s the a helicopter is $13,830, plus $121 per mile way it has been.” flown with the patient on board. One of up to five fire dispatchers on “A lot of that is the cost of readiness,” duty is the first to enter information into says Bisson. Helicopters are worth $4 milthe region’s computer-aided dispatch syslion. Insurance is $12,000 a month, • Locally made soap not to tem, in which all the necessary agencies are mention fuel costs and personnel, who are • Great gifts for foodies connected. all double certified as either nurse and para• Sustainable woodtherapist. earrings • Fair trade wool clothing Without saying a word, fire dispatch medic, or EMT and respiratory and goods Sustainable kitchenware will have at hand info straight from the Some folks• know their odds of needing • Local caller’s phone. This will include the phonegreenery MedStar’s attention arefree better than most, • Gluten baking supplies number and the address if it’s a landline. since they live• in the middle of nowhere • Poinsettias and bouquets Local, vegetarian, and gluten If it’s a cell phone, it might provide• the cell madeorjewelry are on ski hills allfoods winter these free forlong. your For holiday meal Locally tower the call last bounced off of, and a people, MedStar offers an annual $59 GPS location if the connection is good. membership, which offsets the cost of a Then the questions start. ride. About 27,000 people have signed up “We ask again for the address,” says for this service. Markham. “We ask questions to determine Most of MedStar’s work entails moving age, gender, is it them having the problem patients from hospital to hospital. Just 17 or someone they’re with, the mechanism percent of the work its helicopters do is of injury. If they’re conscious or breathing, “scene work,” or 911 calls. bleeding, what type of wound it is.” Of these calls, MedStar’s goal is to be It’s at this point that dispatchers and on the ground for 10 minutes. The imporemergency personnel must determine tant thing is getting someone who’s hurt to which mode of transportaa hospital. tion is faster if a patient Peggy Hensley works needs to get to a hospital. two days a week as a from the puzzle on page 13 Generally, and regardless transport triage nurse for 9=O of the extent of injuries, if MedStar and a medical liaithe emergency is within city son in its communications limits, AMR is the best choice to respond center. She estimates that most calls last and sends one of its 20 ambulances. Each 30 to 40 minutes, from hangar to hospital. ambulance has a paramedic and an EMT Sometimes the ride is bumpy. Other times on board. it’s frightening. “Our transport volume is high,” says “It’s always interesting taking off sideGayle Jernstrom, AMR’s local supervisor. ways,” she says. “It’s just what you do. You “We’re dedicated to the city and county. focus on what you’re doing.” We are the only providers. We cover all the But it’s all worth it. 911s.” “If you like the adventure,” she says. “Sometimes you just go into savior mode, I f you’re transported by AMR within guess. You buy somebody some time, that city limits with basic life support, the golden hour.” rate begins at $382 plus $17.57 per mile Once the crew gets to the closest apyou’re moved. For advanced life support, propriate hospital, the patient is out of their the initial charge is $527 plus the same hands. For them, the emergency’s over and mileage rate. Receiving oxygen adds anthe waiting, and paperwork, begin anew.
Local gifts, local food
By investing in a healthy diet
Spokane’s source for healthy local foods. Nutritious Local Produce • Local Grass-Fed Beef Local Milk & Eggs • Delicious Healthy Breads Kombucha and Keﬁr • Health & Wellness Products
Downtown’s full time full service grocery store
44 W. Main Ave 509-458-2667 www.MainMarket.coop Mon~Sat 8a-8p | Sun 10a-6p FREE PARKING
44 W. Main Ave 509-458-2667 www.MainMarket.coop Mon~Sat 8am – 8pm Sun 10am – 6pm Free Parking
Need a New Doctor? WE ARE NOW ACCEPTING NEW PATIENTS INTO OUR FAMILY PRACTICE! Locally owned and operated with 30 years combined medical practice in Spokane.
Linda S. Harrison, MD | Susan K. Lehman, DO • Same-day appointments for established patients • Beautiful new Valley location • Relaxed atmosphere • Personalized health care at its finest • Most major insurance plans accepted
KEEPING FAMILIES HEALTHY - ONE VISIT AT A TIME
OPPORTUNITY MEDICAL, PLLC 16201 E. Indiana Ave., Suite 2300 509.924.8721 APRIL-MAY 2013
Health 21 3/27/13 2:20 PM
Derek Garcia of Post Falls with his young family: “It was scary to think what life would be like if I was sick for an extended period of time.” cancer
Derailed Dreams When cancer hits young adults, the effects ripple outward By heather caro
ecember 7, 2007 is forever etched into Spokane resident April Bell’s memory. Following months of vague gastrointestinal complaints, that was the day Bell’s doctor finally diagnosed her with cancer. It was also exactly seven months after another important date for the then-30-year-old — her wedding. Like most young brides, Bell did not foresee testing the ‘in sickness and in health’ vow so early in her marriage. But soon after being diagnosed with follicular non-Hodgkin’s lymphoma — a particularly aggressive form of cancer typically found in patients many decades older — Bell was
faced with crippling medical treatments, financial burden and uncertain fertility. The American Cancer Society estimates more than 700,000 young people ages 15 to 39 are diagnosed with cancer each year in the United States. In fact, after accidental injury, cancer is one of the leading causes of death in this demographic. And despite treatment advances in both older and younger counterparts, the mortality rate for adolescents and young adults diagnosed with cancer has remained virtually unchanged for more than 30 years. That’s probably because these cancers tend to be more aggressive, less responsive
to treatment and diagnosed later. Many young people may not consider themselves at risk for cancer and screening tests are not routinely provided. Others may delay treatment because they are uninsured. Even providers may prolong diagnosis by initially mistaking fatigue or stress for often vague presenting symptoms. Those who survive find a cancer diagnosis can derail many of the normal transitions that occur during this time — things like forging ahead in careers and starting a family. “It takes so much away from you,” says Bell, who refers to her life in terms of BC and AC — before and after cancer.
hen Post Falls resident Derek Garcia was diagnosed with testicular cancer in 2012, he did not have insurance. Young adults, like the 28-year-old Garcia, boast the highest uninsured rate of any age bracket. For them, a cancer diagnosis can be financially devastating. After being diagnosed, Garcia eventu-
22 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 22
3/27/13 2:20 PM
ally was able to obtain coverage through a government-sponsored high-risk insurance program. It’s expensive and doesn’t cover everything, but he says he is grateful to have it. “For the short time that I had to deal with the aftermath, it was scary to think what life would be like if I was sick for an extended period of time,” says the married father. “My career would have been
Many young people may not consider themselves at risk for cancer… impossible to continue had it been worse.” Because of early detection, Garcia, a professional triathlete, did not require radiation or chemo following his surgery. For Bell, the process was more complex. “It hit us so hard,” she says, referring to her thick stack of medical records as War and Peace. After initially undergoing
11 months of chemotherapy followed by two years of maintenance therapy, Bell has been in remission since February 2009. But complications — including peripheral neuropathy and a chemo-related immune disorder — still plague her. Bell, who works as a pediatric oncology nurse, worries that future changes to her company’s insurance policy might leave her unable to afford ongoing immune therapy that costs $14,000 a month. And because she says fertility options like banking eggs weren’t discussed initially in her treatment, she’s uncertain whether she’ll be able to have children.
n addition to physical and financial stressors, a cancer diagnosis can isolate 20- and 30-somethings at a particularly vulnerable time in life. Bell admits she couldn’t identify with the largely older population who shared her diagnosis and avoided the offered support groups. She found herself isolated from her peers as well. “They get tired of hearing about cancer,” says Bell, relating that she eventually stopped talking about her health concerns with friends. “But it’s just a fact of life for me.” Instead, she networks online with
help at any age Young Survival Coalition provides information and fundraising — including the annual Tour de Pink bike race — to benefit young women with breast cancer. This organization makes pink look good. youngsurvival.org Stupid Cancer serves as the quintessential guide to surviving a cancer diagnosis at a young age while keeping a sense of humor (check out the “give cancer the bird” button). The nonprofit provides social networking for survivors and hosts an annual convention for survivors. stupidcancer.org First Descents takes young cancer survivors and fighters into the great outdoors. Weeklong adventure camps are offered in categories such as surfing, kayaking and rock climbing, all with a focus on cancer survivorship. firstdescents.org other survivors who understand what she has been through. She admits it would be nice to receive similar support within her own community. “We as a group need to be more vocal about what we need,” says Bell of her co-survivors. “You can’t just ‘get over’ cancer… we all suffer from PTSD.” n
Stay Connected, Wherever You Are Follow the Inlander on Pinterest, Twitter, YouTube and Facebook for exclusive content, contests and more!
