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Influenza vaccinations recommended with flu season almost here Rachel Jamieson rjamieson@havredailynews.com

Flu season is right around the corner and people can stop by the locations offering vaccinations to reduce the chance of contracting the illness.

Medical Department Manager Desirée Norden of Havre’s Bullhook Community Health Center said Bullhook will be offering influenza vaccines to its patients starting the end of September, beginning of October.

Hill County Public Health Director Kim Larson said the majority of their influenza vaccine is delayed in shipment, however, they had 90 doses as of Sept. 20, when this article was being written.

“If you are wanting a flu shot now, come in on Tuesday’s during our regular hours and we will gladly give you one,” Larson said. “We will have our schedule of clinics out to the community as soon as we can. If you have questions, please call us at 4002415.”

The Hill County Health Department’s hours are 8 a.m. to noon and 1 to 5 p.m.

The Centers for Disease Control and Prevention defines a flu shot as a vaccine against the influenza virus.

The CDC webpage at https://www.cdc.gov/flu/ index.htm provides tips for people to prevent the flu, recognize symptoms, get treatment, and find flu surveillance and activity in the United States.

■ See Flu vaccine Page A2 Havre Daily News/Colin Thompson Influenza vaccine sits on a table at Bullhook Community Health Center.

Blaine County’s Sweet Medical Center offers health services Derek Hann dshann@havredailynews.com Blaine County’s Sweet Medical Center has a number of programs in the area to help increase care for communities across the Hi-Line, Sweet Medical Center Nurse Practitioner Lindsay Rucinsky said.

Sweet Medical Center has two clinics, one in Chinook, located at 419 Pennsylvania St., the Chinook Medical Center, and the other in Harlem, located at 116 Main St. South, inside the Little Rockies Retirement Center.

The Sweet Medical Center was first established in 1988, the same year the center’s founder Lloyd D. Sweet died.

Sweet also helped fund and establish the Sweet Home, a nursing home in Chinook Sweet first established in 1969.

Rucinsky added that Sweet Medical Center is not the Sweet Home and they are completely separate entities.

The Chinook location of the medical center is open Monday through Friday from 7:15 a.m. to 5:45 p.m.

The Harlem clinic is open Tuesday through Thursday from 8 a.m. to 5 p.m.

Sweet Medical Center receives some of its funding from the U.S. Department of Health and Human Services Health Resources and Services Administration, it’s

website says. The center also offers services such as dental, vision and mental health, pharmacy, and transportation assistance for medical services. “(Sweet Medical Center) is committed to helping our patients afford health care,” it added.

The center also offers assistance to patients who may not be able to afford health care, it says.

“We ask every patient to complete our HealthShare Partnership assessment to ensure we’re doing all we can to help,” the website says about applying for the sliding fee scale. “If you know your income is above the 200 percent poverty level listed, simply write declined.”

“If you do qualify for assistance, based on completion of the application and income verification, your appointments will be discounted based on the sliding fee level associated with your household income and family size,” it says.

Rucinsky said one of the long-standing programs the center has is offering laboratory work for patients at a reduced cost. She added that the program is to help people who don’t have insurance afford lab work at a discounted price. The lab indicates the service applies to things like the amount of electrolytes, thyroid and lipids.

“Some people can’t afford that without

www.havredailynews.com tives meet to investigate individual suicides with an eye toward prevention. The review group might include health care organizations to look for recent visits to the doctor; veterans’ organizations to check service records; law enforcement; faith leaders; pain clinic managers; and mental health support groups.

The idea, Repp said, isn’t to point fingers.

It’s to look for system-level interventions that might prevent similar deaths.

“We were able to identify touchpoints in our community that we had not seen before,” Repp said.

For example, data revealed a surprising number of suicides at hotels and motels. It also showed a number of those who killed themselves had experienced eviction or foreclosure or had a medical visit within weeks or days of their death. It revealed that people in crisis regularly turn their pets over to the animal shelter.

But what to do with that information?

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to h e l p . T h a t ’s w h e re D e b ra D a r m a ta , Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

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Adam Wickham for KHN Washington County, Ore., epidemiologist Kimberly Repp poses for a photograph. In 2012, Repp was asked by county officials to study suicide. She accompanied one of the county medical examiner’s death investigators on his grim rounds for more than a year.

