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Dr. Jeremy Archer, a pediatric cardiologist at Billings Clinic, reviews the results of Amanda Langve’s fetal echocardiogram that showed her baby’s heart defect.
JAMES WOODCOCK/Billings Gazette
Billings Clinic builds team of pediatric specialists keeping families close to home By CINDY UKEN cuken@billingsgazette.com At 22 weeks pregnant, Amanda Langve’s obstetrician recommended she get a fetal echocardiogram, an ultrasound that evaluates the baby’s heart for problems before birth. There was good reason. Given Langve’s age — 36 — and the fact that her 3-year-old daughter has a ventricular septal defect, commonly known as a hole in the heart, Dr. Maureen Lucas recommended the test out of an abundance of caution. It paid dividends. The fetal echocardiogram is similar to that of a pregnancy ultrasound and is usually done during the second trimester of pregnancy. After reading the results, Dr. Dana Damron, a maternal fetal medicine specialist, diagnosed Langve’s unborn child with tetralogy of Fallot, a rare condition caused by a combination of four heart defects that are present at birth. These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and into the rest of the body. It is often diagnosed during infancy or soon after. However, it might not be detected until later in life, depending on the severity of the defects and symptoms. With early diagnosis followed by appropriate treatment, most children with tetralogy live relatively normal lives, though they will need regular medical care. Tetralogy of Fallot can be genetic, but most of the time, the cause is unknown. It’s named after the French physician Étienne-Louis-Arthur Fallot, who first described the condition in 1888. Tetralogy of Fallot occurs in about five out of every 10,000 babies and affects boys and girls equally. The four defects that make up tetralogy of Fallot are a thickening of the right ventricle of the heart, a hole in the wall that separates the lower two ventricles, a shifting in the position of the aorta, called an “overriding aorta,” and a narrowing of the pulmonary artery. It is considered one of the most common complex types of congenital heart disease. Damron referred Langve to Dr. Jeremy Archer, a pediatric cardiologist who joined Billings Clinic in August 2013, but not without first sug-
JAMES WOODCOCK/Billings Gazette
Amanda Langve, right, with her infant son, Thorin, listen as Dr. Maureen Lucas, Billings Clinic ob/gyn, and Dr. Jeremy Archer, Billings Clinic pediatric cardiologist, discuss how they worked as a team to have Thorin delivered at Billings Clinic despite his complex heart defect.
gesting that she and her husband, Seth, might need to travel out of state to Seattle, Salt Lake or Denver for the proper medical care. Archer confirmed Damron’s diagnosis. “I immediately began praying,” Langve said. Archer performed three fetal echocardiograms, each confirming that nothing had changed. He was confident that the Langve’s child could be born in Billings, specifically at Billings Clinic. “God just placed everyone together to create an amazing team that made it possible for our son to be delivered right here,” she said. Thorin Langve was born on July 13, weighing 6 pounds 2 ounces. Those responsible for helping Thorin make his debut on the world stage was a team of pediatricians, pediatric specialists, obstetricians and gynecologists that Billings Clinic has quietly, methodically and strategically building for at least a decade.
The team, their specialty and their length of service at Billings Clinic include: Archer, pediatric cardiologist, one year; Lucas, OB/ GYN, seven years; Dr. Kristen Day, pediatrician, two years; Damron, maternal fetal medicine specialist, 11 years; and Dr. Nadine Seger, neonatologist, six years. All are housed under one roof, which makes it easy to communicate, consult and collaborate. That’s not the case in all places, Archer said. “We’re incredibly blessed that we have everyone we need to take care of Thorin and they all communicate so well,” Langve said. “God has a purpose for him.” Without the team of specialists, Langve might have had to go out of state to give birth. And, without the availability of the fetal echocardiogram the heart defect likely would not have been detected until after he was born. Knowing the situation from the outset has allowed physicians to treat Thorin accordingly from the
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outset. He will likely need surgery before he turns 1. “The real value of the interdisciplinary team is in preparing Seth and Amanda for the birth and what to expect afterward,” Archer said. “The thing I am most proud of is the ability to collaborate and reach the conclusion that she could deliver at home — safely. That’s the goal.” As for Thorin, he burns energy like a coal furnace. To fatten him up, Mom feeds him a diet of breast milk, formula and a combination of both. The prognosis is excellent, according to both the mother and her doctors. “He’s doing really well,” Langve said. “We definitely expect him to be a normal little boy.” To illustrate her point, Langve points to Shaun White, the American professional snowboarder, skateboarder and two-time Olympic gold medalist. He was born with tetralogy of Fallot. She smiled at the possibilities for her own little boy.
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Courtesy photos
Stent grafts are positioned precisely at the level of the renal arteries. Three St. Vincent Healthcare doctors have been invited to participate in a trial that is studying a device to repair infrarenal abdominal aortic aneurysms.
St. Vincent’s vascular surgeons invited to participate in worldwide clinical trial
By CINDY UKEN cuken@billingsgazette.com St. Vincent Healthcare has been chosen as one of 30 sites in the world to participate in a pivotal clinical trial that will evaluate the safety and effectiveness of new technology to treat aneurysms. Specifically, the trio of vascular surgeons at St. Vincent Healthcare — Dr. Kevin Bruen, Dr. Mark Morasch and Dr. Arne Olsen — have been invited to participate in a trial that is studying a device to repair infrarenal abdominal aortic aneurysms. Endologix Inc. of Irvine, Calif., is sponsoring the trial. An abdominal aortic aneurysm is a bulging, weakened area in the wall of the aorta, which is the largest artery in the body, resulting in an abnormal widening or ballooning greater than 50 percent of the normal width. An aortic aneurysm is a dilation in a section of the aorta, the body’s main artery, the surgeons explained. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death. Each year, physicians diagnose approximately 200,000 people in the United States with abdominal aortic aneurysms. Of those 200,000, nearly 15,000 may have an aneurysm threatening enough to cause death from its rupture if not treated. The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys, which is called an infrarenal aneurysm. This is where the trial, new technology and St. Vincent Healthcare vascular surgeons come in. The technology is called the Nellix endovascular aneurysm sealing system. The Nellix system is a new generation of abdominal aortic aneurysm therapy designed to seal the entire aneurysm. The device was developed to simplify
Completion angiogram demonstrating successful sealing of the aneurysm sac. The patient was discharged the following day.