APRIL-MAY 2013 INH_NEWS_04_13.indd 23
Health 23 3/27/13 2:20 PM
Christi Gerhardt, a pediatric endocrinologist at Sacred Heart Children’s Hospital, is a rare breed today: a specialist working with kids. STEPHEN SCHLANGE PHOTO doctors
Special Needs Pediatric specialists are in short supply By lisa waananen
n her last official day before retirement, Dr. Vicki Volz sorted through papers in her office and saw a few patients in the cheerful exam rooms down the hall. After eight years evaluating children with autism and other developmental disorders at Sacred Heart Children’s Hospital, she’d been asked whether the ending was bittersweet. It was more sweet than bitter, she said, because she’d seen encouraging progress with a number of patients in her final weeks. “It’s working with the kids that’s the most gratifying.” Sacred Heart has been recruiting a new
specialist to replace Volz, but it’s unlikely there will be a replacement in the near future. “Almost everyone in the Pacific Northwest is looking to hire a developmental-behavorial specialist,” says Dr. Judy Felgenhauer, who oversees recruiting for outpatient pediatrics at Sacred Heart. She doesn’t have trouble getting CVs from general pediatricians, but recruiting subspecialists requires working connections and getting creative. The first time she recruited a hematology-oncology specialist, it took two years.
hat’s not unusual — a national shortage of pediatric specialists means many children’s hospitals have long vacancies, and many families wait months for appointments. “Across the country, you’re looking at long wait times to see pediatric specialists,” says Dr. Jim Kaufman, vice president of public policy for the Children’s Hospital Association. A recent survey of children’s hospitals found that families often wait more than two months to get an appointment with a pediatric specialist, and that many hospitals have had vacant positions for longer than a year. Of all the specialties tracked in the survey, developmental-behavioral physicians like Volz are in shortest supply, with reported waiting times of more than four months. The wait to see Volz was up to 18 months at one point. The causes of the national shortage come down to long training and lowerthan-average physician pay. Medical students interested in pediatric specialties will
24 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 24
3/27/13 2:20 PM
spend more years in training, and then they’ll find the health care payment structure is stacked against them. Medicaid, the joint federal-state health program for lower-income children, reimburses at a much lower rate than Medicare or private insurance. At the average children’s hospital, 52 percent of the patients are covered by Medicaid, Kaufman says. “How do you incentivize people to move into this type of field?” he asks. This is especially true for the developmental-behavorial specialty, which involves a great deal of consulting and coordinating — “a lot of work that you basically get no reimbursement for,” Felgenhauer says. National efforts to improve the outlook have run up against budget constraints. Because of a provision in the Affordable Care Act, Medicaid started reimbursing at the same rate as Medicare — but only for some procedures, and only for two years. The Children’s Hospital Association is asking Congress to expand the policy beyond its expiration in 2014, but prospects are grim during these days of budget cutbacks. There’s also funding uncertainty for
hospital training programs, and cuts in training spots now could mean specialist shortages that persist even if the budget scenario gets rosier. “We’re not talking something [where] you can flip a switch and have a pediatric specialist in a year,” Kaufman says. Some ambitious doctors train to treat both children and adults, but children have different diseases and needs. Kaufman uses the example of the cardiologist, who works with adult hearts the size of a fist. “The pediatric cardiologist could be working on something the size of your thumbnail,” he says.
ospitals devoted to patient care, like Sacred Heart, face another recruiting challenge: Many pediatric specialists choose to stay at academic medical centers where they can do research along with seeing patients. “Very many of us are here because we specifically chose not to be in an academic setting,” Felgenhauer says. For some doctors, like pediatric endocrinologist Christi Gerhardt, caring for patients was the appeal. She came to Sacred Heart last summer from a position
at Seattle Children’s Hospital, where she realized her favorite part of the job was doing outreach clinics in places like Olympia and Anchorage. “I really liked that and I wanted it all the time, not just when I went away to outreach clinics,” she says. At Sacred Heart, she works in a tightknit clinic treating children who have diabetes or other hormone and growth problems. The whole environment is small enough that doctors can work closely with the hospital’s other specialists. Gerhardt can call another physician and say that a patient scheduled in their clinic next month should be seen sooner. “We’ll always work out a spot, even if we don’t have availability, to see someone when they need to be seen,” she says. She still does outreach clinics once a month in the Tri-Cities so families don’t have to make the drive themselves, and hopes all families feel welcomed if their child is diagnosed with Type I diabetes or another chronic illness that will require ongoing care. “I hope they feel what we feel about this place,” she says, “which is that it’s a family.” n
THE INNOVATORS OF COMFORT ™
For your health. Find the largest selection at The Tin Roof. Interior design services available.
1727 E. Sprague Ave Spokane, WA 99202
Health 25 12:47 PM
3/27/13 2:20 PM
Sunrise at Gonzaga University
Gonzaga’s commitment to respect and care for our planet Environmental sustainability, defined in a Jesuit context, is an essential
Moving ahead with this plan, the university will advance its
commitment to respect and care for creation, the life-giving gift
goals toward climate neutrality through education, research,
from God. As a Jesuit, Catholic and humanistic institution, Gonzaga
student-development programs and operational change. Gonzaga
University takes this commitment very seriously. That’s why we have
is already an EPA Green Power Partner and we will continue to
adopted a comprehensive Climate Action Plan, which puts GU on a
buy clean, renewable energy. Our campus buildings will become
path to achieving climate neutrality by 2050. “Care for the planet is
more energy-efficient, we will choose vehicles that help reduce
an important emphasis for the church and the Jesuits; thus, Gonzaga’s
emissions, we will encourage employees to live closer to campus,
mission calls for us individually and collectively to be good stewards of
and we will broaden and integrate sustainability initiatives in our
the Earth’s resources,” said Dr. Thayne McCulloh, university president.
curriculum and co-curricular programs. Together, our faculty, staff
“This Climate Action Plan provides a road map for carrying out our
and students will take up this effort not as an add-on but as an
commitment to sustainability. While it is ambitous, I have every
integral part of whatever they study and however they envision
confidence that the Gonzaga community will respond to the challenges
their lives for today and the future.
it presents, given the importance of what is at stake.”
The changes begin now. By 2020, Gonzaga expects to have achieved 20 percent reduction in emissions from 2009 baseline levels and by 2035 we will be at 50 percent, according to the plan. The Gonzaga University Climate Action Plan: 2013-2035 Roadmap can be found online at gonzaga.edu/ClimateActionPlan
Join the celebration gonzaga.edu/125
26 Health APRIL-MaY, 2013 INH_NEWS_04_13.indd 26
3/27/13 2:20 PM
h t l a e H Good Studies show gardening at any age will keep your disposition sunny BY E.J. IANNELLI
inety-eight-year-old Elizabeth Welty isn’t your typical smallspace gardener. For starters, she has the distinction of having been alive to see 17 of America’s 44 presidents. She also has a tenacity that would put many of her much younger fellow hobbyists to shame. Welty, a retired area physician and local arts advocate, exemplifies certain benefits of gardening that scientists have only recently begun to pinpoint experimentally. For instance, studies in the Netherlands and Norway have found that the mere act of cultivating plants offers essential respite from the frenetic pace of modern life and can alleviate symptoms of depression. ...continued on page 29
Dr. Elizabeth Welty’s wisdom: “Gardening energizes a person.”
