Innovation & Quality in Health Care

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INNOVATION & QUALITY IN

HEALTH CARE Challenging delivery at St. V’s performed by team of specialists

CASEY PAGE/Gazette Staff

Dr. Roger Wallace of St Vincent Healthcare Maternal Fetal Medicine holds Tina Craft’s daughter Kinzley Puskas.

BY LAURA TODE For The Gazette

Wallace diagnosed placenta increta, one of a trio of placenta implantation disorders that is caused when the plaEven though Dr. Roger Wallace centa invades the muscle wall around has delivered hundreds of babies, he the uterus. doesn’t usually get a chance to hold A less serious, more common disorthem beyond his duties in the delivery der called placenta accreta occurs when room. the placenta simply attaches to the Wallace works in maternal fetal uterus wall. When the placenta grows medicine at St. Vincent Physician through the uterine wall, it’s called Network, assisting mothers and their percreta, the most rare and dangerbabies through high-risk pregnancies. ous of placenta disorders. In the most Five-week-old Kinzley Puskas recently severe percreta cases, the placenta came for a visit and gave him some grows through the wall of the uterus well-deserved snuggle time. and invades other organs. The kind of “A lot of these kids we see for weeks tissue destruction that it can cause is and months on ultrasound and 3-D im- similar to what doctors see in cancer aging, but unless mom brings them in, cases, Wallace said. we don’t see them again after delivery,” Placenta increta occurs most Wallace said, beaming, as he fingered frequently in patients who have had her tiny, pink toes. previous C-section births, and because The tenderness in his hands showed the number of C sections has steadily that Wallace loves what he does, but increased in the past couple of decades, this little girl’s birthday is one he will so has the prevalence of increta. In the never forget. Her complicated and risky ’70s, the incidence of placenta increta delivery was the work of eight special- was one in 4,000. In the ’80s, that inists, including two vascular surgeons, creased to one in 2,500. By 2002 it was who all helped make history at St. one in 500, Wallace said.

Vincent Healthcare.

In many cases, the placenta reacts Kinzley’s mother, Tina Craft, devel- to scar tissue, implanting over the area oped placenta increta, an abnormality where the C section was performed, that occurs when the placenta becomes Wallace said. With each C section, a implanted on the wall of the uterus. woman’s risk increases. Craft’s 7-yearThe abnormality causes severe hemor- old son was delivered by C section, so rhaging during birth as the placenta is her risk was higher. ripped from the uterus. Mothers will In his work in the sub-specialty of often need multiple blood transfusions maternal-fetal health, Wallace has seen during delivery, and if doctors aren’t numerous cases of accreta and increta. prepared for the massive blood loss, the The mother in his most recent case in mother could die. his practice in Texas had increta and Thanks to Wallace and a team of required a transfusion of 80 units of specialists, Craft didn’t require a single blood during delivery. blood transfusion, and through Cesar“It’s the kind of procedure that can ean section baby Kinzley had a healthy, empty the blood bank,” Wallace said. normal delivery. The rare, complicated The diagnosis rattled Craft, espeprocedure was the first of its kind at St. cially after she saw a segment on plaVincent Healthcare. centa increta on a morning talk show, Craft made her first visit to Walwhich described the mother’s survival lace’s office when she experienced as “a miracle.” unusual bleeding early in her pregnan“The fear in me every time that I had cy. Using ultrasound images and MRI, a cramp or anything was unbelievable,”

INDEX

Pediatric oncologists ................................ G3 Family medicine residency ..................... G4 Billings Clinic Metabolism Center........ G8 New technology in eye care ................... G8

Craft said.

Wallace’s steady demeanor and confidence in the procedure kept Craft from panic.

“I tried my best to keep the stress level down,” she said. “You just have to pray for the best.”

To avoid the major hemorrhaging that would be caused as a result of a normal, vaginal birth, Craft was scheduled for a C section five weeks before Kinzley was due. Eight physicians from five specialties attended the birth.

Vascular surgeons Dr. Kevin Bruen and Dr. Mark Morasch played a critical role by blocking major blood vessels to the uterus with tiny balloons. The procedure is fairly common in other vascular surgeries, but not usually performed in a delivery room. An anesthesiologist, a neurologist and an urologist also assisted, and a neonatologist attended to the newborn.

“The key was we knew it was there and the vascular surgeons did proce-

dures ahead of the delivery to keep the bleeding from occurring,” Wallace said.

Planning included several dry runs with all the players prior to the planned delivery. Wallace alerted the blood bank to be ready in case things didn’t go as planned.

“Another really neat part of this was the support of the nursing staff,” Wallace said. “When we were walking through the procedure, everybody said, ‘We can do this.’”

As planned, Craft didn’t require a blood transfusion, and although little Kinzley came early, she weighed a solid 5 pounds, 3 ounces and had to spend only three weeks in the neonatal intensive care unit.

“I couldn’t have done it without everybody here,” Craft said. “They gave me the hope that everything would be great, and everything came out perfect.”

CASEY PAGE/Gazette Staff

Wallace holds Craft’s daughter Kinzley as Craft’s son Dalton Snyder, 7, looks on.

Billings Clinic pediatric specialty ......... G9 Child life specialist ................................... G12 Research of Alzheimer’s program ..... G12 St. Vincent’s new joint center............. G13

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Proper foot care ....................................... G14 Gum disease ............................................... G15 RiverStone Health primary care ........ G16

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Pediatric oncologists want to do even more for kids with cancer

LARRY MAYER/Gazette Staff

Dr. Paul Kelker, left, and Dr. Courtney Lyle work to help young cancer patients at Billings Clinic.

BY LAURA TODE For The Gazette

department. It’s that relationship that Lyle values most.

“When you’re dealing with On Dr. Courtney Lyle’s first childhood cancer, you’re not just day on the job at Billings Clinic dealing with the child, you’re last month, she met six children dealing with the whole family,” whom she will likely see for years said social worker Sara Blackburn. to come. Lyle is a new pediatric “You basically become a part of oncologist at the clinic, and her that family, and it’s a big honor.” favorite part of the job is getting to Lyle joined Dr. Paul Kelker, know her patients and maintaina 25-year veteran of pediatric ing that relationship as they grow. oncology, at Billings Clinic. Her “The kids are amazing. They journey to Billings has taken go through a lot and have a lot to her from her childhood home in share,” Lyle said. “It’s wonderful Eagle River, Alaska, to New York to see them through treatment state, Atlanta, Denver and, most and graduate from high school recently, San Diego, where she and go on to college and do great did her fellowship in hematology. things.”

In addition to serving oncology Treatment for childhood can- patients, Lyle will also see patients cer can last as little as six months with hematologic disorders. or up to five or six years depending Lyle’s husband, also a docon the type of cancer a child may tor, was hired by Billings Clinic have. In that time, a tight bond as well, and the couple has an forms between the child and his 8-month-old son. or her family and the team at the The team in the pediatric onBillings Clinic pediatric oncology cology department is a tight-knit

group, dedicated to patient care.

Although the number of patients is constantly in flux, they usually have about 20 patients actively receiving treatment. The doctors there also provide follow-up care and regular screenings for former patients.

Children with cancer usually start their journey in the emergency room of Billings Clinic with symptoms that ER doctors think could be cancer related. Kelker or Lyle is called immediately for help with a diagnosis. They are almost always referred to Children’s Hospital Colorado in Denver, where they will receive their first treatments. While there, the youngsters will be enrolled in cancer research programs, and if surgery is necessary, they’ll receive it there as well. Continuing treatments, including chemotherapy and follow-up care, is done in Billings.

The travel and distance is often taxing for families, and Kelker and

Lyle said they believe more could be done for children with cancer at Billings Clinic. The department has started the process of becoming a member of the Children’s Oncology Group, and Lyle’s involvement and expertise will help make membership possible. The application process is expected to take at least 18 months, but when it’s approved, Kelker and Lyle will have the opportunity to expand treatment offerings and chemotherapy protocols.

“It will also give children the opportunity to get enrolled in research studies through Billings Clinic instead of having to go to Denver,” Kelker said.

The Children’s Oncology Group is the most sophisticated research network for any medical specialty, Lyle said, and its research programs have been critical in fi nding cures for childhood cancer. They are often the only way a child has

access to advanced medicines and the latest treatment protocols. They also provide doctors and scientists an opportunity to study the disease.

“Children’s cancer is so rare that the only way you can learn anything is by getting kids involved in studies,” Kelker said.

In Montana, about 30 children are diagnosed with cancer each year, compared to about 5,000 adult diagnoses a year.

Survival rates for kids with cancer in the ’60s was between 20 and 40 percent, Kelker said, and children with leukemia had no chance of surviving the disease. Now, the survival rate is between 80 and 90 percent, and children with leukemia can expect to survive the disease 100 percent of the time.

“Hopefully we’ll continue to make strides like that for other forms of cancer other than leukemia,” Lyle said.

Brewer Dental Center Brett Breshears had given up hope. His teeth, damaged from years of neglect, needed a crown and bridge, but it was dental work that he just couldn’t afford.

“I haven’t taken a picture I could smile in for nearly 15 years,” Breshears explained. “I’ve always been ashamed of my teeth. I wasn’t able to look people square in the eye, and because of my teeth I started becoming an introvert.”

Breshears said his poor dental health affected every part of his life. “At work, people would stare at my teeth.

I wasn’t angry with them, but I would be angry with myself and cut the conversation short. It affected my relationship with my wife, also, because I was ashamed.”

While on Facebook, Breshears’s wife came across an offer that seemed too good to be true: a free smile makeover. Brewer Dental Center launched the FREE Smile Makeover campaign earlier this year and is giving away a smile makeover every month for a year.

After announcing the Smile Makeover campaign, the office was flooded with letters and emails from people hoping to be chosen. Applicants had to submit their story explaining why they felt they needed a Smile Makeover.

“We had an overwhelming response,” said Kevin M. Brewer, DDS and founder of Brewer Dental Center. “It is so hard to pick. This is impacting someone’s life big time.

It’s life changing.”

BEFORE

AFTER Photos courtesy of Brewer Dental Center

Breshears was the first person to receive this smile makeover. In early July he received the crown and bridge he so desperately needed. After receiving this generous gift of dental work, Breshears said everything changed for him. “I love to laugh, and I love to meet people. I’ve gotten my confidence back, and I can’t stop smiling.”

est to Valentine’s Day, Dr. Brewer gives away free dental services, including cleaning, filling and extraction. Last year the dental center saw nearly 450 people and gave away upward of $130,000 in free dental work.

surgery to veneers to wisdom teeth, hard and soft tissue grafting, Brewer Dental Center focuses on care that begins at childhood and continues into the last years of a person’s life.

“When you give back, you get far more in return than Breshears said he’s still trying to wrap his head around the generosity offered by Dr. Brewer and Brewer Dental you give away,” Dr. Brewer said.

