HealthWatch Magazine - June 2013 by Brainerd Dispatch and Echo Journal

Table of

Who we are Publisher • Tim Bogenschutz Advertising • Susie Alters and Phil Siebel Editor • Sarah Nelson Katzenberger

Contents YOU CAN-DO IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cuyuna Regional Medical Center introduces community health initaitive: Project Can-do

Cover Design • Jan Finger Contributing Writers Jodie Tweed, Sheila Helmberger, Jessica Larsen

HealthWatch is a quarterly publication of the Brainerd Dispatch.

Read HealthWatch online at www.brainerddispatch.com.

Fore advertising opportunities call Susie Alters at 218-855-5836 or Phil Siebel at 218-855-5862. Email your comments to sarah.nelsonkatzenberger @brainerddispatch.com or write to: Sarah Nelson Katzenberger HealthWatch P.O. Box 974 Brainerd, MN 56401

4 6 8 10 12 13 14 17 18 20 21 By CRMC

BOSTON HOSPITAL TO OFFER HAND TRANSPLANTS FOR KIDS . . . . . . . .

By Associated Press

EXPERIENCING FLU-LIKE SYMPTOMS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Your body may be trying to tell you something

By Jodie Tweed

FINDING A NEW NORMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Merrifield woman connects the dots on dreaded diagnosis

By Sheila Helmberger

TO EASE THE SHORTAGE OF ORGANS, GROW THEM IN LABS? . . . . . . . .

By Associated Press

Q &A ON COURT RULING AFFECTING MORNING AFTER PILL. . . . . . . . .

By Associated Press

FACING THE UNKNOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palliative Care Program Provides Choices In End-Of-Life Care

By Sarah Nelson Katzenberger

KOMEN BREAST CANCERT CHARITY NAMES NEW CEO . . . . . . . . . . . . . .

By Associated Press

STROKE OF GENIUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Essentia Health’s Stroke Code Team reduces impact in stroke patients

By Sarah Nelson Katzenberger

HOW’S YOUR HEAD? . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . Behavioral health hospital still going strong

By Jessica Larsen

COURT RULING MAY OPEN UP BREAST CANCER GENE TEST . . . . . . . . . .

On the cover

Lakewood Health System Palliative Care Case coordinator Karen Kochsiek discussed the hospital’s palliative care program.

By Associated Press

CUYUNA REGIONAL MEDICAL CENTER

You Can-do it. Cuynuna Regional Medical Center introduces community health initiative: Project Can-do

uyuna Regional Medical Center has joined the Healthy Communities Partnership, a three-year, $6.5 million program to experiment with different health improvement methods in 13 communities throughout Minnesota and western Wisconsin. The Healthy Communities Partnership includes the George Family Foundation, Allina Health, and ten other health organizations.

The program is managed by the Penny George Institute for Health and Healing, the part of Allina Health that is responsible for health promotion and wellness. George, also co-founder of the George Family Foundation, says integrative medicine will be woven into the fabric of local health services. “We need to move away from the ‘find it, fix it, and forget it’ model currently in wide use in the medical comm u n i t y.

These partnerships are a step toward making integrative healthcare more mainstream, and we believe that is central to empowering individuals to take more responsibility for their own health,” George said. Hospital representatives, primary care doctors and others from community health resources are working together to: ■ Create resource guides of all community health and wellness services to en ensure that residents have access to a full range of programs to im■ Develop and test innovativee programs p prove community health to takin taking ng aan inventory of local resources to identify and fill gaps in local wellness programming guide ■ Make a wellness care guid de available who will work with each participantt on a health improvement plan that combines medical and nonmed m medical approaches. CRMC in Crosby is calling th the he Healthy Communities Partnership initiative, Project Pr Can-do. This name is a testament to a long-standing comlon ngmitment of the medical campus to educate, motiliifes vate and communicate healthy lifestyle habits. It’s a full circle approach to cha cchanging the way w residents and patients think about wellness. Project Can-do Ambassador at CRMC, Jennifer Holmvig said, “Everyone wants to know the secret kn We guess what to weight loss and living well. Well, b – there’s no secret! It’s all about being mindful, and making regular exercise and h healthy foods a part of your lifestyle.” Project CanCan-do has set out d the h llocall communities i i on how to do to educate just that. The process starts with the free sself assessment on Family Health Manager at www www.cuyunamed. org. Here, users are asked a series o of questions related to how they feel about their eating, sleep, activity and habit patterns. Are you feeling rested when yo you wake up in the morning? Do you exercise regu regularly and at an adequate level? What kind of food are you eating and how often? Do you feel stresse stressed or sad regularly? When the assessment has be been completed,

a health score is compiled – 100 being perfect on a scale of 0-100. “Most people will fall in the 65-80 range. It’s really the first step in making people aware of all their areas of wellness and giving them a baseline to make positive adjustments and improvements,” said Holmvig. After the Family Health Manager assessment is completed, the participant takes part in a free health screening. Here they receive a lab test that determines their blood sugar and cholesterol levels, receive a blood pressure assessment as well as a BMI and waist circumference evaluation. There’s an opportunity to ask questions to a wellness care guide and educational materials are provided based on the needs reflected in the participant’s screening results. From that point, the participant’s lab results are integrated into their online personal Family Health Manager profile where they have the opportunity to review their results, learn about areas they need to focus on, and are introduced to physicians available who may be able to help them improve their health. Then, Holmvig says, “We set our sights on keep people engaged with everything from social media, community programs, educational events, and promotions. Our goal is to make wellness a part of everyone’s lifestyle and provide at least a weekly dose of motivation and encouragement whether it’s through a targeted email reminding someone to review their goals, showing work-out ideas, or offering people an opportunity to learn new ways to cook and introducing healthy foods to incorporate into their diet.” She adds, “Getting started is the hard part and that’s why we are here. We want our community to set an example for our youth and be a place where people want to go for recreation and wellness opportunities.” To learn more about Project Can-do and to get involved, contact Jennifer Holmvig at 218546-700 ext. 4128, jholmvig@cuyunamed.org, or search Project Can-do on Facebook.

By MARILYNN MARCHIONE AP CHIEF MEDICAL WRITER

Boston hospital to offer hand transplants for kids A Boston hospital is starting the world’s first hand transplant program for children, and doctors say it won’t be long until face transplants and other radical operations to improve appearance and quality of life are offered to kids, too.

