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It’s been quite a decade for Bullhook Community Health Clinic With the opening of a new $7.2 million facility in downtown Havre, the clinic now houses all of its services
easier. There is a private dental station for young people who might be especially unhappy and may be expressing an opinion in a vocal way. A new telemedicine station allows people to show their injuries and talk directly to a doctor in New Jersey via a television set up. The facility is open to all people. It accepts all forms of insurance, Fox said. And it is especially attractive to people in need. There is a sliding-fee scale based on income. Medicaid patients are welcome.
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By Centers for Disease Control and Prevention
What are the symptoms of EV-D68 infection?
An uncommon virus, enterovirusD68, has spread across 12 states to cause respiratory illnesses. Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Montana, New York, Oklahoma and Pennsylvania have more than 130 confirmed cases between them, including the five cases recently confirmed in Montana. According to an Associated Press story, the virus can cause mild to severe respiratory illness. Children with asthma are especially vulnerable to the virus and, in some extreme cases, patients are put on life support for breathing difficulties, though the virus has not been reported to have caused any deaths. It is not known what triggered the outbreak or whether it is getting worse or not. Havre Daily News/Eric Seidle The new waiting lobby at the Bullhook Community Health Center.
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Enterovirus- Questions, answers about Enterovirus-D68 infection D68 spreads across 12 states John Paul Schmidt jpschmidt@havredailynews.com
John Kelleher news@havredailynews.com Bullhook Community Health Center started out in the Hill County Health Department offices where people in need could get basic health care. The clinic’s new $7.2 million facility in downtown Havre is a two-story, bright, light and airy facility that provides some of the latest technologies in health care. Mental health services are available, along with addiction counseling, family care and dental services. When patients enter the building, they are in the Tillie Patterson Waiting Room, named after a woman who helped out financially with the clinic over the years. The light flows into the waiting room, making things a bit more pleasant for people who may be under the weather. At the front, there is a plant that was purchased when the staff moved into the new building last month. Next to it is a similarsized plant the clinic purchased when it moved into its old building on the Northern Montana Health Care campus. The new facility was built with funds from the federal Affordable Care Act. Colleen Fox, an executive assistant at the clinic, beams as she shows off the new facility to visitors. There are more dental stations. Each of them face to the outside. People can see 4th Street and 5th Avenue below. The natural light may make an unpleasant situation a bit
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Enterovirus-D68 can cause mild to severe respiratory illness. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Severe symptoms may include wheezing and difficulty breathing. See EV-D68 in the U.S., 2014 for details about infections occurring this year.
How does the virus spread?
Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.
What time of the year are people most likely to get infected? In the United States, people are more likely to get infected with enteroviruses in the summer and fall. Cases are likely to decline later in the fall. Keep your child from getting and spread-
ing Enterovirus-D68
ting worse.
Who is at risk?
What are the treatments?
In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become ill. That's because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.
There is no specific treatment for people with respiratory illness caused by EV-D68. For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children. Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68.
EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat. Many hospitals and some doctor’s offices can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. Some state health departments and CDC can do this sort of testing. CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are get-
How can I protect myself?
How is it diagnosed?
You can help protect yourself from respiratory illnesses by following these steps: Wash hands often with soap and water for 20 seconds, especially after changing diapers. Avoid touching eyes, nose and mouth with unwashed hands. Avoid kissing, hugging and sharing cups or eating utensils with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick. There are no vaccines for preventing EV-D68 infections.
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Fighting breast cancer – what you can do October is National Breast Cancer Awareness Month By Jacqueline Stiff, MD UnitedHealthcare vice president, Health Care Strategies When it comes to breast cancer, spreading the word means spreading the cure so talk with your loved ones this month about the importance of breast cancer screenings and the risk factors associated with the disease. Despite progress in the fight against the disease, the Centers for Disease Control and Prevention (CDC) estimates that each year more than 200,000 women will be diagnosed with breast cancer. The American Cancer Society estimates that about one in eight women in the United States will be diagnosed with breast cancer at some time in their lives. The chance of breast cancer increases with age. A woman in her 70s is twice as likely to have breast cancer than a woman in her 40s. But incidence numbers tell only half of the story. Equally important are rates of survival. Due in part to public awareness campaigns, more women are beating breast cancer by taking charge of their own breast health. According to the American Cancer Society, about 67 percent of women aged 40 and older in the United States had a mammogram in the past two years, compared to only 29 percent in 1987. Today, the five-year survival rate of women who are diagnosed early is more than 90 percent, and the primary reason is early detection.
Risk Factors Although no one knows yet how to prevent breast cancer, certain risk factors have
been linked to the disease. They include: • Age: the chance of getting breast cancer increases as a woman gets older • Family History: having a mother, sister or daughter who has had breast cancer • Long-term usage of hormones (HRT); oral contraceptive agents • Longer time menstruating: women who started menstruating before age 12 or continued after age 55 are at greater risk • Having no children or had their first child after age 30 • Personal history of breast cancer or ovarian cancer • Lack of breast feeding • Genetic conditions (e.g., BRCA 1 or BRCA 2 genes), but this only applies to about 1 percent of women with breast cancer.
tables, and exercising.
African-American women at risk
Screening is important for all women, especially for African Americans. According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer among African-American women with an estimated 27,000 new cases this year. Although at lower risk of actually developing breast cancer than Caucasian women, African-American women are more likely to die from breast cancer. The American Cancer Society states that part of the reason
is that African-American women have faster-growing tumors so the cancer spreads more quickly, which makes screening tests even more important. Hispanic, Asian and Native-American women have a lower risk of getting and dying from breast cancer.