Center. “For me, being able to look at people and to sit Dr. Brewer has been a dentist for 30 years, and he beand have conversation and smile and laugh is just pricegan his dentistry practice in Billings in 1983. He grew up less. It’s such a great feeling to be myself again.” in Forsyth in a farming and ranching family and was the It was Breshears’s fear of dentists that contributed to first of his family to graduate college. the poor state of his teeth. “I hated dentists,” he said. “I Though Dr. Brewer has many proud moments, he’s would have to be in a lot of pain to go.” most proud of his ability to give back, whether it’s to his When Breshears finally decided it was time to do patients or through teaching and mentorship. “In my something about his dental health, he called Brewer heart, I’m a teacher,” he said. “Right now I spend my time Dental Center. “Even on the phone I felt I’d made the teaching these young doctors what I’ve learned over all right decision. The customer service there is incredible. those years, so a lot of my knowledge is being passed on They make you feel very comfortable. For the first time, I to these young, brilliant doctors.” wasn’t afraid to go to the dentist.”

There’s no doubt that Dr. Brewer has a passion for Breshears’s dental makeover would have cost $12,000, dentistry. A lot of his passion comes from staying current but Dr. Brewer and his staff believe in giving back. “Giv- and constantly going to seminars. He attends and often ing is so important, and we’d been brainstorming ways presents at seminars across the country. to give back,” said Dr. Brewer. “Since we’re dentists, we Dr. Brewer attributed his success to the golden rule: decided to give smiles.”

Treat people how you’d want to be treated. His approach The selection committee is still reviewing applications to dentistry is so successful that clinics from around the and will select 12 people in total for makeovers through- country model their approach after the Brewer Dental Center model. out the year.

From patients to staff—some that have been with Dr. Brewer for almost as long as his practice has been around—Dr. Brewer’s business model incorporates core values centered on integrity and the golden rule. “We never settle. We’re always striving for excellence and looking for improvement.”

Part of Dr. Brewer’s dental philosophy involves the In addition to the FREE Smile Makeover campaign, for the past several years Brewer Dental Center has hosted Three Cs: comprehensive, convenient and conformable.

Dentistry From The Heart. On the Saturday that falls clos- His practice offers a broad spectrum of dental care. From

Advertorial by Anna Paige for Brewer Dental Center

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Brewer Dental Center has convenient hours and is open from: 7 a.m. – 7 p.m. Monday – Friday Saturday hours from 8 a.m. – 5 p.m.

The clinic offers same-day care and has a doctor on call 24-7. Call the office at 1-877-325-6100 to schedule an appointment today.

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Family medicine residency a model for programs across the U.S.

BY DIANE COCHRAN For The Gazette

the health care reform law that established a pilot program for co-located medical residencies As they sift through stacks of and community health centers. applications from hopeful medical The funding stream was designed students each spring, leaders of to last five years. In the first two the Montana Family Medicine grant cycles, 22 sites received Residency in Billings can’t help funding. RiverStone Health but feel a little proud. earned a grant the first year, Sixteen years after becoming which it used to add a resident slot the state’s only medical residency to the Montana Family Medicine program, the school has turned Residency. out dozens of well-rounded “This is so right on in addressphysicians prepared to practice ing the health care needs of the medicine in rural areas. It has also country,” Fahrenwald said. become a model for other residenBecause they usually care for cies around the country. people of little means, community The Montana Family Medicine health centers take a holistic apResidency is unique because it is proach to medicine. That means located within RiverStone Health, that, rather than just addressing a health care system that includes the problem that brings a patient a federally funded community in the door, community health health center as well as Yellowcenter providers look for the other stone County’s public health enti- challenges in patients’ lives and ties. Medical residents learn by for ways to solve them. If a patient working at the community health comes in for asthma, for instance, center, where patients tend to be an alert doctor asking the right desperately in need of a doctor’s questions might discover that care as well as in need of many of old carpet in the patient’s apartlife’s other basic necessities. The ment aggravates her breathing program produces physicians problems. The doctor can connect with a strong sense of civic duty the patient with local resources who, because they have treated to swap out the offending carpet, such high-risk populations, are thus reducing the frequency of the capable of working in virtually patient’s visits to the clinic and any medical environment improving her overall well-being.

The unusual setup has placed “This is the most innovathe residency program in high tive place I’ve worked,” said Dr. demand. Last year, 800 medical Emily Colson, a 2006 graduate school graduates applied for its of the Montana Family Medicine eight resident slots.

Residency program who recently “We attract residents because returned to become a member of of our model,” said Dr. Roxanne the faculty. “Not only is everyFahrenwald, senior vice president one committed to continuing to of clinical and educational inteimprove and move everything in gration at RiverStone Health and a better direction, the structure director of the residency program. of the organization encourages “People apply here because they that.” see medicine as a community “I have colleagues in big service.” academic centers,” Colson said.

Boosters of the residency pro“The bureaucracy has a bit too gram, which provides three years much inertia. They get frustrated of on-the-job training to medical because ideas don’t get very far. school graduates, argued for years Here, everyone encourages forthat the program’s teaching health ward thinking. Everyone’s ideas center model could be the answer are valued.” to the nation’s worsening shortVisionaries at RiverStone age of primary care physicians.

Health see this sort of proactive, Finally, someone listened. forward-thinking care as one Authors of the federal Papart of the solution to the nation’s tient Protection and Affordable deteriorating health.

Care Act included a provision in “The health care system has

BOB ZELLAR/Gazette Staff

Dr. Emily Colson, left, a faculty member at the Montana Family Medicine Residency, makes a point with resident Kate Krebsbach at RiverStone Health.

got to change from taking care of sick people to keeping people well,” said John Felton, president and chief executive officer for RiverStone Health.

Imagine, say Felton and others at RiverStone Health, if all 1,200 community health centers in the country were staffed by medical residents whose residency programs were right on-site. The number of new physicians trained in family medicine would burgeon, and those centers’ 20 million patients would have access to the latest in medical knowledge.

And make no mistake about

the quality of the medical care at teaching health centers. Although they might be inexperienced, medical residents have just left the classroom, where they learned the latest and greatest in medical theory and practice.

“When you have a residency program, it really drives all the physicians in that practice to be very current and evidencebased,” said Megan Littlefield, medical director for RiverStone Health. “Medicine is constantly evolving. When you’re teaching, it really drives you to be on the cutting edge. It brings up the

caliber of the physicians in that community.”

Littlefield and her colleagues hope that RiverStone Health and the other pilot sites can convince Congress to extend the funding for co-located residencies and community health centers.

RiverStone Health’s leaders are almost counting on it: They plan to admit another eight residents next spring, even though the students will graduate after the five-year pilot program is scheduled to end.

“Most of us have taken a leap of faith,” Fahrenwald said.

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St. Vincent Healthcare’s New Heart & Vascular Center of Excellence Hybrid Operating Room Will Deliver Life-Saving Care With cardiovascular experts representing some of the most experienced clinical experts in the country, St. Vincent Healthcare has a long-standing tradition of providing the highest standard of heart and vascular care throughout Montana, Wyoming and the Dakotas. Recently, the organization’s President and CEO, Jason Barker, announced that it was expanding its efforts to deliver life-saving care through its creation of the Heart & Vascular Center of Excellence.

“The Heart & Vascular Center of Excellence will mirror the talents and expertise of our physicians,” Barker noted. “It will also include the creation of a hybrid operating room, the first of its kind in this region.”

According to the Centers for Disease Control, nearly 1 out of 4 deaths in Montana are attributable to heart disease.

Cardiovascular disease is the leading cause

of death in Big Sky Country, with many Montanans having experienced heart attacks, heart failures or stroke.

The hybrid room will host both catheterization and open surgical procedures, providing both rapid and comprehensive treatment for cardiovascular disease. It will eliminate the need to move a patient from one operating room to another, a particularly critical advantage during emergency procedures, when time is of the essence.

“It’s going to allow us to take care of really, really sick patients, and to allow them to be done here and not have to be sent out to the Mayo Clinic, or Cleveland, or Houston,” says Tim Dernbach, MD. “I think it’s absolutely critical to the program.”

Funds for the new hybrid operating an added boost of stellar technology so room will be raised through the St. Vin- they can do even more.”

cent Healthcare Foundation according to The funds raised at the annual SAINTS David Irion, the foundation’s president ball, scheduled for October 6 of this year, and CEO. will go toward the Heart & Vascular Cen“We have an amazing team, but they ter of Excellence and the new hybrid ophave the expertise, and the ambition to erating room. To purchase tickets for this be a destination heart and vascular cen- event or for more information on how to ter beyond what they’ve already accom- donate, call (406) 237-3600. plished,” he said. “Our aim is to give them

St. Vincent Physician Network — Heart & Vascular Center located at 2900 12th Ave. N., Suite 502E For more information or to make an appointment, please call (406) 238-6820.

Montana’s First Hybrid Operating Room Will Allow Multiple Procedures Simultaneously

Courtesy of St. Vincent Healthcare

Hybrid operating room to be built.

Designed to be highly functional and allow optimum movement, the hybrid operating room will include the latest state-of-art imaging system. This fusionimaging system provides physicians detailed, real-time images of a patient’s heart and blood vessels, allowing them Many heart and vascular patients to determine diagnosis and begin apneed to undergo multiple surgical and propriate treatment. non-surgical procedures in the diagnoMost importantly, the imaging capasis and treatment of their disease. In the past, this has often meant having to con- bilities provided in the new facility will duct testing and treatment on separate play a key role in procedures such as the occasions, or moving the patient from placement of valve stents and other deone room to another to complete a pro- vices designed to treat aortic aneurysms as well as other heart and vascular concedure. ditions.

The hybrid operating room currently being planned at St. Vincent Healthcare allows surgeons and physicians to perform a combination of non-invasive, minimally invasive and open procedures simultaneously if needed.

Nationally Recognized Vascular Surgeons Join St. Vincent Heart & Vascular Center Dr. Kevin Bruen has recently joined St. Vincent Healthcare, having completed his vascular surgery fellowship at the University of Florida. While there, he performed more than 1,300 open, endovascular and hybrid procedures.

DR. Kevin Bruen

“I wanted to come to a place where I could use the full set of skills I learned there,” said Dr. Bruen. “[St. Vincent Healthcare] has a rich history with my senior partner, Dr. Dernbach, and the infrastructure and care being given here was at a very high level.”

of care being provided. As an example, he noted that in the past, an open surgery to repair an aortic aneurysm would generally require a 5-day hospital stay, long-term recovery and large incision.

“Now with the use of aortic stent grafts, the procedure takes about 45 minutes,” he said. “And the patient goes home the next day.”

Dr. Bruen, who has also received advanced training in the next generation of stent grafts designed to treat aneurysms in the abdomen and iliac arteries, also works with patients to treat arterial and venous diseases as well as many other vascular conditions.