Dr. Kevin Bruen primes the dispenser containing the Nellix polymer. The polyethylene glycol solution fills two bags within the aneurysm sac to prevent future growth and rupture.
procedures, reduce re-interventions, and expand the treatable patient population, according to Endologix. The company announced in December 2013 that it had received investigational device exemption approval from the U.S. Food and Drug Administration to begin the trial. About 30 of the participating sites are in the United States; others are located in Canada and Europe. Other U.S. sites include the Cleveland Clinic, Yale University and the University of Arizona, putting St. Vincent Healthcare in some prestigious company. St. Vincent Healthcare was chosen in part because Bruen and Morasch each has a longstanding relationship with Endologix and each has participated in other clinical trials the company has sponsored. “When the company started looking at sites, it wanted sites that would enroll patients,” Morasch said. “They saw a robust
vascular program, treating a significant number of patients with aneurysms and saw it as a site that could help them get to their goal.” And Bruen, Morasch and Olsen are each vascular surgeons — a rarity in Montana. None double as cardiovascular surgeons, a distinction they argue is worth making. The trial is approved to enroll 180 patients. Dr. Dittmar Boeckler, a vascular surgeon at Heidelberg University Hospital in Heidelberg, Germany, performed the first procedure in the trial. As of Aug. 15, St. Vincent Healthcare vascular surgeons have used the technology on four patients; they, like all participating sites, have been approved to enroll 23 patients with ongoing access to the device until it is brought to market. Patients enrolled in the study will participate in follow-up visits 31 days, six months and at one year following the procedure. “Privileged,” said Morasch,
describing what it feels like to participate in the trial. “We’re pretty darned lucky to be able to offer this to the people of Montana so they don’t have to travel out of state. There’s nothing in vascular surgery that we can’t handle in Billings. We have the access to technology, the equipment, the clinical expertise. We are vascular surgeons, not cardiac surgeons doing vascular surgery.” Added Bruen, they have a track record of good outcomes, the necessary infrastructure, a clinical trial coordinator and the patient volume. Risk factors for developing an abdominal aortic aneurysm are those who have been diagnosed with atherosclerosis, or hardening of the arteries, high blood pressure, smoking and those 60 years of age and older. An abdominal aortic aneurysm is more common in men than in women and having an immediate relative, such as a mother or brother, who has had it also increases the risk.
The aneurysms are typically treated in one of two ways, according to Bruen and Morasch. In a traditional (open) repair, a large incision is made in the abdomen and the abnormal vessel is replaced with a graft of man-made material. This method involves major surgery and longer recovery times. The other approach is called endovascular stent grafting. This procedure can be minimally invasive, and results in shorter recovery times, according to Bruen and Morasch. However, endovascular stent grafting may develop leaks over time and requires frequent monitoring and possible repair over time. The Nellix system is considered groundbreaking therapy because it is designed to seal the entire aneurysm with a biocompatible polymer, according to Bruen and Morasch. They said Nellix has the potential to dramatically change the way abdominal aortic aneurysms are treated universally. The possibilities excited Bruen and Morasch. “When we look at what we’re trying to do here as a group … we are trying to give the people of Montana all of the components of an academic center here so they don’t have to travel to the Mayo Clinic or out of state,” Bruen said.
James Woodcock/Billings Gazette
Drs. Kevin Bruen, left, and Dr. Mark Morasch, right, deploy the cobalt chromium-covered stent grafts that provide blood flow through the polymer to the lower extremities.
Dr. Kevin Bruen, left, and Dr. Mark Morasch, vascular surgeons at St. Vincent Healthcare, discuss being selected as one of 30 clinical sites in the world to perform surgery with a new device for repairing abdominal aortic aneurysms.
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High-tech health care in your hands cisions — enabling consumers to find the best provider at the most affordable cost. IPF and MLE have the real When Montanans make important decisions about potential to save members significant amounts of outtheir health care, Blue Cross and Blue Shield of Montana of-pocket expenses long-term. (BCBSMT) has the tools they need at their fingertips to BCBSMT has used best-in-class website principles to make the most informed decision possible. transform a typical provider directory experience into BCBSMT goes above and beyond to provide robust one consistent with sites like Orbitz.com or Amazon.com. and easy-to-use online and mobile tools, which provide “It’s very intuitive and packed with information the crucial information that helps improve the quality of care member can use to his or her advantage,” Doran said. and reduce costs. Advertorial courtesy of Blue Cross Blue Shield of Montana
The following are examples of information members Whether at home, in the office, or on the go, BCBSMT members have access to a suite of cutting-edge engage- have access to via the IPF and MLE: ment tools. • General provider directory search with enhanced demographics data (such as pictures, publications, “Our purpose is to do everything in our power to etc.). stand with our members in sickness and in health, and to do that we provide our members with cutting-edge solu• The ability to submit or view reviews on their tions to access important health care information from physician. home, work or on the go,” said John Doran, BCBSMT director of public relations. “The engagement tools we • National clinical quality information around provide allow members to find the care they need and facilities and physicians. save on out-of-pocket expenses.” • Cost information where members can see what BCBSMT’s website, www.bcbsmt.com, delivers topthey would expect to pay out of pocket for certain notch service and information to its members 24 hours a procedures. This takes into account BCBSMT’s epiday, seven days a week. sodic contracted cost information (based on claims data), their individual benefit plan as well as claims From there, members can log into Blue Access for accumulated real time at any point in the year. Members (BAM), a secure online portal that provides unfettered access to transparency tools and information • Information that links to additional treatment insuch as a provider finder, wellness alternatives and other formation so that members can view alternatives to important member-centric information. Through BAM, the surgery they are researching. members can view eligibility and enrollment informa tion, check claims status, identify and track deductibles, While BCBSMT’s transparency solution is a key comout-of-pocket amounts and benefit accumulations, order identification cards, view explanations of benefits ponent to member engagement, access to wellness tools and information (Well onTarget), health care educa(EOBs) and more. tion (Health Care School), a member discount program And for those members who have smart phones, (Blue365) and My Blue Community shouldn’t be overBCBSMT offers Blue Access Mobile, which provides an shadowed. innovative, convenient and secure portal for self-service Well onTarget provides a health assessment, selfactivities such as locating providers, viewing claims status or obtaining an ID card, benefits and coverage informa- directed courses to help members reach wellness goals, opportunities to earn points by completing specific action, and potential plan options/quotes. tivities and achieving goals online, and tracking tools to “Someday soon, everything you need you will be able monitor progress. The wellness portal also offers helpto access from your smart phone,” Doran said. “From the ful information on important health topics like obesity, health insurance perspective, we’re bringing that tech- depression, smoking cessation, what to expect from a physical exam, alcohol awareness, heart health, breast nology to market now.” cancer, fitness and nutrition, just to name a few. BCBSMT has a comprehensive solution to making the Other tools available through the wellness portal health care process more transparent. Its Integrated Provider Finder (IPF) and Member Liability Estimator (MLE), are “Be Smart. Be Well.”, an award-winning website dea suite of engagement modules, present members with signed to deliver news about health-related issues that access to a consumer-friendly program for decision sup- affect members and their family; NurseLine, a 24/7 service that connects members with a registered nurse; a port. fitness program; and the Special Beginnings program for The IPF and MLE application combines cost, quality, expectant mothers. patient input and advanced capabilities (photos, publicaHealth Care School offers information to help memtions, etc.) to give members the feel of a retail website when they are looking for a provider online. IPF and MLE bers best use their health care benefits, a key feature for are consistent wherever the member looks for care — in members who are gaining access to health care coverage for the first time and for those who simply need a Montana or across the nation. refresher course on the basics. Among the topics covered This transparency tool is one of the most innovative are understanding deductibles and out-of-pocket costs; ways members can take control of their health care de- the ABCs of HSAs, HCAs and FSAs; understanding EOBs;
Courtesy of Blue Cross Blue Shield of Montana
understanding the difference between in-network and out-of-network providers; how to talk to your doctor; and essential prescription drug knowledge. Within each topic, more articles allow members to continue educating themselves. The Blue365 program provides members with access to an online destination for health-focused discounts, only available to members through agreements with health and wellness companies. The program not only helps members save money, but also encourages healthy lifestyle choices. Among the deals are discounts on fitness products, health monitors, and healthy meal plans and products. My Blue Community, meanwhile, is an online health and wellness community that connects members from across the country. With more than 60,000 live posts and more being added daily, this social network lets members share wellness information, tips and stories, and talk about ways to live healthier. They can also: • Get advice from experts on nutrition, health, fitness and more. • Offer and get support from others who share the same goals. • See what the experts have to say through their blogs. • Read and comment on message boards. • Upload pictures and share interests. • Join thousands of discussions and connect virtually with new friends. With industry-leading member engagement tools, BCBSMT provides its members with knowledge and power to make important decisions that impact the quality of health care they receive, and at the same time, reduce out-of-pocket costs. “We are doing everything possible to add to the value we provide Montanans,” Doran said.