The move shows the growing willingness to do transplants to enhance a patient’s life rather than to save it as donated hearts, livers and other organs have done in the past. More than 70 hands and at least 20 faces have been transplanted in adults, and doctors say it’s clear these operations are safe enough to offer to children in certain cases, too. “We feel that this is justifiable,” Dr. Amir Taghinia said of the pediatric hand program he will lead at Boston Children’s Hospital. “Children will potentially benefit even more from this procedure than adults” because they regrow nerves more quickly and

have more problems from prosthetic hands, he said. Only one hand transplant is known to have been done in a child — a baby in Malaysia in 2000. Because the donor was a twin who died at birth, her sister did not need to take drugs to prevent rejection. That’s the main risk in offering children hand transplants — the immune-suppressing drugs carry side effects and may raise the risk of cancer over the long term. However, one independent expert thinks the gains may be worth it in certain cases. “We understand so much more about immune suppression” that it’s less of a risk to put children on it, said Dr. Simon Horslen, medical director of the liver and intestine transplant program at Seattle Children’s Hospital. “This is never going to be done as an emergency

A Boston hospital is starting the world’s first pediatric hand transplant program, a profound sign of the increased acceptance of doing face, hand and other transplants to improve quality of life rather than to save a life as donated hearts, livers and other organs have in the past.

procedure, so the families will have plenty of opportunity to weigh the options.” Also, a hand can be removed if rejection occurs, and that would not leave the child worse off than before the transplant, Horslen said. Several types of kids might be candidates — those born without hands, children who lose them in accidents and children with infections that wind up requiring damaged hands to be amputated. Quality of life is a key concern for people missing arms and hands — prosthetics for those limbs are not as advanced as those for feet and legs. In December, doctors at Johns Hopkins Hospital in Baltimore did a doublearm transplant for former soldier Brendan Marrocco, who lost all four limbs while serving in Iraq. It was the seventh double-hand or double-arm transplant performed in the U.S. d For a child missing two hands, “the qualityof-life issues are a big deal,” said Dr. Douglas o Diekema of the Center for Pediatric Bioethics D at a Seattle Children’s Hospital and a member of o the American Board of Pediatrics’ ethics committee. c “In terms of how we interact with the social world, it’s mostly our face and our hands,” so w a transplant “is a reasonable thing to offer a family,” he said. f Boston Children’s Hospital plans to make its i first cases healthy children 10 or older who are a missing both hands. “Some of them can’t feed themselves, they can’t go to the bathroom, someone needs c to t assist them with almost every activity,” Taghinia said. T The hospital also will consider children missing one hand who already are taking m immune-suppressing drugs because of transi planted organs, or those with only one hand p that doesn’t work well. t The hospital will cover the cost of the operation and care for three months afterward, e then ask insurers to pay for immune suppression and follow-up.

Experiencing

By JODIE TWEED Contributing Writer

flu-like symptoms? Your body may be trying to tell you something

f you think you’ve got the flu, but it’s lasting longer than it should, it may be time to see your doctor and ask whether you may be suffering from rheumatoid arthritis or another inflammatory joint disease.

There are more than 100 types of arthritis, causing painful joints and limiting mobility. Arthritis also can cause symptoms that may not seem like arthritis. Rheumatoid arthritis is an autoimmune disorder that causes painful inflammation of the lining of the joints, but it also affects many other areas of the body, causing skin rashes, shortness of breath, painful eye conditions and hoarseness of the throat, and it can lead to heart attacks. Rheumatologist Dr. Frank Vasey, who joined Essentia Health St. Joseph’s-Brainerd Clinic in March, said new pain management treatments and diagnostic tools can help ease the pain, stiffness and swelling caused by arthritis, osteoporosis and other diseases that affect the joints and other parts of the body, without surgery. Vasey said more than 50 percent of people 75 years and older suffer from a form of arthritis. Osteoarthritis, a progressive degenerative form of joint disease, is the most common form. Some forms of arthritis are caused by overuse or injuries. “Listen to your body,” Vasey said. “People are living

longer, and they need to protect their joints.” While some symptoms of arthritis are obvious, others are not. Many seniors may think that joint pain is simply part of the aging process, and haven’t spoken to their doctors about it. Younger people, including children, also can suffer from arthritis, and may not realize that arthritis could be the reason for their joint pain. One out of every five adults and 300,000 children suffer from arthritis in the United States, according to the Arthritis Foundation. It is the leading cause of disability in the country, according to the foundation. Vasey said if it takes 15-20 minutes each morning for you to shake off morning stiffness, or loosen up your

achy and stiff joints, you may have osteoarthritis. If it takes more than one hour after getting out of bed before your joints aren’t as stiff and painful, you may have rheumatoid arthritis or another form of inflammatory arthritis. Patients who suffer from psoriasis, a skin condition, have a 10 percent

Rheumatologist Dr. Frank Vasey and Licensed Nurse Practitioner Anna Smithee.

chance of developing psoriatic arthritis, said Vasey. Food poisoning, especially salmonella poisoning, can cause an autoimmune response in which the body’s immune system attacks itself, causing arthritis. Vasey also treats patients suffering from other inflammatory disorders that cause arthritic pain, including polymyalgia rheumatica and gout. Vasey re-

“Listen to your body. People are living longer, and they need to protect their joints.” DR. FRANK VASEY, RHEUMATOLOGIST, ESSENTIA HEALTH ST. JOSEPH’S MEDICAL CENTER

Signs and symptoms of rheumatoid arthritis Many people experience occasional joint pain. But if you are experiencing any of the following signs of rheumatoid arthritis, it is a good idea to make an appointment with your physician: ■ Regular morning joint stiffness ■ Joint pain that is persistent and doesn’t improve ■ Joint pain that seems to worsen ■ Joints that are red, tender, hot or swollen to the touch ■ Joint pain that includes a fever ■ Joint pain in several joints ■ Joint problems that limit your movement or mobility Information provided by the Arthritis Foundation.

cently served as chief of the Rheumatology Division at Wayne State University School of Medicine in Detroit, Mich. A U.S. Navy veteran, Vasey also served as Chief of Rheumatology at the University of South Florida College of Medicine in Tampa, Fla., and worked at the nearby James A. Haley Veterans Administration Hospital. He is board-certified by the American Board of Medical Specialties in internal medicine and rheumatology. Vasey said during his 30 years of practice in Florida, he treated more than 2,000 women suffering from silicone-related disorders related to breast implants. He said one percent of women who undergo breast implants each year develop a unique illness which goes away once the implants are removed.