When not working, Dr. Bruen and his He noted that while wire and catheter- wife Erica, who is also a physician, enjoy based procedures were being done at St. skiing, fly fishing and spending time with Vincent, the need to expand the ability family. to do more of these procedures in this region was important to continue the level

Are You At Risk for Cardiovascular Disease?

The American Heart Association has reported that heart disease is the second most common cause of death among Montanans each year. Some people are unaware that they are at risk for cardiovascular disease, however.

Risk factors include: • • • • • • •

High blood pressure High cholesterol Diabetes Smoking or using tobacco products A body mass index (BMI) of 25 or greater A sedentary lifestyle, with little or no regular exercise An unbalanced diet, particularly those without a proper amount of fruits and vegetables

If you have one or more of these risk factors, or suffer from any cardiovascular symptoms, contact St. Vincent Healthcare today.

According to Dr. Mark Morasch, who nity to move to a place where he could recently joined St. Vincent Healthcare, make an even bigger impact, he took it. vascular surgery was something he be“Here in Montana, specialists are fewcame interested in very early on in medier and farther between, and between cal school. my partners and I we’re comfortable “One of the fellows that we’ve got all of vascular surgery covI remember working ered,” he said. “I don’t think there’s anywith used to call the thing technically that we can’t do. There vascular surgeons total shouldn’t be anything we need to refer body surgeons,” he said. out of Montana anymore. And that’s “We really do go every- something that excites me.” where in the body outThis ability to provide exceptional vasside the heart and the brain. We operate from cular care in state, without the need to the base of the skull to transfer them to a larger facility, makes Dr. Mark the tip of the toe, in the a particular impact for those who would Morasch hand, in the chest, the not have the ability to travel to Seattle or abdominal cavity—we to other facilities like the Mayo Clinic. go everywhere.”

Dr. Morasch, who was raised in OrBefore coming to St. Vincent Health- egon and spent time in Montana while care earlier this year, Dr. Morasch was growing up, also enjoys all that living in Professor of Surgery at Northwestern Billings offers to him and his young famUniversity’s Feinberg School of Medicine ily. He recently traveled with his family in Chicago for 15 years. He was also an at- to Butte where he was able to research tending vascular surgeon at Northwest- his roots, which go back four generaern Memorial and Children’s Memorial tions, on his Irish mother’s side. They’ve Hospitals, completing more than 6,000 also enjoyed touring Yellowstone, going to Paradise Valley and Big Sky, and spendopen and endovascular procedures. ing time in Red Lodge. He’s looking forBut after 25 years in Chicago, Dr. ward to the many more adventures that Morasch said when he had the opportu- Montana has to offer.

All advertorial courtesy of St. Vincent Healthcare

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Sunday, September 9, 2012

I am not a preemie.

I am a little guy with a big heart.

St. Vincent Healthcare is proud to offer a Level III Neonatal Intensive Care Unit for newborns with specialized care needs.

And as your newborn grows, we’re thrilled to welcome them back to benefit from our expertise in primary and specialty pediatric care. If the need should arise, we also provide pediatric intensive care with pediatric specialists around the clock.

Because you never know when you’ll need it. Learn more about our pediatric services at svh-mt.org.

Hear more in Rafe’s parents’ words.

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New Regional Neuroscience Center for Brain and Spine at St. Vincent Healthcare Brings Unmatched Level of Comprehensive Treatment and Patient Convenience Delivering the highest quality care is the priority of St. Vincent Healthcare. For that reason, the organization, a longtime leader in neurologic care, is pleased to announce the opening of its new Regional Neuroscience Center for Brain and Spine.

“The St. Vincent Healthcare Regional Neuroscience Center for Brain and Spine is dedicated to providing comprehensive and compassionate care to patients diagnosed with diseases or injuries of the brain and spine,” said the program’s director, Dr. Lashman Soriya, along with Dustin Strandell, Neuroscience Service Line Director at St. Vincent Healthcare. “Utilizing modern technologies and evidence-based treatment protocols, our goal is to provide the best possible outcomes, enhance the lives of our patients by reducing their pain and discomfort, and maintain excellence in clinical practice through commitment to high professional and ethical standards.”

According to Strandell, the new Neuroscience Center provides an improved, comprehensive level of patient care.

“By bringing together neurosurgeons, neurologists and clinics into one space, our patients benefit from the team approach it provides,” he said. “The new center also has imaging services available for the convenience of our patients.”

Staffed by many specialists, St. Vincent Healthcare provides services across the continuum of care for neurologic patients.

These include: •

•

24/7 Neurohospitalist program providing coverage for emergent neurological illnesses Stroke diagnosis, treatment and rehabilitation

•

Expertise in Parkinson’s Disease, Multiple Sclerosis and other movement disorders

•

General neurosurgery including evaluations and treatment of afflictions of the brain and spine

Courtesy of St. Vincent Healthcare

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Comprehensive spinal care, with both complex and minimally invasive procedures offered

•

Acute and chronic pain management

•

The Headway Program for patients who have suffered a traumatic brain injury

•

New Hope, a comprehensive, CARF-accredited rehabilitation unit

The St. Vincent Neuroscience Center for Brain and Spine is located at 1041 North 29th St. in Billings.

For more information or to make an appointment, please call (406) 237-7011.

Available Only at St. Vincent Healthcare Deep Brain Stimulation Provides Relief from Tremor, Rigidity, and Freezing for Parkinson’s Patients Usually affecting people age 50 and up, Parkinson’s disease is a motor system disorder caused by a loss of the brain cells which produce dopamine. Symptoms include trembling (tremor), difficulty maintaining balance, a loss of coordination and stiffness. Symptoms worsen over time, with some patients seeing a slow progression and others experiencing faster onset.

A leader in the treatment of movement disorders, St. Vincent Healthcare is the only organization across this region offering the latest in Parkinson’s treatment: deep brain stimulation, or DBS. “The loss of dopamine leads to an overactivity of certain areas of the brain,” said neurosurgeon Dr. Stuart Goodman, who performs the procedure at St. Vincent

The benefits of undergoing deep brain Healthcare. “The DBS stimulator provides some regulation to the traffic of the brain stimulation at St. Vincent Healthcare insimilar to how flashing traffic lights pro- clude: vide some regulation of motor vehicle • Offering relief from symptoms traffic.” safely, with minimal risk to healthy brain tissues During deep brain stimulation, electrodes are implanted into a patient’s • The ability to adjust the level of brain, then buried under the skin and atelectrical stimulation without adtached to a neurostimulator placed in his ditional surgeries or her chest. Similar to a pacemaker, this neurostimulator delivers electrical pulses • The option of turning off the stimto the brain, helping to block the tremorulator if needed causing signals as well as symptoms of stiffness and freezing.

• An improved quality of life for patients without the need to make a According to Dr. Goodman, “Deep permanent brain lesion. brain stimulation is one of the most satisfying procedures for the patients, their families as well as physicians.”

Nationally Certified Primary Stroke Center at St. Vincent Healthcare Leads the Way in Care for Stroke Patients Nationally certified as a Primary Stroke Center, St. Vincent Healthcare meets the needs of stroke patients from the moment they arrive at the hospital either by car, ambulance or our HELP Flight program. Every patient with stroke symptoms is evaluated quickly and treatment begins immediately, which may include the administration of tissue plasminogen activator (tPA) for eligible patients.

Physical Therapists: Assess stroke patients for the ability to walk and move, providing exercises and education to improve independence and preserve function

Speech Therapists: Work closely with stroke patients to assess needs that go beyond the ability to talk. Our therapists work with patients to relearn how to swallow, use their facial muscles, unSometimes referred to as a brain at- derstand speech and make decisions. tack, stroke occurs when blood vessels Occupational Therapists: Teach pain the brain become blocked or begin to leak, causing the brain not to receive tients how to make adjustments in daily the proper amount of oxygen. When activities and try different methods for that attack occurs every second that it self care in an effort to give survivors the goes untreated means more damage. In most independence possible. fact, for every minute that passes after a Rehabilitation Physician: Collabostroke, it has been estimated that 1.9 million brain cells will die. That may lead to rates with the Neurologist, nurses and paralysis, difficulties in speech and other therapists to customize a therapy plan for each stroke patient after discharge. problems.

While a stroke patient is at St. Vincent, care will be provided by a specially trained multidisciplinary team. Neurologists provide expert emergency care, testing and daily follow up, while a team of neurosurgeons is on standby to provide surgical interventions and relief. The nurses who work with stroke patients have also undergone extensive training which allows them to assess patient condition and provide education to patients and families.

St. Vincent also offers a comprehensive program designed to help patients regain any skills lost when they had a stroke, such as speech or movement on an inpatient basis through our New Hope Rehabilitation facility or through Headway, our acclaimed outpatient brain injury rehabilitation program.

Team members include:

Pharmacists: Assess stroke patient medication regimens, manage patients who are on blood thinners and deliver medication education prior to discharge In Montana alone, nearly 27,000 people are told they have suffered a stroke every year, according to the American Stroke Association. Statistics indicate that less than 500 of those patients will die, however, thanks to rapid improvement in stroke treatments like those offered at St. Vincent Healthcare.

This procedure is not right for every patient and does not necessarily eliminate the need for medications to help control symptoms. Studies have shown, however, that patients who undergo the procedure see a long-term benefit in the form of decreased tremor and improved speech and muscle movement. It has also been shown to be beneficial for patients with other types of movement disorders.

For more information about deep brain stimulation at St. Vincent Healthcare or to learn if you are a candidate for this potentially life-changing procedure, please contact (406) 237-7011.

Are You Experiencing Symptoms Which Could Indicate a Neurological Problem?

Your nervous system plays a key role in many of your body’s functions, so symptoms which could indicate a neurological problem or disorder vary greatly.

Some individuals may experience just one symptom, such as muscle weakness, while others have multiple symptoms simultaneously.

Some of the most common neurological symptoms include: • Anxiety, panic attacks or depression • Blurred vision, sensitivity to light or other difficulties seeing • Changes in bathroom habits • Fatigue • Headaches • Muscle weakness or numbness • Pain in the neck, back, joints or muscles • Prickling sensations (pins-&-needles) • Poor memory &/or difficulty concentrating • Problems walking • Tremors, twitches or spasms Because these symptoms may also be related to other non-neurological conditions, St. Vincent Healthcare recommends you speak with your primary care doctor about them as soon as possible.

Courtesy of St. Vincent Healthcare

If you or someone you know experiences any of the following neurologic symptoms, call 9-1-1 or come to the Emergency Room at St. Vincent Healthcare immediately: • Dizziness or fainting • Slurred speech or difficulty finding the right words • Difficulties swallowing • Loss of coordination • Breathing problems • Paralysis

For more information about preventing strokes or about St. Vincent’s comprehensive approach to assessment and care of stroke patients, call (406) 2375542.

All advertorial courtesy of St. Vincent Healthcare

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I am not a new hip.

I am my wife’s new favorite dance partner.