When it’s time to find the health insurance solution that’s right for you, choose the one voice that speaks on your behalf and has been there for you since 1940—Blue Cross and Blue Shield of Montana. True Blue.
800.447.7828 | bcbsmt.com
®Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
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CyberKnife® Brings Unmatched Versatility, Precision to Cancer Treatment
Courtesy of St. Vincent Healthcare
The new state-of-the-art CyberKnife® Radiosurgery suite at St. Vincent Frontier Cancer Center opened in July 2014.
Cancer patients throughout our region now have access to an efficient and quick, noninvasive option to treat primary and metastatic tumors in the brain, spine, lung, abdomen and prostate: the CyberKnife® Robotic Radiosurgery System. St. Vincent Frontier Cancer Center is the first to offer CyberKnife in Billings, and is only one of two treatment centers in a four-state region. According to radiation oncologist Dr. Lee McNeely, it represents a significant step forward in patient care. “This technology allows greater flexibility in how treatment can be delivered,” Dr. McNeely explains. “It targets the precise location of the tumor while adjusting for the patient’s movements, making it especially effective in the treatment of tumors in the lung or upper abdomen, which naturally move as part of the body’s respiratory process.” Dr. McNeely says that one of the first patients who received a CyberKnife treatment at Frontier was surprised at just how adaptive the machine was. “She said it looked as though the machine was breathing with her,” he recalls. “She saw that it responded each time she inhaled or exhaled.” McNeely notes that CyberKnife offers several advantages when compared to other radiation treatments. “Patients receive a higher, more concentrated dose of radiation with each treatment, with less of the healthy tissues that surround it damaged,” he says. “As a result, most patients require five treatments or less as opposed to the 20-30 or more which may otherwise have been administered. It is effective as a primary treatment method, and because it is noninvasive, it allows patients to immediately begin complementary protocols such as chemotherapy without having to recover from surgery.” St. Vincent Frontier Cancer Center medical physicist Justin Sherman, who works closely with Dr. McNeely in creating patient treatment plans, explains that the CyberKnife’s delivery system varies from other stereotactic radiosurgical procedures in the way the radiation is delivered. “It uses a series of beams to deliver concentrated doses of radiation to the tumor, one right after another
from different angles,” he says. “It is generally most ef- and around them, delivering up to 100 or more targeted fective on tumors from 5cm down to 1-2cm, but is ac- beams of radiation at various angles, each focused dicurate down to even 5mm (about the size of a pencil rectly into the tumor. eraser). Whether it’s right for a specific patient, however, Although a custom mesh mask is used for patients is a decision made by the physicians.” being treated for tumors in the head or neck, the CyDr. McNeely works closely with general surgeons, berKnife’s utilization of advanced imaging and sophistineurosurgeons, thoracic surgeons and other specialists cated software and tracking system eliminates the need in determining which treatment options will be most ef- to use a “halo” or other rigid frame to restrict movement. As the patient breathes or otherwise moves, the fective for each patient. unit instantly adjusts, ensuring that the beams of radia“We take a very collaborative approach,” he says. tion remain locked on the tumor. “Doing so means every patient receives the best and Once the treatment has been delivered, most pamost comprehensive level of care available.” tients can return to their normal activities the same day, “The installation of the CyberKnife Robotic Radio- with little or no discomfort or side effects. surgery System has been made possible thanks to a $4.2 Radiation oncologist Dr. million grant from The Leona M. and Harry B. Helmsley Charitable Trust,” says David Irion, President and CEO of Lee McNeely came to St. Vinthe St. Vincent Healthcare Foundation. “The Trust’s gen- cent Frontier Cancer Center in erosity ensures cancer patients from across our region— December of 2013. An early including those in rural communities—have access to the adopter of CyberKnife® technology, Dr. McNeely not only latest and best treatments available anywhere.” assisted in the development of the system’s treatment The CyberKnife® Difference protocols, but has used the it Radiation therapy has long been utilized as a treat- to treat more than 2,000 pament in the battle against cancer; in fact, it was first used tients over the last decade. at the beginning of the last century. In the more than “The goal of any cancer 100 years since, its effectiveness has improved, along Dr. Lee McNeely treatment is to achieve the with its ability to be focused with laser-like precision. Radiation Oncologist best possible outcomes while The CyberKnife® Robotic Radiosurgery System now minimizing the side effects patients experience,” he in use at St. Vincent Frontier Cancer Center takes that says. “CyberKnife allows us to accurately deliver higher precision to a new level, with unrivaled flexibility. The therapeutic doses of radiation to virtually anywhere in process begins with the patient undergoing a CT scan, the body in a matter of minutes with little or no discomMRI or PET scan to verify the size, type and location of the fort.” tumor. Using this information, the radiation oncologist Dr. McNeely attended the University of Utah School and medical physicist develop a treatment plan which determines the amount of radiation to be delivered to of Medicine, where he also completed residencies in inthe tumor. Each treatment plan is unique, but the goal ternal medicine and radiation oncology. Board certified remains constant: to damage the cancerous cells and in radiation oncology, he practiced in Boulder, Colorado prevent their spread while protecting the healthy tissues for 24 years, where he specialized in bracytherapy and radiosurgery. He was an assistant clinical professor at and structure near or around he tumor. the University of Colorado Department of Neurosurgery During the treatment session, which may last 30-90 prior to moving to Billings. minutes, patients lie on a padded table where they can Raised in Cody, Wyoming, Dr. McNeely is an avid outbe closely monitored by the treatment team via video. Equipped with a lightweight linear particle accelerator, doorsman, enjoying hiking, sailing and fly fishing. the CyberKnife’s flexible robotic arm then moves over
Screenings for Early Detection of Lung Cancer Available at St. Vincent Healthcare According to the American Cancer Society, lung cancer is the third most common cancer diagnosed among U.S. adults, topped only by breast and prostate cancer. What may be surprising for many people to learn, however, is that lung cancer kills more Americans each year than breast, colorectal and prostate cancer combined. What contributes to this high mortality rate? According to St. Vincent Healthcare thoracic surgeon Dr. Walter Graves, the answer is a lack of early detection.