YOUNG KWAK PHOTO
april-may, 2013 INH_LIVING_04_13.indd 27
Health 27 3/27/13 2:20 PM
re you infamous for turning healthy houseplants into withered stalks? Do you have a knack for over-watering and under-fertilizing? As with any hobby, gardening requires some know-how, and it takes time to accumulate it. But don’t let fear of the unknown or past misfortunes deter you. The great thing about small-space gardening is its minimal up-front investment. That allows more freedom to experiment. Lea Scott spent years crisscrossing the country to practice organic farming; she came to Spokane as the AmeriCorps volunteer for Vinegar Flats. Although she now works as produce buyer for the Main Market Co-op in downtown Spokane, she still encourages prospective gardeners to cultivate their own plots. “Herb gardens are a really good place to start,” says Scott. “They flourish, you can cook with them, and they smell great. Basil does exceptionally well in pots, and if you frequently pinch it back at the nodes, it encourages the plant to bush out rather than to grow vertically. You’ll be eating a lot more basil and making more pesto as a result.” She also advises erring on the large side when selecting a container. “As a general rule, whatever
size plant you’re hoping for above ground, you need to give it that amount of space under the soil. Having good soil health is really beneficial too — you’ll want to add compost.” Although compost is best created out of household organic waste in
JOIN THE TEAM. SUIT UP. Suit up and buy a “believe” t-Shirt at cvcSpokane.com.
THE FIGHT STARTS HERE.
a dedicated outdoor bin, there are several online guides on how to vermicompost (that is, with worms) in a styrofoam cooler in the space under your sink. And if you haven’t planned ahead, you can buy compost in bags or by the truckload. “There are a lot of ways to be innovative,” says Scott. When growing from seed, she personally uses reclaimed fluorescent strip lighting and homemade newspaper pots to get maximum results with little cost. “It all depends on what kind of space you’ve got. If you don’t have access to space, there’s an incredible number of community gardens in Spokane that are worth plugging into.” The most important piece of advice for beginners and experts alike is to not be afraid to fail. Whether you begin with seeds or buy starts, have courage — and confidence. “Plants are geared to grow. They’re going to do what they’re meant to do,” Scott says. “Gardening doesn’t have to be a precise art. Getting out there and doing it is the first right step.” — E.J. IANNELLI
WE ARE GETTING SOCIAL
PROCEEDS BENEFIT LOCAL C A N C E R F I G H T I N G O R G A N I Z AT I O N S .
Follow the Inlander and INHealth on Pinterest, Twitter, YouTube and Facebook for exclusive news, contests and more!
28 Health APRIL-MAY, 2013 INH_LIVING_04_13.indd 28
3/27/13 2:20 PM
“SEEDS OF GOOD HEALTH,” CONTINUED...
She finds that tending to flowers like heliotrope, petunias and geraniums sustains her by giving her something “that’s ongoOther studies have shown that long-term ing, that has a future to it. That’s what’s gardeners are up to 47 percent less likely appealing about plants — the future. It’s the to develop dementia in old age, or that 45 magic of the development of the arrangeminutes of gardening can burn the same ments and the interplay of number of calories as half color. That’s why I do it.” an hour of aerobics. A 2010 According to Tonie report in Science Daily noted Fitzgerald, author of Garthat bacteria in the soil dening in the Inland Northwest appear to decrease anxiety and statewide Master and boost intelligence in Gardener Program Leader mice by increasing levels of at Washington State serotonin in the body. University, the posited Welty’s own evidence health benefits stem from a is less quantifiable and complex interplay of differmore anecdotal. “Certainly, ent factors. gardening energizes a per“Seniors who garden son. During the winter it report a higher quality of keeps your mind going on life, fewer health problems what things to plant — how and more consumption you’re going to arrange of fruits and vegetables, them, what you’re going which in turn leads to a to do differently this year. healthier diet,” she says. It keeps me busy because “It’s the same thing with I have to take care of [the Master gardener Tonie Fitzgerald kids who garden. Early on, plants]. You have to get up they develop a higher level of awareness of and go, and that can be quite a challenge sometimes,” she chuckles. ...continued on next page
Your All Inclusive Venue Event Design • Catering • Exceptional Service • Affordable Elegance
Melissa Murphy Consistently ranked as a top ten producing agent since 2008
5125 S. Lincoln Way
Entertainers delight! This stunning view rancher has vaulted ceilings, extensive Brazilian Cherry plank hardwood floors, cherry cabinetry, custom tile, & granite throughout. A showstopper! Features a fully finished daylight basement with dramatic 17’ ceilings & a top of the line wetbar area. Large, open kitchen features Jenn-Air stainless appl, pantry, & oversized island with eating bar. Fully landscaped, window coverings, A/C, covered decks. Beautiful views and rare fully fenced backyard!
Plans to move? Plan now with Prime.
Always offering pre-staging consultations, pre-inspection ser vices and professional photography. Get started now and be show-ready by Spring!
melissa@propert ybyprime.com www.beaconhillevents.com • 509.482.3556 • email@example.com
melissamurphysells.com APRIL-MAY, 2013
Health 29 3/27/13 2:20 PM
LIVING “SEEDS OF GOOD HEALTH,” CONTINUED... nutrition, and they’re more likely to garden through life than their counterparts.” That in turn leads to healthier behavior, which begets more healthy behavior. Both Fitzgerald and Welty began gardening long before a relatively recent surge in its popularity — a surge that ...continued on page 32
Dr. Stiller is a board certified General and Cosmetic Surgeon by the American Board of Surgery and the American Board of Cosmetic Surgery.
At Linea Cosmetic Surgery, you can
Be the you, you want to be.
2400 West A Street :: Moscow, ID
minutes of gardening can burn the same number of calories as 30 minutes of aerobics
Acquire a Permit for
Spring Savings Coupon
Save 10% Every Wednesday
Your Purchase of $30 or More
May not be combined with other offers
Expires June 1, 2013
THCF Medical Clinics
New Spokane Clinic Conveniently Located off 3rd Ave.