A lingering injury can affect more than your joints. That’s why, at the St. Vincent Joint Replacement Center, we evaluate the entire person in order to develop a comprehensive treatment plan.

From diagnosis to surgery to aftercare and rehabilitation, we make sure our patients are informed, comfortable and ready to enjoy a higher quality of life. If you’ve been considering joint replacement, call (406) 237-7005 to set up an appointment or learn more at svh-mt.org.

Hear more in Chris’ words.

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Billings Clinic Metabolism Center focuses on patient, quality of life New program offers surgical and non-surgical options for weight loss, health

BY LINDA HALSTEADACHARYA For The Gazette

“Metabolic weight loss surgery is a tool,” he explains during one of his monthly informational sessions. “These are anatomical The team at Billings Clinic’s alterations that yield metabolic Metabolism Center doesn’t talk effects.” about pounds shed. Instead, the The paradigm shift from doctors and staff members focus pounds lost to benefits gained is on the numbers that really count: the basic philosophy of the Billlower blood pressure, reduced ings Clinic Metabolism Center. blood sugar and the 70 percent of Dr. Chris Sorli, department chair, patients who enjoy improvement has earned national recognition in joint disease. for his work with diabetes and “We won’t judge you based on metabolic research. scales,” said Dr. Walter Medlin, “Energy storage is an endothe new surgeon on staff. “It’s not crine disorder,” he said. “Horso much weight loss as treating mones are involved.” metabolism. This really is the While the center offers several language of healthy living, not surgical options — including gasdeprivation.” tric bypass, sleeve gastrectomy With nearly 1,000 metabolic and gastric banding — staff first surgeries under his belt, Medlin tries to determine, on a case-bybegan performing surgeries at case basis, whether non-surgical Billings Clinic this summer. The tools are more appropriate. Each former director of the Duluth patient is subject to a thorough Clinic Comprehensive Weight medical evaluation and consultaManagement Program truly walks tions with a team of experts rangthe walk. Several years ago, he ing from a financial counselor, to opted for metabolic surgery him- cover insurance issues, to a social self. His blood pressure fell just as worker, who helps with behavioral his energy level rose. changes

“That’s what makes our center unique,” Sorli said. “Ideally, you try to put this all under one roof.”

Lindsey Bouchard, a young mother of three, scheduled gastric bypass surgery with Medlin in mid-August. Her decision followed weeks of appointments and counseling to determine her readiness.

It also follows years of dieting and exercise that seemed to go nowhere. She lost 50 pounds after the birth of her second child, but her body “stalled out” at that level – whether she ate 1,500 or 3,500 calories a day, she said.

As Sorli explains it, the ability to store energy is a survival mechanism.

“Every research that’s been done says that weight management is just as strong a component as breathing,” he said. “It comes down to how much you can convince your brain that you’re a hunter/gatherer again.”

Besides dieting, Bouchard exercised religiously — changing it up between spinning, the treadmill and even pooling with friends

CASEY PAGE/Gazette Staff

Lindsey Bouchard fixes dinner for her children August, 4, left, and Stella, 6, at their home.

CASEY PAGE/Gazette Staff

Dr. Walter Medlin, left, and Dr. Christopher Sorli of the Billings Clinic.

for a private trainer.

“I’ve always made a conscious effort that it (extra weight) wouldn’t hold me back,” she said.

“I’ve tried to let it not be who I was.”

But the deal-breaker hit during her third pregnancy, when she developed gestational diabetes.

Knowing that put her at higher risk of developing Type 2 diabetes, she decided the time was right. With skepticism, she attended one of Medlin’s sessions.

She appreciated his first-person perspective and she related to the way he described the surgery as “resetting a thermostat.” From there, she began the months-long pre-operative process. She knows she has a lifetime of work ahead of her, that it’s not a quick fix.

“I don’t have a number in mind,” she said. “I have a goal — to hike up to Mystic Lake and not die.”

Bouchard opted for gastric bypass surgery based on its proven track record. Now typically performed laparoscopically, the surgery is no more risky than common gall bladder surgery, Medlin said. Most patients can expect to lose one-third of their

body mass, and some conditions, such as diabetes, show marked improvement even before the pounds drop off. Other typical benefits include healthier blood pressure and cholesterol levels, a decrease in joint problems, an increase in energy and better sleep.

“You will search long and hard to find any medication on the market that shows as much life expectancy advantage,” Medlin said.

To prepare for surgery, patients shift to a liquid diet for the two weeks prior to the procedure. The patient typically spends one or two nights in the hospital and one to three weeks off work. For six months after surgery, food doesn’t taste good, Medlin said. Then the appetite begins to return and the patient can introduce normal foods — only the sensation of fullness comes much quicker. Ultimately, most patients can expect to regain 20 to 30 pounds from their post-operative low, but their health benefits continue.

“Now it’s a frontline recommendation for people early in the disease process,” Sorli said. “Now it’s not considered a last resort but preventative therapy.”

New technology brings big changes to eye care

BY DIANE COCHRAN For The Gazette

a lot like an MRI machine, except that it examines the inner eye.

And it is a lot smaller. The one in Visiting the eye doctor these Steiner’s office is about the size days consists of so much more of a monitor for an older desktop than just squinting at a line of computer. giant upside-down and backward As a patient looks into the letter E’s on the far side of the machine’s viewfinder, the OCT room. uses light waves reflected off the As it does in so many mediback of the patient’s eye to map its cal fields, technology is changing anatomy. The OCT can take meathe way professionals address eye surements that are as small as 500 health. microns. That’s half a millimeter, “The main part of our schoolor about half the thickness of a ing is new technology,” said Dr. compact disc.

Joseph Steiner, a recent graduate The result is a multicolored, of optometry school at Pacific Lu- three-dimensional image that can theran University who practices at reveal abnormalities or, if it is a reDrs. McBride and McBride in Bill- peat scan, changes in a particular ings. “Technology in the medical patient’s eye. The two-minute test field is unbelievable.” does not require a patient’s eyes Among the many gadgets to be dilated, and it is safe, Steiner and techniques Steiner learned said. to wield is the optical coherence “It can give you some pretty tomographer, or OCT. An OCT is fine detail of the anatomy of the

eye,” he said. “With that fine of detail, you can see abnormalities and rate them at certain stages.”

OCT imagery allows optometrists to examine the health of a patient’s optic nerve as well as to look for signs of glaucoma, macular degeneration or cancer.

If something appears unusual on the OCT test results, an eye doctor will conduct further testing.

OCT technology was first developed about 20 years ago, but it has been continuously refined. Although not all eye doctors invest in an OCT machine, ordering OCT scans for some patients is quickly becoming standard practice, Steiner said.

“It’s able to detect eye disease sooner, and we’re able to treat it sooner,” Steiner said. “That saves vision.”

When should you go to the eye doctor?  Children age 5 and younger: Until about age 3, pediatricians will address a child’s eye health needs. A child’s first comprehensive eye exam should be conducted between ages 3 and 5, depending on how cooperative the child is.  School-aged children and adolescents: All children should have their vision checked before they begin first grade. If there are no symptoms of problems and no family history of eye or vision problems, children should be rechecked every two years. If that first exam detects a problem, follow the eye doctor’s recommendation for follow-up checks.  Adults: Healthy adults with no vision problems should have their eyes examined every five to 10 years when they are in their 20s and 30s. After age 40, eye exams should be done every two to four years, and, after age 65, every one to two years.

(Source: Mayo Clinic)

How the OCT fights glaucoma The optical coherence tomographer, or OCT, helps eye doctors diagnose eye diseases such as glaucoma and macular degeneration.  Glaucoma is the second-leading cause of blindness in the United States. It is typically caused by abnormal pressure in the eye that damages the optic nerve. Damage to the optic nerve eventually leads to blindness, although glaucoma can advance so slowly that people who have it do not immediately realize it.  There are two types of glaucoma, open-angle and closed-angle. People with open-angle glaucoma usually do not have any symptoms other than gradual vision loss. Closed-angle glaucoma comes with obvious symptoms, including severe eye pain, nausea, vomiting and blurry vision.  Glaucoma cannot be cured, but it can be managed through medicine or surgery.  Dry macular degeneration does not lead to blindness but it does impair vision by creating a blind spot in the center of the visual field. Its cause is unknown. Like glaucoma, dry macular degeneration develops gradually. Symptoms include difficulty reading in low light, blurriness of printed words, hazy vision, and a blurred or blind spot in the center of vision. There is no treatment for dry macular degeneration.  Wet macular degeneration is more severe than the dry version, but it can be treated. It is the result of swelling in the eye caused by leaking blood vessels. Treatment consists of medication or surgery that stops the abnormal growth of blood vessels in the eye.  Symptoms of wet macular degeneration include visual distortion, decreased central vision, decreased intensity or brightness of colors, and a well-defined blurry or blind spot in the field of vision.

BOB ZELLAR/Gazette Staff

(Source: Mayo Clinic)

Dr. Joe Steiner displays the Optical Coherence Tomograph at McBride and McBride Optometrists in Billings.

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New doctor offers new pediatric specialty at Billings Clinic

CASEY PAGE/Gazette Staff

Dr. Crystal Knight, a pediatric gastroenterologist at Billings Clinic, sits with patient Dylan DeLay and his mother, Jodie.

By LINDA HALSTEAD-ACHARYA For The Gazette Dylan DeLay was only 7 or 8 when his symptoms first struck.

Today, the 13-year-old remembers the sensation all too well.

“Ten minutes after I ate, it felt like a freight train was running through my back,” he said.

His mother, Jodie DeLay, remembers him moaning and crying while he slept. She also recalls the point when she could no longer persuade him to eat.

Since then, Dylan has been diagnosed with Crohn’s disease, an autoimmune disease of the gastro-intestinal system. When “triggers” prompt his body to “attack,” they create painful ulcers along his GI tract.

During the years prior to Dylan’s diagnosis, the DeLays struggled for answers and solutions. Now the Bozeman family has added one major tool to their toolbox: Dr. Crystal Knight, the first board-certified pediatric gastroenterologist in the region.

When Knight began practicing at Billing Clinic in January of this year, the demand for her specialty grew instantaneously.

“My waiting list was 100 right away,” she said. “The first few weeks I saw a lot of really sick patients, from neo-natal to late teens.”

As a pediatric gastroenterologist, Knight treats children’s gastrointestinal problems, many of which manifest in severe and often chronic gastric discomfort that can prove difficult to diagnose.

Before Knight arrived, the DeLays had struggled to find an explanation for Dylan’s post-eating pain and his lack of energy. They suspected Crohn’s, because Jodie DeLay had been diagnosed with the disease after her first pregnancy. But Jodie’s gastroenterologist declined to treat a child and the pediatrician they consulted was unable to target the cause of Dylan’s problems.

“It (Crohn’s disease) is not that well known and Dylan didn’t have the typical markers,” Jodie explained.