Spread the word Recognizing October as Breast Cancer Awareness Month is a good reminder for everyone to create awareness about the importance of breast cancer screenings and for women to talk with their doctors about breast health. By spreading the word, you can help efforts to reduce the number of diagnoses and deaths from breast cancer.
Screening is key
Other possible signs of breast cancer include:
• Swelling of all or part of a breast (even if no distinct lump is felt) • Skin irritation or dimpling • Breast or nipple pain • Nipple retraction (turning inward) • Redness, scaliness, or thickening of the nipple or breast skin • Nipple discharge (other than breast milk)
n Continued from page 2 If low-income patients need specialists to treat them, Bullhook can provide coupons to help them pay, even with doctors who often don’t accept Medicaid patients, she said. “It’s hard for some people to be able to get to Great Falls,” Fox said. The long road to the new clinic started in early 2005 when the clinic was part of the health department. The recently formed Hill County Health Consortium decided the year before that the number one health priority in the county was a place that could provide health care to the needy, paying fees on an income-based sliding scale, as well as people on Medicaid, Medicare and Montana Healthy Kids. Federal funds were cut in 2006, and Bullhook reorganized as an independent nonprofit group. That enabled it to apply for federal and state grants. In 2007, it secured a Community Health Center grant. It opened up in expanded facilities in a building adjacent to Northern Montana Hospital, just east of the hospital itself. In 2008, the clinic responded to a growing need for dental care. The lack of dentists in the area made itdifficult for people on limited income — and many other people — to obtain dental care.
Havre Daily News/Eric Seidle Dental assistant Alicia Richmond preps for a patient at Bullhook Community Health Center Sept. 25.
Signs and symptoms of breast cancer
Bullhook clinic
n Continued on page 8
Screening is key for early detection. Different organizations have different recommendations for screening, so women should talk to their doctors about their risk to determine the right age to begin breast cancer screenings. "High-risk" women may need mammograms at an earlier age or more often than "average-risk" women. Mammograms are not foolproof. They can be normal when breast cancer is present, so women should see their doctor right away if they find any change in their breasts, such as a lump or nipple discharge that is not breast milk. In addition to screening, it is a good idea to incorporate a healthy lifestyle to reduce the risk of breast cancer. This includes limiting alcohol, controlling weight by eating less fat and more fruits, whole grains and vege-
Widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Still, some breast cancers are not found by mammogram, either because the test was not done or because, even under ideal conditions, mammograms do not find every breast cancer. The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new breast mass or lump or breast change checked by a health care professional experienced in diagnosing breast diseases.
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Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast tissue is large enough to be felt. Swollen lymph nodes should also be reported to your doctor. Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to your doctor so that he or she can find the cause.
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Family health care facilities combine Over the last year, planning, construction took place to move two departments into one building. Renovation cost $3.5 million.
More than a year ago, Northern Montana Health Care’s officials decided it was time to put the Family Medicine and OB/GYN departments under one roof. OB/GYN had been in Northern Montana’s East Clinic, while Family Medicine was in the West Clinic. Both the staff and patients would benefit from by putting the two under the roof, it was agreed. A 15,000-square-foot building attached to the hospital that once house the chemical dependency program and later the behavioral science department was sitting empty and seemed like the perfect location. So, over the last year, planning and construction took place to move the two departments into the the one building. The renovation cost $3.5 million. Finally, the weekend of Sept. 13 and 14 was D-Day. The staff had to close shop as usual Friday night, move everything, makes sure all was in working order and get it operational by Monday morning. Doctors and other staff joined in the effort. After a hectic weekend, by Monday morning, everything was set. The whole project went as smoothly as hoped. Patients so far have been very pleased w i t h t h e n ew b u i l d i n g s a i d We n d y Wertheimer, director of clinic nursing. “It went off without a hitch,” she said. Two weeks into the move, patients remain happy with the new building. From the start, Wertheimer said, the top goal was to make access to care easier for patients. And patient confusion was kept to a minimum. For several months, when patients made their appointments, they were told of the new addition and where they would find the building and offices “Doctors from the beginning said they weren’t concerned with nice, big offices for themselves,” she said. Instead,they were looking for ways to make it easier and more pleasant for patients. They wanted to improve patient flow so that people could get in and out faster. They want to make coming to the doctors more pleasant.
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Quit Day Here are some steps to help you get ready for your Quit Day: • Pick the date to quit smoking and mark it on your calendar. • Tell friends and family about your Quit Day. • Get rid of all the cigarettes and ashtrays in your home, car, and at work. • Stock up on oral substitutes — sugarless gum, carrot sticks, hard candy, cinnamon sticks, coffee stirrers, straws and/or toothpicks. • Decide on a plan. Will you use nicotine replacement
John Kelleher news@havredailynews.com
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treatment or other medicines? Will you attend a stop-smoking class? If so, sign up now. • Practice saying, “No thank you, I don’t smoke.” • Set up a support system. This could be a group program or a friend or family member who has successfully quit and is willing to help you. Ask family and friends who still smoke not to smoke around you, and not to leave cigarettes out where you can see them. • If you are using bupropion or varenicline, take your dose each day leading up to your Quit Day. • Think about your past attempts to quit. Try to figure out what worked and what didn’t. Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan. Some options include using nicotine replacement or other medicines, joining a stop-smoking class, going to Nicotine Anonymous meetings, using self-help materials such as books and pamphlets, or some combination of these methods. For the best
Helping a smoker quit: Do’s and Don’ts General hints for friends and family Havre Daily News/Eric Seidle Karrie Lien, MD, left, and Debbie Paulsen, PA-C look at an X-ray Sept. 25 at Northern Montana Health Care’s Family Medical Center.