225 East 3rd Ave. Spokane WA 99202
Spokane’s Spo Sp okane’s Local Local Garden Loc Garrden den & Pet Pet Stor Store Sto re Sup Su Supplying pply lyiing Spokane Spookane Sp ne With Wiith Quality W Qual aliity Products Produ duccts Since Since 1944 2422 E E.. Sprague Sprag Sp ragu ue Ave. 534-0694 5344-0694 53
7302 N. N. Division Divviissiion St. St. 484-7387 4844-7387 48
nwseed nwseed.com d.com
www.thc-foundation.org 30 Health APRIL-MAY, 2013 INH_LIVING_04_13.indd 30
3/27/13 3:01 PM
vertical gardening W
hen developers want to maximize land use without increasing their physical footprint, they start building upward. The same goes for gardeners. The concept is called vertical gardening, and though it’s recently become fashionable as city dwellers rekindle their connection to nature, it’s as old as civilization itself. And all it requires is a wall. “Vertical gardening is very popular among people who’ve downsized to a condo, a townhouse or an apartment,” says Stacey Mann, facility manager at Lima Greenhouses/Vicki’s Garden Center. “They find ways to put things up on the wall so they have space to garden.” As an example, she points to an upright shipping pallet. It looks ordinary enough, but Mann has made small modifications like adding a wooden back and “bottoms” to form long container rows. The rows can then be filled with potting soil and a variety of plants: herbs like thyme, oregano and parsley; edible flowers like nasturtium (its pickled seeds become capers) and pansies; and decorative plants like grasses and cyclamen. Its sturdiness and slim profile allow the pallet to be easily screw-mounted to a wall, or attached to a fence or balcony railing prior to planting. Another one of Mann’s ideas is to use a hanging shoe rack. “You can poke a hole in the bottom of every pouch, then you put your potting soil in the pouches. And each pouch can hold a different plant. As long as you water it, it’ll grow.” As Mann shows, a vertical garden is limited only by your creativity. In her own home garden, she uses half-planters and old mailboxes to take advantage of free wall space on her garage or shed. She also notes that you don’t really even need a wall. A whiskey barrel and a trellis make a perfect platform for climbing flowers like clematis or vining veggies such as beans. Once you start thinking about it, you’ll be
Stacey Mann with one of her green pallets. YOUNG KWAK PHOTO surprised at the sheer number of vessels that can be transformed into little gardens. Mann recommends perusing photos online and scouring thrift and antique stores once you’ve been inspired. If
It’s time to relax... Let us do the work! Lawns • Trees • Sprinklers • Pest Control
you’d rather leave the imagining to someone else, Mann says Vicki’s Garden Center offers pre-finished pallets that come ready to hang. — E.J. IANNELLI
15% OFF NEW SERVICE ANY
FREE Estimate & Landscape Analysis
(509) 483-5249 for more details visit our website
www.SpokaneProCare.com APRIL-MaY, 2013 INH_LIVING_04_13.indd 31
Health 31 3/27/13 2:21 PM
Your Ultimate t s e w h t r o N d n la n I Restaurant Guide
living “seeds of good health” continued... coincides with a growth in urban populations. That has resulted in something of a paradox. More people are gardening as a hobby (Fitzgerald’s annual WSU Master Gardener report highlights the program’s work with thousands of first-time gardeners in 2012 alone), but many of them have less space in which to do it. Enter small-space gardening. Far from being cutting-edge, it revives a common practice that dwindled in the post-World War II era when Americans became more reliant upon the convenience of supermarkets. In 1944, for example, the small plots of urban land known as victory gardens were stewarded by around 19 million families across America. They are estimated to have accounted for 40 percent of the country’s total vegetable supply at the time. “The average person under 40 years of age is two generations removed from any association with gardening or producing their own food,” says Fitzgerald. “That’s why it’s essential that we teach gardening, because these are not skills that have been passed along.” Small-space gardening takes many forms: container gardening, vertical gardening, raised beds, and community gardens, to name only a few. What all of them have
In 1944, 19 million Americans had
On Stands April 23
ace by April 5th
your sp Restaurants - Reserve
9.525.0634 ext. 215
firstname.lastname@example.org | 50
Health APRIL-MaY, 2013 32 TheMenu_03.26.13_InHealth_TwoThirdV.indd INH_LIVING_04_13.indd 32
in common is that each garden is only as large — or as tiny — as you want it to be. Fortunately, the limited scale of smallspace gardening isn’t accompanied by a limitation of its health benefits. In fact, reducing a garden to a manageable size for even the casual gardener reduces the pressure to generate big yields and allows more people to access its perks. The meditative calm of planting, the fun of trying new vegetables or enjoying a bright, colorful flower display, and the soul-deep satisfaction of the harvest are the same whether you have a 10-foot plot or a 10-inch pot. n
3/27/13 1:34 PM
3/27/13 4:14 PM
Welcome to 3rd Avenue Plaza
Coworking Office Space 725 E. 3rd Ave Spokane, WA 99202 3rd Avenue Plaza offers exclusive office services and professional space to a diverse group of Spokane professionals boasting private, coworking (full time & part time), drop-in and virtual office space. Business services include, but are not limited to phone, mail, conference space, work space, technology, marketing and all administrative services your business needs to succeed.
Spokane’s East Central Community Garden YOUNG KWAK PHOTOS
COMMUNITY GARDENS I f your backyard or balcony isn’t an ideal growing spot, or if you want to supplement the bounty of your home garden with greater variety, consider joining a community garden. “The biggest benefit [of community gardening] for me is the sharing of the workload,” says Paul Kimball, who runs the Emerson Community Garden in the Emerson-Garfield neighborhood alongside his wife Sara. “I really only have to garden a couple weeks a season. Another benefit is that networking with neighbors provides a wider base of knowledge. This last year we had one member who had expert knowledge on composting.” Community gardens come in as many flavors as the crops they produce. Some allow individuals or families to claim one or more plots, which are then tended and harvested separately. Others have a large shared space that is maintained and harvested collectively. Some charge a membership fee; some are free. Some require participants to invest a minimum amount
of time in upkeep; others share the yield with anyone who shows up. No matter your preference, there’s probably a nearby community garden for you. The relative advantages of community over private gardening are manifold. An obvious one is that they provide more opportunities to socialize — especially come late summer, when harvest time can blossom into a neighborhoodwide event. And community gardens have the advantage of being larger than many backyards. That means more room for space-hungry crops like corn and pumpkins. “The biggest joy comes from meeting neighbors and building friendships,” says Kimball. “Our motto for the Emerson Community Garden is ‘Neighborhood Roots, Garden Fruits.’” There are about two dozen easy-to-find community gardens in the Inland Northwest. To locate one, visit www.greenspokane.org or get in touch with your neighborhood council. — E.J. IANNELLI
Scan to visit website
509-868-9181 www.3rdAvePlaza.com APRIL-MAY, 2013
Health 33 3/27/13 2:21 PM
Chef Branden Moreau and the Manito Tap House’s roasted heirloom carrot and avocado salad.
Tapping into Healthy Food The Manito Tap House offers fresh food for unique diners STORY BY CARRIE SCOZZARO | PHOTOS BY YOUNG KWAK
f a roasted heirloom carrot salad dressed in grapefruit-lime vinaigrette doesn’t sound like your typical pub grub, it’s because Manito Tap House isn’t your typical pub. Credit atypical owner Patrick McPherson and his mercurial, mustachioed executive chef, Branden Moreau. “I love upscale pub food,” says McPherson, who collaborated with Moreau on the roasted carrot salad for
the spring menu. “To me what makes pub food ‘upscale’ is using fresh ingredients in a creative way… not just using a bunch of frozen and fried foods.” That means from-scratch, seasonal menus with something for omnivores, carnivores, vegetarians, vegans and even diners with unique food concerns. “We’re gaining a reputation that this is a safe place to eat,” says Moreau, certified through the Washington Restaurant
Association’s “Spot Check” Allergy Safe program. Accommodating food allergies or providing gluten-free options, for example, “can’t be a looked at as a hassle,” says Moreau, “because it’s somebody’s life… or it’s somebody’s life choice.” Another goal for Moreau is featuring local products. “I am on a constant communicative basis with my purveyors and meet with them several times a week,” says Moreau, who sourced the carrots for this
34 Health APRIL-MaY, 2013 INH_COOK_04_13.indd 34
3/26/13 12:45 PM
recipe from Spokane’s Main Market. And of course, the food has to look and taste good. His salad, says Moreau, is “a balanced dish with flavors that work well with each other: bitter, tart, and sweet… also a great source of vitamins and nutrients with the roasted carrots and arugula, a little fat with the avocado, and a small amount of protein with the sunflower seeds.” Roasting the carrots heightens this humble veggie’s hidden sweetness, but isn’t the only cooking method Moreau would employ for this dish. “Consistency in cooking is key,” says Moreau, who is hot on the sous-vide cooking method. French for “under vacuum,” sous-vide involves sealing foods in specialized, airtight bags and immersing them in precision-heated water, sealing in juices. With their required Hazard Analysis & Critical Control Points (HACCP) plan now in place — just one of many food safety requirements chefs and restaurant owners have to be aware of — Moreau can begin experimenting with the technique in earnest. Persistence is just part of his nature, says Moreau, who remembers learning to cook an omelet as a 7- or 8-year-old. Inspired to cook by his grandmother, Moreau seized an opportunity to take a class at the NEWTECH Skill Center (formerly the Spokane Skill Center). “I just remember wanting more,” says Moreau, who worked at Longhorn Barbecue during his Mead High School years. Then he caught the attention of Mead alum Alexa Wilson, formerly of the Davenport Hotel and Wild Sage Bistro and currently corporate executive chef at food and beverage distributor Sysco. Wilson hired Moreau to work at Prospectors Bar and Grill, which he did until attending Western Culinary Institute’s Le Cordon Bleu in Portland. Culinary school brought sweet success for Moreau. In addition to meeting future wife Brittany there — she is Manito Tap House’s resident baker — Moreau also earned an internship at famed restaurateur Thomas Keller’s Las Vegas Bouchon Bistro inside the Venetian. Then it was off to Seattle, where Moreau became sous-chef at the venerable Place Pigalle in Pike Street Market. That’s where he won the 2011 Master of the Market “Iron Chef” cooking competition, impressing judges with not only his culinary skills, but also his impromptu yo-yo demonstration. An avid yo-yoist since 1996 — he was ranked fifth nationwide in 2000 — Moreau still mentors yo-yoists and judges competitions in his spare time but would rather be in the kitchen. “Whenever people get together for a meal,” he says, “eventually everyone ends up in the kitchen.”