Eventually, they were referred to a pediatric gastroenterologist from Denver, who made monthly trips to Billings. But Knight’s arrival, and the fact that she provides outreach to Bozeman, has proven a godsend.

“As a parent, I can’t say how nice it is,” Jodie said. “In the course of a year, we went from having to go to Denver to now having somebody who comes to us.”

The DeLays’ dilemma is not so unusual when it comes to children suffering from diseases like Crohn’s, Celiac disease and other inflammatory bowel diseases.

Knight also deals with food allergies, constipation, liver disease, asthma, growth failure and acid reflux.

“The pediatricians were doing

LARRY MAYER/Gazette Staff

Knight, right, anesthesiologist Dr. David Khoe, left, and scrub tech Mary Ahlander watch a video screen as Knight inserts a camera into the stomach of a young patient at the Billings Clinic Surgery Center.

what they could,” Knight said, “but they (children) were not being seen as they needed to be.”

Knight not only has the training but also takes the time to evaluate her patients. By conducting a thorough analysis of her patients’ medical histories — she averages 10 to 12 patients a day — she gleans information that will help in making a diagnosis.

“There are signs, red flags,” she said.

Knight points out that identifying and treating gastrointestinal problems in children differs considerably from adults.

For example, she said, children’s symptoms are much less likely linked to cancer. On the other hand, because some conditions and diseases inhibit growth, it’s especially critical to diagnose children as early as possible.

“Kids definitely aren’t just little adults,” she said. “Their physiology is different so it’s really important that they’re seen by someone who understands kids.”

Even dealing with young patients takes a special touch, which seems apparent while visiting with Knight. When a child needs a procedure, such as a colonoscopy, she works closely with the family to determine how much information to share with the child.

Some, like Dylan, appreciate knowing what’s going on inside their bodies.

“I like to see the pictures,” he said, smiling. “It’s good to know how bad it is at that time.”

Knight has been treating Dylan for Crohn’s disease.

Children also receive special treatment in preparation for procedures. Depending on the child’s age, he or she may be offered tours or stuffed animals to ease anxieties. Likewise, medicines can be used to sedate the child well before the actual procedure begins.

In order to cover the many aspects associated with gastrointestinal diseases in children, Knight works closely with a team.

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A dietician advises the family on dietary changes that can modify or even eliminate symptoms and a social worker helps the family deal with the varied social dynamics of a chronic disease.

Dylan, who missed much of seventh grade due to his Crohn’s, has come to recognize possible triggers for his flare-ups. Working with Knight, he’s also discovered a medication that has given him his

CASEY PAGE/Gazette Staff

life back.

As for Knight, she finds great rewards in seeing sick children thrive again.

“Kids are so resilient,” she said. “They bounce back from just about everything. If you can be involved in that, it’s really amazing.”

For more on Crohn’s disease and a fundraising walk in Billings, go to cctakesteps.org/billings.

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Patient Safety & Quality is Job #1!

An ‘A’ grade. 5 stars. #1 in Montana.

What do all these awards mean to someone needing hospital care?

At Billings Clinic, these accolades point to a great deal of work going on behind the scenes to ensure that every patient receives the right care and that no errors are made. Patients owe it to themselves and their loved ones to do their homework and check for safe practices and inquire about such things as: How many wrongsite surgeries were performed in the last year; What does the organization do to prevent patient falls; and what procedures are in place to reduce medication errors.

Checking consumer data to see how a hospital or health care organization is ranked can be helpful in making choices.

Billings Clinic recently received an “A” rating from the LeapFrog Group’s national hospital quality ratings. Billings Clinic is the only health care organization in Montana voluntarily participating in this national quality comparison – details at www.leapfrog.com. Hospital Compare is operated by the federal government to rate quality and safety: www.hospitalcompare.hhs.gov.

Awards and Recognition Billings Clinic has received numerous awards and recognitions yet is constantly striving to improve in all areas of quality and safety. Patients benefit from the integrated Clinic, Hospital, Long-Term Care and Research all in one health care organization. The ability to implement quality initiatives into all locations, including affiliate hospitals and branch clinics in rural locations, benefits all patients. Billings Clinic was one of the first in our region to participate in Core Measures and Hospital Compare through Centers for Medicare and Medicaid (CMS), offering transparency to our patients and referring physicians. Core Measure scores are looked at regularly in each clinical area to work for improvement where indicated and learn from best practices in outstanding performance.

Billings Clinic was recently cited by US News & World Report as the number one Hospital in Montana for a variety of medical specialties. This is an unsolicited award.

“We’d like to recognize the entire ‘body of work’ our organization has achieved around dozens of quality and safety recognitions, ranging from the Beacon Award for Intensive Care to the Magnet® award for Excellence in Nursing. We try to focus on what this means for patients and to recognize all of the Billings Clinic staff who contribute on a daily basis,” said CEO Nick Wolter, MD.

World Health Organization Surgery ‘Checklist’: Billings Clinic implemented in 2009

This may be something most people take for granted, like getting on an airplane and assuming the engine has been checked and the flight checklist has been implemented by the pilot and co-pilot before the flight is approved for takeoff. A simple checklist has been recognized as a huge quality and safety tool for surgery.

Atul Gawande, MD, general surgeon and

Courtesy of Billings Clinic

The team of surgeon, physician assistant, anesthesiologist and surgical nurses work together to practice safe surgery protocols on a joint replacement.

leader of the World Health Organization’s Safe Surgery Saves Lives program, champions a standardized approach to surgery and patient care to prevent errors by medical professionals. He talks in his book The Checklist Manifesto about such simple things as hand washing to reduce the spread of infection and a checklist that must be implemented every time an operation is performed to ensure that no harm is done to the patient. This twominute “Time Out” is started by the circulating nurse who checks the patient’s name and birthdate, announces the procedure and makes sure the surgical site is correctly marked. Other items include allergic and aspiration risks; having the surgeon address the possible blood loss to ensure an adequate supply of blood is on hand; how long the procedure should take; if the anesthesia equipment is working; if there are anticipated non-routine steps to be taken and if the SCD (Sequential Compression Devices to prevent blood clotting) are in place on the patient’s legs.

Before the patient leaves the operating room, the surgeon leads the “case debriefing” to discuss key concerns for recovery and management of the patient and if any errors occurred. The nurse verbally accounts for needles and sponges and if a cavity was opened, accounts for the medical instruments. Billings Clinic tracks the “near misses” caught by the “Time Out” checklist and errors have been prevented.

All operations in the Hospital and Surgery Center and most invasive procedures in various departments practice the “Time Out” checklist to prevent errors and ensure the best safety for the patients.

A Joint Commission surveyor recently complimented a Billings Clinic surgery team after observation of surgeries in the operating rooms, saying, “Billings Clinic has benchmark compliance, show-stopping performance, and amazing use of Time-Outs.”

A Billings Clinic operation begins with a “Time Out!” led by the circulator nurse who identifies the patient name and birth date, the operation and other items on the “Checklist” to insure patient safety.

Courtesy of Billings Clinic

Courtesy of Billings Clinic

Inpatient Surgical Floor Magnet nurses, CNAs and staff practice hand-washing protocols to reduce the transmission of MRSA.

Courtesy of Billings Clinic

Billings Clinic Infection Control staff produced the “Scrubby Dubby” video promoting hand hygiene won national acclaim in the Association of Perioperative Registered Nurses contest. With over 2500 votes on YouTube, the video won first place & a $5000 grant for nursing education.

The Germ Terminators!

Billings Clinic Infection Control practitioners round the hospital and clinic on a daily basis and staff reacts when they see them coming. “I washed my hands! Really!” They are the germ squad and there is no fooling around with them. It doesn’t matter who you are, everyone is expected to wash their hands each and every time to prevent the spread of infection. Every time a physician or medical staff enters the exam room or patient room they are to wash their hands. Alcohol-based hand antiseptics are readily available where staff, patients and visitors can have easy access to ensure consistent utilization.

“Our CEO, Dr. Wolter, supports quality and safety projects, such as bringing in Complexity Science principles and novel change approaches, such as Positive Deviance, to help in our efforts to improve care,” said Nancy Iverson, Director of Patient Safety and Infection Control. “This has helped our clinical team apply new methods and sustainable behavior changes, resulting in a safer environment for our patients.”

Preventing Health Care – Associated Infections:

Courtesy of Billings Clinic

Surveillance testing, environmental cleaning and hand hygiene promotion have been implemented over several years to reduce the transmission of MRSA infection.

the risk of health care associated-Legionnaire’s disease.

C. difficile (gastrointestinal infection): Billings Clinic is currently the only health care organization in Montana using an innovative approach to sterilize patient rooms between patients. In 2011, Billings Clinic began using BIOQUELL, a 30% vaporized hydrogen peroxide to terminally disinfect rooms between patients to prevent the spread of C. difficile.

Infection prevention using quality air safeguards: Reverse air-flow rooms in the Inpatient Cancer Center protect the neutropenic (very low immunity) patients who are most vulnerable to infection.

What you can do as a patient: 1. B e your own advocate and be a part of the care team.

Have the courage to challenge what the doctor or other providers may be telling you. Don’t be afraid to ask the nurse or doctor to wash their hands. Speak up if you can’t afford a medication being recommended.

2. N ever tire of giving your name and birth date.

That means the doctors, nurses and Methicillin Resistant Staphylococcus others are following safety protocols to prevent medication errors, wrong operaaureus (MRSA): The spread of hospital acquired MRSA, tion, wrong procedure or wrong-site surthe deadliest bacteria, has been one of gery. the teams’ focus of stringent precautions for several years. Each patient has a nasal 3. Get home—the sooner the better.

Everyone likes to be taken care of in the swab taken on admission to the hospital to identify if they came in with MRSA hospital, but once you are up and around, and are later checked for acquiring MRSA not feeling disoriented, faint or unsteady, while in the hospital. Strict hand washing find out what services and supplies you policies, environmental cleaning, and iso- will need at home and be on your way. lation precautions with consistent gloving Make sure you understand your discharge and gowning practices for patients with instructions.

MRSA have all contributed to the reduced Stay informed by accessing your rate of healthc are-associated MRSA in- 4. medical record. fections at Billings Clinic by an average of Now Billings Clinic offers online access 60% since 2006. Billings Clinic has been cited as one of the leading organizations to your medical records at www.billingin the nation to reduce health care-associ- sclinic.com/MyBillingsClinic.This helps you better understand what is going on with ated MRSA infections. your care, by seeing your test results and checking on the next steps. You can get Legionella (legionnaire’s disease) Billings Clinic is the only Hospital in this set up at any registration desk.

Montana using a copper-silver ionization Advertorial courtesy of Billings Clinic system to eliminate Legionella bacteria in the water. This system has eliminated

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We found our answers at Billings Clinic.

Hear our stories.

When you don’t know what’s wrong, it’s hard to know where to look. But what if there was a place called Answers?

Where it all comes together.

A place where you and your physician worked with teams of specialists, in one organization, with all the resources they need to find answers where no one else could.