“Nothing can prepare you for what you’re going to see,” she says.

From 2012 to 2018, Washington County’s suicide rate decreased by 40 percent, preliminary data shows. To be sure, though, 68 people died by suicide here last year, so preventing even a handful of cases can lower the rate quite a bit.

Taking the Idea Elsewhere Repp cautions that the findings can’t be generalized. What’s true in suburban Portland may not be true in rural Nebraska or the city of San Francisco or even suburban New Jersey, for that matter. Every community needs to look at its own data.

Still, Jay Carruthers, who runs New York’s Office of Suicide Prevention, saw the potential.

“To be able to close the loop and connect (the data) to prevention? That’s the beauty,” he said.

This year, the state is beginning to test a similar system in several counties.

In Northern California’s Humboldt County, public health manager Dana Murguía had been frustrated for some time that local prevention plans weren’t making a dent.

“I said, ‘We don’t need another plan. We need an operations manual.’ That’s what I feel Dr. Repp has given us.”

Humboldt began using a Washington County-style checklist this year, and county officials have identified several unexpected touchpoints, including public parks and motels where people have died by suicide.

Now, those sad facts can become action plans.

In Colorado, a different effort to reduce suicides also began with extensive data analysis. There, they realized that while youth

suicide has understandably been a focus, but the biggest numbers are among older men.

They’ve not only crafted materials specifically for men in crisis, but they’ve also created materials for specialized groups, such as veterans, farmers and construction workers.

“What was unexpected to me was how empowering these data would be to so many different people to make change,” Repp said — including Lovato and the other death investigators. “To know that they’re actually keeping the living alive is really powerful.”

If You Need Help If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Chat, both available 24 hours a day, seven days a week.

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Diabetes: Monitor, supplies require prior authorization from insurance provider ■ Continued from page 3 new tool consistently to manage his diabetes have been stymied by insurance problems that began about a year ago.

The newest Dexcom continuous glucose monitor has three parts: a sensor that measures glucose levels, a transmitter that sends out the sensor’s readings wirelessly and a receiver that displays those readings on a screen.

For each of these parts, Peralta needs “prior authorization” — a requirement that his physician get approval from his insurance company before prescribing the device.

The Dexcom sensors last about 10 days each, and Peralta’s insurance allows him to buy a three-month supply at a time. But he also has to get prior authorization for each supply, meaning every three months his doctor needs to reconfirm with his insurance company that the sensors are medically necessary. Same goes for the device’s transmitters — which last about six months each.

“I have to jump through hoops and they have to jump through hoops to get information from my insurance to get authorization,” Peralta said in frustration, adding that “for the last year, basically every time there’s been something that’s gone wrong.”

“Prior authorizations are in place to protect patients, to improve safety and to try to make sure that the care they receive is as safe as possible and also as affordable as possible,” said Kate Berry of the trade group America’s Health Insurance Programs.

But to Peralta, the requirement is a bur-

den.

The most recent snafu happened in March. Peralta ordered a new supply of sensors directly from Dexcom but said the company submitted a request for approval of a new transmitter as well. And because his insurance approves the sensors and transmitters on different authorization timelines, the whole claim was denied.

Peralta estimates he spent four hours on the phone with Dexcom and his insurer over the next month and a half to sort it all out.

During that time he had to revert to fingerstick tests.

“It’s maddening,” Peralta said. “If I do not have my proper management of this disease, I’m going to die from it. And they’re making it as difficult as possible.”

A burden on doctors, too Prior authorizations have become a major concern of physicians across the U.S. health care system, as evidenced by a December survey by the American Medical Association.

Of the 1,000 physicians surveyed, 91 percent said prior authorizations “have a negative impact on patient clinical outcomes”; 75 percent said the requirements “can at least sometimes lead to patients abandoning a recommended course of treatment”; and 28 percent said the prior-authorization process had “led to serious or life-threatening events” for their patients.

“In my practice, we have five individual

physicians, and we hired five full-time employees whose primary duty is obtaining prior authorization and dealing with insurance companies,” said Dr. Bruce Scott, an otolaryngologist from Kentucky and speaker of the AMA House of Delegates.

“Prior authorization is a burden on providers and diverts valuable resources,” Scott said. “That’s a problem.”