RECIPE Roasted Heirloom Carrot and Avocado Salad 6 oz. (3-4) heirloom carrots 2 tablespoons ground cumin 1 teaspoon crushed red pepper 1 tablespoon brown sugar 1 teaspoon salt 1 teaspoon black pepper ¾ cup canola/salad oil 1 ounce grapefruit juice 1 ounce lime juice ½ cup canola/salad oil ½ cup organic arugula ½ cup spring mix lettuce ¼ avocado, julienned 1 teaspoon black & white sesame seeds 1 tablespoon toasted sunflower seeds
Scenes from the Tap House
Wash and trim the tops off the heirloom carrots. Blanch in a small pot of boiling water for about eight minutes. Remove blanched carrots and place in an ice bath to stop the cooking process. Remove from water and peel any loose skin from carrots. You want the carrots to be slightly cooked but not too soft. Combine cumin, crushed red pepper, brown sugar, salt, and black pepper in small mixing bowl. Whisk ¾ cup of canola oil into the spice mixture. Toss carrots in spice mixture; remove carrots, draining excess oil, and roast for 20 minutes at 400 degrees. Refrigerate carrots until ready for use. Combine citrus juices and slowly whisk in ½ cup of canola oil to create vinaigrette. Add a small pinch of salt and pepper if preferred. Toss arugula and spring mix in a small mixing bowl with citrus dressing. Add enough dressing to coat the lettuce to your liking — there will be some left over. Add sunflower seeds. Place dressed salad on a chilled plate, cut carrots diagonally and shingle onto bed of lettuce. Julienne the avocado and lay over the shingled carrots. Garnish with sesame seeds. Serves two as side salad, or one main-dish salad.
APRIL-MAY, 2013 INH_COOK_04_13.indd 35
Health 35 3/26/13 12:45 PM
Curt Helsper of the Aspen Sleep Center finds one patient’s problem: “When he’s sleeping he’s not breathing.” JACOB JONES PHOTO 55-PLUS
Resting Uneasily Sleep apnea can cause more than daytime fatigue BY JACOB JONES
urt Helsper traces his finger along a jagged line charting a patient’s breathing throughout a recent overnight sleep study. Moving along the line, he points out dozens of flat breaks in the line, counting several breaks each minute. “That’s where the patient isn’t breathing,” he says, checking the length of one break. “This one’s just under 23 seconds long.” Helsper, technical director for the Aspen Sleep Center in Spokane Valley, says this patient snorts and thrashes all night long, struggling to breathe. He wakes up exhausted. He nods off at work. It’s all due to a common sleep disorder called sleep apnea. “Basically, when he’s sleeping he’s not breathing,” he says of the patient.
The American Academy of Sleep Medicine estimates as much as 4 percent of the adult population suffers from some form of obstructive sleep apnea, which occurs when soft tissue at the back of the throat collapses into a person’s airway when he or she sleeps, blocking oxygen to the body. Michael Coats, a neurologist and sleep expert at Aspen, warns that sleep apnea increases risk of high blood pressure, heart disease and stroke. The resulting daytime fatigue can also lead to inattentiveness at work and increased risk of occupational injuries. But with growing awareness in recent years and new therapies, people struggling with sleep apnea now have more options than ever before. “It’s something that is diagnosable and treatable,” Coats says confidently.
ommon symptoms of sleep apnea include shallow or intermittent breathing, snoring, high blood pressure, overnight restlessness and daytime fatigue. Sleep experts agree men face a greater risk of developing sleep apnea. The disorder is also more prevalent in the elderly or overweight. While those populations face the highest risks, Coats notes even younger patients, women and people within a healthy weight range can develop symptoms of sleep apnea. The Spokane area has four sleep labs that can perform various sleep testing, including overnight evaluations. Inside the Aspen Sleep Center, patients can undergo testing for 84 different sleep disorders, but sleep apnea is by far the most common. Technicians welcome patients into cozy motel-like rooms with TVs, lamps and private bathrooms. These rooms have also been wired with infrared cameras and microphones to document sleeping patterns. Technicians connect monitors and belts to patients to measure brain activity, breathing, heart rate, oxygen levels and other vital signs. Helsper says the monitoring equipment can seem uncomfortable or intimidating,
36 Health APRIL-MaY, 2013 INH_55+_04_13.indd 36
3/26/13 12:44 PM
but technicians try to make patients feel at ease. “It’s fairly accommodating,” he says. Many sleep physicians express a preference for overnight evaluations in a controlled sleep lab. Helsper says cheaper at-home tests, measuring heart rate and oxygen levels, can show warning signs, but do not include as much observation or track certain variables. “The best thing that patients can do if they suspect that there might be a potential sleep disorder is they just need to seek a consultation with a sleep physician,” he says. “These board-certified sleep physicians are experts in what they do.” Once tested, patients can explore a variety of treatment options.
or the most severe cases of sleep apnea, sleep physicians almost always recommend Continuous Positive Airway Pressure treatments, or CPAP. Coats calls the airway support system the “gold standard” in sleep apnea therapy. “It is the most effective treatment for most people,” he says. CPAP involves wearing a pressurized mask over the nose or mouth while sleeping to prop open the back of the throat with air pressure. While some find the mask uncomfortable, Coats says it offers the best results for the effort. Helsper says more than 200 different custom masks offer a wide variety of comfort options. Many medical plans will also cover machine rental fees. Some patients can seek a surgical solution, Coats says. Procedures include removing tonsils, cutting away sinus tissue or realigning the jaw. Sleep experts have also started to embrace the use of mouth guard-like oral appliances to hold the jaw forward. Spokane dentist Robb Heinrich, with Sleep Better Northwest, says oral appliances offer a versatile middle-ground option for patients who cannot get used to a CPAP mask. “We have a number of different appliances we use,” he says, noting that for patients on the go, an appliance is much more portable and does not require electricity. Heinrich says he does not make oral appliances for patients without a consultation from a sleep physician. He stresses the importance of continually working alongside physicians to pursue the best treatment for each person. “We don’t just make an appliance and that’s it,” he says. “We do the follow-up.” Heinrich and sleep experts agree those patients who take a holistic approach of eating healthier, exercising more and staying active see better results. Patients with mild
An oral appliance worn overnight can help some patients. JACOB JONES PHOTO to moderate sleep apnea may see improvements by losing weight. With the many increased health risks associated with the disorder, Helsper says
the old medical warning applies to diagnosing and treating sleep apnea. “It’s see me a little now,” he says, “or a lot later.” n
The Tax Credit is Back. May qualify for to up for 3 1 20 FEDERAL TAX CREDIT
Save with a Fedral Tax Credit up to $500* Save with reduced energy bills for your home
Take advantage of a Federal Tax Credit opportunity and help lower your energy bills with Duette® Architella® Honeycomb Shades. Call for your free in-home consultation, today!