Vasey grew up in Fargo, N.D., and attended the University of North Dakota before earning his medical degree from the University of Pennsylvania School of Medicine in Philadelphia, Penn. He served as an internal medicine resident at Highland Alameda County Hospital in Oakland, Calif., and fellowships in internal medicine and rheumatology at Royal Victoria Hospital in Montreal, Quebec. To make an appointment with Vasey, patients need a referral from their own physician. JODIE TWEED is a freelance writer who lives in Pequot Lakes. A former longtime Brainerd Dispatch reporter, Tweed now writes for many regional publications and national clients.

By SHEILA HELMBERGER Contributing Writer

Finding a new normal Merrifield woman connects the dots on a dreaded diagnosis

f you have never heard of Fabrys disease, don’t feel bad. Twenty-one year old Ellie Whiteman hadn’t heard of it before, either, until a doctor in Duluth told her she had it.

Whiteman, the daughter of Carla and Bill Whiteman, Merrifield, was a college student at St. Scholastica two and a half years ago when she started to feel like something wasn’t quite right. “It was my sophomore year of college and I just wasn’t feeling good. I felt tired a lot and I knew it was more than just from school. Then I started to get bloody noses that would last for an hour. Finally I went to health services. Then, she , things got scary. “They told me to go to St. Mary’s Hospital. They thought it might be Leukemia at first, but of course they didn’t tell me that at the time. Then they told me I needed to call my parents.” Ellie said she spent a lot of time with a lot of doctors. “They had a hard time identifying what the problem was right away,” she said. She had constant blood draws and lots of biopsies. Then the family met with genetic counsel-ors. “They would tell me these different diseasess it could be and I would get scared,” she said.. “One of them said Fabrys but I didn’t really thinkk it could be that. It sounded like the least likelyy one,” she said, “and the one that sounded thee worst.” Looking back now she said the dots in herr diagnosis are connecting. After learning moree about Fabrys, she knows now that she expe-rienced some of early warning signs, but likee most patients didn’t know it, including one off the most common. “When I was younger,” she said, “My feett n would get really hot and feel like they were on h fire.” She had her mom wrap them in cold wash cloths before she went to bed. o Fabrys is rare, which is also why it’s hard to diagnose. It is an inherited, genetic disorderr caused by a defective gene. Patients have a deficiency of an important enzyme that breakss down the fat in our bodies. Fabrys allows fattyy deposits to build up in several areas, includingg the organs, and nervous system of the body. “II have started to have little issues with my Kid-neys,” she said, “We will track that as I get older.. Patients often end up needing an organ trans--

plant or surgery. One treatment is to use an enzyme replacement but she said it hasn’t yet been proven to be that affective. The pain Ellie had in her hands and feet is called acroparesthesia, and even though it mainly affects those areas it can spread to other parts of the body. Episodes are called “Fabry crises”, and they can be debilitating, lasting anywhere from a few minutes to several days. “It’s just an achy feeling,” she said, “It still happens to me. It gets worse over time.” “It’s hard to explain,” she said about her diagnosis. “This still isn’t something I feel is happening to me.” She said she has also grown used to the pain and chronic fatigue. “Sometimes I feel perfectly normal and then I go to the doctor and it’s a big reminder.” “One of the other things that is a common

detector I’ve had since early teens. They are these things called angiokeratomas. Capillaries rise to the skin. Over time they accumulate on my legs. She recently had surgery on some angiokeratomas but she said the fix is temporary. “They will come back.” The only treatment for Ellie right now in this stage of her Fabrys is for her physicians to monitor it. She knows eventually she may need to go on an organ transplant list or go on dialysis. Because of the involvement of the kidneys and liver she takes no medications yet for her disease or other pills, including vitamins or supplements. She she has tried some other things to ease some of the symptoms. “I’ve done some holistic stuff. I’m gluten free.” She said that seems to help with her inflammation. It’s hard to get information from other patients going through the same thing

Ellie Whiteman (left) visited the Grand Canyon with her friend, Ronia Gramer

“It’s hard to explain... Sometimes I feel perfectly normal and then I go to the doctor and it’s a big reminder.”

because every patient’s progression and experience is different and because it’s so rare. Her doctor in Duluth has only one other patient with the disease. Ellie said she probably couldn’t have gone through all of this without her roommates, her friends at college and her parents, who have experienced their own emotional rollercoaster. It has been hard explaining Fabrys to others and conveying the serious of it. “I don’t want to make people uncomfortable,” she said. So she logged onto Facebook recently to try to explain it in easier terms and talk about some of the things she is feeling. ‘It’s hard to convey in conversation what days are like with Fabrys. Some days I forget I have it, others it’s exceedingly apparent. But, either way it has improved my quality of life, which may seem incongruous. I don’t dread class or work anymore, I don’t live for vacations or breaks; its cliché, but, I cherish the little things. I have become more confident, less fearful, more patient and appreciative. I still have bad days, really bad days, but I take life a little less seriously. I hope we all have the opportunity in our lives to be reminded that we have the power to choose our attitudes, no matter the situation.’ For all of the questions Ellie has about her future she is even excited right now about the present. A recent college graduate, she has her first job as a clinical information analyst at Essentia Health -St. Mary’s Medical Center, in Duluth. She still has so many questions about Fabrys and her future, but as she said in her Facebook post, she is hopeful that someday it will be recognized and treated by many doctors.

What is Fabry Disease? Fabry disease is caused by the lack of or faulty enzyme needed to metabolize lipids, fat-like substances that include oils, waxes, and fatty acids. The disease is also called alpha-galactosidase-A deficiency. A mutation in the gene that controls this enzyme causes insufficient breakdown of lipids, which build up to harmful levels in the eyes, kidneys, autonomic nervous system, and cardiovascular system. Fabry disease is one of several lipid storage disorders and the only X-linked lipid storage disease. Since the gene that is altered is carried on a mother’s X chromosome, her sons have a 50 percent chance of inheriting the disorder and her daughters have a 50 percent chance of being a carrier. A milder form is common in females, and occasionally some affected females may have severe manifestations similar to males with the disorder. Symptoms usually begin during childhood or adolescence and include burning sensations in the hands that gets worse with exercise and hot weather and small, non-cancerous, raised reddish-purple blemishes on the skin. Some boys will also have eye manifestations, especially cloudiness of the cornea. Lipid storage may lead to impaired arterial circulation and increased risk of heart attack or stroke. The heart may also become enlarged and the kidneys may become progressively involved. Other signs include decreased sweating, fever, and gastrointestinal difficulties. Information provided by the National Institute of Neurological Disorders and Stroke (NINDS)

