Inhealth 4/3/2017

Help With Opioids

15

| Time To Unplug?

31

| Vegan Mac ’n’ Cheese

36

LESS

HEALTHY LIVING IN THE INLAND NORTHWEST • FREE

IS MORE How to downsize your dream home

SPECIAL HEALTHY HOME SECTION | PAGE 20

A P R I L- M AY, 2 01 7

SPECIAL SUPPLEMENT TO THE INLANDER

“M

y school-age daughter and I both have ADHD. We had each been to many different providers in both Seattle and Spokane, but none of them seemed to understand the nuances of female ADHD...and none of them helped.

When we finally found Dr. Beck, it was such a relief. After years of searching, he has been by far the most effective provider I have met – and, on top of the great ADHD care, the Winston Center also addresses learning disabilities. My daughter, who struggles with dyslexia, is making fantastic progress with the help of a learning specialist at the center. She also sees an in-house psychologist, who is helping her manage all the frustrations that come with being a kid with ADHD and dyslexia. All in all, we couldn’t be happier with the Winston Center and recommend it highly.”

Spokane’s Premier ADHD & Reading Disorders Center

Call now!

509-465-1252

winstoncenter.com CNTS inhealth 04-03-2017.indd 2

3/24/17 5:19 PM

PlanetFitness.com

1617 W NW BLVD, SPOKANE

NOW OPEN!

Join NW Blvd or Valley For Only

1 10

$

$

DOWN!

A MONTH!

Expires Weds. 4/12. Last Chance to Save!

Tons of Equipment. Super Clean. Friendly Staff, No Salesmen. Non-intimidating Atmosphere.

13112 E Sprague Ave SPOKANE VALLEY, WA Open & Staffed 24/7

HOME OF THE JUDGEMENT FREE ZONE!

1617 W Northwest Blvd SPOKANE, WA Open & Staffed 24/7

*Limited time offer. Home club only. Billed monthly to a checking account. Subject to an annual membership fee. Includes T-shirt. *Must be at least 18 years old, or 13 with parent/guardian.

Incentives offered for enrolling in other memberships. Participating locations only. Planet Fitness facilities are independently owned and operated. Planet Fitness.

CNTS inhealth 04-03-2017.indd 3

3/24/17 5:19 PM

Life-changing Education and Research

EDUCATION AND RESEARCH

Health

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

EDITOR Anne McGregor

annem@inlander.com

MANAGING EDITOR Jacob H. Fries CALENDAR EDITOR Chey Scott COPY EDITOR Michael Mahoney CONTRIBUTORS Kristen Black, Robin Hamilton Brodt, Jennifer DeBarros, Raven Haynes, Jonathan Hill, E.J. Iannelli, Young Kwak, Robert Maurer, Linda Hagen Miller, Taryn Phaneuf, Carrie Scozzaro, Matt Thompson, Daniel Walters, John R. White PRODUCTION MANAGER Wayne Hunt ADVERTISING DIRECTOR Kristi Gotzian DIRECTOR OF MARKETING Kristina Elverum ADVERTISING SALES Autumn Adrian, Mary Bookey, Gail Golden, Jeanne Inman, Claire Price, Carolyn Padgham-Walker, Wanda Tashoff, Emily Walden SALES COORDINATION Kati Bronson, Camryn Barker DESIGN AND PRODUCTION Tom Stover, Derrick King, Alissia Blackwood Mead, Jessie Hynes DISTRIBUTION MANAGER Justin Hynes

Helping to slow disease progression.

Making health care more accessible.

Advancing solutions that reduce costs.

BUSINESS MANAGER Dee Ann Cook CREDIT MANAGER Kristin Wagner PUBLISHER Ted S. McGregor Jr. GENERAL MANAGER Jeremy McGregor InHealth is published every other month and is available free at more than 500 locations across the Inland Northwest.

One copy free per reader. Subscriptions are available at $2.50 per issue: call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x215. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2017. InHealth is locally owned and has been published since 2004.

spokane.wsu.edu SUPPLEMENT TO THE INLANDER

4 Health APRIL - MAY, 2017 CNTS inhealth 04-03-2017.indd 4

3/24/17 5:19 PM

INSIDE

APRIL - MAY, 2017

ON THE COVER | ALI BLACKWOOD DESIGN AND ART

CHECK-IN 100% LOCAL

Sweet Smell of Success 12 CHARITY CORNER 9 / ASK DR. MATT 10 / PILL BOX 12

Sign Up Now

NEWS PUBLIC HEATLH

Solving Opioid Addiction 15 POLITICS OF ADDICTION; MORE THAN MEDICATION

FOCUS

Pink Ribbon Run www.EveryWomanCan.run

Sunday, April 23, 2017 Riverfront Park Run Expo Opens 7:30 am Run Begins 9:00 am

HEALTHY HOME

Less Is More 20 RETHINKING THE DREAMHOUSE; ENDING HOMELESSNESS

LIVING TECHNOLOGY

Is It Time to Unplug? 31

Every Woman Can… With Your Support!

Educate, encourage and empower the women you know over 40 to get a mammogram.

Early Detection is the Best Protection.

Continue the conversation with us on Facebook (EWCinc).

PINK RIBBON RUN PRESENTED BY:

COOKING 36 / INNOVATION 38 / PSYCHOLOGY 42 always at inlander.com/inhealth APRIL - MAY, 2017 CNTS inhealth 04-03-2017.indd 5

Health 5 3/24/17 5:19 PM

Dr. Pierre Leimgruber is joining the HASPC!!!

FROM THE EDITOR

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

Dr. Pierre Leimgruber MD, FACC Fellow American College of Cardiology Clinical Associate Professor of Medicine University of Washington School of Medicine Cardiovascular Prevention Specialist

P

reviously, Dr. Leimgruber worked for 32 years as an interventional cardiologist, affiliated with four leading Spokane hospitals. “After performing thousands of angioplasties and stent placements in patients with severe CVD, I am excited to be changing my focus to helping people avoid these procedures by working to prevent the disease I used to treat.”

In his new role Dr. Leimgruber, who also serves as Clinical Associate Professor of Medicine at University of Washington School of Medicine in Seattle, will check patients for hidden heart-attack-and-stroke risk using the comprehensive, science-based Bale Doneen Method employed by hundreds of practitioners worldwide. “If caught early, and treated with evidence-based therapies--including optimal lifestyle--this disease is beatable, even if you have a strong family history of CVD, as I do,” he adds.

Dr. Leimgruber received his medical degree from University of Zurich Medical School and trained with Andreas Gruentzig, MD, the inventor of balloon angioplasty, at Emory University Hospital in Atlanta. Dr. Leimgruber is the author of 26 peer-reviewed research studies published in leading medical journals and is board-certified in internal medicine, cardiovascular diseases, and interventional cardiology.

p: 509.747.8000 | f: 509.747.8051

For more information visit thehaspc.com 507 S. Washington #170

The Stress of Stuff

I

n 2012, UCLA published a book entitled Life at Home in the Twenty-First Century: 32 Families Open Their Doors. The book was the result of nine years of meticulous research by a team of scientists — including anthropologists, psychologists and, believe it or not, archaeologists — who probed the lives of a group of middle-class, dual-income families in Southern California. They collected a mountain of data, including 20,000 photos and nearly 1,500 hours of videotaped interviews. One of the most prominent findings was the degree to which “stuff” was impacting families’ lives: three-quarters of the families had garages so full of possessions that cars could no longer fit in; bulk items from warehouse stores overflowed from storage areas. And toys, toys and more toys were everywhere.

(Despite parenting just 3 percent of the world’s children, Americans buy 40 percent of the world’s toys.)

What was the impact of all that stuff?

Moms in the study said the mess equaled stress (and cortisol levels in their saliva confirmed it), while researchers were surprised that dads weren’t affected by their jam-packed environments.

Is there another way? E.J. Iannelli examines a trend toward smaller homes (and fewer toys), but perhaps more satisfaction, in our Healthy Home special section.

To your health!

baledoneen.com | thehaspc.com 6 Health APRIL - MAY, 2017 CNTS inhealth 04-03-2017.indd 6

3/24/17 5:20 PM

uses Plese Printing for their business printing and marketing materials.

The sales staff at Plese Printing promptly takes printing orders and offer suggestions for our printing needs. Dependability is the one word that I would use to describe our business relationship!

- Rita Santillanes, Owner Best Western Plus Peppertree Nampa Civic Center Inn - Nampa, Idaho

Rendering courtesy of Baker Construction and Development MARY FARNSWORTH Direct Marketing/ Account Representative Plese Printing & Marketing

VALERIE SANTILLANES VP - Sales & Marketing Peppertree Hospitality Group

RITA SANTILLANES Owner Peppertree Hospitality Group

KIM PLESE Owner Plese Printing & Marketing

How can Plese Printing help you?

• FULL COLOR OFFSET PRINTING • LAYOUT & DESIGN SERVICES • DIRECT MAIL MARKETING • DIGITAL COLOR / BLACK & WHITE PRINTING • FULL BINDERY SERVICES

• FORMS MANAGEMENT • PROMOTIONAL PRODUCTS • SIGNS - POSTERS - BANNERS • TRADESHOW MATERIALS

™

FREE LOCAL PICK-UP AND DELIVERY • (509)534-2355 • FAX (509) 534-2707 WWW.PLESEPRINT.COM • ORDER@PLESEPRINT.COM • 4201 E. TRENT • SPOKANE, WA 99202

CNTS inhealth 04-03-2017.indd 7

3/24/17 5:20 PM

BEAUTY It’s in our nature.

S TAY & P L AY PAC K AG E S FROM

$219*

One Night Stay & Golf for Two Book today or visit CDACasino.com for more packages.

1 800 523-2464 | CDACASINO.COM |

Worley, Idaho | 25 miles south of Coeur d’Alene

*See website for details and restrictions.

CNTS inhealth 04-03-2017.indd 8

3/24/17 5:20 PM

CHECK-IN

CHARITY CORNER

Seeds of the Future

I

f you’ve driven or walked through Spokane’s West Central neighborhood in the spring and summer months, you may have seen them: Troops of teens wearing navy-blue T-shirts, trekking through the area. It’s common to see some of these kids with unnoticed garden soil smudges on their tees, or carrying shovels and rakes slung over shoulders. As seasonal employees of the local nonprofit Project Hope, these kids are on an important mission, tending to the organization’s community gardens so they can then sell the fruits of their labor to the public at area farmers markets.

At this year’s fundraiser for Project Hope, the

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

Project Hope kids, including Luis Arroyo, upper right, work in a garden at Boone and A Street, in the summer of 2016.

Monicea Brown, lower right, sells locally grown vegetables at the the Kendall Yards Night Market.

organization celebrates a decade of offering job and skills training to West Central teens, many of whom come from low-income households and rely on the opportunity to help feed, clothe and shelter their families.

Funds raised at this annual event bring in about 15 percent of Project Hope’s annual budget, which includes wages for its teen employees, explains development director Jenifer Priest. Mostly between 14 and 18 years old, some younger kids, ages 11 to 13, can also get involved in the summer training program as volunteers who are paid a small stipend. Besides tending the gardens and working Project Hope’s farmers market stands (see its website for a list of where to find them), some teens are also employed in its yard care program.

“We will generally have more youth than we have available spaces for, so in the end it’s really dependent on how much the community is able to come out and support,” Priest says.

This year’s Washington state minimum wage increase also impacts the nonprofit’s ability to hire more kids. Priest says the organization is happy to pay its teen employees more because of the new law, but that raise directly affects the number of summer job openings. Last year, Project Hope employed around 50 local kids, but the year before that number was closer to 75.

“We would love to be able to grow back up into that 60-to-75 range,” she adds.

The benefit includes a plated dinner, live music by local musician Nick Grow, a gardening-themed auction and a chance for supporters to meet some of the teens who’ve gained important job and leadership skills through Project Hope’s programs.

— CHEY SCOTT Growing Hope • Sun, April 30 from 5-8 pm • $50/person • Cataldo Hall, 429 E. Boone • projecthopespokane.org • 703-7433 APRIL - MAY, 2017

CHECK-IN inhealth 04-03-2017.indd 9

Health 9 3/24/17 5:21 PM

CHECK-IN ASK DR. MATT

Colorless, Odorless and Deadly

C

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

There are a variety of carbon monoxide detectors on the market.

andy bars almost killed my dad. When I was 15, I had the opportunity to play baseball in Australia, but I had to earn a few thousand dollars to make the trip. I launched a one-man World’s Finest Chocolate bar campaign, getting a buck for every $2 bar I sold.