The AMA has even created a website that catalogs stories of patients and providers who say they’ve struggled to gain access to important medical products and procedures because of problems with getting prior authorization from insurers — everything from pain medication for a cancer patient to X-rays in the ER. Scott said the AMA doesn’t expect insurers to completely do away with requirements for prior authorization, “but we believe that it should be focused and that it should be betterplanned.”

The American Association of Clinical Endocrinologists — an organization of the physicians whose specialty is often associated with diabetes treatment — goes further.

“We feel that physicians that are specialists in endocrine disease should not be required to fill out prior authorizations for endocrine treatments,” said Dr. Scott Isaacs, an endocrinologist from Atlanta and a member of the board of directors of AACE. “It’s a huge burden for the patients trying to get this sorted out. Sometimes it’s red tape; sometimes it’s a true denial,” Isaacs

said. “It’s a huge burden for the doctors as well, and the doctors resent it.”

Berry, of America’s Health Insurance Programs, acknowledges there’s room for improvement in the prior-authorization process. In fact, in January 2018, the AMA and AHIP signed a consensus statement identifying five areas for improvement. It was cos i g n e d by t h e A m e r i c a n H o s p i ta l Association, the American Pharmacists Association, the Blue Cross Blue Shield A s s o c i a t i o n a n d t h e M e d i c a l G ro u p Management Association.

Who bears the greatest burden?

For Peralta, the ultimate burden of getting all these prescriptions filled falls on him and other patients like him.

After his latest mix-up with the sensors in March, he discovered the battery in his transmitter had died.

Peralta made another frustrated call to Dexcom, and recently got a complimentary transmitter to get him back on the system while his formal order goes through the approval process.

“I’m quite nervous about what’s going to happen again in two months when I am needing to call in orders again,” Peralta said.

“Am I going to have to go through this whole thing over again?”

—— This story is part of NPR’s reporting partnership with Kaiser Health News.

Follow the data — to medical offices, motels and even animal shelters — to prevent suicides Maureen O’Hagan Kaiser Health News HILLSBORO, Ore. — On Kimberly Repp’s office wall is a sign in Latin: Hic locus est ubi mors gaudet succurrere vitae. This is a place where the dead delight in helping the living.

For medical examiners, it’s a mission.

Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, isn’t a medical examiner; she’s a microbiologist with a Ph.D. And as the Washington County epidemiologist, she was most accustomed to studying infectious diseases like flu or norovirus outbreaks among the living.

But in 2012 she was asked by county officials to look at suicide. The request led her into the world of death investigations and also appears to have led to something remarkable: In this suburban county of 600,000 just west of Portland, the suicide rate now is going down. It’s remarkable because national suicide rates have risen despite decades-long efforts to reverse the deadly trend.

While many factors contribute to suicide, officials here believe they’ve chipped away at this problem through Repp’s initiative to use data — very localized data that any jurisdiction could collect. Now Repp’s mission is to help others learn how to gather and use it.

New York state has just begun testing a sys t e m l i ke h e rs. H u m b o l d t C o u n t y, California, is implementing it. She’s gotten inquiries from Utah and Kentucky. Colorado, meanwhile, is using its own brand of data collection to try to achieve the same kind of turnaround.

Following the Death Investigators Back in 2012, when Repp looked at the available data — mostly statistics reported periodically to the federal Centers for Disease Control and Prevention — she could see that suicide was a big problem and that rates were highest among older white men.

But, beyond that, the data didn’t offer a lot of guidance. Plus, it lagged two years behind.

She returned to her bosses.

“I can tell you who has the highest suicide rate, but I can’t tell you what to do about it,” she recalled telling them. “It’s too broad.”

So she turned to the county medical examiner’s death investigators. They gather information at every unnatural death scene to determine the cause — say, drowning or gunshot) and manner — homicide, suicide and accident. It’s an important job, but a grim one, and it tends to attract unusual personalities.

Repp mustered the courage to introduce herself to one of the investigators, Charles Lovato. “I said, ‘Hi, my name is Kim and I was hoping to go on a death investigation with you.’ And he’s like, ‘You’re that weirdo that does outbreak investigations, aren’t you?’ And I’m like, ‘You’re the weirdo that does death investigations.’”