By MALCOM RITTER AP Science Writer

To ease shortage of organs, grow them in a lab? N

EW YORK (AP) — By the time 10-year-old Sarah Murnaghan finally got a lung transplant last week, she’d been waiting for months, and her parents had sued to give her a better shot at surgery. Her cystic fibrosis was threatening her life, and her case spurred a debate on how to allocate donor organs. Lungs and other organs for transplant are scarce. But what if there were another way? What if you could grow a custom-made organ in a lab? It sounds incredible. But just a three-hour drive from the Philadelphia hospital where Sarah got her transplant, another little girl is benefiting from just that sort of technology. Two years ago, Angela Irizarry of Lewisburg, Pa., needed a crucial blood vessel. Researchers built her one in a laboratory, using cells from her own bone marrow. Today the 5-year-old sings, dances and dreams of becoming a firefighter — and a doctor. Growing lungs and other organs for transplant is still in the future, but scientists are working toward that goal. In North Carolina, a 3-D printer builds prototype kidneys. In several labs, scientists study how to build on the internal scaffolding of hearts, lungs, livers and kidneys of people and pigs to make custom-made implants. Here’s the dream scenario: A patient donates cells, either from a biopsy or maybe just a blood draw. A lab uses them, or cells made from them, to seed onto a scaffold that’s shaped like the organ he needs. Then, says Dr. Harald Ott of Massachusetts General Hospital, “we can regenerate an organ that will not be rejected (and can be) grown on demand and transplanted surgically, similar to a donor organ.” That won’t happen anytime soon for solid organs like lungs or livers. But as Angela Irizarry’s case shows, simpler body parts are already being used as researchers explore the possibilities of the field. Just a few weeks ago, a girl in Peoria, Ill., got an experimental windpipe that used a synthetic scaffold covered in stem cells from her own bone marrow. More than a dozen patients have had similar operations. Dozens of people are thriving with experimental bladders made from their own cells, as are more than a dozen who have urethras made from their own bladder tissue. A Swedish girl who got a vein made with her marrow cells to bypass a liver vein blockage in 2011 is still doing well, her surgeon says. In some cases the idea has even become standard practice. Surgeons can use a patient’s own cells, processed in a lab, to repair cartilage in the knee. Burn victims are treated with lab-grown skin. In 2011, it was Angela Irizarry’s turn to wade into the field of tissue engineering. Angela was born in 2007 with a heart that had

only one functional pumping chamber, a potentially lethal condition that leaves the body short of oxygen. Standard treatment involves a series of operations, the last of which implants a blood vessel near the heart to connect a vein to an artery, which effectively rearranges the organ’s plumbing. Yale University surgeons told Angela’s parents they could try to create that conduit with bone marrow cells. It had already worked for a series of patients in Japan, but Angela would be the first participant in an American study. “There was a risk,” recalled Angela’s mother, Claudia Irizarry. But she and her husband liked the idea that the implant would grow along with Angela, so that it wouldn’t have to be replaced later. So, over 12 hours one day, doctors took bone marrow from Angela and extracted certain cells, seeded them onto a 5-inch-long biodegradable tube, incubated them for two hours, and then implanted the graft into Angela to grow into a blood vessel. It’s been almost two years and Angela is doing well, her mother says. Before the surgery she couldn’t run or play without getting tired and turning blue from lack of oxygen, she said. Now, “she is able to have a normal play day.” This seed-and-scaffold approach to creating a body part is not as simple as seeding a lawn. In fact, the researchers in charge of Angela’s study had been putting the lab-made blood vessels into people for nearly a decade in Japan before they realized that they were completely wrong in their understanding of what was happening inside the body. “We’d always assumed we were making blood vessels from the cells we were seeding onto the graft,” said Dr. Christopher Breuer, now at Nationwide Children’s Hospital in Columbus, Ohio. But then studies in mice showed that in fact, the building blocks were cells that migrated in from other blood vessels. The seeded cells actually died off quickly. “We in essence found out we had done the right thing for the wrong reasons,” Breuer said. Other kinds of implants have also shown that the seeded cells can act as beacons that summon cells from the recipient’s body, said William Wagner, director of the McGowan Institute for Regenerative Medicine at the University of Pittsburgh. Sometimes that works out fine, but other times it can lead to scarring or inflammation instead, he said. Controlling what happens when an engineered implant interacts with the body is a key challenge, he said. So far, the lab-grown parts implanted in people have involved fairly simple structures — basically sheets, tubes and hollow containers, notes Anthony Atala of Wake Forest University whose lab also has made scaffolds for noses and ears. Solid internal organs like livers, hearts and kidneys are far more com-

plex to make. His pioneering lab at Wake Forest is using a 3-D printer to make miniature prototype kidneys, some as small as a half dollar, and other structures for research. Instead of depositing ink, the printer puts down a gel-like biodegradable scaffold plus a mixture of cells to build a kidney layer by layer. Atala expects it will take many years before printed organs find their way into patients. Another organ-building strategy used by Atala and maybe half a dozen other labs starts with an organ, washes its cells off the inert scaffolding that holds cells together, and then plants that scaffolding with new cells. “It’s almost like taking an apartment building, moving everybody out ... and then really trying to repopulate that apartment building with different cells,” says Dr. John LaMattina of the University of Maryland School of Medicine. He’s using the approach to build livers. It’s the repopulating part that’s the most challenging, he adds. One goal of that process is humanizing pig organs for transplant, by replacing their cells with human ones. Ott’s lab and the Yale lab of Laura Niklason have used the cell-replacement process to make rat lungs that worked temporarily in those rodents. Now they’re thinking bigger, working with pig and human lung scaffolds in the lab. A human lung scaffold, Niklason notes, feels like a handful of Jell-O. Ott is also working to grow human cells on human and pig heart scaffolds for study in the laboratory. There are plenty of challenges with this organbuilding approach. One is getting the right cells to build the organ. Cells from the patient’s own organ might not be available or usable. So Niklason and others are exploring genetic reprogramming so that, say, blood or skin cells could be turned into appropriate cells for organ-growing. Others look to stem cells from bone marrow or body fat that could be nudged into becoming the right kinds of cells for particular organs. In the near term, organs might instead be built with donor cells stored in a lab, and the organ recipient would still need anti-rejection drugs. How long until doctors start testing solid organs in people? Ott hopes to see human studies on some lab-grown organ in five to 10 years. Wagner calls that very optimistic and thinks 15 to 20 years is more realistic. Niklason also forecasts two decades for the first human study of a lung that will work long-term. But LaMattina figures five to 10 years might be about right for human studies of his specialty, the liver. “I’m an optimist,” he adds. “You have to be an optimist in this job.”