I took my school address book, went around to the houses of kids who attended my high school, and acted like it was a happy coincidence when they opened the door. “Doesn’t Johnny live here? We have algebra together! So, I’m selling these candy bars… ” This was an extremely effective way to raise money. But the campaign nearly killed my dad. He would drive me from house to house and wait in the car while I peddled my goods. Little did we know that a faulty exhaust was allowing the silent killer, carbon monoxide, to seep into the car.

For days, my dad was dizzy, confused, weak, lightheaded, nauseated and had a brutal headache. Fortunately, my mom has been solving medical mysteries since before Dr. House was in short pants. She got to the bottom of things before any long-term damage — or death — occurred.

Each year in the United States, hundreds of deaths and thousands of hospitalizations occur due to CO poisoning. Carbon monoxide is a colorless, odorless gas produced by the burning of any carbon-based fuel. Oxygen binds to an iron-based portion of a red blood cell called heme. This is, in essence, the basket into which oxygen is placed in the lungs and delivered to tissues throughout the body. Carbon monoxide is a heme hog. It holds tighter to heme than oxygen, preventing red blood cells from being able to deliver the vital oxygen to tissues.

Don’t let this happen to you or your loved ones.

Here are some tips how to prevent this highly preventable illness:

1

Get CO detectors and install them where you sleep, or at least near where you sleep. There are battery-powered detectors, and detectors that plug in. Although they tend to be more expensive, there are also detectors with a digital readout, which can be useful, as they can show if there is significant CO at all in the space, and not just wait to indicate toxic levels.

Follow the manufacturer’s instructions closely, as some are designed to be placed high in the room, some low.

Replace detectors at least every five years.

2

Get your furnace, water heater, fireplace and any other gas-burning appliance serviced at least yearly to make sure it is functioning properly. You can put a detector near these appliances, but not too close, or you might get some false positives just from normal functioning — check manufacturer’s recommendations.

3

Never use your gas range or oven to heat the house, trailer or cabin. Never use barbecue grills or heaters in an enclosed space like a home, trailer, cabin or tent; Never let a car run in an attached garage, or run in any garage without the door open.

4 5

If burning wood, make sure your chimney is regularly cleaned and maintained.

Have your car’s exhaust system maintained and serviced according to manufacturer’s recommendations; emissions testing is an additional check. In a car, SUV or wagon, if the tailgate is open, keep the windows open, too. And if you get headaches or feel dizzy while in your vehicle, remember to check for the clear, odorless killer, CO. Be safe.

Especially when selling candy bars.

— MATT THOMPSON

10 Health APRIL - MAY, 2017 CHECK-IN inhealth 04-03-2017.indd 10

3/24/17 5:22 PM

LIFE COACHING

Home is Where the Heart Is

T

CHARITY CORNER

Turn Out For Outspokane

T

he Oscars (and that awkward Best Picture announcement) seem far behind us now, but an upcoming fundraiser for OutSpokane, the local nonprofit that offers support to and awareness of the local LGBTQ community, is hosting a reprisal of sorts. This year’s 8th annual Murder Mystery fundraiser is themed around an imaginary Oscars afterparty, but something’s gone awry. During the night’s festivities, which include a plated dinner, cash bar and a silent auction, guests can also test their detective skills to find out “whodunit.”

Funds raised at the event support OutSpokane’s annual Pride Parade and Festival in downtown Spokane held every June, now in its 26th year. Beyond celebrating the cultural, social and political advances the LGBTQ community has seen come to fruition over the past several years, the event often holds deeper significance for the community and its allies, explains OutSpokane board member Michael Jepson.

“I really would emphasize how important Pride is in today’s environment,” Jepson says. “We had our 25th anniversary last year, and while we were watching fireworks, someone walked into a nightclub in Florida and killed dozens of people of color, LGBTQ and trans people.”

Beyond its role of further establishing Spokane as a welcoming and supportive place to all, regardless of one’s sexual or gender identity, OutSpokane’s annual celebration often serves as a milestone moment for LGBTQ people who come out to their families, Jepson says.

“We’ve come so far in the 25-plus years that Pride has been in Spokane, but we still have a long way to go,” he adds.

— CHEY SCOTT 8th Annual Murder Mystery Dinner • Fri, April 21 at 6 pm • $55-$65/person • The Lincoln Center • 1316 N. Lincoln • outspokane.org • 720-7609

he title above may not be original, but poetically, it captures the primary source of our nourishment. Food and shelter, of course, are basics. For true well-being, however, we humans have another need that is just as essential: the need for attention and appreciation.

We are aware of this need in children, who unabashedly call out: “Mommy, Daddy, look at me!” We respond naturally with praise, a hug or by posting their brilliant works on our refrigerator doors. What is less understood, however, is that human beings never outgrow this need.

Consider John and Julie Gottman’s extraordinary research on the predictors of romantic success. They discovered that, in couples who were thriving, positive attention was five times more common than negative (e.g., criticizing, ignoring, Robert Maurer is a etc.). Positive attention Spokane psychologist, consisted of small moconsultant and author. ments and gestures each day, such as taking your partner’s hand across the dinner table, putting the phone or newspaper down when your mate walks through the door, or your voice lighting up when they call home, rather than implying that they have interrupted something more important.

Such findings may be a key to success in all of our closest relationships, whether partner, child, parent, sibling, housemate or friend. Home is where love and friendship are birthed and nourished. It is where we feel most cared for, heard, seen and known, and it is hopefully a place where our human need for appreciation is frequently met.

— ROBERT MAURER

Reach over 90,000 readers, advertise in the next INHealth!* * 2016 Media Audit

Contact: advertising@inlander.com • 509.325.0634 ext. 215 APRIL - MAY, 2017 CHECK-IN inhealth 04-03-2017.indd 11

Health 11 3/24/17 5:22 PM

CHECK-IN PILL BOX

Money and Meds What is the most expensive prescription drug in the United States, and why are drug prices so high?

T

The Ohmygaia line of locally made deodorant comes in 14 scents.

100% LOCAL

Sweet Smell of Success

I

t’s been said that necessity is the mother of invention. That’s true for Wendy Harris, who created Ohmygaia, an all-natural deodorant. A long-distance runner with an entrepreneurial spirit — she operated Poppy clothing boutique in downtown Coeur d’Alene for six years — Harris was concerned about traditional antiperspirants. She worried about chemicals that were in them, but also didn’t like that they blocked the natural sweating process.

“I just wanted to smell good,” says the mother of two, who relocated to North Idaho 12 years ago.

Now Harris works out of her Hayden home, admitting that her kitchen can sometimes look more like a chemistry lab. “I love apothecary. I love lotions and potions,” she says, laughingly calling herself a beauty scientist.

A friend suggested the name for the business, says Harris, who liked how Ohmygaia ties into the “ om” in yoga, the flirty, youthful quality of the exclamation OMG, and Gaia, an ancient name for Mother Earth.

Ohmygaia sells 14 scented and one unscented deodorants in 2-ounce bottles ($10), including Egyptian musk, lavender, honeysuckle and cherry almond. One additional scent, Goddess, is made and sold exclusively by one of her largest area distributors, Mountain Madness Soap Company in Coeur d’Alene.

Harris recently added scented beard oil ($18) and fragrance oils ($18) to Ohmygaia’s line.

Additional retail outlets include Salon 208 in Coeur d’Alene, Club Tan in Hayden and Rocket Market in Spokane. Ohmygaia is also available online (ohmygaia.com) and in select Seattle and California locations.

— CARRIE SCOZZARO

he dubious honor for the most expensive prescription drug today likely goes to the drug Sovaldi. This is a very successful and effective medication that is used to, in many cases, actually cure hepatitis C. It is typically used in combination with other antiviral medications. Usually the patient takes this medication for three to six months. The cost per tablet according to GoodRx is $1,000.

This translates into a cost of approximately $30,000 per month — a very high price, but in most cases a cure for a potentially deadly disease. This drug is in a category with very few other medications that are ultra-expensive.

However, the number of John R. White chairs medications that are considered WSU-Spokane’s by most people to be expensive is Department of growing. The factors that contribPharmacotherapy. ute to the expense of prescription medications are complicated, but in most cases can essentially be explained by cost of development, cost of production and level of demand.

The cost of the development of a new medication today is astronomical — it was recently pegged at around $2.6 billion. Second, the cost of production can be a factor. Not only does the medication have to be produced, but it must be produced under strict FDA guidelines (and thankfully so). The complexity of this production is increased substantially in the case of specialized medications called “biologics” which are also growing in popularity. Also, demand plays a role. Medications that are older (in other words, no longer under patent) and also commonly used are typically relatively inexpensive.

Conversely, medications that are infrequently used tend to be more expensive.

— DR. JOHN R. WHITE

Get Fit! Max Support “Momentum” sports bra.

Exclusively at Audrey’s

3131 N. DIVISION ST. • SPOK ANE, WA 99207 P 509.324.8612 F 509.324.0357 HOURS MON-FRI 10 AM -5:30 PM • SAT 10 AM -4 PM

12 Health APRIL - MAY, 2017 CHECK-IN inhealth 04-03-2017.indd 12

3/24/17 5:22 PM

BRAIN EXERCISE

8

Sudoku

3 9 4

RATINGS: Moderate (left), Killer (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.

8 2

Answers to all puzzles on page 38

6 5 4 7 4 1

1 6

6 5 7 2 4 1

6 5

4

2 4 1

3

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

9 2 3

Codewords

Each letter has been replaced by with a number. Using the starter clues, work out the words that must go in each cell on the codeword grid. Some well-known phrases and names may also be found. For a three-letter clue, turn to page 19.

26

23

11 21

20

13

4 7

4

R

21

R

5

1

R

21

6

4

R

23

21

11

21

22

18 2 2

4

R

21

1 5

3

23

19

10

R

21

21

8

10

14

25

23

19

1 23

13

2

3

4

1

5

6

25

7

8

19

9

10

5

19

11

12

6

5

13

14

15

16

12

17

18

23

19

20

15

21

22

19

23

24

26

25

26

6

18

R

23

4

R

9

7

21

1

17

21

19

6

1

6

1

9

6

7

2 22

19 19

21

21

2

7 21

2

12

1 3

1

4

4

R

16

10 21

23

4

R

2

21

21

21

21

16

R

16

J

21

5

4

12

21 24

4 18

12

7

2 19

4

4

R

21

7 21

5

19

2

7

R

J

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

1 to 25

9 3 2 2 6

6

1 4 6 7

8 4

9 1 4 3 21 2

4

5

4 2 9 7 5 8 10 11

13 17 16 13 12 11 12

To solve 1 to 25, move the 15 18 15 14 9 10 18 numbers from the outer 20 19 20 21 8 7 19 ring onto the board in the 24 2 1 22 6 24 22 directions of the arrows. The 23 3 4 5 23 25 3 number must appear on the line — up, down or diagonal 9 17 16 14 6 7 25 — that the arrow indicates. As you place them, they must snake together vertically, horizontally or diagonally so they link in sequence from 1 to 25. We started you out with a number to work from. A solved puzzle will look like the one above. There is only one solution.

6

5

4 25 10 11 18

7

24

22

8

21

1

19

15

2

16

13

23 17 3 14 9 12 20

"Guess who read his first book on his 8th birthday!

I seriously tear up every time I hear him read!

He has come so far, and I can't thank you enough for all your help.

I don't even want to imagine where he would be if we hadn't found you!

Thanks for all that you do!"

Spokane's Premier ADHD & Reading Disorders Center (509) 465-1252 winstoncenter.com APRIL - MAY, 2017 CHECK-IN inhealth 04-03-2017.indd 13

Health 13 3/24/17 5:22 PM

Accepting new patients.

Healthcare for all.

Our Community’s #1 Choice in Hospice Care “It’s always been the mission to serve people, and I love that about our organization. We are true to ourselves, we are true to the community, and we’re very inclusive of all people.”

- Trina, MSW

Serving patients and families since 1977 Comfort. Dignity. Peace of Mind.