The family medicine doctors at Family Medical Center are: • Carol Kerr • Karrie Lien • Michael Nolan • Jeremy Patrick • Debbie Paulsen • Jessica Sheehy • Britney Wever
The OB/GYN doctors at Family Medical Center are:
• Fatima Abdulai • Anita Kellam • Margo Muntz
American Cancer Society • Do respect that the quitter is in charge. This is their lifestyle change and their challenge, not yours. • Do ask the person whether they want you to ask regularly how they’re doing. Ask how they’re feeling — not just whether they’ve stayed quit. • Do let the person't know that it’s OK to talk to you whenever they need to hear encouraging words. • Do help the quitter get what they need, such as hard candy to suck on, straws to chew on, and fresh veggies cut up and kept in the refrigerator. • Do spend time doing things with the quitter to keep their mind off smoking – go to the movies, take a walk to get past a craving (what many call a “nicotine fit”), or take a bike ride together. • Do try to see it from the smoker’s point of view — a smoker’s habit may feel like an old friend that’s always been there when times were tough. It’s hard to give that up. • Do make your home smoke-free, meaning that no one can smoke in any part of the house. • Do remove all lighters and ash trays from your home. Remove anything that reminds them of smoking • Do wash clothes that smell like smoke. Clean carpets and drapes. Use air fresheners to help get rid of the tobacco smells — and don’t forget the car, too. • Do help the quitter with a few chores, some child care, cooking — whatever will help lighten the stress of quitting. • Do celebrate along the way. Quitting smoking is a BIG DEAL! • Don’t doubt the smoker’s ability to quit. Your faith in them reminds them they can do it. • Don’t judge, nag, preach, tease, or scold. This may make the smoker feel worse about him or herself. You don’t want your loved one to turn to a cigarette to soothe hurt feelings. • Don’t take the quitter’s grumpiness personally during their nicotine withdrawal. Tell them that you understand the symptoms are real and remind them that they won’t last forever. The symptoms usually get better in about 2 weeks. • Don’t offer advice. Just ask how you can help with the plan or program they are using.
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chance at success, your plan should include at least 2 of these options. On your Quit Day: • Do not smoke. This means not at all — not even one puff! • Keep active — try walking, short bursts of exercise, or other activities and hobbies. • Drink lots of water and juices. • Start using nicotine replacement if that’s your choice. • Attend a stop-smoking class or follow your self-help plan. • Avoid situations where the urge to smoke is strong. • Avoid people who are smoking. • Drink less alcohol or avoid it completely. • Think about how you can change your routine. Use a different route to go to work. Drink tea instead of coffee. Eat breakfast in a different place or eat different foods.
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Quit Line helps Montanans break the habit
By HRDC Montana Tobacco Quit Line services • • • • • • • • •
A free personalized quit plan Five free pro-active cessation coaching sessions Eight weeks of free nicotine replacement therapy (gum, patches or lozenges). Callers who enroll in Quit Line services may be eligible for up to 8 weeks of free NRT. The Quit Line will explain to the caller how and when these medications will be mailed out. Chantix at a reduced cost ($50 co-pay per month for three months) Bupropion at reduced cost ($5 co-pay per month for three months) Free educational materials for health care providers as well as friends and families of tobacco users A fax referral system for health care providers who have patients that want to quit using tobacco (see provider link) Trained staff that offers culturally appropriate services for American Indians Pregnancy and Postpartum Program offers special services to women who enroll while they are pregnant.
You can reach the Montana Quit Line in two ways: • Call 1-800 QUIT-NOQ • Visit www.QuitNowMontana.com Bullhook clinic n Continued from page 3
There was no room at the hospital location, so dental offices were established at the Atrium Mall. In 2012, the clinic obtained a nearly $5 million grant that was designed to rehabilitate the historic Donaldson Hall at Montana State University-Northern. The building had fallen into disrepair over the years, and preservationists saw this as great way to keep the building in use. But a new administration at the campus saw things differently and backed out of the agreement. Then, the clinic got permission from the federal government to buy land and build the clinic across the street from Havre City Hall, more centrally located building. Before work could begin on the building, asbestos had to be removed from buildings that were to be demolished at the location. Bear Paw Development Corp. helped secure the money for the abatement. Close to 60 people attended the groundbreaking ceremonies July 14, 2013. Goldplated shovels were made for the special occasions. Then-board chairman Todd Hanson said praised the clinic staff for its work.
“This is seven years of dreaming and two years of focused planning to really get to where we are today,” he said. One of the shovel-wielders at the ceremony was U.S. Sen. Jon Tester, who had worked to obtain the grant money. “The bottom line is, once you get done, you’re going to have a beautiful piece of infrastructure that’s going to serve the people of this area in a way that you can be proud of,” Tester told the crowd. Tester was back at Bullhook Aug. 1 of this year, when the ribbon-cutting ceremony was held for the facility. This time, the clinic staff honored him by naming a training room in his honor. In a tearful dedication, the Elsie Rose St. Dennis Memorial Wall was dedicated. St. Dennis was one of the early board members and a fervent believer in the clinic travelling to Washington D.C. several times to lobby for its approval. She died four days before the clinic opened. Other than that, joy dominated the ceremony. “Wow, we did it,” said Cindy Smith, Bullhook CEO. “Just over a year ago, this was an empty lot,” Tester said. “Havre didn’t have a stateof-the art facility,” Tester said. “Now 13 months later, Havre has it.”