Q & A on court ruling affecting By LINDSEY TANNER AP Medical Writer

morning-after pill CHICAGO (AP) — Don’t expect to see morning-after pills for all ages on drugstore shelves anytime soon. A federal appeals court decision allowing girls of any age to buy emergency contraception without a prescription won’t immediately change access. Labels first need to be revised to remove age restrictions, and the government could file another appeal to block moving the products from behind pharmacy counters. Doctors, reproductive health specialists, manufacturers and pharmacists struggled Thursday to make sense of the appellate ruling that allows the original two-pill version of emergency contraception to be sold immediately without restrictions. Theoretically that means girls of any age could buy the pills without a prescription and without providing identification — just like aspirin, ointments and most other over-thecounter medicines. But the ruling doesn’t lift restrictions on newer one-pill versions, which means pharmacists and pharmacy clerks will have to be clear on the differences among five or so available versions. Some basic questions and answers: Q: How quickly will there be a change? A: No one knows. The government has two weeks to file another appeal. Labels for pills affected by the ruling currently restrict over-the-counter sales to girls 17 and older. Younger girls need to have a prescription.

Q: What are pharmacies and manufacturers doing? A: Pharmacies and manufacturers said Thursday they were reviewing the ruling. Manufacturers could seek label changes, or the Food and Drug Administration could reach out to manufacturers to speed the change. They could also try to bypass the FDA by relabeling and shipping the drugs with a copy of the court order.

Q: Didn’t the FDA recently rule on morning-after pills? A: Yes, the agency announced last month that one brand — Plan B OneStep pills — could be sold without a prescription to those 15 and older. The manufacturer, Teva Women’s Health, plans to begin those sales soon. This week’s court ruling won’t change that. Also, against objections from conservatives, the FDA had planned to remove age restrictions on over-the-counter sales for emergency contraceptives two years ago. But Health and Human Services Secretary Kathleen Sebelius overruled that decision in late 2011.

says the IUD and other implants are the most effective way for teens to avoid pregnancy, and says both are safe and nearly 100 percent effective.

Q: What’s the history behind the court case? A: A federal district judge in New York ruled in April in favor of a reproductive rights group’s lawsuit seeking over-the-counter access without age restrictions for emergency contraceptives. The Department of Justice appealed and a federal appellate court is considering that objection. The government sought to block overthe-counter sales while the appeal is

being considered, but a three-judge panel rejected part of that request on Wednesday.

Q: How does the emergency contraception work? A:Pills affected by the ruling contain progesterone, the same hormone found in many birth control pills, but at higher doses. They are to be used as soon as possible within 72 hours of unprotected sex. The two-pill version was initially recommended to be taken 12 hours apart; it was later determined that taking them simultaneously was easier and as effective. The pills block ovulation and fertilization of an egg.

Q: Who uses morning-after pills? A:The biggest users are women in their early 20s. A government report earlier this year said 14 percent of women aged 15 to 19 who’ve had sex have ever used emergency contraception, versus 23 percent of those aged 20 to 24. Only about 13 percent of teens have had sex by age 15, according to data from the Guttmacher Institute, a nonprofit group that focuses on reproductive issues. Q: What’s available and how much does it cost? A: There are several one-pill versions in the U.S.; the only two-pill version still being made is a generic, according to reproductive rights groups. Costs for one- and two-pill versions are generally around $30 to $50, with generics at the lower end of that range. Q: What’s the advice for teens? A: To prevent pregnancy, the American Academy of Pediatrics recommends using condoms plus birth-control pills or IUDs, or abstinence. The academy also endorses morning-after pills, but they don’t work quite as well — about 90 percent effective. The American College of Obstetricians and Gynecologists

Facing

By SARAH NELSON KATZENBERGER Health Watch Editor

Palliative care program provides choices in end-of-life care TAPLES — Sandy Wierenga knows she’s going to die. And maybe soon.

“It’s really just a matter of how long,” Wierenga, 58, said of her terminal prognosis. Despite what many might consider pending doom, Wierenga, is at peace with her fate. “I’ve had enough time to think about it,” Wierenga said. “It doesn’t bother me — I’ll be in a place where I’ll be fine. I’ll be with friends. And family. And God.” Six years ago, Wierenga was diagnosed with breast cancer. In 2007, she underwent a successful mastectomy and lived symptom free for four years. Then the pain came back. Wierenga’s cancer had metastasized to her hip, chest wall, liver and lungs. “Other than that I’m just cheery,” Wierenga said. Wierenga has fought her cancer — taking medication, undergoing radiation at one point, but chose not to do chemotherapy. “The side effects have been tolerable,” she said. While visiting her oncologist, Dr. John Weitz at Lakewood Health System in Staples, Wierenga saw a brochure for Lakewood’s palliative care program — a program designed for patients with chronic illness. “I guess I’m considered your chronic disease,” Wierenga said. “So I thought I’d give them a call.” Palliative care is a specialized medical care for people with serious illnesses. Patients diagnoses vary from cancer to dementia to degenerative disorders like Huntington’s Disease or Parkinson’s, to congestive heart failure and liver failure. Palliative care focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and their family. Dr. Julie Benson is family medicine physician at Lakewood Health System and the Hospice and Palliative Care Medical Director.

Benson acknowledges that the idea of palliative care for most conjures up ideas of impending doom, and end of life conversations. “Patients think we are there to tell them they have no hope,” Benson said. “We want to change that.” Lakewood’s palliative care team was developed in 2008, and has been operating since early 2009. Care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support, as defined by the Center for Advance Palliatve Care. “The goal is to improve quality of life at and any age, any stage, any illness,” Benson said. Benson said it is important to note the palliative care is not hospice. They are similar when it comes to providing care for terminal patients. “All hospice is palliative care, but not all

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Lakewood Health System Palliative Care Case Coordinator Karen Kochsiek discuss the hospital’s palliatve care program .