A place where reality is just as powerful as hope.

There is. Billings Clinic.

Visit BillingsClinicAnswers.com for patient stories and more.

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Child life specialist works to speed healing, relieve stress

BY LAURA TODE For The Gazette To anyone who has never visited the pediatric care unit at St. Vincent Healthcare, the sounds of children at play might come as a surprise.

This is a hospital, after all, so why the singing, games, stories and peals of laughter? It’s the work of Child Life Specialist Kristy Adams and the techniques she uses with children in the hospital to speed healing and foster cooperation during difficult procedures.

“We blow bubbles. We sing songs and read books — just anything to get their minds and eyes off what’s going on,” Adams said.

The hospital setting can be overwhelming for most anyone, but children are especially vulnerable. The circumstances surrounding a hospital visit are acutely stressful. Children in hospitals are often dealing with trauma, injuries, disability, chronic illness or the death of a loved one, and how they internalize their emotions can have a long-lasting effect on their development.

Adams works with all the children in the pediatric care unit and assists children and families who have a loved one in other departments in the hospital.

Her work ranges from therapeutic play, and distraction and calming techniques, to teaching children about diseases and disabilities. She also prepares children for what they will experience when they meet a sibling in the neonatal intensive care unit or make their first visit to a loved one’s hospital room.

“A lot of times, parents think that if kids don’t know, they won’t be scared, but they’re listening in on phone calls and watching, and their imaginations blow things out of proportion,” Adams said.

“We’re trying to give them everything they need to know at their developmental level.”

Adams works with children of all ages from toddlers to teens. She usually starts off with questions to

PAUL RUHTER/Gazette Staff

Kristy Adams shows some dolls she takes to children at the pediatric unit at St. Vincent Healthcare. The children dress and decorate the dolls.

determine what the child already knows, then tries to explain what those things mean, giving them an idea what they’ll experience during their stay or visit.

Adams addresses their concerns and lets them play with pieces of tubing, masks and other things they will see in a hospital room but won’t be allowed to touch. She’ll tell them what kinds of wounds to expect and how they’re being cared for, always relating to them at their level of understanding.

Not long ago, Adams accompanied two little boys on their first visit to their father’s hospital room in the intensive care unit. Adams had prepared them for the visit.

They talked about the tubes and hoses they’d see, the monitors, the mechanical bed and how their

daddy would look with his head shaved for treatment.

When they walked into the room, most everyone thought they’d be shocked and silent, but the boys broke out in laughter.

They had never seen their father without a full head of hair, and to them, it looked funny. The boys lightened the mood for everyone in the room.

“I’ve discovered that kids will often bring out the positives in a situation whereas adults think only of the negative,” Adams said.

While child life specialists are common in children’s hospitals, they are relatively rare in hospitals the size of St. Vincent Healthcare. That’s probably why Adams is the only child life specialist in Montana and Wyoming.

Child life specialists are en-

dorsed and recommended by the American Academy of Pediatrics, and research done by the Child Life Council, an association of child life specialists, suggests that the work child life specialists do reduces anxiety in children and increases cooperation, which can lead to less procedural and postprocedural pain, faster recovery and shorter hospital stays.

Child life specialists are highly trained. Adams has a bachelor’s degree in child and family studies with a teaching license for birth to grade 3. Her master’s degree is in early childhood special education, with a license to teach special education. She did an internship at the Minneapolis Children’s Hospital and additional coursework as well as an exam to become a

certified child life specialist.

Adams’ background in education is key in empowering children to take on disease and disability.

Recently a little girl was admitted to the hospital and diagnosed with diabetes. Adams worked with the little girl throughout the process and also worked with her two older brothers, who were very concerned about their little sister.

Adams told them about the disease and how doctors were helping their sister get better.

They play-acted with dolls to learn what to do if their sister ever got sick again.

“Now, they understand how they can help, and that’s a big thing for kids,” Adams said.

“They want to know their role.”

Latest research helps provide foundation of Alzheimer’s program

BY LAURA TODE For The Gazette

dementia patients.

According to the Alzheimer’s Association, one When families of Alin eight older Americans zheimer’s and dementia — some 5.2 million people patients meet with Jean — suffer from Alzheimer’s Holmquist at Home Instead disease, the most common Senior Care, they don’t form of dementia. share much with Holmquist The Home Instead that she hasn’t experiSenior Care network enced. She lost her mother developed the Alzheimer’s to Alzheimer’s disease, and or Other Dementias CARE she knows what it can do to program. CARE stands for a family.

Changing Aging Through It’s why she partnered Research and Education, with her husband and and the program is based daughter last year and on the latest research. It opened Home Instead provides an in-depth look at Senior Care at 19 36th St. Alzheimer’s disease and deW., Suite 3, in Billings. mentia, and gives caregivers And it’s why she’s offering practical tools to manage free training for families difficult behaviors and keep of people with Alzheimer’s their loved ones engaged disease and dementia. and safe.

“My heart is for the famFor now, the training ily caregivers,” Holmquist is only being provided to said. “I want them to know the staff of caregivers at there is help and there is Home Instead Senior Care, support out there for them.” but it will be available free Home Instead Senior of charge for families of Care is part of a nationwide Alzheimer’s and dementia network of locally-owned patients this fall. Holmquist franchise offices that prois certified through the vide non-medical, in-home organization to teach the care to seniors. The ascourse, which is delivered sistance they provide ranges in several sessions lasting a from companionship and total of eight hours. light housekeeping to more “I would have appreciintensive personal care ated having this kind of and hygiene. Their clients information when we were include Alzheimer’s and going through that pro-

cess,” Holmquist said.

Most Alzheimer’s and dementia patients are cared for at home by a family member, usually a spouse or son or daughter. For Alzheimer’s and dementia patients, the familiarity of home is calming even if it seems as though they don’t recognize their surroundings, Holmquist said.

Holmquist’s father was his wife’s primary caregiver. She lived nine hours away and provided respite for him when he needed a break. She would stay with her mom for a week at a time several times a year.

People suffering from Alzheimer’s and dementia experience more than just memory loss. They often experience erratic mood swings and can become confrontational or withdraw from family and loved ones. Efforts by caregivers to redirect them are often met with resistance.

“That’s because they have a different reality than ours,” Holmquist said.

Many Alzheimer’s and dementia patients will wander if left unattended, or attempt tasks — like cooking and driving — that they cannot accomplish.

Their family caregivers

are always on alert, never leaving them alone for even a minute. As a result, primary caregivers never sleep soundly and can suffer from physical as well as psychological exhaustion.

“I’ve been there, and I can say you need to take a break,” Holmquist said. “If you’re not taking care of yourself, you can’t take care of someone else.”

That’s where Home Instead Senior Care, a similar organization or another family member can make a difference.

“We come in and take

some of those tasks off their shoulders and provide relief.

Even an hour and a half a day or a week can help,” Holmquist said.

In addition to the practical advice, the Alzheimer’s or Other Dementias CARE program offers ways families can draw out and record long-term memories. Sometimes music or photographs will stir a deeply buried memory, Holmquist said.

“Long-term memories are the last to go, and we want to record them and use them to make connections,” she said.

The Alzheimer’s or Other Dementias CARE program is also offered free online at www.helpforalzheimersfamilies.com. The e-learning course provides flexibility for families who might not be able to attend the course she offers.

However, Holmquist said the face-to-face format provides social support and collaboration that families won’t find online.

“Just knowing that someone else is walking the same path as you are is important,” Holmquist said.

CARE program available The Alzheimer’s or Other Dementias CARE program will be offered free of charge starting this fall. For more information, call Jean Holmquist at Home Instead Senior Care, 534-6609. The course is also available online at www.helpforalzheimersfamilies.com.

Dr. Ofelia Marin is the first full-time Pediatric Gastroenterologist in Montana.

Dr. Marin has 18 years of experience, providing diagnosis, procedures and treatments for pediatric digestive and nutritional disorders including: • Acid Reflux • Celiac Disease • Chronic Abdominal Pain • Constipation • Diarrhea • Food Allergies

JAMES WOODCOCK/Gazette Staff

Jean Holmquist, center, with her husband, Thomas Holmquist, and daughter, Jennifer Barthell, own and operate Home Instead Senior Care, a service to help keep elderly in their own homes and provide resources to caregivers.

• Growth Failure • Foreign Body Removals such as coins and batteries • Inflammatory Bowel Disease • Hirschsprung Disease

Marin Pediatric Gastroenterology & Nutrition

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St. Vincent Healthcare’s new joint center benefits patients and staff

BY LAURA TODE For The Gazette Not many well people check into hospitals. Most people come because they are suffering from illness or injury, but joint replacement patients are the exception.

They’re almost always in good health, active folks, looking for a little more movement and a little less pain in their daily lives. It was with that in mind that St. Vincent Healthcare opened its newly remodeled Joint Replacement Center last month.

“We’re really focused on serving the well patient,” said Gina Zuech, orthopedic care coordinator at St. Vincent Healthcare.

The center, which was designed by CTA Architects and built by Langlas and Associates, looks more like a well-appointed motel than a hospital. The lighting is softer, the rooms are open and airy, and there is enough space for visitors to stay as long as they like.

Each room has an adjustable bed, recliner, chairs and a couch that can be pulled out for a family member or friend to stay overnight. The rooms open into community spaces with wide walkways that provide joint replacement patients with the opportunity to get out of their rooms, move freely and socialize.

“In joint replacement we don’t encourage patients to stay in gowns and lay in bed,” Zuech said. “We’re getting patients up and showered and dressed. Our patients don’t get to lie around. If they need to they can, but we want them up and moving around.”

The new rooms don’t just serve the needs of patients. They are designed for the convenience of doctors, nurses and hospital staff as well. Each room has its own computer terminal, which allows staff to access and maintain electronic medical records, monitor medication dosing and track patient progress.

Not all rooms in St. Vincent Healthcare have computers, Zuech said. In other areas of the hospital, nurses use portable,

St. Vincent Healthcare orthopedic care coordinator Gina Zuech gives visitors a tour of the newly remodeled wing of the hospital.

“workstations on wheels” and during peak times of the day, nurses often have to wait to use a computer.

Medical equipment is concealed in cupboards in the patient rooms, and nurses have access to “nursing servers” in each room that contain all the supplies they need for patient care. The servers are stocked from outside the room to minimize disruption to patients. To encourage more patient contact, the new joint center has decentralized nurses stations, with several locations conveniently located outside patient rooms.

Joint replacement patients usually spend only two to three days in the hospital, and a good portion of that time is spent in physical therapy. The new physical therapy room offers ample room for group sessions.

St. Vincent Healthcare encour-

ages joint replacement patients to have “coaches” participate in the sessions alongside the patients to encourage them and help them stay active and safe once they go home.

“They get a sense of camaraderie out of it,” Zuech said. “They’re cheering each other on and asking questions they might not have asked on their own.”