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Flu shot season hits US John Paul Schmidt jpschmidt@havredailynews.com The time of year for people to get their flu shots has come again. Health officials have changed their tunes, saying that some kids should get the nasal spray version of the flu shot and seniors will be urged to get a new kind of pneumonia shot along with their flu shot. "The best way to protect yourself against the flu is to get a flu vaccination," said Tom Frieden, the Centers for Disease Control and Prevention director. It is suggested by the government that children begin getting their flu shots starting at 6 months old. The flu kills 24,000 Americans a year, but only half of the population gets the shot every year, according to the CDC. Last year, the vaccination rates were highest for kids under 5 and seniors. A third of people 18 to 64 were vaccinated and hospitalization rates were highest in that
age group. Kim Larson, the program assistant at the Hill County Health Department, said that people can get their flu shots at any pharmacy or clinic. Brittne Zimmer administers the flu shots at Western Drug Pharmacy, and said she is only giving shots to adults 18 and up. Walmart is not administering shots until the end of October and did not know the age restrictions or prices as of yet. Larson said the Health Department administers 1,000 shots throughout the season and at their community flu shot clinic at the Havre High School Gymnasium Oct. 8 from 2 to 7 p.m. "This is the best way to protect yourself against getting influenza during each flu season," Larson said. She said their prices for the shots are $15 for kids 18 and younger, $25 for people 19 and older, $30 for the nasal spray and $50 for high dose flu shots, which are generally reserved for people 65 and older.
Havre Daily News/Hi-Line Shopper Family Medical n Continued from page 4 From the time they enter the front door, visitors and patients can see how the hospital has succeeded. The modern-looking building is bright and airy. Light from the outdoors fills the waiting room. There are still some finishing touches, Wertheimer said. But for the most part, the building is set to go. The building is attached to Northern Montana Hospital, making it easier for doctors to quickly get to the hospital if they need to. “The delivery room is just upstairs,” Wertheimer said. “And the emergency room is just down the hall if doctors have to take someone there.” Everything from the doctors’ offices to the examination rooms have been remodeled. The idea was to make the center a family wellness center where the whole family can plan on coming to the same place. “It’s designed to serve the whole family from birth to death,” Wertheimer said. Throughout the center, there will be a renewed effort to stress preventative medicine, she said. Havre Daily News/Eric Seidle Registered nurse Malissa Chinadle inputs patient information on the computer Thursday at Northern Montana Health Care’s new Family Medical Center.
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Kicking the habit HELP Committee helps chip away at tobacco industry
John Kelleher news@havredailynews.com The battle to curb cigarette smoking in the public, and especially in the young, is making slow progress, reports Gal Simanton, a tobacco prevention specialist for the HELP Committee. Groups such as React, a student group at Havre High School, are working hard to reduce or eliminate youth smoking, she said. Cigarette smoking is “still a problem, but less of a problem than in the past,” she said. The student group is now involved in an effort to prohibit smoking at Eagles Manor, a senior citizens residence. Smoking is now prohibited for people moving into the Manor, she said, but some people are grandfathered into old rules. Five people can still smoke in their apartments, she said. Other residents, some who have respiratory problems, are concerned that the smoke may affect them, she said. Anti-smoking residents are proposing that smoking be limited to a certain area outside the manor, she said. A vote of residents may be held soon, she said. The student group will be helping those who want smoking prohibited, she said. Going forward, she said, education will be a key component of the effort to reduce smoking among young people and the general population. The group also wants to let people know about the resources that Montanas have to help them quit smoking. Despite the widespread efforts over recent decades, some people are still not aware of the health effects of smoking. The tobacco industry is spending millions of dollars each year convincing people to start or keep smoking, she said. The anti-smoking forces cannot match that kind of money, she said. React will be holding educational events at the school and are planning special efforts at football games and other sporting events to get their message across, she said. They plan activities during Red Ribbon Week, the week of Oct. 23. The week is set aside to promote healthy behaviors among students. Efforts are concentrated on reducing bullying, drug use and tobacco use in
high schools. The students will also be working on projects for the Great American Smokeout, to be held the third Thursday of November. On Smokeout Day, people are asked to quit smoking for just one day in hopes that this will lead to a permanent cessation. The American Cancer Society provides all kinds of materials on the dangers of smoking and tips on how to quit. In trying to convince people to quit smoking, her group tries to be as nonjudgemental as possible, she said, concentrating on the health problems that develop from smoking. React members have been involved in past years by taking part in lobbying efforts in Helena to secure anti-smoking legislation. They were strong supporters of the bill that banned smoking in taverns, restaurants and casinos. While they will continue to keep an eye out for legislation that will discourage smoking, Montana’s laws are already among the best in the region. The state has a $1.70 tax on a pack of cigarettes, much more than neighboring states. Wyoming and North Dakota, she said, have a 40-cent per pack tax. Other states have been far slower to ban smoking in public places, she said. Research shows that a hefty tax on cigarettes is a key factor in convincing people to quit, she said, especially among younger smokers. The Montana Quit Line is one of the best benefits the state provides to smokers, she said. By calling 1-800-QUITNOW or viewing MontanaQuitNow.com, people can enroll in the program that offers smokers a variety of options in their effort to get kick the habit. People are entitled to five free coaching session with coaches provided by the University of Utah. Specially designed quit programs are provided for every participants. They can get eight weeks of nicotine replacement therapy — patches, gum and lozenges. Adults can get Chantix, a drug that helps people quit. A prescription is needed for Chantix, but it is offered at very reduced rates. Specially trained people will provide culturally appropriate help to Natives who want to quit and special help is available to pregnant women. Programs such as these have helped chip away at tobacco use in Montana, she said. But there is still a lot to do to help people kick the habit.