palliative care is hospice,” Benson explained. Both hospice and palliative care provide patients with support with medications, day-to-day care, required medical equipment, bereavement counseling and symptom treatment. Palliative care differs in eligibility, care location — most patients are seen at home, timing, and payment. Benson explained that most people experience end of life conversation in a time of crisis, when death really is looming. “Even though we can’t avoid crises, we can be better prepared for crises,” Benson said. “The goal is to move that conversation upstream —this is about providing extra support.” Benson compared the palliative care process to preparing for childbirth. Medical professionals do their best to prepare new mothers for childbirth by giving them as much information and support as they might need. ”I still can’t predict what their delivery is going to be like — they still might need an intervention, they might still have a high risk issue, they might have a complication but we’ve at least prepared them for some of those possibilities and they understand better about some of the decisions they might have to make,” Benson said. Benson said the idea is to have tough conversations before the crisis arrives. The palliative care team works hard to provide holistic care for their patients by not only addressing medical needs, but by building relationship with family members and caretakers, addressing concerns over finances, drug costs, social service needs, and spiritual needs. “Our goal is to take the patient and their family as a whole versus just a snippet of what’s wrong with them,” said Karen Kochsiek, Registered Nurse and Palliative Case Coordinator. “We are truly about meeting the patient where they’re at, and what their goals of quality of life are,” added Licensed Social Worker, Kali Pachan. “Everyone is so individual.” The team also includes Cindy Sauber, Registered Nurse and Palliative Care Case Coordinator, Kimberly Bryniarski LPN and Palliative Care Team Coordinator, Julie Moriak, Pharmacist and Daryl Jacobson, Chaplain. For Sandy Wierenga, Lakewood’s palliative care team has provided a great deal of support. After reaching out to the program, Wierenga said she met with Kochsiek to discuss what she could expect from the palliative care team. Wierenga wasn’t ready for hospice yet, but knew she needed help navigating the decisions in her near future. “They signed me up and welcomed me with open arms,” Wierenga said. Wierenga said she has gained valuable knowledge in regards to her finances, her doctor/patient relationship, and support for her family. They have even helped her develop her health care directive and walked her through the steps required to donate her body to science. Wierenga calls Kochsiek anytime she needs something. While she said she had been at peace with her situation for a long time, the support provided by the palliative care team goes a long way. “It’s still very fulfilling to have that support on your side,” Wierenga said, speaking of

Sarah Nelson Katzenberger• sarah.nelsonkatzenberger@brainerddispatch.com

Lakewood Health System palliative care patient Sandy Wierenga met with nurse and palliaitve care case coordinator Karen Kochsiek.

her described ,“sweetheart” Mitch. “I know he will have support.” “Sandy is very you unique,” Kochsiek said. “She’s a planner —she likes to have things all planned out. I think that take away some the anxiety about the future.” Kochsiek said Wierenga has taken advantage of using the entire See CARE, Page 16

“Our goal is to take the patient and their family as a whole versus just a snippet of what’s wrong with them.” KAREN KOCHSIEK, REGISTERED NURSE AND PALLIATIVE CASE COORDINATOR

“We’re all going to die... Most of us will die over a course of time. And yet we are not prepared for this.” DR. JULIE BENSON, LAKEWOOD PALLIATIVE CARE MEDICAL DIRECTOR

CARE, From Page 15 palliative care team and has been able to gain insight from each person and their disciplines — something Wierenga said has allowed her to just live without worrying about what will happen when she’s gone. “I’m more about quality than quantity anyway,” Wierenga said. Despite her prognosis, Wierenga hasn’t given up yet. She is currently part of a clinical drug trial at the Mayo Clinic. Wierenga said she has made the decision to focus on living. She works a seasonal job as a fire watch for the Minnesota Department of Natural Resources and also serves with the regional library system. “And I pretend to farm,” Wierenga joked about her home vegetable garden. “I like to eat what I grow.” Kochsiek said Wierenga’s proactive approach has added to her health. “What is does for her is what we want it to do for everybody,” Karen Kochsiek said. Wierenga said she has toured Lakewood’s hospice suite, but she has some reluctancy about surrendering to that part of the journey. “I’m just not quite ready yet,” she said. For most patients, connection with the palliative care team comes through a referral from their doctor. If the patient agrees, a member of the palliative care team will have a conversation with the patient about their illness, their concerns and needs, and the best way to approach their pain management care. Benson said referrals are often made due to social service reasons, financial concerns — often to due with drug cost or paying for home

medical equipment. Lakewood’s palliative team said it is not their goal to be the bearers of bad news, but to help patients, like Sandy Wierenga, get through the darkest days of their illness. “It’s not about taking away hope,” Kochsiek said. “It’s changing its direction.” Cindy Sauber said there are many people who could be on palliative care, but are not — in many cases because they don’t understand what it means. “We’ll hear people say, ‘I’m not ready for this.’” “That’s the exact person who needs it,” Benson added. Benson said palliative care is not something widely understood by the medical community at large, much less patients who might need it. “That’s one of the barriers that we have to breakthrough here and nationally,” she said. “It’s about trying to educate people about what it can be.” Perception is a key part of education, Pachan added. “It’s not our job to talk you into or out of anything,” she said. “It’s our job to educate the patient to be able to make that decision — we’re just there to walk along side of them.” Benson said crisis experiences are the minority when it comes to end of life decisions. Most people have time to address the tough questions that come at the end of life, it’s just a matter of willingness to face the questions. “We’re all going to die,” Benson added. “Most of us will die over a course of time. And yet we are not prepared for this.”

LAKEWOOD HEALTH SYSTEM PALLIATIVE CARE TEAM

Dr. Julie Benson, Hospice and Palliative Care Medical Director.

Karen Kochsiek, Palliative Care Case Coordinator

Cindy Sauber, Palliative Care Case Coordinator

Benson explained that health care systems invest a great deal of money into emergency care — preventing deaths that result from trauma like heart attack, stroke, pulmonary embolism. “But that’s 10 percent of the population,” Benson said. “Ninety percent of us are going to die from our chronic diseases. We have to prepare people for those things.” Benson said one of the greatest misconceptions among physicians is what chronic disease care should look like. “Physicians will say, ‘I’m going to give them their fourth line of chemotherapy because everything else has failed, and I’m not going to bring up everything else because their still coming into me,” Benson said, describing the patient’s view is often that the doctor’s course of treatment must reflect their prognosis. “Now one is willing to talk about the elephant in the room — that we have to start talking about these things. “It’s not about giving up if something changes.” Sandy Wierenga said she regardless of what happens with her treatment and the path her illness takes she is at peace, a lot of peace that she said she owes to the Lakewood palliative care team. Whatever happens, she will face it without fear. “I’ve had a good life,” she said. “I’m ready.” SARAH NELSON KATZENBERGER may be reached at sarah.nelsonkatzenberger@brainerddispatch.com or 855-5879.