509.456.0438

hospiceofspokane.org

14 Health APRIL - MAY, 2017 CHECK-IN inhealth 04-03-2017.indd 14

3/24/17 5:22 PM

NEWS PUBLIC HEALTH

Solving Opioid Addiction Medical treatment offers an exit — for those who can get it

BY TARYN PHANEUF

I

n the three months Teila Murfin waited for a slot to open at Spokane’s Opioid Treatment Program to finally address her heroin addiction, she hit bottom. She was using heroin and methamphetamine, getting high just to avoid the awful feeling of withdrawal. When she added her name to the waiting list, she did it half-heartedly, not really believing she’d ever be free. But then she ran out of money to pay for drugs and resorted to trading sex instead.

“I knew when I started doing that … I knew automatically I’ve got to get clean,” she says. “It just happened to be not even three weeks later that I got the call saying I was in.”

Murfin, who’s 23, remembers the day in October 2015 when she started the program at the Spokane Regional Health District, which provides medication-assisted treatment to hundreds of people addicted to opioids — pain relievers that come in legal and illegal forms.

For Murfin, the trouble started seven years earlier with a friend’s invitation to take oxycodone at a summer party. She later swapped painkillers for cheaper alternatives.

In the 18 months since she started treatment, she’s relapsed twice. She says each time reinforced that she can’t do this on her own if she wants to keep ...continued on next page

APRIL - MAY, 2017 NEWS inhealth 04-03-2017.indd 15

Health 15 3/24/17 5:23 PM

NEWS

Teila Murfin, left, and Kasey Ehlert participate in a Spokane Regional Health District program to combat opioid addiction.

“SOLVING OPIOID ADDICTION,” CONTINUED... this new life. She has a job she likes and an apartment that’s all her own. She just learned she’s pregnant — barely 12 weeks along. And she’s able to think more about the importance of quitting cigarettes and coffee than about a deadly drug habit.

“It saved my life, that’s for sure,” she says. “I can’t have a life and do what I need to do being dirty. It doesn’t work like that.”

The three-month wait Murfin experienced has been the story for addicts seeking help here for a long time. Meanwhile,

gled to rally the support it needs from those who control funding, as well as other professionals who see and deal with the ramifications of addiction.

“If this was the Zika Virus or if this was Ebola — we have emergency resources to try to bring those kinds of epidemics under control. We’ve had to fight tooth and nail to get funding out of the siloed system to meet the demand,” says Dr. Matt Layton, the program’s medical director.

But the fight is paying off. In January, Spokane County commissioners voted to give the program 142 more spaces for

“If this was the Zika Virus or if this was Ebola — we have emergency resources to try to bring those kinds of epidemics under control. We’ve had to fight tooth and nail to get funding…”

— Dr. Matt Layton KRISTEN BLACK PHOTO

the number of overdose deaths involving at least one opioid in Spokane County increased from 36 in 2014 to 64 in 2015, according to state numbers. The 78 percent increase outpaces the 9 percent rise seen across the state from 2014 to 2015. There were 727 overdose deaths in Washington in 2015.

Despite an opioid overdose epidemic that touches the whole country, the public treatment program in Spokane has strug-

Medicaid patients, bringing the number of slots for that group up to 740 and eliminating the waiting list.

Space to help more people is valuable, but it’s not the only help the program needs. Layton and others at the Regional Health District also spend time with doctors and law enforcement officers to help more people understand the scope of the opioid problem and the success of medication-assisted treatment so that the

KRISTEN BLACK PHOTOS

community, as a whole, improves the way it responds to drug users.

“We just want to provide evidencebased treatment. And the evidence really is with medication-assisted treatment,” Layton says.

FROM PILLS TO HEROIN

In Spokane, as in communities across the country, prescription drug use is going down while heroin use increases.

State and federal legal restrictions dating back to 2008 and 2009 have successfully limited access to prescribed painkillers like oxycodone. But people who already were addicted and lost access through a doctor’s office turned to buying painkillers on the street. The expense of pills persuades many to switch to heroin.

Because so many people who become dependent on opioids were introduced through a legitimate prescription, they don’t fit the common stereotype of a junkie. They’re regular people by anyone’s standards. Like Terry Schelin, who’s 61 and was first prescribed painkillers after a motorcycle accident when he was young.

He served in Vietnam and had a tough childhood — both of which made the pills’ numbing effect appealing.

“I was always looking for something to shut my head off,” he says.

He managed a car dealership in Oregon at the time. After a while, it became harder to get prescription opioids. One of his employees used heroin and got Schelin hooked as well. He battled the addiction for 18 years. His drug use led to a series of demotions at the dealership until he was

16 Health APRIL - MAY, 2017 NEWS inhealth 04-03-2017.indd 16

3/24/17 5:23 PM

POLITICS OF ADDICTION

I

n December, the Centers for Disease Control released new data showing that prescription and illicit opioid overdoses caused 33,091 deaths in 2015. According to the National Center for Health Statistics: Heroin overdose deaths increased 23 percent.

Synthetic opioids, excluding methadone, caused 9,580 deaths — a 73 percent increase.

The rise is due mostly to deaths caused by illegally manufactured fentanyl, a painkiller that is 80 to 100 times more potent than morphine.

Overdose deaths caused by prescription opioids, excluding the group predominated by illegal fentanyl, went up only 4 percent, leading officials to believe that attempts to limit access to prescription drugs is working.

During his campaign, President Donald Trump vowed to “end the opioid epidemic” by stopping drugs coming into the country, including heroin entering via Mexico and other overseas operations that send fentanyl and other drugs through the mail. He also called for increased access to treatment and expanding use of overdose reversal drugs, such as naloxone.

In February, former Republican congressman Newt Gingrich, progressive activist Van Jones, and former Democratic congressman Patrick Kennedy co-authored an editorial in

fired. He tried various methods of breaking the habit, but none of them worked for long. He moved to Spokane, hoping it would help him change. Instead, he was arrested in 2003 for robbing a bank.

He says he used prison as an opportunity to clean himself up. But then a painful medical problem led to a hydrocodone prescription. The temptation was back.

“I got out and I was in really good shape,” he says, but “the issues that caused my addiction were still there.”

As a last resort, Schelin started taking methadone through the Spokane treatment program. He doesn’t give it glowing endorsements. He doesn’t like that he has to return to the clinic week after week to pick up his daily doses. He calls it his “leash.”

But the truth is, it’s the only thing that’s worked.

Study after study shows that medication-assisted treatment is more effective than other detoxification efforts. Methadone is a legal opioid that stimulates the same receptors in the brain as heroin and

The Hill calling on Trump to follow through on his campaign promise.

“The most efficient and cost-effective way to achieve this is by breaking down the barriers to the treatments that actually work.

What works best is medication assisted treatment (MAT) — the combination of behavioral counseling and recovery medication.

“Today, only three out of every 100 people living with opioid addiction are receiving this type of treatment. The scale of the epidemic, as well as the medical community’s endorsement of MAT, makes these numbers even more dramatic and indefensible. The economic case for MAT is also clear. Studies show that every dollar spent on treatment saves $4 in healthcare costs and $7 in criminal justice costs.

“The bottom line — breaking down barriers to opioid addiction treatment that works will save lives and money. And the president, who knows what it is like to lose someone close to him to addiction, has an opportunity to act.”

They suggested that Trump work to reform policies that keep treatment out of reach for some addicts, change criminal justice policy to favor treatment over jail, and push for funding to address opioids as a public health emergency.

— TARYN PHANEUF prescription painkillers. Using methadone to treat opioid addiction started in the United States in 1965 in response to the first heroin overdose epidemic. Use is regulated by the U.S. Drug Enforcement Agency and carefully controlled through treatment programs.

Skepticism of and opposition to methadone persists. Basically, addicts trade one drug for another, which opponents criticize.

But when using methadone, they can function as normal. Methadone doesn’t produce a high and prevents opioid withdrawal symptoms, including anxiety, nausea, vomiting and abdominal pain. People in treatment can put their lives back together, making it a verifiable solution to a unique problem.

“Opioids change the brain chemistry,” says Julie Albright, director of the Spokane opioid treatment program. “That, unfortunately, is a different animal than other addictions.”

Opioids attach to receptors in the brain ...continued on next page

Got Pain?

• Legs • Back • Arms • Neck • Nerve • Genetics • Musculoskelatal • Neuropathy Pain • Medicine Sensitivities We offer lots of options: • Frequency/Electric Stimulation • Bemer • Microvas • Vibration • Massage • Osteopathic Treatment • Exercise plans • Full work up and medical evaluation available

1315 N. Division | 509-919-3002 accesshealthchoices.org

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

Inlander.com/Inhealth APRIL - MAY, 2017

NEWS inhealth 04-03-2017.indd 17

Health 17 3/24/17 5:23 PM

NEWS “SOLVING OPIOID ADDICTION,” CONTINUED... and lead to the same feelings of pleasure that people derive from regular life activities, like eating and sex, according to the National Institutes of Health.

“Opioids are prescribed therapeutically to relieve pain, but when opioids activate these reward processes in the absence of significant pain, they can motivate repeated use of the drug simply for pleasure,” states a 2002 article written to explain the chemical effects on addicts. “Further prolonged use produces more long-lasting changes in the brain that may underlie the compulsive drug-seeking behavior and related adverse consequences that are the hallmarks of addiction.”

At the same time that opioids produce feelings of pleasure, they also suppress the release of another chemical, noradrenaline, leading to the classic symptoms of the high — drowsiness, slow breathing and low blood pressure. The problem is the brain adapts to chronic opioid use and becomes

tolerant, requiring higher doses to achieve a high and regular use just to function normally. Without it, the user is physically ill.

“Cutting off cold is the worst thing to do,” Layton says.

That’s because people who quit cold turkey will likely relapse, but their tolerance isn’t what it was when they used regularly, making them more likely to overdose.

Spokane Fire Department personnel carry naloxone, a medication that reverses opioid overdose. Firefighters used the life-saving drug 371 times last year.

PRACTICING CARE

Layton, Albright and their staff are adamant that detox methods that emphasize abstinence lead to relapse. Their next objective is to convince others, whether in the medical field, law enforcement or public office, amassing a broader coalition of influential people who are all on the same page.

Stigma is the next barrier to improving care for people addicted to opioids, Albright says. “I think the perception is

MORE THAN MEDICATION

Hope is available at the Spokane Regional Health District.

I

n addition to daily doses of medication, people in the Regional Health District’s Opioid Treatment Program meet with counselors individually and have the opportunity to attend group sessions.

Licensed counselors see individuals once a week for their first three months to focus on

KRISTEN BLACK PHOTO

their personal issues and concerns and set goals for their recovery. They set goals like securing a job, reuniting with family, or finding a safe place to live, says Mimi Berlinger, who’s worked as a counselor at the program for six years. Counselors check in on how they’re feeling on the medication.

changing, but there’s definitely the attitude that these are people that just made bad choices. And we really want that perception to change.”

Spokane Police Officer Shane Phillips says attitudes in the department toward opioid users have softened over the past 10 years or so. They’ve all seen “relatively normal people” whose lives were upended after they got hooked on painkillers.

Through training sessions and tours at the treatment program’s dispensary, including conversations with people in the program, law enforcement officers gain a better understanding of the positive side of treating addiction with methadone.

“It’s better for the community,” Phillips says.

Albright works with Spokane County Detention Services to treat opioid users in jail. Addicted pregnant women were the first inmates to be put on the program.

That happened a long time ago, says Sgt. Tom Hill, an administrator at the jail who works with the contract health provider,

“We’re always working on that stability,” Berlinger says.

Group settings provide a chance to hear from others experiencing the same struggles, working toward the same goals, and seeking the skills to cope with stress or find other ways to prevent relapse.

The hardest part of starting recovery is often breaking the habits that centered on drug use.

“Many of them come in here with very chaotic lifestyles where there is no structure,” Berlinger says. “It’s just constant running — either seeking it, getting it, or feeling it.”

With a narrow window — 5:30 to 11:30 am — to get into the dispensary for a daily dose of methadone, program participants are suddenly required to rein in the chaos.

For people whose opioid dependency was concealed — whose lives looked normal on the outside — starting treatment means they don’t have to hide any more.

“I have to say that I love this job simply because people voluntarily come into the program,” says Berlinger, who previously spent four years in an abstinence-based program. “They come in because they want to make changes in their lives, and it is a lot easier to work with individuals that want to make changes — that want to get into treatment; that want to stop using illicit drugs. They want to get a ‘normal life’ going again. It’s very enjoyable for me to work with people who want to do this.”