Havre Daily News/Hi-Line Shopper
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Kicking the habit HELP Committee helps chip away at tobacco industry
John Kelleher news@havredailynews.com The battle to curb cigarette smoking in the public, and especially in the young, is making slow progress, reports Gal Simanton, a tobacco prevention specialist for the HELP Committee. Groups such as React, a student group at Havre High School, are working hard to reduce or eliminate youth smoking, she said. Cigarette smoking is “still a problem, but less of a problem than in the past,” she said. The student group is now involved in an effort to prohibit smoking at Eagles Manor, a senior citizens residence. Smoking is now prohibited for people moving into the Manor, she said, but some people are grandfathered into old rules. Five people can still smoke in their apartments, she said. Other residents, some who have respiratory problems, are concerned that the smoke may affect them, she said. Anti-smoking residents are proposing that smoking be limited to a certain area outside the manor, she said. A vote of residents may be held soon, she said. The student group will be helping those who want smoking prohibited, she said. Going forward, she said, education will be a key component of the effort to reduce smoking among young people and the general population. The group also wants to let people know about the resources that Montanas have to help them quit smoking. Despite the widespread efforts over recent decades, some people are still not aware of the health effects of smoking. The tobacco industry is spending millions of dollars each year convincing people to start or keep smoking, she said. The anti-smoking forces cannot match that kind of money, she said. React will be holding educational events at the school and are planning special efforts at football games and other sporting events to get their message across, she said. They plan activities during Red Ribbon Week, the week of Oct. 23. The week is set aside to promote healthy behaviors among students. Efforts are concentrated on reducing bullying, drug use and tobacco use in
high schools. The students will also be working on projects for the Great American Smokeout, to be held the third Thursday of November. On Smokeout Day, people are asked to quit smoking for just one day in hopes that this will lead to a permanent cessation. The American Cancer Society provides all kinds of materials on the dangers of smoking and tips on how to quit. In trying to convince people to quit smoking, her group tries to be as nonjudgemental as possible, she said, concentrating on the health problems that develop from smoking. React members have been involved in past years by taking part in lobbying efforts in Helena to secure anti-smoking legislation. They were strong supporters of the bill that banned smoking in taverns, restaurants and casinos. While they will continue to keep an eye out for legislation that will discourage smoking, Montana’s laws are already among the best in the region. The state has a $1.70 tax on a pack of cigarettes, much more than neighboring states. Wyoming and North Dakota, she said, have a 40-cent per pack tax. Other states have been far slower to ban smoking in public places, she said. Research shows that a hefty tax on cigarettes is a key factor in convincing people to quit, she said, especially among younger smokers. The Montana Quit Line is one of the best benefits the state provides to smokers, she said. By calling 1-800-QUITNOW or viewing MontanaQuitNow.com, people can enroll in the program that offers smokers a variety of options in their effort to get kick the habit. People are entitled to five free coaching session with coaches provided by the University of Utah. Specially designed quit programs are provided for every participants. They can get eight weeks of nicotine replacement therapy — patches, gum and lozenges. Adults can get Chantix, a drug that helps people quit. A prescription is needed for Chantix, but it is offered at very reduced rates. Specially trained people will provide culturally appropriate help to Natives who want to quit and special help is available to pregnant women. Programs such as these have helped chip away at tobacco use in Montana, she said. But there is still a lot to do to help people kick the habit.
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Quit Line helps Montanans break the habit
By HRDC Montana Tobacco Quit Line services • • • • • • • • •
A free personalized quit plan Five free pro-active cessation coaching sessions Eight weeks of free nicotine replacement therapy (gum, patches or lozenges). Callers who enroll in Quit Line services may be eligible for up to 8 weeks of free NRT. The Quit Line will explain to the caller how and when these medications will be mailed out. Chantix at a reduced cost ($50 co-pay per month for three months) Bupropion at reduced cost ($5 co-pay per month for three months) Free educational materials for health care providers as well as friends and families of tobacco users A fax referral system for health care providers who have patients that want to quit using tobacco (see provider link) Trained staff that offers culturally appropriate services for American Indians Pregnancy and Postpartum Program offers special services to women who enroll while they are pregnant.
You can reach the Montana Quit Line in two ways: • Call 1-800 QUIT-NOQ • Visit www.QuitNowMontana.com Bullhook clinic n Continued from page 3
There was no room at the hospital location, so dental offices were established at the Atrium Mall. In 2012, the clinic obtained a nearly $5 million grant that was designed to rehabilitate the historic Donaldson Hall at Montana State University-Northern. The building had fallen into disrepair over the years, and preservationists saw this as great way to keep the building in use. But a new administration at the campus saw things differently and backed out of the agreement. Then, the clinic got permission from the federal government to buy land and build the clinic across the street from Havre City Hall, more centrally located building. Before work could begin on the building, asbestos had to be removed from buildings that were to be demolished at the location. Bear Paw Development Corp. helped secure the money for the abatement. Close to 60 people attended the groundbreaking ceremonies July 14, 2013. Goldplated shovels were made for the special occasions. Then-board chairman Todd Hanson said praised the clinic staff for its work.
“This is seven years of dreaming and two years of focused planning to really get to where we are today,” he said. One of the shovel-wielders at the ceremony was U.S. Sen. Jon Tester, who had worked to obtain the grant money. “The bottom line is, once you get done, you’re going to have a beautiful piece of infrastructure that’s going to serve the people of this area in a way that you can be proud of,” Tester told the crowd. Tester was back at Bullhook Aug. 1 of this year, when the ribbon-cutting ceremony was held for the facility. This time, the clinic staff honored him by naming a training room in his honor. In a tearful dedication, the Elsie Rose St. Dennis Memorial Wall was dedicated. St. Dennis was one of the early board members and a fervent believer in the clinic travelling to Washington D.C. several times to lobby for its approval. She died four days before the clinic opened. Other than that, joy dominated the ceremony. “Wow, we did it,” said Cindy Smith, Bullhook CEO. “Just over a year ago, this was an empty lot,” Tester said. “Havre didn’t have a stateof-the art facility,” Tester said. “Now 13 months later, Havre has it.”