Without financial assistance, the cost of the lung day and multiplying it by the number of years a patient smoked. For instance, two packs of cigarettes smoked cancer screening test is currently $199. For more information about the Pulmonary Nodule Clinic or to ardaily for 10 years is equal to 20 pack years. range for a screening, please contact Kristy Schneider “Until recently, insurance companies—includ- at (406) 238-6800. ing Medicare—were often unwilling to pay for these screenings,” Dr. Ryan says. “Fortunately, following recommendations by the U.S. Preventative Services Task Force issued last year, coverage became far more common.”
“Lung cancer is frequently slow growing, and there Dr. Graves and Dr. Ryan are also pleased to note that are few, if any symptoms in its initial stages,” he says. “As a result, even people who may be at higher risk for resources are now available for those without insurance the disease, including smokers or those who may have or with limited financial resources. worked around toxic chemicals for years, may not be de“St. Vincent Healthcare was recently awarded a gentected until it’s late, incurable stages. Until now there erous grant from the Whedon Cancer Detection Founhas been no effective way to screen for lung cancer.” dation,” says Dr. Graves. “These funds assist those who would otherwise be unable to pay for the screening, Radiologist Dr. Kathleen Ryan agrees. which could ultimately have a wide-reaching impact on “In cases in which lung cancers are found early, while our community.” they are still localized within the lung and have not spread to other tissues, the 5-year survival rate for patients is approximately 52 percent,” she says. “Without early detection, that survival rate falls to less than 20 percent.” Drs. Ryan and Graves, together with a multi-disciplinary team at St. Vincent Healthcare, worked together to create the Pulmonary Nodule Clinic. The program utilizes low-dose CT scans in screening for the disease, and includes a smoking cessation component. The program has specific eligibility criteria which includes adults aged 55-74 who currently smoke or who have quit within the last 15 years. Participants must also have a history which demonstrates 30 “pack years” of smoking, which is calculated by taking the number of packs smoked per
Dr. Kathleen Ryan Radiologist
All advertorial courtesy of St. Vincent Healthcare
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Dr. Walter Graves Thoracic Surgeon
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I’m not 240 lbs.
I’m 26.2 mi. With the most experienced Weight Management Surgery Team in the region, St. Vincent Healthcare is committed to helping those who are ready to achieve and maintain a healthy weight. If you feel ready to take this important step, come to our free seminar to learn about our full range of bariatric surgery options. And let us help you begin your weight loss journey. Register at svh.org/seminar or call 406-237-4580.
Cheryl Miller Bariatric Surgery Patient/Marathoner
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INNOVATION AND QUALITY IN HEALTH CARE
Telemedicine bringing pediatric ICU to rural clinics By DEREK BROUWER dbrouwer@billingsgazette.com An infant breathes rapidly, and his lips are blue — urgent symptoms that could be a sign of congenital heart disease. Whether the infant’s life is in danger depends on the specific defect present. If that child is in one of the remote clinics in Eastern Montana, the doctors and nurses are faced with a dilemma: Care for the baby here, or call for helicopter transport? Increasingly, they are getting help from specialists at St. Vincent Healthcare in making those decisions, thanks to investments in telemedicine that have put the pediatric ICU on their computer screens. The hospital now has 95 stations in Montana and northern Wyoming that allow doctors to videoconference and read medical images in real time. Physicians say the technology is showing promise in treating pediatric emergencies. “You’re bringing the ICU to these rural communities who see these very infrequent, critically ill children,” Dr. Richard Salerno said. Salerno has spearheaded the implementation of telemedicine for St. Vincent’s. He first found success using it for emergency pediatric care at the University of Vermont, which has led the country in telemedicine consultations. Salerno himself has consulted remotely in more than 50 critical cases. The medical landscape in eastern Montana, he said, poses similar challenges for emergency pediatric care, “in that you have a central hub hospital with a pediatric ICU and you have a lot of rural communities surrounding it that require often prolonged transport.” Once a clunky novelty, telemedicine has become a valuable tool for physicians, telemedicine technician Robert Parker said. But with the ability to consult live from the home, office or baseball game, more doctors are looking for ways to incorporate it into their practice. “Really the paradigm has changed,” Parker said. The doctors can dial in through a keypad on their computer monitors to videoconference, then read echocardiograms or listen to the heart through an electronic stethoscope. They can even view ultrasounds on their smartphones through a secure connection. With telemedicine, local providers are better able to administer an emergency procedure or make a more precise diagnosis. In
LLOYD BLUNK/Gazette Staff
St. Vincent Healthcare pediatric cardiologist Andrew Lashus performs an ultrasound on patient Jack Jackson, 6 months.
doing so, they often save the child from cautionary procedures or long-distance transport that may be risky or expensive, Salerno said. “Our advice tends to de-intensify care somewhat. At a ratio of three-to-one, we tell people, ‘Don’t put the kid on the ventilator,’ as opposed to ‘Put them on the ventilator.’ “ he said. “It saves children a very risky procedure.” Beyond improving referral patterns, live consulting with rural clinics has myriad medical advantages, St. Vincent pediatric cardiologists said. Physicians can check the quality of medical images instantly and easily ask or direct the local practitioner to obtain another, Dr. Andrew Lashus said. “Having the chance to do a live study really minimizes the chance that we’ll miss something,” he said. In his consultations, Dr. James Wiggins has counseled local providers on the appropriate use of emergency drugs. “It’s basic triage, and it’s very effective,” he said. Wiggins also likes the ability to answer questions from family members and discuss their child’s treatment options. “It’s enough at least to give them the assurance that they’re
LLOYD BLUNK/Gazette Staff
St. Vincent Healthcare pediatric cardiologist James Wiggins reads an echocardiogram via the health care network’s telemedicine system.
going in the right direction,” he said. Medical centers still need appropriate imaging equipment to participate in the consultations, which St. Vincent has been in-
stalling during the past year. Just as important as the equipment is training and buy-in by medical staff, Salerno said. St. Vincent has used grant funding to study the level of ac-
cess to pediatric emergency care around the state and conduct simulated consultations during site visits. “We’re right on the verge of really taking off,” Salerno said.
Sessions teach newly insured how to use health care By SUSAN OLP solp@billingsgazette.com For the estimated 30,000 Montanans who earlier this year acquired health insurance for the first time, learning how to use that coverage is a crucial next step. With that in mind, RiverStone Health in Billings will host several one-hour education sessions, starting in September. The goal of the Coverage to Care campaign is to take the mystery out of insurance and out of health care, said Barbara Schneeman, RiverStone vice president of Communication and Public Affairs. “Not only do we want people to be able to get health insurance coverage, we want to help them be wise consumers of health care,” Schneeman said, joined in an interview by Jade Jagers, resource advocate coordinator at Riverstone. Starting Sept. 5 and going through Dec. 16, Jagers and her team will hold six one-hour sessions to look at what health coverage is and the best way to go about getting it, Jagers said. “I feel like this emphasizes preventive health, developing a relationship with your primary care physician and just knowing how to use your insurance,” Jagers said. It’s about helping people “take charge of their own wellness,” Schneeman said. With the number of people added to the insurance rolls, she said, there was an initial fear that primary care
doctors in the state would be inundated with new patients. That didn’t happen. Schneeman thinks that’s because a lot of people new to insurance don’t know where to start to access health care. In the past, many of them couldn’t afford a doctor visit. They would wait until a problem turned into an emergency and then visit a same-day care office or a hospital emergency room. “Ideally, you go to a doctor when you’re well to talk about what’s going on with your life and how to stay well,” Schneeman said. Health insurance helps people afford preventive care, she said, and gives people more options. All of the insurance plans offered through the Affordable Care Act include preventive/ wellness services. Since the ACA went into effect, millions of people in the United States have obtained health insurance policies though the online health insurance marketplace. In Montana, the Office of the Commissioner of Securities and Insurance said about 30,000 previously uncovered individuals gained insurance from January through May of this year. Some people went directly to the online marketplace to get that insurance, Schneeman said. Others worked with insurance brokers and insurance companies.