— TARYN PHANEUF

18 Health APRIL - MAY, 2017 NEWS inhealth 04-03-2017.indd 18

3/24/17 5:23 PM

NaphCare. This year, the treatment program has gained access to its own clients who end up in jail, many of them for outstanding warrants. Preventing an interruption in their methadone dosing ensures they don’t go through withdrawal and lose all the progress they’ve made.

The next step involves enrolling new clients in treatment when they’re in jail.

Hill speculates that five to 10 people come through the door every day who could be candidates for the program. He’s convinced treatment reduces the likelihood that incarcerated people will commit more crimes after they’re released.

“People commit property crimes to support that habit,” he says. “This addiction leads to desperate behavior.”

In addition to working closely with law enforcement, Layton meets with doctors who prescribe from the puzzle on page 13 painkillers, convinc15 = X; 18 = B; 23 = I ing them to take responsibility for their role in their patient’s addiction and commit to helping by doing more than just yanking the prescription. When that happens, “they’ll use whatever they can get their hands on,” he says.

He says the medical community is working toward creating a more integrated system that connects primary, mental and behavioral care to treat the whole person, not just the addiction.

“Those really don’t exist — yet,” he says. “We’re building this machine as we’re flying it, for sure.”

Encountering compassionate people who will offer to help can make a big difference. In July, Kasey Ehlert, 28, was five months pregnant and addicted to heroin — and scared that would mean losing custody of her baby when she gave birth. But on the recommendation of her doctor, she entered the methadone program. There, she felt accepted and free from the judgment she was sure she’d experience from people who can’t empathize with her struggle.

Coming up on a year in treatment, she spends more time with her 4-month-old son and 4- and 6-year-old daughters than she did in the two years she was using, when it seemed like all day, every day, was spent chasing the next high.

“The worst part was the withdrawals — laying in bed all day like you had the flu,” she says. “I didn’t even know there was a methadone clinic at all. … If they didn’t have programs like this, I don’t know where I’d be. I’m not just saying that.” n

CODEWORDS: HINT

It’s time for you

at Riverview

We offer flexible living arrangements and beautiful facilities like our state-of-the-art aquatic center, woodshop and stunning views adjacent to the Centennial Trail. At Riverview we go beyond providing exceptional care to give out residents the opportunity to explore their unique interests.

Let’s meet:

509-482-8474 Terrace Assisted Living 509-482-8471 Village Independent Living

www.RiverviewRetirement.org • 1801 E. Upriver Drive Spokane, WA 99207

inc.

e to...

s nam t i g n i g n a h c is

de expo&event SERVICES

• Same great company and staff.

• Just a fresh new look and more offerings. offerings.

• Stay tuned for information on our new website and much mor new website and much more!

Design Events is an exposition and special events company serving the Inland NW for over 32 years.

When we began in 1984 we were primarily known for our custom themed events. Over the years WE GREW- as did the scope of our offerings. We believe our new logo captures that growth perfectly.

So when you see that new logo going down the road on one of our trucks just remember -we’re still the same great company with just a new look and much more to offer!

208.765.2595 • designevents.com • sales@designevents.com

Health 19 DesignEvents_NewName_040317IH_3rdS_KS_NEW.pdf APRIL - MAY, 2017

NEWS inhealth 04-03-2017.indd 19

3/24/17 5:23 PM

FOCUS: HEALTHY HOME

The Shears family — Sarah, Simone, Eric and baby Harvey (left to right) — at home in Kendall Yards. YOUNG KWAK PHOTO

Thinking Smaller

Families are finding that having less stuff — and less living space — leads to less worry and a more satisfying life

C

asting aside excess and paring our possessions down to the essentials has held a certain appeal for millennia. It’s a practice — usually in its more extreme forms — that has even come to characterize whole civilizations or religious orders, resulting in adjectives like spartan and monastic to describe a bare-bones lifestyle stripped of all frills.

In this day and age, however, taking a more minimalistic approach to our living arrangements often seems like an impossible dream. Ours is a consumer culture, which means that many of us are awash in belongings, objects, things — stuff. And that stuff requires space, whether it’s in regular use, out on display or tucked away in stor-

BY E.J. IANNELLI age. Scaling back is widely regarded as a noble goal, but it’s assumed to be achievable only by that subset of the population who are already of retirement age, or willing to make serious sacrifices in terms of convenience and comfort.

Yet more and more people are beginning to question that assumption — along with the necessity of their stuff, and all the space it requires. Instead, they’re starting to examine the trade-offs that all that excess entails, and looking at their various trappings as, well, a kind of trap.

To people in this situation, the process of downsizing — that is, moving into a smaller home and shedding some or even most of their material possessions — is

becoming increasingly attractive.

R

andy Wells is a Spokane-based real estate agent who has witnessed a noticeable uptick in the number of home buyers looking to downsize.

“I’ve been doing this for 23 years, and being at it that long I can see some trends.

In 2005, 2006, 2007 when the market was crazy, everybody kept trying to upgrade, to move up and get bigger. Ever since the big crash, that’s not happening anymore. Most of the people are really trying to simplify.

A good majority of people are saying, ‘You know what? I don’t need the 5,500-squarefoot house. It’s too much.’ And so there’s definitely a trend for smaller,” he says.

20 Health APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 20

3/24/17 5:25 PM

Wells says the motivation to downsize, and the form it takes, can vary from person to person. For some, it means scaling down the size of their urban home while keeping a large cabin at the lake. For others, it means building a cottage home on a property that already contains a standardsized house, then moving into the cottage and renting out the house. Still others will take the more traditional downsizing path of moving out of the longtime family home and into a smaller-scale retirement community with bungalows or patio homes.

For Whitworth University professor Kathryn Picanco, downsizing became a tempting option when she and her husband Kevin, an engineer for the city of Spokane, were contemplating the sheer scale of their roughly 5,000-square-foot home on the upper South Hill. While offering “lots of space for the kids to play in during the dark, cold winters,” it had always seemed a stark contrast to the more modest 1,200-square-foot home they had owned in San Jose, California, before moving to Spokane in 2003.

“We just started thinking about maybe not being quite so tied to the house — relooking at what our priorities were and making conscious decisions [about] finances and cost, and how we were using our time in general,” she says. “Because it was a lot of upkeep, having to spend a lot of time on the yard and interior of the home with cleaning and renovations.”

The space afforded by the larger house became burdensome in more subtle ways.

The large rooms called for furnishings so as not to look empty, which led to a yearslong hunt for tables, chairs and shelves.

Some of those objects came in the form of “hand-me-downs” from nearby family, says Picanco, “which was great, but it was never very personalized.”

In autumn of 2015, the Picancos and their three children, ages 16, 14 and 11, chose to move into a home a little over half the size of their former one. Although still situated in the same general area of Spokane and laid out with the same number of rooms, the downsized home has already delivered its anticipated benefits.

“Coming to the smaller house, everything seems so much more manageable,” Kathryn says. “It’s alleviated a lot of day-today stress and let us focus more on family and the kids, doing fun activities with them. We just spend more time together, because we’re not spread out all over the place. We had a lot of closets [in the old

house], too, and quite frankly, it was hard to find things because they were tucked away behind other things that we might not necessarily have needed. It feels great now not to be living in all of that extra stuff.”

M

uch like the Picancos, Eric and Sarah Shears found themselves wondering if their large South Hill residence — in this case, a 3,600-squarefoot historic Victorian — was best suited to the quality of life they wanted.

“It had four bedrooms, a library, huge kitchen, massive rooms. And it was great, but it was just so much work. Every weekend there was another project to do, either house projects or yard work,” Eric says. His wife’s job as a therapist and his in IT kept them busy enough during the working week, and they saw downsizing as an opportunity to free up their weekends to

The third bedroom was barely a walk-in closet. But we really did fall in love with that culture, that European approach to transportation and walkability and more simple living. Typically, people there don’t have huge houses with giant basements and garages and big yards. I think it did kind of prime us for that downsize.”

After several months in the new house, Shears says that cleaning seems like “a breeze.” “We can do it in a couple hours, whereas with the old one, we had to take breaks and do it over a couple days. Less time cleaning means more time spent with each other.” Another advantage has been “purging ourselves of all these material items that we just don’t use.”

But even in smaller homes, life can sometimes throw you a curveball. When the Shearses initially made the call to swap their Victorian for a townhouse, they based

Eric Shears says cleaning the family’s smaller new home is “a breeze.” YOUNG KWAK PHOTO spend time with their 13-year-old daughter.

But the Shears family ended up taking a very different route to their destination.

Last year, they purchased a two-bedroom townhouse on the north side of the river in Spokane’s booming Kendall Yards. The new home marked a significant reduction in square footage, but required much less time and effort in maintenance. It also reduced their mortgage payments by several hundred dollars per month — money they can now redirect toward different priorities, such as family outings.

One reason his family felt comfortable scaling down to such a degree is because they had already lived abroad quite happily in London, where living space comes at a premium.

“We were there for a couple of years,” Shears says. “We had a flat that was a lot smaller, only about 800 square feet.

their decision on their family makeup at the time: two adults and a teenager. But that changed in the interim.

“We have a baby boy who’s 5 weeks old now, and the baby was unexpected before we decided to downsize,” he says.

“Which kind of makes it more interesting.

We just bought a two-bedroom house for four of us. So we have to think about how we’re going to make that work.”

But he’s not too worried. “In our old house, we had a big basement and an attic.

And anytime you buy new stuff, the old stuff goes into a box in the basement and just sits there. Having that stuff bothered me — just knowing it was there and taking up space and not being useful,” he says.

“I’m happy to get rid of it. It lifts this weight off my chest.”  ...”Healthy Home” continues on page 24 APRIL - MAY, 2017

INFOCUS inhealth 04-03-2017.indd 21

Health 21 3/24/17 5:25 PM

Cath oli cC INFOCUS inhealth 04-03-2017.indd 22

s e i t ri a h

3/24/17 5:25 PM

INFOCUS inhealth 04-03-2017.indd 23

3/24/17 5:25 PM

HEALTHY HOME

Smaller Homes, Bigger Market

As dream homes evolve beyond big houses on big lots, local developers work to cater to the needs of modern homebuyers

BY E.J. IANNELLI

L

iving closer to amenities, enjoying less upkeep, taking pride in a smaller carbon footprint and lower energy bills, or just enjoying more family camaraderie. Whatever buyers of smaller homes have in mind, developers and realtors in the Inland Northwest are ready to make those dreams a reality.

Prominent local developer Greenstone, responsible for Kendall Yards, is already catering to those downsizing into new homes, but realtor Randy Wells notes that local demand — fueled in part by younger families — for more adequately-sized residences that are also near amenities like shops and parks, is continuing to outpace supply.

On a regional level, some developers have created unique brands that directly address the myriad ways that individuals, couples and families might downsize into new or custom builds. WiseSize, for example, is part of the Simplicity division of Hayden Homes.

It specializes in kit homes that come in various sizes — 400, 680, 880 and 1,064 square feet — and can be placed on existing

parcels of land. Depending on location, the house prices start at just $47,990 — less than the average down payment on a conventional home.

“We build traditionally constructed structures, but we make them small, compact and efficient,” says Amanda Lenke, marketing manager for Simplicity. She points to their single-level starter model as an example of how radically they can shrink the footprint while retaining archetypal house features: “It looks just like a little cottage house with Craftsman trim on the outside, traditional roof, stem wall construction, the whole nine yards. You get a living room, kitchen, bedroom and bath with utility hookups. We make it feel as spacious as possible with tall ceilings, and by offering room for a kingsized bed and two nightstands, which you’re never going to get with a tiny ‘tiny’ house.”

WiseSize’s scaled-down houses have piqued the interest not only of downsizers, but also of buyers looking for investment opportunities such as vacation rentals. In 2016 the company sold a modest 70 homes, yet that number represents year-on-year growth that Lenke anticipates will continue as the niche market expands.

“Our motto is ‘Live big in a tiny house.’ Ba-

24 Health APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 24

3/24/17 5:25 PM

Tiny home interiors from hOMes; some are as small as 200 square feet. sically, by downsizing, you can live better and in more quality ways. A lot of people’s self-worth is wrapped up in how many things they have. What I see our customer appreciating is that once you get rid of the stuff and you switch your paradigm to the quality of the life you’re living, it just makes for a happier person. You’re saving tons of money on utilities, which means you probably have to work less, which means you can enjoy life more. You can spend your time, money and energy doing

other things,” she says.