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Flu shot season hits US John Paul Schmidt jpschmidt@havredailynews.com The time of year for people to get their flu shots has come again. Health officials have changed their tunes, saying that some kids should get the nasal spray version of the flu shot and seniors will be urged to get a new kind of pneumonia shot along with their flu shot. "The best way to protect yourself against the flu is to get a flu vaccination," said Tom Frieden, the Centers for Disease Control and Prevention director. It is suggested by the government that children begin getting their flu shots starting at 6 months old. The flu kills 24,000 Americans a year, but only half of the population gets the shot every year, according to the CDC. Last year, the vaccination rates were highest for kids under 5 and seniors. A third of people 18 to 64 were vaccinated and hospitalization rates were highest in that
age group. Kim Larson, the program assistant at the Hill County Health Department, said that people can get their flu shots at any pharmacy or clinic. Brittne Zimmer administers the flu shots at Western Drug Pharmacy, and said she is only giving shots to adults 18 and up. Walmart is not administering shots until the end of October and did not know the age restrictions or prices as of yet. Larson said the Health Department administers 1,000 shots throughout the season and at their community flu shot clinic at the Havre High School Gymnasium Oct. 8 from 2 to 7 p.m. "This is the best way to protect yourself against getting influenza during each flu season," Larson said. She said their prices for the shots are $15 for kids 18 and younger, $25 for people 19 and older, $30 for the nasal spray and $50 for high dose flu shots, which are generally reserved for people 65 and older.
Havre Daily News/Hi-Line Shopper Family Medical n Continued from page 4 From the time they enter the front door, visitors and patients can see how the hospital has succeeded. The modern-looking building is bright and airy. Light from the outdoors fills the waiting room. There are still some finishing touches, Wertheimer said. But for the most part, the building is set to go. The building is attached to Northern Montana Hospital, making it easier for doctors to quickly get to the hospital if they need to. “The delivery room is just upstairs,” Wertheimer said. “And the emergency room is just down the hall if doctors have to take someone there.” Everything from the doctors’ offices to the examination rooms have been remodeled. The idea was to make the center a family wellness center where the whole family can plan on coming to the same place. “It’s designed to serve the whole family from birth to death,” Wertheimer said. Throughout the center, there will be a renewed effort to stress preventative medicine, she said. Havre Daily News/Eric Seidle Registered nurse Malissa Chinadle inputs patient information on the computer Thursday at Northern Montana Health Care’s new Family Medical Center.
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Family health care facilities combine Over the last year, planning, construction took place to move two departments into one building. Renovation cost $3.5 million.
More than a year ago, Northern Montana Health Care’s officials decided it was time to put the Family Medicine and OB/GYN departments under one roof. OB/GYN had been in Northern Montana’s East Clinic, while Family Medicine was in the West Clinic. Both the staff and patients would benefit from by putting the two under the roof, it was agreed. A 15,000-square-foot building attached to the hospital that once house the chemical dependency program and later the behavioral science department was sitting empty and seemed like the perfect location. So, over the last year, planning and construction took place to move the two departments into the the one building. The renovation cost $3.5 million. Finally, the weekend of Sept. 13 and 14 was D-Day. The staff had to close shop as usual Friday night, move everything, makes sure all was in working order and get it operational by Monday morning. Doctors and other staff joined in the effort. After a hectic weekend, by Monday morning, everything was set. The whole project went as smoothly as hoped. Patients so far have been very pleased w i t h t h e n ew b u i l d i n g s a i d We n d y Wertheimer, director of clinic nursing. “It went off without a hitch,” she said. Two weeks into the move, patients remain happy with the new building. From the start, Wertheimer said, the top goal was to make access to care easier for patients. And patient confusion was kept to a minimum. For several months, when patients made their appointments, they were told of the new addition and where they would find the building and offices “Doctors from the beginning said they weren’t concerned with nice, big offices for themselves,” she said. Instead,they were looking for ways to make it easier and more pleasant for patients. They wanted to improve patient flow so that people could get in and out faster. They want to make coming to the doctors more pleasant.
n Continued on page 5
Quit Day Here are some steps to help you get ready for your Quit Day: • Pick the date to quit smoking and mark it on your calendar. • Tell friends and family about your Quit Day. • Get rid of all the cigarettes and ashtrays in your home, car, and at work. • Stock up on oral substitutes — sugarless gum, carrot sticks, hard candy, cinnamon sticks, coffee stirrers, straws and/or toothpicks. • Decide on a plan. Will you use nicotine replacement
John Kelleher news@havredailynews.com
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treatment or other medicines? Will you attend a stop-smoking class? If so, sign up now. • Practice saying, “No thank you, I don’t smoke.” • Set up a support system. This could be a group program or a friend or family member who has successfully quit and is willing to help you. Ask family and friends who still smoke not to smoke around you, and not to leave cigarettes out where you can see them. • If you are using bupropion or varenicline, take your dose each day leading up to your Quit Day. • Think about your past attempts to quit. Try to figure out what worked and what didn’t. Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan. Some options include using nicotine replacement or other medicines, joining a stop-smoking class, going to Nicotine Anonymous meetings, using self-help materials such as books and pamphlets, or some combination of these methods. For the best
Helping a smoker quit: Do’s and Don’ts General hints for friends and family Havre Daily News/Eric Seidle Karrie Lien, MD, left, and Debbie Paulsen, PA-C look at an X-ray Sept. 25 at Northern Montana Health Care’s Family Medical Center.