If you go
CASEY PAGE/Gazette Staff
Jade Jagers, right, and Barbara Schneeman of RiverStone Health show some of the materials they have prepared for the Coverage to Care campaign for the newly insured.
For those who had difficulty figuring out the website or didn’t understand the different insurance plans, “assisters,” such as the members of Jagers’ team, helped them navigate. In Billings, RiverStone Health, Billings Clinic, St. Vincent Healthcare, Planned Parenthood and the Montana Migrant Council had certified application counselors who helped guide people through the process of purchasing insurance. Jagers said the questions she heard most often had to do with how much the insurance cost and exactly what it covered. She and the others also took time to
explain insurance terminology, such as premiums, deductibles and in-network versus out-of-network services. They also helped clients figure out whether they were eligible for a tax credit or subsidy. The online marketplace opened Oct. 1 and initially was scheduled to close by the end of March. But huge glitches at the outset prompted officials to extend the deadline, Jagers said. Altogether, RiverStone Health assisted 1,300 people, and helped 1,000 of them file an application for insurance. Nearly 40 percent of the clients came in for help in March.
“We saw ecstatic people brought to tears that they were able to get insurance and some mad that they were being told what to do,” Jagers said. The next round of enrollment will take place Nov. 15 through Feb. 25. People with qualifying events, such as getting married or divorced, having a baby, moving to another state or aging out of their parents’ health insurance, can sign up any time of year. The good news, Jagers said, is the website “now works like a peach.” For those newly enrolled how to make the best use of it. in the insurance plans, “It’s all about investing in Schneeman said, it’s worth your health,” she said. taking the time to figure out
“Not only do we want people to be able to get health insurance coverage, we want to help them be wise consumers of health care.” — Barbara Schneeman
RiverStone vice president of communication and public affairs
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People are invited to attend a free one-hour session during the the Coverage to Care campaign, to learn more about how to effectively use health insurance benefits. Each session will explain a patient’s road map to health, which includes a series of steps. They are: Put your health first Understand your health coverage Know where to go for care Find a provider Make an appointment Be prepared for your visit Decide if the provider is right for you Next steps after your appointment Sessions will take place: Sept. 5, 1-2 p.m.; Sept. 16, 5:30-6:30 p.m.; Oct. 3, 1-2 p.m.; Oct. 14, 5:30 to 6:30 p.m.; Nov. 7, 1-2 p.m.; and, Dec. 16, 5:30-6:30 p.m. If needed, more sessions will be added. No registration is required for the classes that will all take place in the RiverStone Health Clinic group room, at 123 S. 27th St. in Billings. For information, call 651-6540 or send an email to marketplace@ riverstonehealth.org.
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“The main focus is prevention. We want to look at sources of lead and eliminate (the problem) before it happens. We want to include an educational outreach. Once we’ve done the research, I’d love to see us be part of health fairs, including schools, day cares and churches as part of our outreach to the community.” — Hannah Silveus
CDC Public Health Associate
Getting the lead out Hannah Silveus is one of only three across the nation working on a CDC program to help prevent lead poisoning By MIKE FERGUSON
mferguson@billingsgazette.com
There are only two other people in the nation like Hannah Silveus, and Billings children could well be healthier with her working on their behalf for the next two years. Silveus, 24, who has spent the past two years working at RiverStone Health as a Centers for Disease Control and Prevention public health associate, will now spend two more years in Billings. She’s been designated as a CDC public health associate working on lead poisoning prevention with the CDC’s Healthy Homes and Lead Poisoning Prevention Program, one of three associates in the nation (the others are in Illinois and North Carolina). She recently attended a weeklong training at CDC headquarters in Atlanta to learn more about her new assignment. A 2012 study showed that 2.5 percent of Billings children under five had elevated levels of lead in their blood, Silveus said. That’s on par with other communities in Montana and many across the nation, she said. “We will be looking at what the needs are within the community” for rais-
ing the awareness of the dangers of lead poisoning in children and identifying the neighborhoods where lead-based paint might pose the biggest hazard, Silveus said. She’ll also work to help educate landlords, homebuilders, contractors, real estate agents and parents about the health dangers that lead presents. The U.S. Department of Health and Human Services said that water pipes in some older homes contain lead solder. Small children sometimes eat lead-based paint chips, chew on objects coated with lead-based paint or swallow house dust or soil that contains lead. Citing the health risk to children, the U.S. government banned lead-based paint in 1978. About 24 million homes in the U.S. contain deteriorated lead-based paint and elevated levels of lead-contaminated house dust. In four million of those homes, a young child is present. Children are more vulnerable to lead poisoning than adults. A child who swallows large amounts of lead may develop blood anemia, severe stomachache, muscle weakness and brain damage. Even at lower levels of exposure, lead
BOB ZELLAR/Gazette Staff
Riverstone Health Vice President for Public Health Services Shawn Hinz, left, and CDC Public Health Associate Hannah Silveus talk about the new CDC program to raise awareness and lower risk of lead exposure in Billings.
can affect a child’s mental and physical growth. Unborn children can be exposed to lead through their mothers. There are other sources of lead throughout a child’s environment, including certain consumer products, some of which may be imported. The local lead prevention project is still in its infancy, said Sliveus and Shawn Hinz, vice president for public health services at RiverStone Health. Hinz said she has high hopes that with the expertise and support from the CDC, Silveus can make a real impact on the health of Billings residents.
“The support that Hannah brings from the CDC is optimal,” Hinz said. “It is definitely a beautiful opportunity.” Silveus said she’ll use an existing database to help identify and locate Billings’ older homes. She’s also exploring formation of a regional Healthy Housing Workgroup. Potential partners for that group include pediatricians, housing authority staff, real estate organizations, home builders and contractors. In addition, she’ll review regional child blood lead surveillance data to help her formulate her primary prevention work plan. “The main focus is pre-
CyberKnife
®
The No-Surgery Alternative to Tumor Treatment Advertorial courtesy of Benefis Health System
nology that enables continuous coordination with a patient’s tumor movement during treatment. This is especially crucial for patients receiving treatment for lung and prostate cancer – two areas that are in constant motion. Because of the CyberKnife System’s ability to continuously track and adjust in real-time in combination with its sub-millimeter accuracy, a patient can be confident their tumor is being treated while the surrounding healthy tissue and organs are spared.