The gambit worked. Repp accompanied Lovato on his grim rounds for more than a year.

“Nothing can prepare you for what you’re going to see,” she said. “It gave me a very healthy dose of respect for what they do.”

She studied the questions Lovato asked friends and family of the deceased. She watched how he recorded what he saw at the scene. And she saw how a lot of data that helped determine the cause and manner of death never made it into the reports that state and federal authorities use to track suicides. It was a missed opportunity.

Collecting Data on the Dead to Save Lives Repp worked with Lovato and his colleagues to develop a new data collection tool through which investigators could easily record all those details in a checklist. It included not only age and cause of death, but also yes/no questions on things like evidence of alcohol abuse, history of interpersonal violence, health crises, job losses and so on.

In addition, the county created a procedure, called a suicide fatality review, to look more closely at these deaths. The review is modeled on child fatality reviews, a nowmandatory concept that dates to the 1970s.

After getting the OK from family members, key government and community representa-

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She added that Sweet Medical Center partners with a laboratory in Billings to help with getting the labs done at a reduced price. She said this allows more people to be screened before serious health issues occur.

One of the biggest health concerns for the area is mental health, Rucinsky said.

Chinook and Harlem are secluded areas and they are far away from larger areas, which makes it difficult to utilize resources for mental health, she said. But Sweet Medical Center does have a number of counselors and treatments available to help people with mental health concerns or issues.

She added that at the beginning of this year, the center also started implementing

the medication-assisted treatment program, which is used for substance use disorders such as opioid abuse. She said that Sweet Medical Center has two nurses who are certified in the treatment program and with the implementation of medication-assisted treatment, hopefully more people in the area who struggle with drug abuse can receive treatment.

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Another big health concern for the area is diabetes, she said. She said people need to be more aware of the growing issue of diabetes.

She added that Sweet Medical Center is having a Diabetes Beat Down Race Oct. 19 at the Blaine County Fairgrounds to help raise awareness and funds for fighting diabetes.

Sweet Medical Center hosting premier Diabetes Beatdown Race Derek Hann dshann@havredailynews.com Sweet Medical Center will be hosting its premier Diabetes Beat Down Race Oct. 19 at the Blaine County Fairgrounds to raise awareness and funds to fight diabetes in the area, event organizer and Sweet Medical Center Nurse Practitioner Lindsay Rucinsky said.

“We are just really excited to do this,” she said.

Rucinsky, who is originally from Havre and is a Montana State University-Northern alumni, said that the idea for the event originated from the fact that diabetes is a huge issue in the area and across the state.

She added that promoting education and awareness of diabetes has been a passion of hers for a long period of time. A number of people in her family have been diagnosed with Type 2 diabetes.

Diabetes has a large effect on the region and the Hi-Line community, she said.

Montana has about 96,000 people with diabetes. This is approximately 10.9 percent of the adult population in the state with pre-

dominantly Type 2. She added that with the increased rate of childhood obesity medical professionals are also seeing Type 2 diabetes diagnosed at younger and younger ages.

She said that the main focus of the event is Type 2 diabetes, but added that Type 1 is equally as dangerous and is not preventable.

Type 1 is typically diagnosed in younger children whose pancreas is not functioning properly to create insulin to bring the person’s blood sugar down.

With Type 2, the person’s pancreas is working, but it is not able to produce enough insulin to bring down the person’s blood sugar because of the elevated amount of glucose in the person’s body, she added.

She said that Type 2 and Type 1 diabetes can affect the whole body if not properly treated, such as a person’s eyes, organs and limbs.

She added that a person with Type 1 or Type 2 is also more at risk to different diseases because the person’s immune system cannot keep up.

Type 2 diabetes can be directly affected by exercise and amount and choices of food, she said. She added that if a person is at

Flu vaccine: Jumphead text ■ Continued from page A1 “If a patient is uninsured, Bullhook provides services on our sliding fee scale, or discount, depending on the patient’s family size and income,” Norden said.

Larson said the charge at the Hill County Health Department for children 6 months to 18 years of age is $20; adults 19 and older $25; high-dose flu shot for people 65 and older is $50, and the department will bill the patient’s insurance.

Norden added that the risk of not getting a flu shot can be hospitalization, serious illness or even death, missed work and school, and spreading illness to friends, family and community members.