Joint replacement patients used to be scattered throughout the orthopedic unit, which included patients with fractures and other ailments. The protocol wasn’t conducive to healing because it limited patient movement.

Small rooms were the number one complaint of joint replacement patients, said Zuech, and they made patient care difficult for staff as well.

“We were constantly having to move beds and move tables to give them the space they needed to

move,” Zuech said.

The new center, located at 5 Tower, has 18 rooms – nine on the south wing and nine on the north wing. The area used to be a medical surgical floor with 30 patient rooms. In addition to the spacious rooms, ample common areas and large therapy room, the new joint center has plenty of storage for bulky items such as walkers and wheelchairs.

The design process included not only nursing staff and physical therapists, but all the core departments in the hospital, including security, food service and environmental services.

“It’s in the details,” Zuech said demonstrating the automatic sensors for the lights in the storage room. “This is great because we’re always holding something or carrying something.”

As the orthopedic care co-

LARRY MAYER/Gazette Staff

ordinator, Zuech reaches out to patients before surgery to help them navigate the myriad of appointments, diagnostic imaging, blood tests, and medical and insurance forms that all need to be done before their joint replacements. She also teaches a class on what patients can expect during the surgery and in their recovery.

She also follows up with them once they go home to make sure there are no complications.

St. Vincent Healthcare does about 1,000 joint replacements a year — more than any other hospital in Montana — and with the new center, hospital staff anticipate doing even more. The program is known for its strong interdisciplinary approach, and the new design fosters even more teamwork.

“This remodel is really just strengthening what we’ve always had,” Zuech said.

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Sunday, September 9, 2012

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Meticulous foot care can help diabetics prevent amputations

BY DIANE COCHRAN For The Gazette

that a wound will go undetected and unhealed until the infection causes so much damage that amputation is the Ted Iverson first knew someonly option. thing was wrong with his feet when “It happens fast,” said Dr. Paul he punctured the bottom of one and Ouradnik, a podiatrist at Rimrock Podidn’t realize it. diatry in Billings. “I don’t know how Iverson stepped on a belt, and the many times I hear, ‘It just started as a tongue of the buckle stuck into his little blister or callus.’” foot. As he walked across the room Over half the amputations perin the dark, he could hear a dragging formed in the United States each year sound. But he couldn’t feel anything, are linked to diabetes, according to the so he had to turn on a light to see what Centers for Disease Control and Prewas going on. vention. Men with diabetes are three That was several years ago, and times as likely to undergo amputait was the first sign that Iverson was tions as are women with diabetes, and suffering from peripheral neuropathy. blacks are more than two times more Since then, he has had all of the toes on likely to lose a foot or lower leg than one foot amputated, but he is thankful are whites. he hasn’t lost more.

But, overall, the rate of amputa“I can’t swim as fast, and I kind of tions is declining. In 1996, there were go in circles, but I can still swim,” he 11.2 lower extremity amputations per joked.

1,000 people with diabetes. The rate Iverson’s minimal amputations had dropped to 3.9 amputations per are thanks to diligent foot care. The 1,000 diabetics by 2008, according to 66-year-old Billings retiree has diaCDC. betes, and diabetics undergo amputaExperts attribute a large portion tions at a far higher rate than do people of the decline to meticulous foot care. without the disease.

Medicare patients who regularly see a Diabetics tend to have poor podiatrist are 23 percent less likely to circulation, and that combined with undergo amputations than are patients nerve damage increases the likelihood who do not see one, Ouradnik said.

“We’re specially trained to do a diabetes foot assessment,” he said.

Ouradnik likes to see his diabetic patients every two months. He tends to calluses or overgrown toenails and checks for sores. His goal is always to prevent wounds from developing, but he is prepared to manage any sores that do develop.

That typically means regularly opening wounds to encourage fresh blood flow.

That’s what Ouradnik has been doing for Iverson. A small sore on the bottom of Iverson’s foot led to the amputation of his big toe last year. His foot healed well after the amputation.

“But all of a sudden, I had an opening on the bottom of the same foot,” he said. “I went immediately to (Ouradnik).”

It turned out Iverson had a staph infection, and the only way to stop it was to amputate the rest of his toes.

But he is hopeful that will be the end of his amputations.

Weekly visits to Ouradnik’s office have kept the amputation site healthy, and it is almost healed.

“He’s right on top of it,” Iverson said. “It’s healing very nicely.”

Tips on foot care The surest way people with diabetes can avoid lower leg amputations is through diligent foot care. Here are some tips on foot care from the Mayo Clinic.  Inspect your feet daily. Look for blisters, cuts, cracks, sores, redness, tenderness or swelling.

If you can’t easily see your feet, use a mirror or ask someone for help.  Wash your feet daily. Use lukewarm water, and be sure to dry your feet, especially between your toes. You can use talcum powder to keep your feet dry between washings.  Don’t remove calluses or lesions yourself. It’s too easy to injure yourself, so let your doctor do this for you.  Trim your toenails carefully. Cut them straight across, and use a file to soften sharp edges. If you need help, your podiatrist can do this for you.  Don’t go barefoot. The risk of injury is too high to go barefoot, even in the house.  Wear clean, dry socks. Cotton socks are best because they wick moisture away from your feet. Avoid socks with tight elastic bands that will interfere with your circulation.  Buy shoes that fit properly. Shoes that fit poorly can lead to sores on your feet. If you cannot find anything that works, ask your podiatrist about custom-made shoes.  Don’t smoke. Smoking reduces circulation, which reduces your body’s ability to prevent and heal sores on your extremities.  Schedule regular foot checkups. Your podiatrist can help you problem-solve and spot issues before they become serious.  Take foot injuries seriously. If a sore doesn’t heal within a couple of days, see your doctor.

PAUL RUHTER/Gazette Staff

Dr. Paul Ouradnik, left, meets with Ted Iverson for a checkup on his foot at St. Vincent Healthcare.

EBMS, the Benefit of Balance Innovation is a distinct advantage that EBMS empha- administering claims and benefits, a compelling adsizes, and is one of several pillars of success that catapults vantage of EBMS was found in the way it helps customers achieve balance in their daily quest for If you think this is an advertising line for an art center, EBMS into a class of its own. health and well-being. you might want to think again.

To articulate and leverage these advantages, the decision was made a few months ago to rebrand the compaThis innovative approach to redefining the company’s Think health care. ny image to better reflect these distinctive qualities that mission resulted in the rebranding process reflecting that differentiate the leader (EBMS) from the pack; and, to balance equals well-being and well-being equals Think well-being. integrate into the rebranding messages the current and EBMS. Think EBMS, Employee Benefit Management Services, future vision for the company and how that vision fits It also resulted in a new EBMS mission statement: Inc.—Montana’s premier strategic health care family that into EBMS’ corporate strategy and culture. designs holistic solutions to improve the overall health To define and reflect what makes EBMS unique in the EBMS designs strategies to transform the health and well-being of individuals, organizations and communities—founded 32 years ago by Park City, Montana health care marketplace, the company embarked on an and well-being of individuals, companies, and com“envisioning journey” that began with a company-wide munities. natives Rick and Nicki Larson. evaluation of what distinguishes EBMS from its industry EBMS’ new brand embraces the fun and friendly culThe company that began as Montana’s first third- peers, and how the company can own and embrace that ture that has been the foundation of the company from party administrator is flourishing today as one of the difference. the beginning. It represents the balance and synergy the country’s top industry leaders, enjoying a reputation for Months of deliberate thought and consideration company strives to create, positively affecting the culintegrity, outstanding customer service, and flexible, customized solutions for clients, with members in every U.S. went into developing the new EBMS brand. Representa- ture of every relationship, business, and community with tives from every department gave voice to their views, which it interacts. state. to define who they are as a company, and to refine the The star symbols of the new rebranding efforts are The history of EBMS is taken for granted today as one focus and direction they want their company to take so of Montana’s greatest health care innovation success sto- their brand identity can sustain them as they venture into eight simple synonyms for well-being, which will be highlighted on the EBMS website, www.ebms.com, when the ries; however, three decades ago, EBMS was a pioneer the next phase of their organizational future. new brand is launched in September. in the industry, providing a template of quality, honesty, What was found through these months of corporate and innovation that has been emulated throughout the introspection was a remarkable organization comprising These synonyms represent the core Benefits of Balyears by industry peers across the country. hard workers, innovators, and experts who are commit- ance that EBMS intends to deliver to each person and With corporate headquarters in Billings and regional ted to transforming their own well-being and the well- company: offices in Portland and Denver, EBMS has achieved na- being of their families and community.

Balance, Symmetry, Stability, Rhythm, Clarity, Harmotional prominence by staying true to its simple core value ny and Synergy = the EBMS Benefits of Balance. of offering the highest quality of customer service.

Balance = Well-being = EBMS Beauty exists in balance and proportion.

This clear, consistent focus on customer satisfaction is provided by loyal, dedicated, and highly-trained professionals who closely adhere to a defined mission and purpose. The fact that EBMS has loyal customers dating back to the company’s founding, over three decades past, testifies to the stellar services rendered to EBMS’ everexpanding list of satisfied customers.

EBMS: In a league of its own

By making the Benefits of Balance a well-being priorThis corporate journey of self-discovery helped the EBMS executive leadership and employees better un- ity within its own walls, this corporate innovator hopes derstand that a balance between work, family, and to set a standard to help others make it a priority for community is essential in sustaining good health. themselves, their businesses and their own communities as well.

Through the rebranding process, EBMS leaders and Advertorial courtesy of EBMS employees found that they were not just third-party administrators. Although they do an outstanding job

Service through innovation puts EBMS in a league of its own.

Throughout the past 32 years, this Montana-founded, homegrown company has thrived and excelled within a kaleidoscopic landscape of evolving needs in the health care marketplace; and, because EBMS is not a national conglomerate with labyrinthine processes and a maze of departments that often move on a glacial clock, EBMS, with its intelligent, innovative employee base, can quickly and flexibly adapt to rapid change.

EBMS enjoys a nationwide reputation for proactive innovation. It was one of the first to boast a comprehensive wellness program that served as an example to other companies.

EBMS was the inspiration behind, and the major founding partner of, the Billings Wellbeing Institute, a new nonprofit organization with the sole purpose of improving the overall well-being of individuals, families, businesses and the community.

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H15

Periodontal disease could lead to other health problems

BY DIANE COCHRAN For The Gazette

linked to multiple other medical problems, including cardiovascular disease, rheumatoid arthritis, Psst. Hey, you. Yeah, you. You kidney disease and cancer. know it’s not normal for your Three in four American adults gums to bleed when you brush have periodontal disease, alyour teeth, right? though most of them don’t realize According to Billings perioit, Fuller said. dontist Dr. Amy Fuller, a lot of “It’s often very underdiagpeople don’t. nosed,” she said. “Until it gets “For some reason, people have to an advanced level, it’s a pretty gotten really OK with bleeding painless condition.” gums,” said Fuller, who specializPainless, but not harmless. es in treating gum disease at Fuller Experts have known for years that Periodontics and Implant Denuntreated gum disease can result tistry. “If any other part of your in deterioration of the jawbone body bled every time you used it, and tooth loss. But scientists only you’d be in to see a doctor.” recently discovered connections Bleeding gums are a sign of between gum disease and other periodontal disease, a condition diseases. that should be taken seriously.