Andrew Morrison echoes those sentiments. A leading proponent of the ‘tiny house’ movement, he’s representative of what is perhaps the terminus of downsizing: compact 200- and 300-square-foot homes capable of being towed and outfitted for off-grid living. Not quite RVs, not quite miniature cabins, his high-quality hOMe models are sold as plans that buyers can then customize according to their needs and tastes.

At the workshops he hosts to provide information on building, financing and siting hOMes, Morrison says that he’s seeing a “very diverse group” and attendance that is “growing exponentially.”

“We have students who are just coming out of college, or in some cases are still in college but don’t want to pay for housing ... all the way through to families and retirees. It really covers the gamut,” he says, while admitting that he would prefer to see a broader spectrum in terms of ethnic ...continued on next page

APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 25

Health 25 3/24/17 5:25 PM

HEALTHY HOME “SMALLER HOMES, BIGGER MARKET,” CONT... diversity, because the major factors behind downsizing are so universal.

“Everyone’s challenged by housing.

The cost of housing in the U.S. is out of control, and the size of housing is out of control. In the last, say, 40 years, housing has gone from fairly reasonably-sized hous-

of paying for their mortgage or their rent.

And then you get into at-risk populations where you’re looking at lower-income families, and they spend up to 50 percent of their income [on housing]. Which leaves nothing for food and clothes and education and anything else you might need.”

As housing costs become a “catalyst” for downsizing, according to Morrison, the tiny home movement is seeing an explosion of choice and creativity, best showcased in enthusiast publications like Tiny House magazine.

Even in a 250-square-foot home, it seems, there’s ample room for imagination.

“What they provide is a fierce simplicity. It meets all of our needs, in a very small space at a very low cost and hardly any upkeep. Tiny houses on wheels have the same benefits, but they also provide flexibility of movement,” Morrison says,

“Basically, by downsizing you can live better and in more quality ways.” es to the point where we have the highest square-footage houses in the world on average: 2,600 square feet,” says Morrison.

“The cost is off the hook in most places. The average down payment for a house is $50,000, and then you get to pay for it for 30 years. The average American spends 27 percent of their income on just the cost

Home At Last Can Spokane and Catholic Charities solve homelessness?

BY DANIEL WALTERS

V

Catholic Charities CEO Rob McCann in front of the new Buder Haven.

olando Peeples says his days of couch-hopping are done. Peeples, 42, has one of the 51 apartments in Catholic Charities’ Buder Haven apartment complex. It’s his own space, one he’s decorated with comic books and issues of Dope magazine. On one wall, Peeples has posted years of poetry, prose and rap lyrics, all laminated. He points to a particular favorite — a poem that he wrote back when he was in the Spokane County Jail.

“It reminds me every time when I sin, we share tears,” Peeples says. “When I’m down and heartbroken and stuff.”

Peeples talks about the deaths of his

26 Health APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 26

3/24/17 5:25 PM

which satisfies the needs of the emerging gig economy, changing costs of living and basic wanderlust.

While quick to highlight the benefits, both Morrison and Lenke aren’t afraid to note that there are caveats to downsizing.

Some of these — like where to store the Christmas decorations or camping gear — are obvious from the outset, whereas others, like a new addition to the family or a change in health status, might only become apparent over time.

However, for those who accept that even large houses come with their share of compromises, embracing downsizing could lead to a healthy shift in priorities that allows for more free time, more disposable income and less stress.

“I’ve never had anyone come back and say, ‘Oh, gosh, this was way too early for us to do this.’ I don’t remember anyone expressing regret,” Spokane Realtor Randy Wells says. “Everyone has been happy. It’s just what you become used to. If they have the mindset of simplifying, they just go, well, that’s part of downsizing.” 

dad and his brother.

“All my friends and family, they’re dying off,” Peeples says. “From stupid stuff.

Little bitty things, man.”

But this place represents a sudden turn in his luck. His housing specialist at Frontier Behavioral Health helped him apply to get this apartment.

“Ah, man. For me? Man,” Peeples says.

“It means not just something good, it means, like, that storm is about to pass.”

He says he’s gotten focused. He’s studying journalism at Spokane Falls Community College. He’s improving his credit.

“I’m not dependent on nobody else,” Peeples says.

Buder Haven is one facet in Catholic Charities’ bid to end homelessness in Spokane. Like Catholic Charities’ other units, Buder Haven has a social service coordinator assigned to it, to assist the formerly homeless get connected with help.

“I found out we had counseling in the building,” Peeples says. “Then I have people I can talk to. I can open up and be myself and talk about real stuff.”

This is Spokane’s boldest move in solving the homelessness riddle, and it’s almost absurdly simple: Give the homeless homes.

It’s a radical departure from the old model of fighting homelessness, where drug addiction and mental health issues had to be

Since the economic downturn, many Americans have started to think smaller.

treated before the homeless could be placed in housing.

“If you had sat in this office 15 years ago and said, ‘Hey Rob, should you take a homeless person who is mentally ill and off their meds ... or who is actively suffering from addiction issues,’ and say, ‘Here is the key to your apartment?’” says Rob McCann, CEO of Catholic Charities of Spokane. “I would have told you no.”

But nationally, places like Salt Lake City have pursued the Housing First model: Give the homeless homes, and then use those homes as staging grounds to address their other issues.

Four years ago, Catholic Charities opened the Father Bach Haven apartment complex right next to the House of Charity, with 50 units of low-income housing aimed directly at the homeless. And while McCann sometimes gets complaints and angry phone calls from neighbors at 2 am, the biggest fears about the apartments becoming a haven for vandalism or violence never came to pass.

“When we build a building, crime actually tends to go down,” McCann says, due to all the new cameras and eyes added to the neighborhood. “If you build a palace, people who live there will eventually believe they are kings and queens. If you build a dump, people eventually will

believe they’re trash.”

So far, thanks to a generous tax-credit market, construction of these sorts of apartment complexes were almost guaranteed to be funded. Tax vouchers from the Spokane Housing Authority allow residents to pay little to no rent.

“The rest of the country is actually looking at us as a model on this,” Washington Gov. Jay Inslee says regarding Housing First efforts.

This past July, Buder Haven opened next door to Volunteers of America’s identical apartment complex, the Marilee.

Pope Francis Haven and another apartment complex are scheduled to open later this year. Catholic Charities is funded to build one more complex after that.

At the same time, Catholic Charities and SNAP are fighting the challenge of homelessness from the other end by focusing on rapid rehousing: As soon as someone first becomes homeless, SNAP assesses who they are, and identifies exactly what they need to get back on their feet as quickly as possible.

“Where I come from, I wasn’t supposed to get past 18, in Chicago,” Peeples says.

“Here I am, I’m 42. That’s the reason for me still being here: To touch somebody’s life… Hopefully, my mark in life will have some sort of effect on somebody.”  APRIL - MAY, 2017

INFOCUS inhealth 04-03-2017.indd 27

hOMe PHOTO

Health 27 3/24/17 5:26 PM

Home & Garden Most people love hanging baskets.

But to have big beautiful ones lasting all summer long, there are a few tricks needed to make that happen. #1 Start with a quality grown hanging basket.

#2 WATER WATER WATERthis is so important! In April, and May you want to be careful not to over water but as our temperatures increase the amount of water going into a basket should increase too. We always recommend if you are watering with a hose/watering can, water your basket until the water comes out the top of the pot. If water runs immediately out the bottom of the basket when you water then your plant was too dry when you started watering.

#3 Apply a systemic granules to prevent bugs.

#4 Fertilize your plant with the correct fertilizer; many of the plants in hanging baskets like calibrachoa - also known as Million Bells - are iron hungry, an all-purpose fertilizer does not have enough iron.

#5 Apply a slow release fertilizer to give your basket that extra boost.

These single things will make your basket the best basket on your street.

• CAL

LIVE LOCA L

L A C O OP L

THINK

LO

Jessica Webb (Creach) - Bloom Broker Plant Farm / Creach Greenhouse

SH

Garden Center Now Open Custom Planters • Gift Items Succulents & Indoor Gardens Yard Art • Full Service Florist FLORIST AND GREENHOUSE, INC.

BUY LOCAL - WE GROW OUR OWN -

8th & Perry • (509) 534-9381 libertyparkflorist.com

28 Health APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 28

3/24/17 5:26 PM

Nature’s Remedy for Emotional Energy

Photo Courtesy Society of American Florists, www.aboutflowers.com

Get Your Daily Dose of Vitamin F:

Personal fulfillment expert and best-selling author of Feng Shui Your Life, Jayme Barrett has revealed that when used in our homes, flowers ease the stress of everyday life and bring about truly inspired living, Barrett says in the vignette. The home office is an ideal place to inject the motivational energy; or the power of now.

Stop in Appleway Florist & Greenhouse today to see what we can do to bring a little more Vitamin F into your life!

Mon - Fri: 8:00am - 5:30pm Sat: 8:00am - 3:00pm

11006 E Sprague Ave, Spokane Valley 509-924-5050 | applewayflorist.com

Our 73rd Year

Save 10% Every Wednesday

Spokane’s Local Garden & Pet Store Supplying Spokane With Quality Products Since 1944

The Most Beautiful Blooms on the Block We can help create your happy place with large or small hanging baskets

14208 E 4th Ave, Spokane Valley | 509.926.9397 | plant-farm.com

APRIL - MAY, 2017 INFOCUS inhealth 04-03-2017.indd 29

Health 29 3/24/17 5:26 PM

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

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

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

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

INFOCUS inhealth 04-03-2017.indd 30

3/24/17 5:26 PM

LIVING

TECHNOLOGY

IS IT TIME TO UNPLUG? STORY BY RAVEN HAYNES

P

ixar’s WALL·E is almost nine years old, but its depiction of people who are overexposed to digital media endures: adult-sized babies in Hoverchairs drinking their meals out of cups, eyes glued to holographic screens. WALL·E implies that a dystopian future awaits us unless we “unplug,” or set some healthy limits on how often we’re tethered to a device, browsing the internet and tending to our social media.

Some experts argue that we’re already living that dark reality: Americans reportedly spend more than 10 hours a day, on average, in front of a screen and check their

n

ART BY JONATHAN HILL

phones nearly 50 times a day. (Apple says that iPhone users unlocked their phones an average of 80 times a day last year.)

Dr. Yujung Nam, a Washington State University professor who studies social media from a health communications standpoint, says that actual numbers may be even higher.

“People underreport how much they check their devices,” Dr. Nam says, “Almost like an addict hiding their bottles. They’ll say, ‘Maybe 30 times, 40 times,’ but when we ask them to download an app [that measures that number] for studies, it’s usually about three times more.”

According to a 2016 CNN analysis, in each week’s 168 hours, people generally spend at least 40 hours working, 49 hours sleeping and 21 hours on personal care, leaving about 58 hours for everything else — quality time with loved ones, to-do’s, hobbies, etc.

Recall that Americans spend more than 50 of those remaining hours on TV, phones and the internet — likely sedentary — and we can see why a kids’ movie is begging us to unplug now and again. ...continued on next page APRIL - MAY, 2017

LIVING-MAIN inhealth 04-03-2017.indd 31

Health 31 3/24/17 5:27 PM

LIVING “IS IT TIME TO UNPLUG?,” CONTINUED...

T

he year 2016 was not well-loved.

See: The 13 million views on comedian and television personality John Oliver’s “F--- 2016” episode; terrorist attacks worldwide and the Syrian civil war; Brexit and the caustic U.S. presidential election; the outbreaks of the Ebola and Zika viruses; and the deaths of Muhammad Ali, Prince, David Bowie, Carrie Fisher, and so many more. Even clown panic made an appearance.

But for many Americans, the election (and the presidency, for half of American voters) was more than a bad blip on the radar — it was a revelation. As we scrambled to stay informed and keep up with the endless stream of scandals, “fake news,” actual fake news and the tweets, we finally felt the weight of those 50 hours a week and the absence of whatever we did before.