Larson said it’s especially important that certain people get vaccinated when they are at high risk of having serious flurelated complications or because they live with or care for people at high risk for developing flu-related complications.

High-risk categories include: • Pregnant women • Children younger than 5, but especially children younger than 2 years old

• People 50 years of age and older • People of any age with certain chronic medical conditions • People who live in nursing homes and other long-term care facilities • People who live with or care for those at high risk for complications from flu, including: — Health care workers — Household contacts of persons at high risk for complications from the flu — Household contacts and out of home caregivers of children less than 6 months of age because these children are too young to be vaccinated.

“During the 2018-2019 influenza season, 13,576 cases, 767 hospitalizations and 38 deaths, one pediatric, due to influenza were reported (in Montana) from all but one county in Montana,” Larson said.

For more information, people can go to the CDC website or visit their health care provider or a local health department, clinic or community health center.

risk of diabetes they should be eating a higher amount of protein, lower amount of fat, a balance of carbohydrates. People should also try to stay physically active, at least 30 minutes of moderate to intense exercise a day and stay away from sugary candies, sodas and fast-food.

The race will have three components, a 1-mile competitive run and fun run, and 3-mile and 5-mile competitively timed runs, she said. The organization Competitive Timing out of Whitefish will be giving every competitor a running badge so their times are marked in real time. The races will also be broken up into male and female categories, and the top runner in each category for each race will be given a prize at the end.

“We want it to be special,” she said.

People can preregister for the races by going to the events website at https://run-

signup.com/Race/MT/Chinook/DiabetesBe atdown?fbclid=IwAR1yEVm_8uGXpGxQINf w 5 3 g O CA- 9 C D n 7 g K 6 Z J 7 7 V B x F n i _ D _ FpLTxtATPmU or http://bit.ly/2kGOhLk or go to the Diabetes Beat Down Race Facebook page, she said.

The cost is $20 to register for the 1-mile race or fun run, $25 for the 3-mile race and $30 for the 5-mile race, she said. People can also register at the race. She added that everyone who competes will get a T-shirt, with the names of all the sponsors written on the back, and a “swag” bag.

The event will also have a variety of vendors, such as the Streatery, which will be providing healthy food for the event, she said. She added that the event will also have a number of craft vendors, as well as small local businesses from the area. Sponsors for the event are also invited to have booths, as well.

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Alzheimer’s and Dementia: The 10 warning signs you need to know

It’s not just insulin: Diabetes patients struggle to get crucial supplies

(StatePoint) Recognizing and taking steps to address the warning signs of Alzheimer’s and other dementias can be extremely challenging -especially in the early stages. It’s easy and common to dismiss cognitive changes in oneself or a family member as “normal aging.”

“Alzheimer’s is not a normal part of aging,” said Dr. Keith Fargo, director, scient i f i c p ro g ra m s a n d o u t re a c h a t t h e Alzheimer’s Association. “With normal aging, you may forget where you parked your car — that happens to all of us. But if you get in your car and get lost coming home — that’s not normal.”

Alzheimer’s is a fatal progressive disease that attacks the brain, killing nerve cells and tissue, affecting an individual’s ability to remember, think, plan and ultimately function. Today, more than 5 million Americans are living with Alzheimer’s. By 2050, that number is projected to skyrocket to nearly 14 million.

To help families identify signs early on, the Alzheimer’s Association offers 10 Warning Signs and Symptoms, a list of some common signs that can be early symptoms of Alzheimer’s or other dementias: 1. Disruptive memory loss. Forgetting recently learned information, asking the same questions over and over and increasingly relying on memory aids.

2. Challenges in solving problems.

From Kaiser Health News and National Public Radio

By Bram Sable-Smith In the first three months after getting his Dexcom continuous glucose monitor, Ric Peralta said, he reduced his average blood sugar level by 3 percentage points.

“It took me from not-very-well-managed blood sugar to something that was incredibly well managed,” said Peralta, a 46-yearold optician in Whittier, California., who was diagnosed with Type 1 diabetes in 2008.