It is the one word no one ever wants to hear their doctor say – cancer. But according to the American Cancer Society, more than 1.5 million Americans received that diagnosis in 2012 alone. Being diagnosed or having a loved one diagnosed with cancer is frightening, stressful and overwhelming. The good news is that the majority of Americans can now continue to live full lives following their initial diagnosis thanks in large part to the new What is a CyberKnife treatment like? medical technology and treatments now When receiving treatment, patients available. simply lie down on a padded table and In the past, having a cancerous tumor breathe normally while the CyberKnife removed meant undergoing invasive System quietly moves around them. surgery and recuperating in the hospital for days. Thankfully, today doctors have A surgeon, who became a access to leading-edge technology that CyberKnife patient, shares his target and eliminate many types of can- experience: cerous tumors without cutting into the “The CyberKnife technology can depatient or requiring an overnight hospitect slight motion of the prostate durtal stay. ing treatment and then recalibrate and The CyberKnife® Radiosurgery Sys- adjust. These features enable the tumor tem was the first, and remains the only, to be treated accurately, with little risk of full-body radiosurgery device designed radiation to the normal adjacent tissues,” to help destroy tumors with intense, said Scott Silver, M.D., a CyberKnife proshighly-focused beams of radiation. The tate patient. “Once I made the decision CyberKnife System can treat tumors any- to go ahead with the CyberKnife, I felt a where in the body, from the brain to the calmness and relief that I wouldn’t have lung to the prostate, and is the best radia- to deal with the potential serious complition oncology solution for treating, track- cations.” ing and adjusting in real-time to moving “Throughout the treatment I was able targets with extreme precision and accuracy. Unlike other radiation systems, to relax and listen to my own music in a the CyberKnife System is able to treat pleasant room,” said Scott. patients in one to five days as opposed Once treatment is complete, a patient to what can be months of other forms of daily radiation treatment. This is because has follow-up appointments with their of the CyberKnife System’s extreme ac- doctor as they follow the destruction of curacy, which enables it to deliver the the tumor. maximum dose very precisely. Not only The CyberKnife System is a great opdo most CyberKnife patients avoid surgery and finish treatment in a week, their tion for patients who are unable to rebrief course of treatment is pain-free and ceive surgery, have surgically complex typically lasts an hour or less per treat- tumors or are seeking an alternative to ment. The majority of patients go about surgery that will allow them to continue their active lifestyle with minimal disruptheir daily routine during treatment. tion. For more information about the CyA unique and important feature of berKnife System, visit www.benefis.org/ the CyberKnife System is its tracking tech- cancer.
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vention,” she said. “We want to look at sources of lead and eliminate (the problem) before it happens. We want to include an educational outreach.” “Once we’ve done the research,” she added, “I’d love to see us be part of health fairs, including schools, day cares and churches as part of our outreach to the community.” Along the way she’ll look around at how other communities are dealing with and mitigating the problem. “Working at the federal level, you have those connections, and you can take them back to tell people” locally, she said.
According to a CDC news release, the role and responsibility taken on by the three new public health associates will be driven by the needs of the community. “Through Hannah and her dedicated time, we will look at this throughout the entire community,” Hinz said. “We look at prevention as a public health effort, and we’re very supportive of her.” To learn more about the dangers of lead for young children, visit these CDC websites: www.cdc.gov/ nceh / lead /infographic. htm or www.cdc.gov/ nceh/lead/acclpp/blood_ lead_levels.htm.
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Sunday, September 7, 2014
Aspen View Retirement
Experience the Holiday lifestyle program and Holiday Touch All advertorial courtesy of Holiday Retirement
Every life has a story. Every person is unique. At Holiday, we get that. Holiday is more then just a place to rest your weary feet and hang your hat. Aspen View is a supportive community made up of dynamic individuals with their own personalities—personalities that shine. With a long list of exciting events every day we make sure that laughter and health is in the forefront of our schedule. From Luaus to classic car shows, we make sure there is an event for everyone to enjoy. It is part of our, ‘layers of the Holiday lifestyle’ program. This is a comprehensive program of activities and events designed to stimulate the seven dimensions of wellness: physical, emotional, spiritual, intellectual, creative, social and vocational. It is a unique program that benefits all of our residence. Here’s what you can expect:
PHYSICAL By providing fun and innovative physical activity, residents stay physically active and healthy. You’ll enjoy 5-7 activities such as tai chi, yoga, chair fitness, wii sports, balloon volleyball and many more every week. Our residents frequently play Bean Bag Baseball, a simple yet highly entertaining game.
INTELLECTUAL At Holiday, we aim to also keep our residents intellectually stimulated. Activities such as brainteasers, spelling bees, board games, puzzles and many more will keep your gears grinding on a daily basis.
Photos courtesy of Aspen View Retirement
SOCIAL We host a variety of social events so you can connect with other residents and build new meaningful relationships. Join our coffee klatch, happy hour, or one of our weekly socials, and start getting to know your neighbors.
One of the many things that truly sets Aspen View Retirement apart from other senior retirement communities are our live-in community managers. These management teams are also residents; they live, work, and eat alongside the family at Aspen View, sharing their lives with the people they serve so selflessly. They’re available day or night to help senior residents with anything they may need and go out of their way to make everyone feel welcome and included. We strive to make each of our residents feel like they are at home where they belong. This is what we call The Holiday Touch, and it is what makes life at a Holiday Retirement community so special. From friendly neighbors who act more like family to a devoted staff who view their work as much more than simply a job. Our staff is eager to help all of our residents and is deeply committed to you, your family and your well-being. Our employees are honest, dependable and loving individuals, who are dedicated to our mission and truly want to help our clients achieve and maintain the highest level of independence and quality of life. Compatibility and continuity is our motto here at Aspen View and we promise to provide caring, compassionate service to all our clients.
EMOTIONAL At Holiday, we aim to create a strong family feeling for all of our residents. This is a natural extension of the Holiday Touch. So share you story during a circle group, or enjoy a local animal group’s pet visits, anything you need to emotionally connect to others.
SPECIAL SERVICES INCLUDE: • Chef-prepared meals • Companionship • Conversation • Light Housekeeping • Live-in Managers
CREATIVE
• Recreational Activities
We know that many of our residents were once teachers, artists, poets, and that they bring many talents to our communities. We love the opportunity to help everyone showcase their talents. Whether it’s photography, knitting, or painting, we’ll gladly adapt our weekly activities to suit your interests.
SPIRITUAL
• Meal Preparation • Mail Bills and Letters • Transportation/Escort • Pet Care • Pet Friendly. Woof!
• Schedule of Events every day Meet the management Emma and Brad have been with Holiday Retirement for three years. They arrived in Billings in January from sunny Florida. As live in managers, they reside at Aspen View with their amazing 6 year old daughter. Emma and Brad have a combined 22 years of management experience that they bring to Holiday Retirement, but most importantly, they both have a great passion for helping others and working to enrich their everyday lives. Aspen View is their family, and they look forward to growing it over time and putting smiles on the faces of everyone they encounter. There’s nothing they wouldn’t do for family. Holiday Retirement has been around since 1971 and continues to grow across the United States. Come visit us today and see all that Holiday has to offer.
Spiritual needs mean different things to
different people. Our communities offer church services, prayer groups, bible study and hymn singing.
VOCATIONAL Holiday Retirement is full of residents that held prestigious careers within their lifetime and some may still volunteer within their professional circle. We know it’s important to create opportunities for residents to be a part of public speaking, creative writing, journalistic writing, and other relevant business avenues.