The family medicine doctors at Family Medical Center are: • Carol Kerr • Karrie Lien • Michael Nolan • Jeremy Patrick • Debbie Paulsen • Jessica Sheehy • Britney Wever
The OB/GYN doctors at Family Medical Center are:
• Fatima Abdulai • Anita Kellam • Margo Muntz
American Cancer Society • Do respect that the quitter is in charge. This is their lifestyle change and their challenge, not yours. • Do ask the person whether they want you to ask regularly how they’re doing. Ask how they’re feeling — not just whether they’ve stayed quit. • Do let the person't know that it’s OK to talk to you whenever they need to hear encouraging words. • Do help the quitter get what they need, such as hard candy to suck on, straws to chew on, and fresh veggies cut up and kept in the refrigerator. • Do spend time doing things with the quitter to keep their mind off smoking – go to the movies, take a walk to get past a craving (what many call a “nicotine fit”), or take a bike ride together. • Do try to see it from the smoker’s point of view — a smoker’s habit may feel like an old friend that’s always been there when times were tough. It’s hard to give that up. • Do make your home smoke-free, meaning that no one can smoke in any part of the house. • Do remove all lighters and ash trays from your home. Remove anything that reminds them of smoking • Do wash clothes that smell like smoke. Clean carpets and drapes. Use air fresheners to help get rid of the tobacco smells — and don’t forget the car, too. • Do help the quitter with a few chores, some child care, cooking — whatever will help lighten the stress of quitting. • Do celebrate along the way. Quitting smoking is a BIG DEAL! • Don’t doubt the smoker’s ability to quit. Your faith in them reminds them they can do it. • Don’t judge, nag, preach, tease, or scold. This may make the smoker feel worse about him or herself. You don’t want your loved one to turn to a cigarette to soothe hurt feelings. • Don’t take the quitter’s grumpiness personally during their nicotine withdrawal. Tell them that you understand the symptoms are real and remind them that they won’t last forever. The symptoms usually get better in about 2 weeks. • Don’t offer advice. Just ask how you can help with the plan or program they are using.
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chance at success, your plan should include at least 2 of these options. On your Quit Day: • Do not smoke. This means not at all — not even one puff! • Keep active — try walking, short bursts of exercise, or other activities and hobbies. • Drink lots of water and juices. • Start using nicotine replacement if that’s your choice. • Attend a stop-smoking class or follow your self-help plan. • Avoid situations where the urge to smoke is strong. • Avoid people who are smoking. • Drink less alcohol or avoid it completely. • Think about how you can change your routine. Use a different route to go to work. Drink tea instead of coffee. Eat breakfast in a different place or eat different foods.
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Fighting breast cancer – what you can do October is National Breast Cancer Awareness Month By Jacqueline Stiff, MD UnitedHealthcare vice president, Health Care Strategies When it comes to breast cancer, spreading the word means spreading the cure so talk with your loved ones this month about the importance of breast cancer screenings and the risk factors associated with the disease. Despite progress in the fight against the disease, the Centers for Disease Control and Prevention (CDC) estimates that each year more than 200,000 women will be diagnosed with breast cancer. The American Cancer Society estimates that about one in eight women in the United States will be diagnosed with breast cancer at some time in their lives. The chance of breast cancer increases with age. A woman in her 70s is twice as likely to have breast cancer than a woman in her 40s. But incidence numbers tell only half of the story. Equally important are rates of survival. Due in part to public awareness campaigns, more women are beating breast cancer by taking charge of their own breast health. According to the American Cancer Society, about 67 percent of women aged 40 and older in the United States had a mammogram in the past two years, compared to only 29 percent in 1987. Today, the five-year survival rate of women who are diagnosed early is more than 90 percent, and the primary reason is early detection.
Risk Factors Although no one knows yet how to prevent breast cancer, certain risk factors have
been linked to the disease. They include: • Age: the chance of getting breast cancer increases as a woman gets older • Family History: having a mother, sister or daughter who has had breast cancer • Long-term usage of hormones (HRT); oral contraceptive agents • Longer time menstruating: women who started menstruating before age 12 or continued after age 55 are at greater risk • Having no children or had their first child after age 30 • Personal history of breast cancer or ovarian cancer • Lack of breast feeding • Genetic conditions (e.g., BRCA 1 or BRCA 2 genes), but this only applies to about 1 percent of women with breast cancer.
tables, and exercising.
African-American women at risk
Screening is important for all women, especially for African Americans. According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer among African-American women with an estimated 27,000 new cases this year. Although at lower risk of actually developing breast cancer than Caucasian women, African-American women are more likely to die from breast cancer. The American Cancer Society states that part of the reason
is that African-American women have faster-growing tumors so the cancer spreads more quickly, which makes screening tests even more important. Hispanic, Asian and Native-American women have a lower risk of getting and dying from breast cancer.
Spread the word Recognizing October as Breast Cancer Awareness Month is a good reminder for everyone to create awareness about the importance of breast cancer screenings and for women to talk with their doctors about breast health. By spreading the word, you can help efforts to reduce the number of diagnoses and deaths from breast cancer.