Steve Kohls • steve.kohls@brainerddispatch.com

Kali Pachan, Licensed Social Worker Palliative Care

Not pictured: Daryl Jacobson, Kimberly Bryniarski, and Julie Moriak

Komen breast cancer charity names new CEO The breast cancer charity named Judith A. Salerno to replace founder Nancy Brinker, whose promise to her dying sister begat a fundraising powerhouse that invested hundreds of millions of dollars in cancer research. Brinker announced last summer she would step down following an onslaught of criticism over Komen’s quickly reversed decision to stop giving grants to Planned Parenthood for breast cancer ASSOCIATED PRESS screenings. Salerno, 61, is executive director and chief operating officer of the Institute of Medicine, a prestigious independent group that advises the government and private sector about health and science. “Komen’s commitment has helped countless numbers of lowincome and medically underserved women and men get care they might otherwise have gone without, and Komen’s research program is one of the most highly respected in the nation,” Salerno said in a statement released by Komen. Brinker, 67, announced in August that she would move from the CEO role, which she’d held since 2009, into a new one focused on fundraising and strategic planning. In late 2011, the Dallas-based charity decided to halt grants to Planned Parenthood, which received about $680,000 that year. News of the move caused a torrent of questions about the decision and calls for its reversal, angering Komen supporters on both sides of the abortion debate. Three days after the initial disclosure, Komen reversed its course, which led to more harsh criticism, this time from abortion opponents accusing the charity of caving to public pressure. Earlier this month, Komen announced it was canceling half of its three-day charity walks due to a drop in participation levels. Komen spokeswoman Andrea Rader described Salerno on Monday as a good fit for the charity due to her experience in a range of areas, from public policy to community health. Asked about Salerno’s views on Planned Parenthood or the controversy over funding, Rader said Komen’s focus was on moving forward. “That’s an issue that was settled a long time ago,” Rader said. Planned Parenthood had no immediate comment on Salerno’s appointment. Brinker founded the Dallas-based charity in honor of her sister, who died of breast cancer in 1980. It grew into a fundraising powerhouse. Its signature color of pink has become synonymous with breast cancer awareness.

By SARAH NELSON KATZENBERGER HealthWatch Editor

Stroke of genius Essentia Health St. Joseph’s Medical Center Stroke Code team reduces impact in stroke patients

hen a patient comes into the Emergency Room with symptoms of stroke every second counts

Or as Dr. Peter Henry of Essentia Health St. cess are so precise, they allow a neurologist to lows the hospital to still treat stroke patients withJoseph’s Medical Center would say, “Time is monitor the movement of a patients pupils. out transporting them to larger, better equipped brain.” medical centers. “It’s very high-tech,” he said. Henry said minimizing the time it takes to “By doing this we are able to keep more paThe system is appropriately named, Telediagnose a stroke and administer treatment is stroke. tients in their own community,” Henry said. vital to reducing the impact a stroke has, and ulHenry said the hospital was approached with Henry explained that once a stroke code is timately saving a patient’s life. the Telemedicine program approximately two called the attending physician assesses the paA stroke occurs when blood vessels that carry years ago. tient while the stroke code team establishes a oxygen and nutrients to the brain is blocked by “We’ve always had a really good relationship connection with a stroke neurologist in St. Paul a clot or ruptures. Henry said the “brain attack” with HealthEast neurology,” Henry said. “This through the Telestroke video monitor. cuts off blood and oxygen from getting to the was a good way of going with the standard of Simultaneously, the multidisciplinary team brain and ultimately brain cells die. care.” works to establish an intravenous access, con“The quicker you can administer intervention, Henry explained that the rural location and nect a heart monitor and oxygen, draw blood for the better the outcome,” Henry explained. low population volume, prevents Essentia from labs, and prepare for a CT Scan. Once a stroke has been identified, Henryy supporting pp g a full-time neurologist g on staff,, but alThe neurologist g at HealthEast does a video assaid, the team has a limited window of timee — about four hours from the onset of symp-toms — to administer clot busting drugs called d tissue plasminogen activator (tPA). Henry said the goal at Essentia is to call a stroke code within 10 minutes of a patient ar-riving in the hospital’s emergency room. Intensive Care Unit (ICU) Nursing Director,, Jennifer Abfalter explained that if an emergen-cy room nurse suspects a possible stroke in a patient, they immediately notify a physician. Iff the stroke is confirmed, and the patient meetss inclusion criteria, a stroke code is activated.. m The stroke code initiates the stroke code team to spring into action. The team includes ICU,, Emergency Department, Nursing, Physicians,, Lab, X-ray, and EMS. “It’s amazing to watch,” Abfalter said. “Our doctors and nurses can recognizee and treat stroke, but we’re not experts,” Henryy added. Recognizing the need to better minimize a stroke victim’s time in the emergency room,, Dr. Henry and his Stroke Code team at Essen-tia Health forged a partnership with Health-East Care System in St. Paul. h The partnership means the Essentia Health o Stroke Code team in Brainerd has access to HealthEast’s stroke neurologist in St. Paul viaa d Dr. Peter Henry (center) and members of the Essential Health St. Joseph’s Medical Center stroke code team real-time remote video access. Henry said c demonstrated a stroke code with the help of Telemed’s remote access to stroke neurologists at HealthEast the two cameras connected to the video acCare System in St. Paul.

sessment through the video monitor and decides whether treating the patient with the tPA is the best option. Henry said the goal for administering the drug from the time the patient arrives is 45 minutes or less. Essentia averages 42 minutes from door to drug, Henry said. The national average is 60 minutes. Henry said the minimized time spent administering the drug increases the likelihood that a patient will completely recover from stroke. “You get the same treatment here that you would get from any larger facility — that’s really the goal,” Henry said. “It’s what you should expect from any facility.” Henry said the ultimate goal at Essentia Health is to become a certified stroke center. “This is something that is becoming standard of care,” he said. Henry said ignoring stroke symptoms should never be an option. If the person suffering a stroke is unable to recognize that there is a problem, it is imperative that family members understand the symptoms to watch for and the importance of seeking immediate medical care. Henry said many times stroke sufferers or their next of kin hesitate to call 911 because they are intimidated by the cost involved or the chance that what they think might be a stroke is in fact a false alarm. Henry said anytime a stroke is even suspected, it’s important to seek immediate medical attention. Stroke symptoms left untreated can have long term affects including; visual impairment, damage to motor skills, impaired speech capability and recognition, even paralysis. “Stroke is an emergency,” Henry said. “It should never be ignored. If you suspect any symptoms the best thing to do is call 911. Don’t wait.”