3075 Ave. C Billings, MT 59102 (406) 652-7788
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Plan your weekend at Aspen View Aspen View
Independent Retirement Living
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INNOVATION AND QUALITY IN HEALTH CARE
MyBillingsClinic gives patients access to personal health records By LINDA HALSTEAD-ACHARYA For The Gazette You shop online and you balance your bank account online. Now Billings Clinic has ramped up its “patient portal” so you can access your own private medical records online, too. “We wanted to get the medical (community) up to the standard of other industries,” explained Dr. Karen Cabell, who splits her time between internal medicine and her role as associate chief of quality and patient safety at Billings Clinic. She has worked closely with Amanda Berglund, the Clinic’s health information management informaticist, to develop a secure, online site for patients to tap into their personal medical histories — from lab results to billing information and so much more. The site, billingsclinic.com/ mybillingsclinic, can be accessed on any device, from desktop computer to iPad to Android. By logging in, patients can view appointment dates, verify prescribed medications and check immunization records. The site also provides access to pathology and radiology reports, the patient’s history of surgeries and procedures, and billing and insurance information. “There’s also a way to message your physician through the portal,” Cabell said. “It’s kind of like an email, but HIPAA protected.” Bobbie Protain of Reed Point, a patient of Cabell’s, discovered MyBillingsClinic earlier this spring. She especially likes the messaging feature that allows her to keep in close touch with Cabell. “It’s an awesome tool,” she said. “You go to the doctor with all these questions, but, inevitably, you forget something. This way you don’t need to go back — you can just email the question. For me, living where I live, it’s nice to have that contact with the doctor without having to drive to Billings.” Protain learned about MyBillingsClinic after hearing of a similar program in Portland, Ore., where her son Adam was fi nishing his nephrology fellowship.
Billings Clinic patient Bobbie Protain uses her online “Patient Portal” to access her medical information from her Reed Point home.
“I wasn’t sure if I’d send an email and hear back in two weeks or what. It ends up, usually if I send an email in the morning, I have a response before noon.”
Find out more For more information about MyBillingsClinic, call 406-2476400 or 1-800-332-7156, extension 6400.
— Bobbie Protain
them days of anxious waiting,
porch. What surprised Protain most was the speedy response time. “I wasn’t sure if I’d send an email and hear back in two weeks or what,” she said. “It ends up, usually if I send an email in the morning, I have a response before noon.” Cabell believes the quick turnaround gives patients a better sense of control. Likewise, the speedy access to lab and pathology results can spare
The site also offers patients a means to view the same information when away from home. Likewise, when a patient moves to a new location, his or her health records can be accessed with the click of a mouse. From the physician’s perspective, Cabell appreciates the increased efficiency and reduced risk of miscommunication. “The hope is to improve quality, safety and value for patients,” she said. MyBillingsClinic has been
Reed Point resident she added. “He loved the system because he could stay in contact with patients via email,” Protain said. “Once he told me about it, I started looking here.” She signed on — to register, patients must present an ID at a registration desk at most any Billings Clinic location in Montana and Wyoming — and found the site user-friendly. She likes the fact that she can log on from home or even while enjoying a summer morning on her front
JAMES WOODCOCK/Billings Gazette
in the works for several years, but has leaped forward in the past few months. Berglund continues to push the technology forward to offer new functionalities every few months. Currently, more than 20,000 patients have signed on and Cabell hopes to see that number increase. “It’s a vehicle for patients to get more interactive in their care,” she said. “We want this to be smart. Ultimately, we hope to engage more (patients) in lifestyle changes.” MyBillingsClinic is available to all patients of Billings Clinic facilities, except children ages 12 to 17. That age group is exempted so as to ensure them a degree of confidentiality. Proxy access can also be arranged for guardians and family members with the proper documentation.
HEALTH Look for the
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CASEY PAGE/Gazette
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l Center has The Glendive Medica grant from The received a $287,469 B. Helmsley ChariLeona M. and Harry will be used to table Trust. The money connects rural pathat ent equipm buy specialists through tients to emergency Falls, S.D. Avera Health in Sioux , it is “Given our remote location provide emervitally important to Powell, CEO gency care, said Parker Center. “With the of Glendive Medical Bakken the by population growth driven severity of and oil activity, the number The addition d. accidents have increase be of great benefit of eEmergency will to our patients.” gives The eEmergency program speaccess to physicians immediate a day. It ensures cialty care 24 hours emergency physithat board-certified nurses are ned ncy-trai cians and emerge rs at Glendive available to assist provide trauma, Medical Center in treating and other critical heart attack, stroke benefilly especia conditions. It will be as eEmergency cial for accident victims, l to diagnose and will allow the hospita close to home, treat more patients g reducin stress improving outcomes, risks and costs asand eliminating the Powell said. sociated with travel, e at the hospiThe biggest challeng of providers, tal is the limited number Powell said. ns to this remote “Recruiting physicia is overwhelmingly part of the country “The physicians difficult,” Powell said. d very thin. we do have are stretche Department ncy Each time our Emerge n, it takes them has to call a physicia job, which means away from their other to go care bedside leaving one patient’s immediate connecfor another. Having ts will be tion to emergency specialis.” wonderful for our patients of Program The Rural Healthcare ble Trust began in the Helmsley Charita has awarded more 2009 and since then grants to nonprofit than $200 million in region. out the organizations through
Watch your knees, girls. the cs, A new study in Pediatri an Academy of journal for the Americ anterior cruciate Pediatrics, found that on the rise, and ligament injuries are this injury get to likely girls are more than their male friends. playing the In the U.S. study, girls are 2.5 to 6.2 times same sport as boys injury than ACL an have more likely to study, girls ages boys. In a Norwegian 0 chance of 10-19 had a 76 in 100,00 that same in tearing their ACL; boys 0 chance 100,00 in age range had a 47 of the same injury. in the knee Usually, you feel a pop , says Dr. Randall and then see swelling with surgeon dic Schultz, an orthope Sometimes it will Texas Orthopedics. pain might not be hurt; other times, the that bad. y suddenl Sports where kids stop usually direction and turn a different rs: soccer, gymare the common offende basketball. nastics, volleyball and they once girls The risk goes up for for boys around hit age 12 or 13 and Puberty. This is the age 14 or 15. Why? faster and their time when kids grow keep up, which bodies can’t always leg’s tibia and the is especially true in femur bones. also make For girls, hormones lax. In boys, the the ligaments more actually helps them testosterone surge and control, increase muscular power rapid the allowing them to handle skeletal growth better.