Screening is key
Other possible signs of breast cancer include:
• Swelling of all or part of a breast (even if no distinct lump is felt) • Skin irritation or dimpling • Breast or nipple pain • Nipple retraction (turning inward) • Redness, scaliness, or thickening of the nipple or breast skin • Nipple discharge (other than breast milk)
n Continued from page 2 If low-income patients need specialists to treat them, Bullhook can provide coupons to help them pay, even with doctors who often don’t accept Medicaid patients, she said. “It’s hard for some people to be able to get to Great Falls,” Fox said. The long road to the new clinic started in early 2005 when the clinic was part of the health department. The recently formed Hill County Health Consortium decided the year before that the number one health priority in the county was a place that could provide health care to the needy, paying fees on an income-based sliding scale, as well as people on Medicaid, Medicare and Montana Healthy Kids. Federal funds were cut in 2006, and Bullhook reorganized as an independent nonprofit group. That enabled it to apply for federal and state grants. In 2007, it secured a Community Health Center grant. It opened up in expanded facilities in a building adjacent to Northern Montana Hospital, just east of the hospital itself. In 2008, the clinic responded to a growing need for dental care. The lack of dentists in the area made itdifficult for people on limited income — and many other people — to obtain dental care.
Havre Daily News/Eric Seidle Dental assistant Alicia Richmond preps for a patient at Bullhook Community Health Center Sept. 25.
Signs and symptoms of breast cancer
Bullhook clinic
n Continued on page 8
Screening is key for early detection. Different organizations have different recommendations for screening, so women should talk to their doctors about their risk to determine the right age to begin breast cancer screenings. "High-risk" women may need mammograms at an earlier age or more often than "average-risk" women. Mammograms are not foolproof. They can be normal when breast cancer is present, so women should see their doctor right away if they find any change in their breasts, such as a lump or nipple discharge that is not breast milk. In addition to screening, it is a good idea to incorporate a healthy lifestyle to reduce the risk of breast cancer. This includes limiting alcohol, controlling weight by eating less fat and more fruits, whole grains and vege-
Widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Still, some breast cancers are not found by mammogram, either because the test was not done or because, even under ideal conditions, mammograms do not find every breast cancer. The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new breast mass or lump or breast change checked by a health care professional experienced in diagnosing breast diseases.
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Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast tissue is large enough to be felt. Swollen lymph nodes should also be reported to your doctor. Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to your doctor so that he or she can find the cause.
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It’s been quite a decade for Bullhook Community Health Clinic With the opening of a new $7.2 million facility in downtown Havre, the clinic now houses all of its services
easier. There is a private dental station for young people who might be especially unhappy and may be expressing an opinion in a vocal way. A new telemedicine station allows people to show their injuries and talk directly to a doctor in New Jersey via a television set up. The facility is open to all people. It accepts all forms of insurance, Fox said. And it is especially attractive to people in need. There is a sliding-fee scale based on income. Medicaid patients are welcome.
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By Centers for Disease Control and Prevention
What are the symptoms of EV-D68 infection?
An uncommon virus, enterovirusD68, has spread across 12 states to cause respiratory illnesses. Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Montana, New York, Oklahoma and Pennsylvania have more than 130 confirmed cases between them, including the five cases recently confirmed in Montana. According to an Associated Press story, the virus can cause mild to severe respiratory illness. Children with asthma are especially vulnerable to the virus and, in some extreme cases, patients are put on life support for breathing difficulties, though the virus has not been reported to have caused any deaths. It is not known what triggered the outbreak or whether it is getting worse or not. Havre Daily News/Eric Seidle The new waiting lobby at the Bullhook Community Health Center.
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Enterovirus- Questions, answers about Enterovirus-D68 infection D68 spreads across 12 states John Paul Schmidt jpschmidt@havredailynews.com
John Kelleher news@havredailynews.com Bullhook Community Health Center started out in the Hill County Health Department offices where people in need could get basic health care. The clinic’s new $7.2 million facility in downtown Havre is a two-story, bright, light and airy facility that provides some of the latest technologies in health care. Mental health services are available, along with addiction counseling, family care and dental services. When patients enter the building, they are in the Tillie Patterson Waiting Room, named after a woman who helped out financially with the clinic over the years. The light flows into the waiting room, making things a bit more pleasant for people who may be under the weather. At the front, there is a plant that was purchased when the staff moved into the new building last month. Next to it is a similarsized plant the clinic purchased when it moved into its old building on the Northern Montana Health Care campus. The new facility was built with funds from the federal Affordable Care Act. Colleen Fox, an executive assistant at the clinic, beams as she shows off the new facility to visitors. There are more dental stations. Each of them face to the outside. People can see 4th Street and 5th Avenue below. The natural light may make an unpleasant situation a bit
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Enterovirus-D68 can cause mild to severe respiratory illness. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Severe symptoms may include wheezing and difficulty breathing. See EV-D68 in the U.S., 2014 for details about infections occurring this year.
How does the virus spread?
Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.
What time of the year are people most likely to get infected? In the United States, people are more likely to get infected with enteroviruses in the summer and fall. Cases are likely to decline later in the fall. Keep your child from getting and spread-
ing Enterovirus-D68
ting worse.
Who is at risk?
What are the treatments?
In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become ill. That's because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.
There is no specific treatment for people with respiratory illness caused by EV-D68. For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children. Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68.
EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat. Many hospitals and some doctor’s offices can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. Some state health departments and CDC can do this sort of testing. CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are get-
How can I protect myself?
How is it diagnosed?
You can help protect yourself from respiratory illnesses by following these steps: Wash hands often with soap and water for 20 seconds, especially after changing diapers. Avoid touching eyes, nose and mouth with unwashed hands. Avoid kissing, hugging and sharing cups or eating utensils with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick. There are no vaccines for preventing EV-D68 infections.
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