This year’s “Stress in America” survey agrees: the majority of Americans are worried about the future of this country. The overall stress level rose from 4.8 to 5.1 on a 10-point scale, the first significant increase in the decade since the American Psychological Association began surveying; 57 percent of Americans call the current political climate a very or somewhat significant

Bored? Try exercise instead of checking your social media. says. “Nowadays, you can have 24/7 exposure to [negative content], whereas years ago you might have been exposed to it in the morning paper, or on the radio, and that was it. If you leave yourself exposed to it, you can easily get overwhelmed by it.”

A therapist for more than 20 years, Dr. Anderson says this stress is actually good — it means we’re listening to our bodies, and they’re saying our media habits aren’t making us happy anymore. He regularly recommends that couples have daily hours dedicated to non-screen time together to combat distracted dinners.

“When I talk to people about worries, one of the first things I ask is, ‘Is it a nonproductive worry or a productive worry?’” he says. “Anxiety is a great thing because it means you’re anticipating a future threat, and it’s a helpful emotion if it’s productive

Apple says that iPhone users unlocked their phones an average of 80 times a day last year. source of stress.

One of the culprits? A news cycle nearly impossible to ignore and stories difficult not to discuss or rant about on social media, says Dr. Dennis Anderson, a senior lecturer in Psychology at Eastern Washington University.

“Bad things make news,” Dr. Anderson

PUZZLE SOLUTIONS 7 4 5 9 8 3 6 2 1

9 2 3 4 6 1 5 7 8

8 1 6 2 7 5 9 4 3

5 8 9 3 2 7 4 1 6

4 3 7 1 9 6 2 8 5

1 6 2 5 4 8 7 3 9

2 5 8 6 3 4 1 9 7

6 7 4 8 1 9 3 5 2

3 9 1 7 5 2 8 6 4

Sudoku Moderate (left), Killer (below) 1 6 3 5 2 4 8 9 7

8 5 7 9 3 1 6 4 2

4 9 2 6 8 7 3 1 5

9 8 5 3 4 2 7 6 1

3 7 1 8 6 5 9 2 4

2 4 6 1 7 9 5 8 3

5 2 9 7 1 8 4 3 6

6 1 8 4 5 3 2 7 9

7 3 4 2 9 6 1 5 8

— if there’s something you can do about it.”

A

my Gregg is definitely doing something about it. She’s abstaining from Facebook and limiting her news intake for Lent (until April 15) to focus on her spiritual and physical self. Gregg realized recently that she spends most of her free time on Facebook or “listening to the news on NPR and getting worked up” and knew it was time to unplug.

“That got me thinking, gosh, I’m not doing very much to feed myself, to feed my soul…” Gregg says. “I thought, ‘What would it be like for me to be putting positive things in?’ I’ve been feeling… just bombarded with news and negative thoughts; what would it be like to give myself more space?”

She didn’t use Facebook much before 2013, when she developed a chronic illness that keeps her mostly at home; soon she was on Facebook at least three hours daily, reading friends’ responses to articles, then reading the article, then articles on similar

Codewords

1 to 25 6

5

4 25 10 11 18

7

6

7 25 24 23 24

22

5

4

21

1

3 19 10 21 19

15

2 18 15 20 11 2

8

9 22 8

16 17 16 14 13 12 13 23 17 3 14 9 12 20

D I A G R A W R U A U S T R I R O A F E N E L L R B WA V Y A H A B R I A R O S Y O O A K I N E N S P R I G

M

MA L A Y A A A A R M E N J O T B K A I R A T E R N S E S P I C T A O Q U A N T UM O I U Z A N T H R A X E U E E N C A S E D

32 Health APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 32

3/24/17 5:27 PM

topics… and down the rabbit hole.

“I think it almost became kind of an addiction,” Gregg says. “The little numbers [on Facebook], the notifications — five people said something, so I better see what they said!”

Dr. Nam, the WSU health communications professor, explains that we “respond in a very biological way” to those likes, retweets and comments; our brains release dopamine every time we get that validation, she says, so we get addicted to the

positive — and crushed by the negative.

“When people don’t pay attention, you don’t have 20 likes within 40 minutes, research shows that people have inflated perceptions of how bad [that is],” she says. “The frequency is linked directly to negative self-esteem… feeling distressed, feeling anxiety, to a medical impact on your health.”

Since Gregg unplugged, she’s had “actual face-to-face time” with friends, tried Christian meditation and started reading

HOW ARE YOU UNPLUGGING? STEPHANIE SLATER “I’m physically putting my phone away when I don’t need it and gaining those 10 minutes back [in the morning] ...

If I want to stop and get a coffee, there’s now time for that. No phone during meals is in day four and going well! I also want to go out for Gonzaga games instead of texting friends and checking Twitter the whole time.”

NICK GILKES “I’ve always had a habit of turning off the TV during dinner, but now I’ve started doing it when I eat with my fiancée and her kids. I also recently purchased some fantasy fiction books, so I’ll do that instead of gaming as much.”

again. She only logs onto Facebook to chat, and her record so far is 20 unopened notifications. “I’ve kind of been enjoying watching the numbers build up,” she says, laughing.

“U

nplugging” does not mean “never plugging back in again,” as Casey Cep argues in her 2014 New Yorker article, “The Pointlessness of Unplugging.” One-day digital ...continued on next page

TAYLOR WILLIAMS “A few years ago, my friends and I started stacking our phones when we go to restaurants, ordering an appetizer, and if anyone touches theirs, they have to buy the app — it works! But now that the weather’s warmed up, I’m excited to read or go outside and play with my dog, so hopefully I’ll do that instead of Netflix and Tumblr.”

7 1 0 2 5 2 NE 24 &

JU

V O L U N T E E R COURT MONITORS Sign up to be a court monitor today and guarantee your Nike swag and the chance to win awesome prizes, like a Fan Cave Package, including a 65” 4k Smart LED TV w/ HDR and a Klipsch R10B Soundbar, courtesy of Huppin’s.

WIN A 65” LED TV

P L A Y REGISTRATION IS NOW OPEN! Come and play at the largest 3on3 basketball tournament on planet earth.

Guaranteed registration deadline is May 8.

S P O K A N E H O O P F E S T. N E T APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 33

Health 33 3/24/17 5:27 PM

LIVING

HOW TO UNPLUG

I

t’ll feel uncomfortable at first, says Tanya Schevitz, spokesperson for the National Day of Unplugging (a day of no devices every March), but that’s how you know you’re practicing moderation.

“I’m the spokesperson and I still have to make an effort to have a real balance in my life,” she says. “We’re on a constant state of alert, always waiting for the next ping, ring, buzz.

It’s common etiquette to be scrolling through a phone while talking to someone (or avoiding talking to someone). It’s not healthy, but we can commit to changing it.” Here’s how: Pause and reflect on your media habits. Are you on your phone the moment you wake up?

Keep a journal for a few days, Schevitz says, or take note of how often you’re “just” going to read one post... and are still there 30 minutes later. What do you want to change?

Discuss what you learn with friends, family and colleagues, and explain how your changes may impact them. “If I don’t answer my mom’s

calls for a few hours, [she thinks] it means I’m dead or in the hospital,” Schevitz says. “Just let people know you’re trying to achieve a better balance … and they’ll understand.”

Set parameters. Leave your phone on a shelf at home and check it once an hour; have unplugged dinners twice a week; watch TV for one hour on weeknights. It’s not one-size-fits-all, Schevitz says, so set achievable goals.

Make it difficult to fall into old habits. “Get an alarm clock!” Schevitz says, instead of reaching for your “alarm” (phone) and getting lost in emails, texts and social media in the morning.

Grab a newspaper and books, print out recipes, and prepare your space.

Discover yourself. Take 10 minutes in the morning for a quiet walk or a cup of coffee, Schevitz suggests. Exercise, rediscover hobbies — if you like to cook, join a class instead of watching a video. And build relationships; Schevitz and her family have “Tea Time,” at least 15 minutes on weekdays when they drink tea, talk or work on puzzles. After just two months, her kids now remind her about Tea Time.

— RAVEN HAYNES

“IS IT TIME TO UNPLUG?,” CONTINUED... detoxes like the National Day of Unplugging aren’t a substitute for healthy limits, but they can keep your eyes off a screen long enough to notice the difference.

Dr. Nam emphasizes that digital media isn’t unhealthy on its own, but overexposure is — even CNN anchor Anderson Cooper mutes President Trump on Twitter, saying, “I just don’t want to have that drama in my life.”

“It’s very important to have … an understanding of how [digital media exposure] impacts our political opinions, our emotions, our relationships, our life in general,” she says. “It’s not just media, it’s not just the news — it’s our emotional and spiritual well-being, our job prospects, our health. You have to be mindful, educate yourself, and pay attention to important research on privacy.”

And there are real benefits to being “plugged in.” Dr. Nam has a live Twitter feed for students to ask questions in class, and students who formerly never raised their hands for fear of public speaking are engaging and talking in class. In her research, she’s seen people with chronic

34 Health APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 34

3/24/17 5:27 PM

A weekly email for food lovers

Consider actual face time as an alternative to screen time. illnesses find and support one another over social media, and even seen how virtual reality headsets allow stroke victims to practice physical therapy at home.

It’s no longer the “online world” versus

the “real world,” Dr. Nam says. These devices were always supposed to help us learn, connect and create. We just need to remember that technology is a tool, and we can always unplug. n

Subscribe at Inlander.com/newsletter

Cross over to the bright side.

Membership makes everything better.

Keep smilin’ at numericacu.com 800.433.1837

Federally insured by NCUA.

APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 35

Health 35 3/24/17 5:27 PM

LIVING

Boots Bakery owner Alison Collins uses nutritional yeast to create vegan versions of creamy salad dressing and a versatile cheese sauce.

COOKING

Vegan Culture It may not make your bread rise, but nutritional yeast is packed with protein and flavor

BY CARRIE SCOZZARO

N

utritional yeast is one vegan staple that would benefit from a marketing makeover, sounding more like a component of baking or brewing than an essential source of dairy-free protein with a cheesy flavor. Unlike the ingredient used in bread making, however, nutritional yeast is inactive, and it has been dried to form fine flakes or powder that dissolve easily. It’s best used as a flavoring additive and to create a creaminess more commonly reserved for cheese, butter and cream.

Bon Appétit affectionately refers to

nutritional yeast as “Cheeto dust,” and suggests you use it like you would grated cheese: sprinkled over salads, vegetables or popcorn, or incorporated into dishes such as risotto or mashed potatoes.

Spokane’s Boots Bakery adds nutritional yeast to soups, enchilada pie and their savory macaroni and cheese, and uses it in salad dressings, says owner Alison Collins: “A, it’s a great flavor booster, and B, it’s nutritionally good for you.”

“It seems like a really good opportunity to add protein into your diet,” says Lenna

YOUNG KWAK PHOTOS

Ahlers, RDN, LD and a WIC dietitian at the Panhandle Health District, as well as a graduate of the University of Idaho Dietetic program.

Nutritional yeast provides 3 to 6 grams of complete protein per tablespoon, depending on the brand. In addition, it may be fortified with iron and more often with B vitamins, many of which are only available from eating meat or dairy. Unlike cheese, it is low in fat and calories, and has a fair amount of fiber.

Nutritional yeast is an important ingredient in Collins’ repertoire. “My very favorite thing to do is de-glutenize and veganize ‘regular recipes,’” says Collins, whose baking experience providing deserts for Mizuna (they still serve her vegan carrot cake), coupled with her interest in vegan cooking, led her to open Boots in 2012.

With its distinctive teal entryway in the historic Longbotham Building next to Main Street Market, Boots is a mecca for vegans, vegetarians and those in search of good gluten-free food. On any given day, the main dish offering might include sausage frittata, crispy tofu fish sticks, coconut curry chick-

36 Health APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 36

3/24/17 5:27 PM

RECIPES

50 TAPS FULL BAR

GIFT CARDS

@MANITOTAPHOUSE

MANITOTAPHOUSE.COM Two options for these tricks of the vegan chef’s trade.

YOUNG KWAK PHOTO

Power Salad Dressing

Boots Bakery serves this tangy dressing over mixed greens — kale, chard, mustard — topped with sunflower and pumpkin seeds.

INGREDIENTS 1 cup lemon juice 1 cup nutritional yeast 2 teaspoons granulated garlic 1 teaspoon salt 1 teaspoon pepper ½ cup oil (your choice)

DIRECTIONS: Combine all ingredients excluding oil in food processor or blender.

Slowly drizzle oil in to emulsify.