By CINDY UKEN te.com cuken@billingsgazet t, one to three laps,” LAUREL — “Alrigh Amy Caldera. barked an enthusiastic a group of youngsterrs Without hesitation, looping the track nearly 75 strong began Sports Complex School at the Laurel High atchful eye. under Caldera’s ever-w was before 8 a.m. on Never mind that it summer vacation of day an otherwise lazy it was raining. The and never mind that rs through 12th-gradgroup, second-grade ex eager to sprint nd an ers, arrived at the Compl bleachers, stretch around the track, run d more. kids about life,” said “Running teaches r l history teache Caldera, a middle-schoo coach. “It’s fun and track If a kiid to get out and move. say y the track at Laurel High wants to run I’ll never school group around with the elementary ’s summer running program Thursday. no.” Kimberly Foote runs ps in the school district Now in its fifth year, k School during warmu Track the Laurel Summer m from Program has grown 0 tto 2010 five participants in eek 105 this year. The six-we $35, program, which costs co STAMPER will onstarted June 2 and mes. Big Sky State Gam clude July 19 with the icipartic to aged Participants are encour on Run in Laurell o n pate in the Chief Joseph Soaked Fun Run in July 4 and the 2-mile s on July 18. They y aare Pioneer Park in Billing ig Sky Bi participate in the also encouraged to State Games. der, -grad eighth an 13, no, Levin Sharbo gy to arrive at the sogg was one of the first g. track Thursday mornin n tthe pating in It is his third year partici program. ono fun,” Sharbo “It’s just always been track season n. for said. “It gets me ready I get to meett m my And, It gets me in shape. friends here, too.” ng for of participatin This is the first year , a fifth-grad der. sum10-year-old Beau Dantic r running the t for in shape School District’s summe “I just want to stay ps during the Laurel ntic said. for football,” Dan Amy Caldera leads warmu on Thursday. mer and get ready at Laurel High School Track, C2 program eT Please see
lap on the track. Right,
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runners warm up on
• Patient success stories • Features on the latest medical technology • A listing of health-related events, including classes, walks, support groups and more • Unique local columnists that weigh in on everything from plastic surgery to weight loss
to Study: Girls in sports need worry about their knees
‘Running tea
they finish a g Ava Caswell, 4, as ula runners, includin , 8, left, congrattulates Left, Henry Roberts Complex. field at the Laurel Sports
ZETTE.COM
The weekly section features:
in Women face challenges fighting addiction
the
Women Are “Men Are From Mars, ted a popular book From Venus” trumpe in the 1990s. sell 50 milAuthor John Gray didn’t and spark a pop lion copies of his book us anything most culture fire by telling by grade school. of us hadn’t learned different. Men and women are nt way in Here’s another significa addiction, its which the sexes differ: nt. aftermath and treatme frequent in “Depression is more addiction is more women than in men; women, but if frequent in men than of addiction women have a problem is more likely of or alcoholism, there tric problems like having other psychia d they were depression. The likelihoo said Dr. higher,” is exposed to trauma or of psychiatry Ihsan Salloum, profess s and chief of and behavioral science and Alcohol ce the Division of Substan Miami Miller of ity Abuse at the Univers School of Medicine. nce different Women also experie triggers, accordinfluences and relapse a residential ing to the Hanley Center, women ages for treatment center 18-46. e for Alcohol The National Institut estimates that and Alcohol Abuse drink alcohol about 5.5 million women their health at risk. at levels that place — From Gazette staff and news services
To subscribe to The Billings Gazette, call 406-657-1298 or visit billingsgazette.com/subscribe
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EvEry lifE HAs A story. EvEry pErson is uniquE. At HolidAy, wE gEt tHAt.
Independent LIvIng
Welcome to Holiday.
WeLcome Home. Aspen View
Independent Retirement Living 3075 Avenue C, Billings, MT 59102 | 406-652-7788 | www.aspenview.net CYAN
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Dentistry As Health Care... ...Dentistry IS Health Care Advertorial courtesy of Periodontal Specialists of Montana
In our everyday lives we experience dentistry as separate from other aspects of health care. This is unfortunate. Recent research indicates that these two areas must go hand in hand to be of the greatest benefit to overall health and well-being. After childhood, dental disease usually becomes a slow insidious process with few acute signs. Consider this both a blessing and a curse. The blessing is that we seldom experience the pain and discomfort. The curse is that low-grade infections simmer along without recognizing they can wreak havoc on our bodies and degrade our general health. Dental infection and heart disease Over the last 20 years, numerous studies confirm that dental infection (periodontal disease in particular) contribute significantly to the development of cardiovascular disease. This is due to direct effects by the bacterial infection and indirect damaging effects to the immune system. This is reflected in measures of full body inflammation and the dysfunction of the cells in your blood vessels. When a patient is successfully treated for oral infections, measures of systemic inflammation and blood vessel cell function return to normal. Periodontal infection and rheumatoid disease In diseases like arthritis and periodontal disease, healthy tissue is destroyed by inflammation. The source of this inflammation can be physical, bacterial or autoimmune, where the body reacts to its own tissues. While there has been a debate on whether auto-immunity plays a role in periodontal disease, the issue remains open. What is becoming clear is that periodontal infection can increase the severity of other rheumatoid diseases. Research shows an increased severity of antibody profiles in patients who test positive for periodontal disease-associated bacteria. These antibody profiles become more benign following periodontal therapy. These results were so pronounced that researchers speculated that periodontal infections may contribute to the development of rheumatoid arthritis.
Periodontal disease and pregnancy Studies in both humans and animals confirm that exposure to oral infections during pregnancy place women at higher risk for premature delivery and lower birth weight infants. While the exact mechanisms and effects of treatments have yet to be confirmed, the connections between these issues is clear. Is there an easy answer? For most people, dealing with periodontal disease is simple and straight forward. The first step is to recognize that just because you have no pain, does not mean you have no problems. In all but the most severe cases, periodontal disease symptoms are subtle and easily missed. All dental problems can have adverse effects on systemic health and well-being. However, it is periodontal disease, which carries the highest risk because it is the easiest to ignore... patients can overlook the problem for decades! The key to the management is early diagnosis. Catching any dental disease problem when it is small means you will have less invasive treatment and better healing. Advanced therapies assure patient comfort and recovery Fortunately advances in treatment using laser-based therapy is proving much more effective in dealing with periodontal disease. Research on patients shows that the Nd-YAG laser used in the LANAP treatment protocol reduce the offending bacteria to undetectable levels, far better than can be achieved with conventional therapy. Not only does this advanced treatment protocol eliminate pathogens more effectively, it provides better, natural healing without the added cost of bone grafts, growth factors and other regenerative materials. New Courtesy of Tom Egenes discoveries and protocols assure that the gulf separating dental and medical problems continue to shrink. The Dr. Scott Manhart can be reached at 406-655-7970. complete health of the complete patient is the desired end point.
Periodontal disease and diabetes The association between diabetes and periodontal disease has been well documented for more than 20 years. Patients with diabetes have a higher incidence of periodontitis, and their symptoms are more severe compared to non-diabetics. They also suffer from increased problems with tooth decay (caries), xerostomia (dry mouth), tooth loss, gingivitis, chelitis, and oral yeast infections (thrush). Untreated periodontal disease has profound effects on control of blood sugars. Infections increase insulin resistance which counters the medications prescribed to control blood glucose levels. Lowlevel oral infections make control of blood sugar levels much more difficult, putting diabetic patients at higher risk for complications. With successful periodontal treatment, blood sugar swings are reduced making the management of diabetes more predictable.
www.DrManhart.com
LANAP Laser Less Pain. Less Discomfort. The Laser Alternative to Traditional Gum Surgery. If your doctor informed you about a practically painless surgery that used a laser instead of a scalpel, would you be more compelled to try it?
Lasers Have Changed The Face Of Medicine. Call Today For A Consultation
50 27th Street West, Suite D, Billings, MT 406-655-7970 | 1-800-801-5076 www.HealthyGumsMontana.com CYAN
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