509.534.5064 | email@example.com | wallflowerdesigns.com Mon-Fri 9-5:30 | Saturday 10-3 | 2820 E. 30th Ave, Spokane
APRIL-MaY, 2013 INH_55+_04_13.indd 37
Health 37 3/26/13 12:44 PM
Lynn Wallace serves a turkey sandwich at Coeur d’Alene’s Ramsey Elementary, where baked potato chips, fresh fruit and fresh vegetables are also on the menu. Young Kwak photo
Remaking school lunches to be healthier is a big challenge, but small victories are starting to emerge BY lisa fairbanks-rossi
here are no lobbying groups for broccoli. Green pepper farmers can’t afford ads on the Disney Channel. And when the USDA mandated changes to school lunches this year, they didn’t include a budget for marketing. Too bad, because transforming children’s tastes and preferences is a tough sell. “The fruits and vegetables are available so that students can taste them and see if they’d consider trying something new,” explains Molly Berg, who is accountable for the lunchroom and kitchen at Spokane’s
Jefferson Elementary School. “There are so many exciting new colors and textures,” explains Berg. In fact, 75 new, healthier foods were added to Spokane Schools’ menu options in the 2012-13 school year. “We want to help kids have a sense of adventure when it comes to fruits and vegetables, but you cannot make anybody eat anything that they don’t want to eat,” Berg says with exasperation, recalling a recent, nearly untouched batch of “gorgeous” carrot raisin salad. Policing the choices elementary chil-
dren make in the lunch line has been an unintended consequence of the USDA’s “Healthy, Hunger-Free Kids Act.” As part of this year’s dietary requirements, students must take at least one fruit and one vegetable from the salad bar. “You have to make it cool,” asserts Terry Perry, who helps run WSU’s Food Sense program, which partners with nutrition services programs to champion healthier diets and lifestyles. “Students don’t care if we tell them eating carrots supplies them with a healthy dose of beta-carotene and vitamin A, which helps eyesight,” she explains. “We tell them ‘These are X-Ray-Vision Carrots!’ ” In fact, baby carrots — specifically, Bolthouse Farm baby carrots — are one of the few vegetables that have actually been represented by a major advertising agency, using what works: videogame imagery and fancy packaging. After one campaign utilizing TV, shelf signs, school vending machines and a catchy slogan, “Eat ’em like junk food,”
38 Health APRIL-MaY, 2013 INH_PARENTS_04_13.indd 38
3/26/13 12:48 PM
baby carrot sales rose 11 percent. Left with no-cost strategies, however, “it takes 12 to 18 exposures — what parents call ‘no, thank you’ bites — to adjust to different tastes,” says Spokane Schools’ Nutrition Services Director Doug Wordell. “Almost all tastes are cultural and learned,” he says, “and changing children’s preferences and behaviors will take a few years.” Both Wordell and Perry accept the necessity of selling healthy, and point to the success of Shaw Middle School’s experiment with fruit and vegetable rebranding. Using the concepts from the national nonprofit Smarter Lunchrooms, a group of students is pushing leaner, greener lunches. “The premise is that as you place, market and promote certain healthy foods, display them differently and perform taste tests,” you’ll have more buy-in, explains Wordell.
ver at the Cheney School District, they’re relying on customer service, passion and perseverance to build healthier habits. “We promote, we educate, and we’re happy about it,” says Nutrition Services Director Brian Levy. “We have to make it really positive, like ‘Look how awesome these lentils are! And they were grown an hour from here!’ It involves treating the students as customers, and the work is constant,” he says. “We’re not going to change their palates quickly.” With the help of an Empire Health Foundation grant, Levy’s schools started scratch-cooking and eliminating fat and sugar this past school year. The principal at Cheney’s Sunset Elementary, Matt Beal, raves about the hot lunches, which he eats every day. “There are about 12 to 15 other staff members who also eat hot lunch, so part of it is modeling,” he says. “I think the big thing is that kids have to be introduced to foods, over and over, whether it’s sweet potato fries, or lentils,” Beal explains. “It is exploration; trying to figure out what’s going to hook them.” He admits there was a lot of waste at the beginning, but enthusiasm and creativity have eased the program’s growing pains. “Our kitchen staff is amazing, especially the head chef. Just three of them — two working part time — feed 500 students scratch meals.” While the Empire Health Foundation helped set up the district’s kitchens and paid for special from-scratch training, Cheney schools are staying within budget. “As a businessperson, I try and operate
new school, new menu
hen Spokane Schools’ Nutrition Services Director Doug Wordell needs ideas and inspiration about how to make small changes that make a big difference, he looks to Spokane Schools’ new project-based high school, The Community School. “It’s very diverse campus,” says Principal Cindy McMahon. Students design their own curriculum based on real-world issues. “The only requirement is that they are invested in their own learning. Students choose here because they want to do school differently,” says McMahon. Who better to make food different? One of the first things they did was start a culinary arts class, led by Chef Rene Sellgren. And they renamed the cafeteria the “Community School Café.”
The café incorporates round tables, plates and silverware, floral centerpieces (supplied by the horticulture program) and an impressive fruit and vegetable buffet from which students and instructors construct artful salads. Sellgren sneaks squash into mac and cheese, and lentils into brownies. The students plant and cultivate a garden, which they use for salads, soups and seasonings. “Chef Rene” is huge fan of herbs: She roasts chicken, vegetables and baby gold Yukon potatoes with thyme, basil and rosemary. “Someone wanted to borrow salt from me the other day, and I told him, ‘the USDA says I can’t use salt,’ ” Sellgren recalls. “He said, ‘You don’t use salt and the food still tastes good?’ You can tell their palates are starting to change.” — Lisa Fairbanks-Rossi
as revenue neutral as possible… and we’re right there,” Levy maintains. “But even if we lost money, going back to scratchcooking and taking out processed food and additives and preservatives is the right thing to do. Children’s lives are worth the up-front cost.” Wordell knows all about up-front cost, and though he’s spent most of this year on
massive paperwork, analytics and staff support, he’s also fostering a scratch-cooking program. He admits the task of reinventing meals has been “challenging and frustrating and crazy,” but it’s also exciting. “We’re going to figure out a way to make foods taste better and still comply. We have really creative people. We’re figuring it out.” n
85% OF HOMES HAVE HARD WATER.
Culligan® homes have soft water and a 100% satisfaction guarantee*.
Stop scouring tubs, showers and sinks. With a Culligan water softener, you will use fewer cleaning products while making soaps and detergents last longer Put Culligan to work on your hard water and get a 100% satisfaction guarantee*. • Reduces corrosive build-up on pipes & appliances • Saves you time & money on cleaning and laundry
100% Culligan water. Feels so good! * Offer valid on residential products only. Consumers must notify their Culligan dealer no later than 30 days after purchase. Offer good at participating dealer locations.
FREE IN HOME WATER ANALYSIS
a Culligan® HE Water Softner
Limited time offer. See participating dealer for details. ©2010 Culligan International Co. May be subject to credit approval. Not valid with other offers. Dealer participation may vary. Coupon must be presented at time of sale. Contaminants may not be in your water.
Limited time offer. See participating dealer for details. ©2010 Culligan International Co. May be subject to credit approval. Not valid with other offers. Dealer participation may vary. Coupon must be presented at time of sale. Contaminants may not be in your water.