Store in refrigerator for up to two weeks.

3011 S. GRAND BLVD. (509) 279-2671

11AM - 10PM SUN-THURS 11AM - MIDNIGHT FRI & SAT

BEST NEW RESTAURANT

Versatile Vegan Cheesy Sauce

Top roasted veggies with this rich yet healthy sauce add the sauce to casseroles, or use it to make an amazing vegan macaroni and cheese.

INGREDIENTS 1 one-pound package organic silken tofu 1 cup nutritional yeast 2 teaspoons salt 2 teaspoons granulated garlic or cooked, chopped garlic 1 teaspoon pepper ¾ cup water

peas or roasted beets, while the dessert case features cupcakes, rice pudding, no-bake cookies, fruit and cream cheese bars, and the ever-popular boozy brownies.

Not only did Boots not start out to be gluten-free, says Collins, they also didn’t plan to offer as much food as they currently do. Concern about cross-contamination led her to go completely gluten-free in the kitchen (their carrot cake is the only non-gluten-free item, and it’s made on separate equipment when no one else is in

DIRECTIONS: Combine all ingredients in food processor or blender.

Store 4 to 5 days in the refrigerator. Can be microwaved or warmed in a pan over low heat as needed.

the kitchen). Customer support prompted Collins and her tight-knit staff to expand beyond baked goods, coffee and alcohol, establishing them as a preferred go-to in the east-end neighborhood known for its eclectic shops, restaurants and proximity to arts and cultural hangouts like the Magic Lantern and Saranac Art Projects gallery.

“What has happened here, which I think to some degree needs to happen for businesses to be successful, is it just naturally evolves,” says Collins. n

150 BOTTLED BEERS, 34 BEER TAPS, 4 WINE TAPS, CRAFT COCKTAILS

HOURS:

Mon - Thurs 11am-9pm • Fri 11am-10pm Sat 8am-10pm • Sun 8am-9pm 905 N. WASHINGTON ST. | 509-392-4000

THE OLD BROADVIEW DAIRY APRIL - MAY, 2017

LIVING-MAIN inhealth 04-03-2017.indd 37

BEST PUB

Health 37 3/24/17 5:27 PM

LIVING

Get In and Get Out

until very recently, the surgery required at least one night in the hospital.

Last November, Northwest Orthopaedic Specialists made the move to add outpatient joint replacement procedures to their services for healthy patients who fit their strict criteria.

The group reports it has done 19 outpatient procedures since Nov. 2, 2016, and all have been successful in terms of recovery, reduced or eliminated pain and satisfaction on the part of the patient.

“This is a common theme in medicine — transitioning from inpatient procedures to an outpatient setting — and for a lot of reasons,” Reichard says.

“We appreciate the necessary resources available in a hospital, but (with this program) we don’t utilize them. They amount to a huge expense for the insurer as well as the patient. … There will still be lots of people who are going to need to be cared for in the hospital, orthopedic patients who might also need a cardiologist, internal medicine or additional interventions,” Reichard says.

But for the healthy patient, the sameday surgery approach can work well. And should something should go wrong in the operating room, the equipment, medication and trained personnel necessary to handle an emergency are readily available.

Replacing a hip doesn’t always require an overnight stay

HIPS DON’T LIE

Dr. Kirk Riechard, left, explains the mechanics of hip replacement to patient Paul Kimball.

JENNIFER DEBARROS PHOTO

INNOVATION

BY ROBIN HAMILTON BRODT

P

aul Kimball’s hip replacement journey started when his back went out.

“It was like, Wham! I couldn’t move,” Kimball says. “It was a couple of days before I could walk again. I never had that experience.”

A year later, it happened again.

The South Hill resident was 50 years old at the time, and enjoyed an activbe lifestyle including downhill skiing, water skiing and softball.

He decided to go to a physical therapist, who watched him walk and tested his joint mobility.

“There’s nothing I can do for you,” Kimball remembers him saying. “Your right hip is shot.”

He was surprised at his therapist’s diagnosis. “I remember thinking it was strange because at that point, I didn’t have much in the way of symptoms,” he says. “But before long, my hip was so bad, I had to mentally prepare to get my shoes on.”

The physical therapist recommended A. Kirk Reichard, an orthopedic surgeon

at Northwest Orthopaedic Specialists in Spokane.

Reichard replaced Kimball’s hip in November 2015, in a surgery that went smoothly. Kimball spent one night in the hospital and a few days in bed at home. A home health nurse came by to check his wound and vital signs, and a physical therapist took him through some basic exercises.

By the next spring, Kimball was back playing softball.

But then his other hip started to bother him.

A NEW APPROACH

A decade ago, patients could expect to spend three to five days in the hospital after a hip replacement, with some patients going to a rehabilitation facility to recover enough to return home.

The advent of the anterior, or front, approach to the hip joint replacement, a technique that moves muscles aside rather than cutting through them to access the joint, changed recovery times dramatically. But

“I started noticing that same pain, and this time, I knew what to look for,” Kimball says. “As soon as I laid down, my left side would start to ache, and it took 30 to 45 minutes before it would slowly subside.

“I called my doc, got a steroid shot, then went to the physical therapist, and he did a bunch of strength and mobility tests.

He said the left hip was impinged, and mobility-wise, it was worse than the right hip.”

Kimball’s steroid shot, which had worked so well on his back, gave him relief for just two days.

He made the decision to have his left hip replaced, but this time, Reichard offered him the option of doing the procedure in one day — Kimball would be admitted in the morning and back home that afternoon.

“I had a good experience the first time,” he says, “and the idea that I could go home right away — no catheter, no increased exposure to stuff like MRSA — it all sounded good to me.”

Sandy Phillip, the Outpatient Total Joint Replacement Coordinator for NWOS, provides an important part of the program in terms of patient screening, planning for the surgery and education. She worked

38 Health APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 38

3/24/17 5:27 PM

and determines their eligibility, “based on their health and their support system at home,” she says.

“We call that support person the ‘coach,’” Phillip says, “and they come to the pre-op meetings (where the procedure and recovery is explained), are there the day of the surgery and then spend five days with the patient after the surgery.”

Specifically, the criteria is that the patient must be under 65 years of age, use no nicotine products, have no other major medical problems such as heart disease or cancers, not require narcotic medications for chronic pain, go through a pre-surgery education class where they learn how to outfit their homes for the safety and comfort of the patient, and have a caregiving team at home to help with daily chores.

The outpatient surgery is also enabled through use of proactive methods of pain control, including an array of pre-surgical nerve-blocking techniques and longeracting narcotics, as well as methods for managing post-surgical blood loss.

Outpatient surgery coordinator Sandy Phillip assesses Kimball’s stair climbing. JENNIFER DEBARROS PHOTO with Kimball to make sure he was a good candidate and was aware of what same-day surgery entailed.

“This (outpatient) surgery isn’t for everyone,” Phillip says. Once a patient is seen by a total hip or knee replacement surgeon and that doctor feels outpatient surgery might be appropriate, Phillip contacts them

‘FELT BETTER IMMEDIATELY’

Kimball says the difference between his two surgeries was remarkable.

After the first surgery, he says he woke up feeling as though he’d been “knocked out.” After the second surgery, “I came to and was wide awake. They put me into a chair right away. After an hour or two, I was up walking on crutches. By five that afternoon, I was ready to go home.”

With the same-day surgery, Kimball says he “felt better immediately.” He could shower over the waterproof bandage the staff had given him. He could tie his shoes again without pain.

Same-day patients don’t leave the hospital with no further monitoring, however.

A home health nurse sees patients the day after they return home.

The nurse is there to “make sure the patient’s pain is controlled, the incision looks good, their bowels are moving — everything that will help them get back to their normal lives,” says Sean Fetters, a registered nurse and case manager for Kindred at Home.

A physical therapist works on mobility of the replaced joint, and helps ensure that the home environment is safe and comfortable.

“A lot of these folks want to come home after surgery, and they’re motivated to get back to normal,” he says. “The results for these patients are generally really good.” 

Experience the Arts

Wednesday, May 17 from 1-3:30pm at Rockwood South Hill Exclusive display of work by Emile Lahner 2:45pm - Discussion Panel with the artists who have permanent art on display at Rockwood South Hill

Lahner

Enjoy a wonderful afternoon of art and food, while you meet and enjoy the featured works of local artists Lisa Brown, David Govedare, Robert Heagy, Ben Joyce, Tom Wakeley and Gay Waldman.

Heagy

Joyce

Waldman

Brown

Independent • Assisted Living • Skilled Nursing • Memory Care 2903 E. 25th Ave., Spokane, WA • www.rockwoodretirement.org APRIL - MAY, 2017 LIVING-MAIN inhealth 04-03-2017.indd 39

Health 39 3/24/17 5:27 PM

LIVING APRIL - MAY EVENTS BLOOMSDAY TRAINING CLINICS | Get in running shape in time for the 41st running of the Lilac Bloomsday Run (May 7) with hosted community training clinics, offering graduated conditioning and supported training courses. Saturdays at 8:30 am, through April 29. Meets at Spokane Community College, 1810 N. Greene. Register at bloomsdayrun.org or phc.org (474-3081) PRACTICAL CENTERING: YOGA | A weekly Pilates-based session on building core strength, led by certified instructor Larkin Barnett. Saturdays from 10:15-11:30 am. $13.50-$15/session. Northwest Museum of Arts & Culture, 2316 W. First. northwestmuseum.org UGM ANNUAL GATHERING | Over a meal, attendees hear stories of how the Union Gospel Mission has helped break the cycle of homelessness, abuse and addiction in the community. Thu, April 6 at noon (lunch) and 6:30 pm (dinner), in Spokane (Hotel RL by Red Lion, 303 W. North River Dr.) and Thu, April 27 at 6:30 pm in Coeur d’Alene (Best Western Plus, 506 W. Appleway Ave.). $25/person or $200/table of eight. uniongospelmission.org/gathering (535-8510 or 208-665-4673) NEGATIVE SPLIT | The annual, locally organized race offers half-marathon, 10K and 5K distances. A portion of proceeds benefit

Spokane HOPE School’s programs and services. Sun, April 9 at 9 am. $30-$85. Route starts/ends in Kendall Yards. nsplit.com LIFE ANIMATED | A coming-of-age story about a boy and his family who overcame great challenges by turning Disney animated movies into a language to express love, loss, kinship and brotherhood.

Screening hosted by Team Autism 24/7.

Fri, April 21 at 6:30 pm. $7 suggested donation. Panida Theater, 300 N. First Ave., Sandpoint. (208-255-7801) STEPS FOR AUTISM | The third annual community fundraiser and awareness walk (5K) benefits the work and programs of the Northwest Autism Center, the Isaac Foundation and the Autism Society of Washington’s Spokane Chapter. Sat, April 22 from 8 am-12:30 pm. $20/person. Riverfront Park, Spokane. stepsforautism.org (328-1582) SPRING YARD CLEANUP | Catholic Charities of Spokane organizes a volunteer cleanup during which community members help low-income seniors and disabled residents clean up their yards for the spring. Bring a rake and gloves if you can. Sat, April 22 at 8:30 am. Meets at St. Aloysius Parish, 300 E. Boone. catholiccharitiesspokane.org (459-6172)

RESOURCE DIRECTORY (509) 325-0634 advertising@inlander.com

CHOCOLATE & CHAMPAGNE GALA | Lutheran Community Services Northwest’s annual gala features tastings of champagne, chocolate and a gourmet dinner, with silent and live auctions. The evening also highlights the local nonprofit’s work with victims of child abuse, with proceeds benefiting the Sexual Assault and Family Trauma Response Center. Sat, April 22 at 6 pm. $95/person. Davenport Hotel, 10 S. Post. lcsnw.org/spokane (343-5078) EVERY WOMAN CAN PINK RIBBON RUN | The inaugural event, which takes the place of the Susan G. Komen Race for the Cure, celebrates breast cancer survivors and pays tribute to those lost to the disease.