“You get the same treatment here that you would

SARAH NELSON KATZENBERGER may be reached at sarah.nelsonkatzenberger@brainerddispatch.com or 855-5879.

get from any larger facility — that’s really the goal...It’s what you should expect from any facility.”

ARE YOU HAVING A STROKE? The American Stroke Association says to use FAST to identify sudden signs of stroke. If you spot these signs, call 911.

F A S T

ace Drooping: Does one side of the face droop or is it numb? Not sure? Ask the person to smile. rm weakness: Is one arm weak or numb? Ask the person to raise both arms and watch if one arm drifts downward.

peech difficult: Is speech slurred? Are they unable to speak or hard to understand? Can they repeat a simple sentence? ime to call 911: Even if symptoms go away call 911 and get to the hospital immediately.

By JESSICA LARSEN Contributing Writer

How’s your head? Behavioral health hospital still going strong

he facility started out with questions and concerns from those living nearby.

Today, however, the neighbors of the Community Behavioral Health Hospital in Baxter call it their own, says facility administrator Richard Slieter. “They were frightened by the stigma and resisted having it built here,” he said. “Now our neighbors see a huge value in it. They know people who were patients here and see now they’re doing well.” The Baxter facility one of seven state-run community behavioral health hospitals in Minnesota. More than 1,000 patients have walked through the doors at the hospital since the doors opened in January 2007. It’s a responsibility Slieter doesn’t take lightly. “When you see people when they come in with symptoms and you see them change, it’s an incredible gift,” he said. Those stories of healing stem from the way staff handles each patient, they say. In the first two

days, the original staff got together to put into words their purpose. Their mission: “To provide compassionate, individualized, safe and effective care for adults with mental illness. We work collaboratively with other agencies and empower patients to achieve their recovery goals.” Their vision: “Adults with inpatient mental health needs trust our ability to provide individualized patient care in an environment that focuses on recovery and reflects our values of integrity, respect, person-centeredness and safety.” Today, when a patient first enters the doors, they are introduced to the concept behind how the facility operates, said Martin Bosch, registered nurse administrative supervisor. “We come with a smile on our face and a main goal of ‘here I am, trust me, know me,’” he said. For a lot of patients, it’s a tough time in their life, so the idea of trust must be gained slowly. Patients are first brought to the exam room, where vital signs are

taken, along with height and weight, and they are talked through what will happen during the stay. It’s a time for staff to learn their story and fully understand just what the patient needs to recover. “It’s not about what the staff sees, it’s about what the patient sees as the needs to recover,” Bosch said. The staff of 48 people is a highly-effective team, Slieter said. “It’s an exceptional, human experience for whoever we serve.” Knowing a patient’s story is vital, Bosch said. “Until you truly know what a person is all about, you can’t get through to a patient,” he said. Three weeks is the average time someone stays at the hospital. Some leave and never come back. Others return, still with work left to do. Across the state’s mental health hospitals, about 10 percent of people are readmitted within 30 days of a discharge. The 16-bed facility in Baxter is at capacity most of the time. Rarely are people turned away. Inside, artwork on the white walls is chosen with meaning. One piece says “passion” and pictures a tree. Another is a painting done by a former patient, showing three colorful trees. The stigma on mental illness is still “very real” today, Slieter said. It can hold patients back in seeking help or even inside the walls of the hospital. But once staff gets through to a patient and they improve, that makes all of the hard work worth it. “It’s not magic,” Slieter said. “It’s about one human being touching another human being in a magical way, in a healing way.” JESSICA LARSEN may be reached at jessica.larsen@brainerd-

dispatch.com or 855-5859. Follow me on Twitter at www.twitter. com/brainerdnews.

By MARILYNN MARCHIONE AP CHIEF MEDICAL WRITER

Court ruling may open up breast cancer gene tests A

ruling by the Supreme Court that human genes can’t be patented is expected to increase access and drop the cost for tests for gene mutations that greatly raise the risk of developing breast or ovarian cancer.

In a bit of a mixed message, the court unanimously decided that certain types of gene tests may still be protected by patents, yet it struck down patents that a company has long held for BRCA genes. The company makes the only test for two of those breast cancer genes, BRCA1 and BRCA2. “It appears that it will allow the market to open up so that other laboratories can offer the test,” said Rebecca Nagy, a genetics counselor at Ohio State University and president of the National Society of Genetic Counselors. And that should make the tests cheaper and available to more women, she said. Hours after the ruling, one company — DNATraits, part of Houston-based Gene By Gene, Ltd. — said it would offer BRCA gene testing in the United States for $995 — less than a third of the current price.

whites and 12 percent of Eastern European (Ashkenazi) Jews. Rates in other groups aren’t as well known, but a recent study suggests they are more common than has been believed in blacks.

Q: How expensive are the Myriad tests? A: They cost $3,000 to $4,000 and insurers only cover them for women thought to be at high risk because of family history of breast or ovarian cancer or other risk factors. The tests are not recommended for women at average risk. Q: What about other tests for breast cancer genes? A: Some other tests look for mutations in 16 other genes less commonly involved

in breast cancer but those have not been able to include BRCA1 and BRCA2 because of Myriad’s patents. Those other tests cost around $2,600. The court’s ruling means these tests likely will be able to include BRCA1 and BRCA2 for no or little additional cost in the future, giving a more complete picture of a woman’s risk, Nagy said.

Q: What about other gene tests that can still be patented? A: The court said tests that involve making cDNA, or complementary DNA, can still be patented. They take an extra step to isolate only the “working parts” or coding regions of a gene.

A primer on the case: Q: What did the court say? A: Patents held by Myriad Genetics Inc. on BRCA1 and BRCA2 genes are not valid, because isolating a naturally occurring segment of DNA cannot be patented. We all have two copies of these genes; mutations in one of them can give a woman up to an 87 percent risk of developing breast cancer and up to a 54 percent risk for ovarian cancer.

Q: How many people have them? A: In the U.S., about 5 to 10 percent of breast cancers are thought to be due to bad BRCA genes. Among breast cancer patients, BRCA mutations are carried by 5 percent of

A technician loads patient samples into a machine for testing at Myriad Genetics n Salt Lake City. DNA samples are moved from one tray to another by the eight-needle apparatus at left. The Supreme Court ruled Tthat Myriad Genetics Inc. cannot patent the BRCA genes, which are tested to check a woman’s risk for breast and ovarian cancer.