“Yes, it’s important to brush Periodontal disease can lead to your teeth and floss your teeth. tooth and bone loss and has been People know that,” Fuller said.

Links between gum disease, other serious illnesses  Cardiovascular disease: Inflammation is a major risk factor for developing cardiovascular disease. Because periodontitis is a type of inflammation, it can heighten your risk for cardiovascular disease.  Diabetes: Gum disease and diabetes are doubly linked. Gum disease is a common complication of diabetes, and people with gum disease can have difficulty controlling their sugar levels.  Pregnancy complications: Women with gum disease are more likely to deliver a preterm or low birth weight baby than are women with healthy mouths.

“How important? We’re learning it’s extremely important.”

Periodontal disease is the inflammation of the gums caused by bacteria. If done properly, regular brushing and flossing gets rid of the bacteria in your mouth.

But if you don’t remove them, the bacteria turn into plaque and tartar. When plaque and tartar collect in the gaps between your teeth and your gums, they cause inflammation.

In its early stages, that inflammation of the gums is known as gingivitis, and it’s treatable.

A deepcleaning performed by a professional can remove the offending buildup and restore your mouth to health.

But if left untreated, gingivitis gets ugly. It begins to eat away at your gum tissue and jawbone, causing bleeding and loosening of teeth. Bone loss can sometimes be treated through grafting, a procedure in which donated sterile bone tissue is implanted in your mouth to stimulate bone growth.

But bone loss more commonly requires a dental implant to hold your teeth in place. Thanks to advances in implant technology, getting an implant is not as painful as it used to be. Many people can go back to work the day of an implant procedure.

The more serious side effect of gum inflammation is bleed-

CASEY PAGE/Gazette Staff

Dr. Amy Fuller holds a model of a tooth implant in an exam room at Fuller Periodontics and Implant Dentistry.

ing. That’s because the bacteria in your mouth can enter your bloodstream through the tiny tears in your gums, and bacteria in your bloodstream is dangerous.

Inflammation itself is also dangerous. Scientists aren’t sure exactly how periodontal disease and other diseases are linked, but the connection is unmistakable. In the case of cardiovascular disease, it is possible for plaque from your mouth to travel through your bloodstream and attach to the inside of an artery.

In general, the explanation for the connections could be as simple as that the diseases linked to periodontal disease are also types of inflammation. Chronic inflammation anywhere in the body is unhealthy.

“The body works as a whole unit,” Fuller said. “Anywhere you have inflammation in your body, if you get rid of it, you’re going to be healthier.”

How to avoid periodontal disease  Stop smoking or chewing

 Respiratory disease: Bacteria in your mouth can be inhaled into your respiratory system and cause pneumonia.

 Brush and floss your teeth at least twice a day and especially after you eat

 Rheumatoid arthritis: People with rheumatoid arthritis are eight times more likely than people in the general population to have gum disease. Both conditions are types of inflammation.

 Replace your toothbrush every three months

 Cancer: Men with gum disease are at a heightened risk for various cancers, including kidney, pancreatic and blood cancer.

 Schedule one periodontal exam a year  Have your teeth cleaned by a professional two to three times a year

 Kidney disease: Studies show that people who have lost all of their teeth are more likely to have kidney disease. Gum disease is a leading cause of tooth loss, and gum disease and kidney disease are both types of inflammation.

(Source: American Academy of Periodontology)

CASEY PAGE/Gazette Staff

A model of a dental implant at Fuller Periodontics and Implant Dentistry.

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 Report any problems, including bleeding gums, to your dental professional.

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RiverStone Health works to integrate public health with primary care

BY DIANE COCHRAN For The Gazette

resources, unreliable transportation, rigid work schedules and other barriers, many of them For families struggling to make never made it to the WIC office. ends meet, public health programs Fast forward to 2012, and WIC can be the difference between is located on RiverStone Health’s making it or not — but only if they downtown medical campus. are accessible.

During its first week there, staffTake the Yellowstone County ers walked two people from the WIC program, which provides community health center to the vouchers for healthy food to WIC office so they could sign up low-income families with young for benefits. children. Until recently, WIC was Integrating public health with located all the way across town primary care makes sense to leadfrom RiverStone Health, where a ers at RiverStone Health, where community health center offers the two types of services were medical services on a sliding-fee first placed under the direction of scale. a single chief executive officer in For years, when parents 1992. Together, primary care and brought their children to the afpublic health simultaneously adfordable medical clinic, providers dress the health needs of individtold them about WIC and how uals and of entire populations. it could help feed their families.

“It’s impossible for one physiAnd, for years, plenty of parents cian to do everything that needs to intended to sign up for the probe done to take care of a patient,” gram. But with limited financial said Dr. Megan Littlefield, medical

JAMES WOODCOCK/Gazette Staff

A patient signs up for immunizations at RiverStone Health.

director for RiverStone Health.

“By being co-located with public health, public health becomes part of the patient care team.”

Primary care providers typically focus on one or two specific patient needs. That could be a broken bone, a bad cold, a simple annual physical or whatever brought the patient through the door. Providers do not have time to talk with their patients about all of the ways that the patients could improve their health.

But public health takes that broader view. It focuses on health trends in populations and identifies ways to promote positive ones and reverse negative ones.

For instance, public health may respond to a rise in untreatable breast cancer among low-income women by offering free breast health screening or to an uptick in smoking rates with a public information campaign.

When the two entities operate side by side, they reinforce one another. Public health workers educate primary care patients about resources available to them that will positively impact their overall health, and primary care providers alert public health to trends they see in their patient population.

“If you’re in private practice, you get very channeled and siloed into your 15-minute encounters,” said Dr. Roxanne Fahrenwald, senior vice president for clinical and educational integration for RiverStone Health. “You forget what’s out there. Here, it’s right there. You walk by it every day.

It’s easy to engage all these systems for patients.”

“And you see practical trends,” Fahrenwald said. “You have someone to tell about bigger trends. It’s a two-way street with information. They tell us the things they have available, and we tell them the things we see.”

In addition to the information exchange, the partnership creates opportunities for a united front against health care threats. Primary care and public health can identify issues that need attention and align their strategies to

Tallman Dermatology & Medical Spa Michelle Neelley was a competitive swimmer and lifeguard in addition to being a lifetime golfer. Like many Americans, she had no idea that her lifestyle— which was based on healthy athletic activities—could contribute to cancer.

“I had had quite a bit of cancer (on my skin),” said Neelley. “So, of course I was nervous about the surgery and the outcome. But I felt absolutely sure that Dr. Tallman and the Mohs surgery was the way to go.”

Yet, when she needed to deal with basal cell carcinoma (BCC), she chose to drive from Manhattan, Mont., to Billings to see Dr. Philip Tallman, Board Certified Dermatologist, who has been a member of the American Society of Mohs Surgery since 2000.

Each year, Dr. Tallman completes more than 600 Mohs surgeries for patients from Montana, Wyoming and North and South Dakota.

JAMES WOODCOCK/Gazette Staff

Karmen Hammermeister, a registered nurse at RiverStone Health, readies an immunization at the clinic.

address them. If every provider in the clinic talks with patients about attaining a healthy weight and public health meets with community leaders to establish walking trails and healthy school lunches, it’s possible that the community will collectively lose weight.

“It’s a golden opportunity to make a difference,” said Debbie Hedrick, vice president of public health services for RiverStone Health.

Another example is immunizations. Montana tends to rank low nationally for its rate of childhood immunizations. But within the state, Yellowstone County and, within the county, RiverStone Health’s community health center, fare well because public health and primary care joined

forces to make it happen. And it’s simple — providers at the medical clinic can administer vaccines paid for through public health programs.

RiverStone Health may have been among the first places to integrate public health and primary care, but it won’t be the last, said John Felton, who serves as RiverStone Health’s president and CEO as well as the Yellowstone County Health Officer.

“Regardless of what happens with the Affordable Care Act, the train that has left the station is that primary care is expected to have a population health component,” said Felton, referring to the federal health care reform law that was recently upheld by the U.S. Supreme Court.

accepting new patients

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More than two million Americans will develop skin cancer this year and one in five Americans will have skin cancer in Developed by Dr. Frederick Mohs in their lifetime. the 1930s, Mohs Surgery differs from Cure rates for BCC and Squamous other techniques in that microscopic examination of all excised tissues occurs Cell Carcinoma—the two most common during rather than after the surgery, types of skin cancer—are an unparalleled thereby eliminating the need to “esti- 98 percent or higher with Mohs, which mate” how far out or deep the roots of is significantly better than the rates for the skin cancer go. This allows the sur- standard excision or any other accepted geon to remove all of the cancer cells method. It was this combination of Dr. while sparing as much normal tissue as Tallman’s experience and the Mohs accuracy along with minimal invasiveness possible. that attracted Neelley to Tallman Der“After the cancer concern is allevi- matology & Medical Spa. ated, almost all patients are concerned “I am the biggest fan of Dr. Tallman about is what their face will look like after the procedure,” noted Michelle and his staff. They really cared about Qualls, practice manager. “Because of my concerns with both the cancer and the accuracy of the Mohs digital “map- the surgery itself,” noted Neelley. “I feel ping,” most patients are pleasantly sur- at such peace now. And, when my husband, who was a fishing guide for 10 prised with their cosmetic outcome.” years, needed to have some basal cell While the actual Mohs procedure carcinoma removed, I wouldn’t let him may take several hours, that time to mi- go anywhere else.” croscopically examine the margins surNow Neelley proudly shows that her rounding the cancer site pays off. A small wound leaving the maximum amount of basal cell carcinoma on her face is gone.

And, anyone looking at her would never healthy tissue heals faster and better. know she had the surgery.

medical

&

f o r

y o u r

surgical care s k i n

our treAtment serviCes inClude Skin Conditions • Benign & Cancerous Growths Mohs Micrographic Cancer Surgery Sclerotherapy • Botox & Fillers

Philip tallman, md

• Board Certified Dermatologist • Member of the American Academy of Dermatology • Fellow of the American Society for Mohs Surgery

Advertorial by Brenda Maas for Tallman Dermatology

Peter Bulley, PA-C

Michelle Neelley and her husband both went to Dr. Tallman for treatment of basal cell carcinoma.

2294 Grant Road, Billings, Montana

JAMES WOODCOCK/Gazette Staff

( B e h i n d C o s t c o)

406.294.9515 • Toll Free 866.988.DERM (3376) w w w.ta l l m a n d e r m a to l o g y.c o m

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