Funds raised are to be distributed within the local community for diagnosis and treatment of breast cancer. Sun, April 23; 9 am start time. everywomancan.run (2020830) SPOKANE RIVER RUN | The 14th annual trail run through Spokane’s Riverside State Park features 5, 10, 25, 50K individual routes and a 50K team relay. Proceeds benefit Spokane’s Garfield Elementary School APPLE program. $19-$67. Sun, April 23 at 7:45 am. spokaneriverrun.com CHEERS FOR KIDS | An interactive, fourcourse dinner paired with locally crafted beer from Big Barn Brewing Co. Guests

enjoy food by Durkin’s Chef Shaun Chambers, while raising money to support the work of the Vanessa Behan Crisis Nursery. $75-$100. Fri, April 28, 6-9 pm. Washington Cracker Co. Building, 304 W. Pacific. bit.ly/2l6wv2T (340-0479) LIGHT THE WAY DINNER AUCTION | An evening of fun to benefit local children with cancer and their families. Includes dinner and an auction, with all proceeds benefiting the American Childhood Cancer Organization Inland Northwest. Fri, April 28 from 6-11 pm. $80/person. Lincoln Center, 1316 N. Lincoln. acco.org/inlandnw UNCORKED! | The 10th annual fundraiser and wine-tasting event supports local entrepreneurs and women-owned businesses. The evening features four wineries, one brewery, one cidery and food by 1898 Public House Executive Chef Tyler Schwenk. $100/person. Fri, April 28 from 6-9 pm. nawbonw.org/nawbo-events MARCH FOR BABIES | This annual, teambased 3-mile walk/run supports March of Dimes’ programs for babies born premature or with a compromising health condition. Sat, April 29 at 10 am; registration at 9 am on race day. Entry by donation. McKinstry Building, 850 E. Spokane Falls Blvd. marchforbabies.org

MENU OPTIONS: • Health & Wellness • High Protein • Vegan

Pantry Fuel

www.pantryfuel.com

MEALS ARE ALWAYS: • Gluten Free • Nutrient-dense • Locally-sourced

Fully Prepared Nutritional Meals - Delivered

self care during medical repair I want to help you to have the best possible outcome for your medical diagnosis or surgery.

509-979-8208 9166 E. Sprague Ave #62 Spokane Valley

Hip-Help.com

April Box, BS, MS Private Health Advocate

40 Health APRIL - MAY, 2017 CAL-DIR-PEEPS inhealth 04-03-2017.indd 40

3/24/17 5:28 PM

MARMOT MARCH | The 12th annual kids’ run preceding Bloomsday is a 1-mile, noncompetitive walk/run/jog for kids in third grade or under. An adult must accompany a child, and strollers are welcome. Sat, May 6 at 9 am. Riverfront Park, Spokane. $10/ child. Register at bloomsdayrun.org/ marmot-march.

CATHOLIC CHARITIES GALA | The 2017 event supports the programs and services of the local nonprofit; details TBA. Fri, May 19 at 5:30 pm. $75-$125/person; $1,250/table sponsorship. Davenport Grand Hotel, 333 W. Spokane Falls Blvd. catholiccharitiesspokane.org (358-4254) SK BALL | The annual barn dance features a bbq dinner, beer, wine and cowboy cocktails, along with live music from The Rub, line dance lessons, mechanical bull riding, a cornhole tournament, live/silent auctions and more. All proceeds benefit families staying at Spokane’s Ronald McDonald House. Sat, May 20 at 6 pm. $85.

Spokane County Fair & Expo Center, 404 N. Havana. rmhcspokane.org WINDERMERE MARATHON | This USATF-certified, Boston Marathon qualifier race offers both full and

Grand Opening

APRIL 7TH & 8TH YOUR LOCAL SOURCE FOR HOLISTIC WELLNESS, SPECIALIZING IN:

Essential Oils Teas / Herbs Tinctures / Elixirs Homeopathic Remedies Spiritual Supplies Massage

half-marathon distances. Proceeds benefit the Windermere Foundation, which assists local low-income families. Sun, May 21 at 7 am. $90-$115.

From Liberty Lake to Riverfront Park, along the Centennial Trail. windermeremarathon.com WOMEN HELPING WOMEN FUND | The 25th annual luncheon features a keynote presentation by Glennon Doyle Melton, New York Times bestselling author of the books Carry On, Warrior and Love Warrior, who also founded the blog Momastery.com.

Proceeds benefit a number of local charitiess serving women and children. Guests who attend are asked to donate a minimum of $125. Tue, May 23 at 11:30 am. Spokane Convention Center, 334 W. Spokane Falls Blvd. whwfspokane.org (328-8285) COEUR D’ALENE MARATHON | The annual USATF-sanctioned, Boston Marathon qualifier event starts and ends at McEuen Park. The race features a scenic route, with distances of 26.2 miles, 13.1 miles and a 5K race (including one for youth). Proceeds benefit the North Idaho Centennial Trail Foundation. Sun, May 28. $20$90. McEuen Park, 319 E. Front Ave. cdamarathon.com (208-292-1634) 

LET US REPAIR your cracked & painful feet with

Restorative Healing Pedicures Befo1e

ROAST HOUSE CRAFTS COFFEE USING ONLY PREMIUM ORGANIC BEANS, SMALL-BATCH ROASTING, AND CHEMICAL-FREE PROCESSES RESULTING IN A CLEANER, BETTER, AND HEALTHIER COFFEE.

After

Reiki

after one treatment

VISIT OUR TASTING ROOM 423 E CLEVELAND AVE. SPOKANE, WA

330 E Main IN PULLMAN

208-502-0349

1105 N. Lincoln St. • Spokane 990-3840 www.facesandtoes.com

ROASTHOUSECOFFEE.COM

APRIL - MAY, 2017 CAL-DIR-PEEPS inhealth 04-03-2017.indd 41

Health 41 3/24/17 5:28 PM

LIVING So-called “trickster” lies have a deceptively playful name. These lies can be devastating. They’re mostly found in the public arena, in business or politics or government. These lies involve knowingly omitting or exaggerating important details, or even complete falsehoods.

Unsubstantiated claims of weapons of mass destruction by the George W. Bush administration ushered us into war in Iraq, and the fantasy posted on ChristianTimes. com (also fake) of ballot boxes in Ohio stuffed with Hillary Clinton votes damaged the credibility of both the candidate and the state’s election commission. Dire consequences result when people in power, or those influencing opinions and thought, manipulate the truth.

WHY DO WE LIE? ALI BLACKWOOD ILLUSTRATION

PSYCHOLOGY

Pants on Fire Why do we lie?

BY LINDA HAGEN MILLER

I

don’t lie. Oh, that time I told my friend her haircut was cute when, well, it wasn’t. That was just a little fib… I didn’t want to hurt her feelings.

You don’t lie either, right? When you called in sick with “food poisoning,” no big deal, right?

What about the time you fudged on your income taxes to save yourself some hard-earned bucks? That doesn’t count. Or does it?

Politicians? Well, that’s another story.

We know they lie. These days, entire websites are devoted to fact checking because of the tidal wave of half-truths, “alternative” facts, exaggerations and downright falsehoods that come out of the mouths of many elected officials. The disassociation with the truth is having a corrosive effect: According to a 2015 Pew Research Center poll, only 19 percent of Americans say they trust the

government all or most of the time.

The media isn’t faring very well, either.

A 2016 Gallup Poll reveals that only 32 percent of Americans trust the media “to report the news fully, accurately and fairly.”

From me to you to the institutions and organizations in the highest realms of power, white lies and whoppers weave their way through the fabric of life.

SHADES OF GRAY

What level of truth-stretching is permissible? There are wide gradations in the concept of falsehoods. My idea of a big, fat lie might fall in the not-that-bad category for you, and vice versa. Writing in Psychology Today, Adrian Furnham, Ph.D., categorizes lies in three ways: white lies, business lies and trickster lies.

White lies, Furnham states, occur when someone hopes to improve social discourse or protect another person’s feelings. These conversational blips seem harmless and are often told to spare someone’s feelings or fit in with customs. The haircut compliment that isn’t exactly forthright. To most of us, these kinds of “white lies” are generally harmless.

The business or professional lie is a much more serious breach. It distorts or omits facts under the guise of expediting business or personal relationships, Furnham says. The prospective employee who pads his résumé with false credentials.

The husband who says he’s working late when he’s cheating on his wife. Lies in this category can damage credibility, destroy relationships and put finances and lives at risk.

It’s easy to justify shading the truth now and then, but it doesn’t matter whether you grew up in a home that preached truthtelling or just crawled out from under a rock; you know that anything but the most harmless white lie is wrong.

Marshall Rosenberg, Ph.D., author of Nonviolent Communication, says that humans have five basic interpersonal needs: attention, acceptance, appreciation, approval and affection. It’s easy to imagine stepping on the banana peel of truth by telling a lie in order to gain those life-affirming reactions from family, friends, employers and social contacts.

“What motivation or secondary gains are being met for this person by the act of lying?” says Crystl Murray-Mills, a Spokane social worker and counselor who has worked with individuals and families for the past decade. “Are they seeking attention? Are they embarrassed about something? Is there an underlying issue such as a drug problem that needs to be addressed?”

WHEN IS LYING A PROBLEM?

Real problems arise when lying becomes compulsive or pathological. (These syndromes are also known as mythomania and my favorite, pseudologia fantastica.)

A compulsive liar habitually tells stories that have elements of truth but are just a little off. They often suffer from low self-esteem and are lying to enhance their image — in their own mind as well as in the listener. Compulsive liars may have learned the habit from their parents, could be coping with childhood trauma or are battling an undiagnosed nervous system condition such as bipolar disorder, ADHD, impulsive behavior, borderline personality, narcissism or substance abuse.

42 Health APRIL - MAY, 2017 CAL-DIR-PEEPS inhealth 04-03-2017.indd 42

3/24/17 5:28 PM

Family Owned and Operated

Pathological liars, also known as sociopaths, are master manipulators who lie for no reason and have absolutely no remorse because they lack empathy for others. Dr. Martha Stout, author of The Sociopath Next Door, says, “The central trait of sociopathy is a complete lack of conscience, which is very difficult for most people to get their heads around, because those of us who do have a conscience can’t really imagine what it would be like if we didn’t.”

HOW DO YOU COPE WITH A LIAR?

COMMERCIAL & RESIDENTIAL Elevators • Stair Lifts • Wheelchair Lifts SERVICE • REPAIR • INSTALL & MODERNIZE

VOELEVATOR.COM 509-951-6416 LIC# VERTIOL890O3

732 N Napa St. Spokane, WA

WOMEN HELPING WOMEN FUND ANNUAL BENEFIT

O

GLENNON DOYLE MELTON

M

EN

HELPING

D

W

If the lying appears to harm no one and falls into the category of what you consider a white lie, let it go. If the lying is frequent, hurtful, manipulative or destructive (to you, the liar or someone else), speak with the liar privately.

“First, you have to recognize that you do not have any control over another person’s behavior,” Murray-Mills says.

“Not shaming someone for lying is really important, because people may not hear your concerns if you guilt or shame them.

Don’t invite them to lie again by asking a question about the lie. Simply acknowledge that you know. It’s appropriate to acknowledge the negative impact of the lie in a way that’s informative and does not inflame the situation. Focus on trust and communication, not the lie itself.”

Dealing with a compulsive liar is much trickier. “Setting boundaries is key when dealing with a compulsive liar,” Murray-Mills says. “Remember, you cannot control or change another person.

They must face the problem and be willing to undergo therapy.”

Antidepressant or antipsychotic drugs and cognitive behavioral therapy (the process of changing thoughts to change behavior) have been shown to be effective ways to treat chronic lying.

If you’re facing a pathological liar, Stout has just one piece of advice: Walk away. She says only a trained psychotherapist is equipped to deal with a pathological liar, through medication and treatment.

Armed with this arsenal of information on lying, the next time I start to rattle off a white lie, a half-truth or a downright falsehood, I think I’ll take a deep breath and ask myself what I’m trying to avoid or manipulate. A confrontation? Negative consequences? Hurting someone’s feelings? Am I trying to look smarter or more competent?

Then, I hope I have the backbone to put on my big-girl pants and tell the truth, with tact and kindness or soul-baring honesty. 

WOMEN

MAY

23

11:30 AM

SPOKANE

1:30 PM

CENTER

to

CONVENTION

FU

REGISTRATION & INFO AT WHWFSPOKANE.ORG

APRIL - MAY, 2017 CAL-DIR-PEEPS inhealth 04-03-2017.indd 43

N

Health 43 3/24/17 5:28 PM

CAL-DIR-PEEPS inhealth 04-03-2017.indd 44

3/24/17 5:28 PM