Peralta was so enthused that he became a “Dexcom Warrior,” a sort of grassroots spokesman for the product. It became hard to imagine life without his new monitor, a device that lets him track the trends in his blood sugar 24 hours a day on his smartphone. And yet, he has spent weeks at a time without the device over the past year because of insurance restrictions. Physician groups and patients consider those rules burdensome, but insurers defend them as necessary.

Diabetes activists and legislators have started to focus attention on the surging price of insulin, leading to legislative pushes, lawsuits and congressional hearings. But insulin isn’t the only thing people with Type 1 diabetes are struggling to get. Managing the condition requires other essential, often lifesaving medical supplies. And patients frequently face hurdles in getting access to those supplies — hurdles put in place by insurance companies.

Changes in one’s ability to develop and follow a plan or work with numbers, such as having trouble following a familiar recipe or keeping track of monthly bills.

3. Difficulty completing familiar tasks.

Difficulty completing daily tasks, such as organizing a grocery list or remembering the rules of a favorite game.

4. Confusion with time or place. Losing track of dates, seasons and the passage of time.

5. Trouble understanding visual images and spatial relationships. Vision problems, which may lead to difficulty with balance or trouble reading.

6. New problems with words in speaking or writing. Trouble following or joining a conversation or a struggle with vocabulary.

For example, calling a “watch” a “handclock.”

7. Misplacing things and losing the ability to retrace steps. Putting things in unusual places and being unable to go back over one’s steps to find them again.

8. Decreased or poor judgment. Changes in judgment or decision-making when dealing with such matters as money and grooming.

9. Withdrawal from work or social activities. Changes in the ability to hold or follow a conversation can result in a withdrawal from hobbies or social activities.

10. Changes in mood and personality.

Mood and personality changes, such as con-

State Point It’s important to note that exhibiting one or more of these 10 warning signs does not mean someone has Alzheimer’s. In fact, these signs may signal other — even treatable — conditions. However, it’s important to talk to your doctor to understand what is driving cognitive changes so you can better manage the condition — whatever the diagnosis. fusion, suspicion, depression, fearfulness and anxiety.

To learn more about Alzheimer’s disease

and to find resources, visit alz.org, the website of the Alzheimer’s Association or call its 24/7, free Helpline at 800-272-3900.

A life-changing device Peralta learned about the latest version of the Dexcom continuous glucose monitor from the mother of one of his patients. He visited the company’s website and, within two weeks, the device was shipped to his front door.

“I still didn’t 100 percent appreciate exactly how it was going to change my life,” Peralta said. “It was amazing.”

Typically, people with Type 1 diabetes check their blood sugar by drawing a drop of blood from a finger and placing it on a disposable test strip that’s read by a blood glucose meter. Doctors suggest checking blood sugar this way between four and 10 times a day. These readings are crucial for helping people with diabetes manage their blood sugar — keeping it from getting too low, which can lead to sudden seizures and loss of consciousness, as well as from getting too high, which can cause vision loss and nerve damage and can even, over time, lead to amputations.

Instead, Peralta’s continuous glucose monitor gave accurate blood sugar readings every five minutes. That’s 288 readings a day, or about 278 more readings than even the most conscientious patients get the oldfashioned way.

“When I had to do the old-fashioned finger prick test, I was only doing that right before I ate, so I could see how much (insulin) I was supposed to take,” Peralta said.

People with Type 1 diabetes have to take multiple daily shots of insulin to keep their blood sugar within the normal range because their bodies stop producing the naturally occurring hormone.

Allison Zaucha for NPR Ric Peralta and his wife, Lisa, check his blood sugar. Both are both able to check Ric's blood sugar levels at any time, using the Dexcom app and an arm patch that measures the levels and sends the information wirelessly.

“I didn’t realize that I had rather severe (blood sugar) peaks and valleys in between my mealtimes,” Peralta said.

Tighter control of blood sugar can reduce the risk of heart disease, kidney failure and nerve damage. For Peralta, it also offered peace of mind.

The monitor sounds an alarm when his blood sugar gets dangerously low; Peralta said his co-workers have started bringing him sugary snacks when they hear the alarm, to help him raise his blood sugar back to normal. When he takes his family on road trips — a favorite activity — he no longer has to worry about the possibility of passing out while driving.

“It even syncs with my car so I can just say, ‘Siri, what’s my blood sugar?’ And it will come over the car stereo system,” Peralta said. “I’m safe for my family.”