An experienced Culligan Man™ will test your water and explain the resultno cost, no obligation!
better water. pure and simple.®
Culligan Water of Spokane 25 East 3rd Avenue • Spokane, WA 99202 1-800-696-8051 • culliganpaciﬁc.com
APRIL-MaY, 2013 INH_PARENTS_04_13.indd 39
Health 39 3/26/13 12:48 PM
living april-MAY events BLOOMSDAY CLINICS Get in shape for Bloomsday at free training clinics hosted by Providence and Group Health on Saturdays at 8:30 am through April 27. Free. Spokane Falls Community College gym, 3410 W. Fort George Wright Dr. phc.org (474-2397) TASTE OF LIFE Celebrate life with an evening of wine, beer, spirits and gourmet food as part of an annual fundraiser benefiting Hospice of Spokane and its end-of-life support programs on Mar. 29 from 5:30-8:30 pm. $75. Spokane Club, 1001 W. Riverside Ave. hospiceofspokane. org (532-6731) CHOCOLATE AND CHAMPAGNE GALA The 29th Annual fundraiser benefitting Lutheran Community Services of Spokane’s Sexual Assault and Family Trauma Response Center features champagne, decadent chocolates and desserts, hors d’oeuvres, drinks a silent auction, live entertainment and more on April 6. Mirabeau Park Hotel, 1100 N. Sullivan, Spokane Valley. lcsnw.org (343-5053) OUR KIDS, OUR BUSINESS Robin Karr-Morse, author of Scared Sick, will trace the roots of violence to early trauma in children at a keynote luncheon and community training sessions, on April 10. Luncheon from 11 am-1 pm; training sessions from 1:30-5 pm. $35/luncheon only, $50/luncheon and training. Spokane Convention Center, 334 W. Spokane Falls Blvd. ourkidsspokane.org NANCY ROCKWELL ALZHEIMER’S GALA & AUCTION 13th annual masquerade ball fundraiser. April 12 at 5:30 pm. $100. Davenport Hotel, 10 S. Post St. (473-3390) STOP DIABETES AT WORK Workplace wellness breakfast hosted by the American Diabetes Association, open to all businesses and companies of any size. April 12 at 7:30 am; RSVP requested. WSU Spokane Campus, 600 N. Riverpoint Blvd. (624-7478) HEALTHY COOKING CLASS Learn to prepare a healthy new meal during this monthly class on April 18 and May 16 from 6:30-8 pm. Free. Holy Family Health Education Center, 5633 N. Lidgerwood St. cherspokane.org (232-8131) ATTITUDINAL HEALING WORKSHOP Lecture by Jerry Jampolsky and Diane Cirincione, founders of Attitudinal Healing International. April 19 at 7 pm. Free and open to the public. Unity Spiritual Center, 2900 S. Bernard St. ahinlandnorthwest.weebly.com (838-6518) SPOKANE WOMENS SHOW Enjoy live music, entertainment, demonstrations, vendors, lectures, exhibits and more from April 19-21. Times vary. Cost: TBA. Spokane Convention Center, 334 W. Spokane Falls Blvd. washington.providence.org RACE FOR THE CURE Participate in a 1-mile survivor’s walk or 3-mile fun run to benefit the Susan G. Komen Eastern Washington Affiliate on April 21 at 9 am. $15-$25. Spokane Convention Center, 334 W. Spokane Falls Blvd. komeneasternwashington.org MARCH FOR BABIES SPOKANE Get a team together and raise money to support March of Dimes’ programs that help babies born premature or ill as part of a 3-mile fun run and other events celebrating the organization’s 75th year on April 27 at 9 am. Gonzaga University Jundt Art Museum, 202 E. Cataldo. marchforbabies.org (328-1920) KIDICAL MASS BIKE RIDE Bring the whole family to this 2-mile afternoon ride on anything with wheels that rolls,
Gears in Motion D
iabetes affects more than 26 million Americans — with another 79 million considered “pre-diabetic.” Diabetes treatment cost $176 billion in 2012 in the United States. Exercise offers health benefits to people with either type 1 or type 2 diabetes. And it can be fun. That’s why the American Diabetes Association hosts the annual Tour de Cure with a mission “to get people outside and healthy,” says event coordinator Ted Duncan. The spring bike ride offers routes that are five, 20, 50 and 100 miles long. It’s a ride, not a race. “The event’s varied distances allow the whole family to participate, and get people who may have signs of pre-diabetes active,” Duncan says. Local organizers are hoping to raise $100,000 — money that will be used to support outreach programs, as well as research and advocacy. — ERIC GAVELIN Tour de Cure • Sun., May 19 • $15 registration; $150 fundraising minimum • Dwight Merkel Complex • 5071 N. Assembly • tour.diabetes.org • firstname.lastname@example.org
in conjunction with West Central Neighborhood Days, and hosted by Spokane’s Summer Parkways. April 27 at 1 pm. Free. Begins at A.M. Cannon Park, 1920 W. Maxwell Ave. summerparkways.com
to honor and remember a mother who’s no longer with us in a safe environment, on May 11 from 9 am-noon. $20, RSVP by May 4. St. Joseph Family Center, 1016 N. Superior St. sjfconline.org (483-6495)
BLOOMSDAY Take part in the 37th annual, 7.46-mile road race through Spokane, with proceeds benefiting the Boys & Girls Club of Spokane and the Martin Luther King Jr. Family Outreach Center, on May 5. $17-$35. bloomsdayrun.org (838-1579)
KIDICAL MASS BIKE RIDE Bring the whole family to this 2-mile afternoon ride on anything with wheels that rolls, hosted by Spokane’s Summer Parkways. May 18 at 1 pm. Free. Begins at Chief Garry Park, summerparkways.com
CATHOLIC CHARITIES GALA Celebrate another year of giving back with Catholic Charities at a social hour and dinner with live music and entertainment, on May 10 starting at 6 pm. $60-$100/person; sponsorships available. The Davenport Hotel, 10 S. Post St. catholiccharitiesspokane.org (358-4250) BLOOD DRIVE Donate blood by appointment or on a walk-in basis on May 10 from 9:30 am-4 pm. Kootenai Medical Center, 2003 Kootenai Health Way, Coeur d’Alene. inbsaves.org (800-423-0151) BIKE RIDING AS A CONTEMPLATIVE PRACTICE Get a new perspective on the spiritual and meditative benefits of an activity you enjoy, such as bike riding, in a retreat event on May 11 from 10 am-3 pm. $25. St. Joseph Family Center, 1016 N. Superior St. sjfconline.org (483-6495) ALTERNATIVE MOTHER’S DAY CELEBRATION Take time
WINDERMERE MARATHON Participate in the USATF Certified and Boston Marathon qualifier race in a full or half-marathon length that also benefits the Windermere Foundation, assisting local low-income and homeless families, on May 19 at 7 am. $87-$125. Liberty Lake to Riverfront Park in downtown Spokane along the Centennial Trail. windermeremarathon.com VANESSA’S PROMISE BENEFIT LUNCHEON “Love Handed Down” is the theme of the Vanessa Behan Crisis Nursery’s fundraiser event this year, featuring keynote presentations by members of Vanessa Behan’s family, on June 4 from 12-1 pm. Spokane Convention Center, 334 W. Spokane Falls Blvd. vanessabehan.org (340-0479) n The calendar is a free service, on a space-available basis. Mark submissions “InHealth Calendar” and include the time, date, address, cost and a contact phone number. Mail: 9 S. Washington, 4th Floor, Spokane, WA 99201; Fax: 325-0638; or E-mail: email@example.com.
40 Health APRIL-MaY, 2013 INH_Events_04_13.indd 40
3/26/13 12:46 PM
from page 13
Over 600 research studies have verified that the daily practice of the TM technique:
Codewords AWKWA R D D E B M E L O D I C I S U O N OO D L E S U T S J E E P T O N S A P H I D P T N OWE U R N R C E I S S T E V E Q
T I F F S A R T E V E X F F E E R A Z O R E E E H E I R D C O L E C A T H Y U H I S E L S G A O U I E T E N
• Reduces Stress, Anxiety • Improves Health • Improves Creativity
• Develops Full Potential • Inner Peace,Happiness
Learn TM, an effortless,natural,effective technique and start enjoying the benefits today. Visit our website: www.tm.org/transcendental-meditation-stmaries
Learn the benefits today.
Ask your doctor about the Transcendental Meditation® technique to help alleviate stress and improve health.
Certified TM Teacher
To advertise, call pm] . - Fri. [8:30am - 5:30 Mon PHONE: (509) 444-7355
ard@Inlan AIL: BulletinBo (509) 325-0634E-M ext. 212, Washington St. IN PERSON: 9 South WA 99201 Spokane,
or e-mail: firstname.lastname@example.org
For as low as $24 per week
Advertise on e Bullethtin Board
For more inform
ation contact bulletinboard@inl ander.com
8 6 7 9 7 8 6 5 3 7 3 2 5 4 2 4 1 3 4 2
7 8 6 5 4 1 2 3
5 4 2 6 3 9
3 2 1 7 4 5 6 8 9
2 3 4 1 6 7 9 5 8
4 3 2 1
1 2 3 8
8 7 7 6 5
Sudoku Gentle (top), Tough (below) 6 5 8 7 4 3 2 9 1
2 4 7 1 6 9 3 8 5
9 3 1 8 5 2 7 4 6
1 2 5 3 8 6 9 7 4
4 9 6 2 7 5 1 3 8
8 7 3 9 1 4 6 5 2
5 1 4 6 9 7 8 2 3
3 8 9 5 2 1 4 6 7
7 6 2 4 3 8 5 1 9
8 9 7 1 2 6 4 3 5
4 1 5 7 3 8 9 6 2
2 6 3 9 5 4 8 1 7
5 2 9 3 1 7 6 8 4
6 4 1 8 9 2 7 5 3
3 7 8 6 4 5 2 9 1
1 3 6 2 7 9 5 4 8
9 5 2 4 8 1 3 7 6
7 8 4 5 6 3 1 2 9
Get the Lead Out! Lead Safe Spokane program 3% IntereSt LoanS up to
$13,000 per unIt to addreSS Lead BaSed paInt hazardS. 75% oF the Loan IS ForgIven over 3 YearS. owner occupIed hoMe & rentaL propertIeS Located In Spokane countY are eLIgIBLe to appLY. hoMe
MuSt Be BuILt BeFore 1978.
MuSt earn LeSS than 80% area MedIan IncoMe. a FaMILY oF Four can QuaLIFY theY Make under $50,300 per Year.
occupIed hoMeS MuSt have chILdren under 6 YearS oF age that LIve In the hoMe, vISIt More than SIx hourS a week, or a pregnant woMan In the hoMe.
Program administered by
For More InForMatIon on Lead SaFe Spokane and other prograMS: 509.755.7555 or khco.coM
MOISTURE IN YOUR WINDOWS? Don’t Replace. RESTORE for Less!!
CALL TODAY! 509-284-4427 TheGlassGuruofSpokaneValley.com
New Patients Welcome!
Associates for Women’s Health Medical Marijuana is Safe & Effective.
• Obstetrics • Infertility • Colposcopy • Laser Surgery • Gynecology • Urogynecolgy • Micro Surgery • In-Oﬃce Ultrasound
225 East 3rd Ave. Spokane, WA
James Brasch, M.D. • Kurt Fine, M.D. Robert Milligan, M.D
(509) 484-1236 • 212 E. Central Ave, Suite 340, Spokane All physicians are Board Certified.
APRIL-MAY, 2013 INH_Events_04_13.indd 41
Health 41 3/27/13 2:11 PM
Derek Khorsand is having trouble choosing a specialty: “I’ve loved everything I’ve done.” STEPHEN SCHLANGE PHOTO people
Studying Spokane One third-year med student relishes his time at UW East By nicholas deshais
he bright young students at the University of Washington’s medical school always spend their second year of studies in Seattle. The hubbub and opportunity offered in the Pacific Northwest’s largest city is exciting. Then their third year begins and some end up learning in Spokane’s hospitals and clinics. Some of them consider this a spell of bad luck. “That’s not the case for me. So don’t worry,” says Derek Khorsand, 24, with a laugh. He came here last July with his wife Kate, both in their third year of studies at UW’s School of Medicine. “We wanted to check out Spokane’s huge medical commu-
nity and see if this is a place we could live in the future, where we could practice.” As the Inland Northwest grows, so does its prominence as a regional medical hub and its need for more health professionals. It’s also why, beginning next year, people like Khorsand may become scarce. That is, rather than transitory students spending just one or two years here, medical students will begin spending all four years in Spokane, thanks to the completion of the Riverpoint Campus that will house a complete four-year program in the University District. Of course, another reason Khorsand and his wife chose Spokane is so they
could spend the year together. Otherwise, they would’ve been moved around — from Juneau to Billings to Pendleton — every six weeks. Which might be an adventure “if you were single,” says Derek. “If you like to see each other, it’s suboptimal.” Spoken like a true doctor.
edical school can be as hard as you imagine, Khorsand says. Some days, he rises at 3:30 in the morning and doesn’t get home from the hospital till 7 that evening. And that’s when the studying begins because, yes, there are still tests. But mostly it’s manageable. “If it’s important to you, you find time,” he says. “I have friends who do full triathlons.” For Khorsand, living a life outside of his studies is important. He and his wife sneak in a date night on a regular basis. With the workload and stress, Khorsand couldn’t be blamed for allowing his
42 Health APRIL-MAY, 2013 INH_PEOPLE_04_13.indd 42
3/26/13 12:49 PM
body to slide into disuse. But he still hits the gym. “You see reasons why you should live to the fullest,” he says of his work at the hospital. Khorsand decided he was going into medicine in middle school. His mom’s an operating room nurse. His older sister’s a first-year anesthesia student at UW. “My dad’s a mechanical engineer,” he says. “All of his siblings are in medicine, so he’s always been the black sheep in the family.” He and his wife met in honors calculus on Khorsand’s first day of college at the University of Washington, where he would eventually get his undergrad degree in biochemistry. The two got engaged two months after beginning medical school and were married last March. It’s been a life, for the most part, of reasoned, dispassionate decision-making. Khorsand knows exactly what he wants to do. Sort of. “That’s a tough question,” he says when asked what type of doctor he wants to be. “Honestly, I’ve loved everything that I’ve done, so it’s going to be a tough choice.” He’s been through his intensive-care unit, radiology, family medicine, internal medicine and obstetrics rotations. There’s still surgery, pediatrics and psychiatry left. How about a top three? “Hmmm. Top three. Let’s see here,” he says. “I’m going to have to say undecided.”
here is one moment during his time in Spokane, however, that has stuck with him like no other. “Getting to deliver a baby,” he says. “[The doctor and I] had done a few together. He was talking me through it, quizzed me beforehand. … I caught the baby. It was totally awesome.” It’s a moment that shows how close these students are to actually being doctors — even if the “real” doctor was right over his shoulder. He says it’s an opportunity he might not have gotten in Seattle, where students are competing with residents and fellows to have the opportunity to deliver a baby. “[There] you’re the low man on the totem pole,” he says. “You won’t really get as intensive experiences with exposure to the depth and breadth of medicine that you would out here, which I think is a huge strength of the program.” Khorsand still has a few years to go before practicing on his own, and he has no idea where he and his wife will land. But you never know. Maybe he’ll treat the baby he delivered as she grows from child to adult. n
20% off any Spa or Salon services. A sanctuary of rejuvenation and repose… Mondays - Thursdays a necessary indulgence.
until May 31, 2013.
Not combinable with other specials or promotions. Not applicable to products.
Complimentary valet parking with services. ARated glass Among of champagne included services. the Finest Spas inwith the World. - Forbes Travel Guide
davenportspa.com • 509 789 7300 Located in the historic •Davenport Hotel 7300 davenportspa.com 509 789 APRIL-MaY, 2013
Health 43 3/26/13 12:49 PM
3/26/13 12:49 PM