Prior-authorization requirements When common chronic conditions such as diabetes are well-controlled, it prevents worsening disease and saves money for the health system and the patient.

But Peralta said his efforts to use this

■ See Diabetes Page 9

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Making the most of the Medicare Annual Election Period (StatePoint) Medicare Advantage plans are increasingly popular, offering robust benefits including vision, health, dental, drug coverage and more.

For the more than 22 million people with an MA plan, the Medicare Annual Election Period, or AEP, running from Oct. 15 to Dec. 7, is the only time each year when they can shop for alternate plans.

“Health care is one of the most important investments you’ll ever make,” said Brian Evanko, who heads Medicare for Cigna, which serves more than 3 million Medicare customers nationwide through its various plans. “For those unsatisfied with their MA plan, the AEP provides a valuable opportunity to shop for a new one that better meets their specific needs.”

Weighing your options this AEP? Consider the following tips from Cigna:

• Review changes. In late September, health plans send their current MA customers a document known as the Annual Notice of Change with information about plan changes for the upcoming year, including costs, benefits, available doctors and facilities. Don’t overlook this important document in the mail. It can help you determine if you need to change plans.

• Weigh extras. When comparing plans, pay attention to extra benefits not available in Original Medicare and consider whether you’re likely to use them. Some of the most popular are dental, vision, hearing and nocost access to fitness programs. Others

might include over-the-counter drug coverage and no-cost transportation to doctors and pharmacies.

• Consider other factors. Beyond cost, consider the doctors and facilities included in any given plan, making sure it includes your favorite physician. Check drug coverage, prices on your regular maintenance medications and whether it’s easy to see specialists. Also pay attention to co-pays, how much you’re required to pay out-ofpocket for doctor visits, and the deductible.

Are they affordable?

• Know yourself. Learn as much as you can about the different plan types and choose one that best suits your budget, lifestyle and health status. Of course, priorities change, which could prompt a need for a plan change.

• Don’t forget prevention. Many MA plans cover health screenings beyond those covered by Original Medicare. Talk to your doctor about which screenings are important for you given your age and health status.

Some MA plans may even provide rewards, such as gift cards, for completing certain screenings.

• Get assistance. Plan Finder, found at medicare.gov/find-a-plan, is an online tool available through the Centers for Medicare & Medicaid Services that helps you compare premiums, costs of medications and more.

You can see how plans are rated from one to five stars based on different quality measures. Additionally, many insurance plans offer seminars at no cost and with no obligation to sign up. You can also check health

State Point “Medicare is a great program, but it can be complicated, especially for those who are new to it,” Evanko said. “Seek out third-party resources and talk to friends and family who have been through the process, asking questions until you understand your options.” plans’ websites or call their customer service for more information. Local and state agencies on aging also connect older adults and caregivers with resources.

Protecting Yourself from Medicare Fraud (BPT) Every year, many seniors are targeted by scammers who want to steal their Medicare numbers to do things like rack up fake health care charges and commit identify theft. These scams hurt seniors and other people eligible for Medicare, cost taxpayers money, and result in higher health care costs for everyone. The good news is that you can protect yourself from fraud and help Medicare stop scammers in their tracks.

How to Spot Medicare Fraud The first step in protecting yourself from Medicare fraud is knowing how to spot it.

Over time, scammers have become very sophisticated and advanced. One of the latest scams you should look out for concerns genetic testing. Scammers are offering "free" genetic tests and claiming Medicare will cover it — so they can get your Medicare number and use it to commit fraud and identity theft. Other Medicare scams include offers for free or reduced-price medical equipment, consultations or health services. These scams can happen anywhere, including through telemarketing calls,

health fairs and even knocking on doors.

Last year, the Centers for Medicare & Medicaid Services removed Social Security numbers from all Medicare cards. Even with this change, people with Medicare should still guard their Medicare card and treat it like a credit card, check Medicare claims summary forms for errors, and be wary of any unsolicited requests for your Medicare number. Medicare will never call beneficiaries to ask for or check Medicare numbers.

To protect yourself from Medicare fraud, keep these things to "do" and "don't do" in mind: • DO protect your Medicare number and treat your Medicare card like it's a credit card.

• DO remember that nothing is ever free.

Don't accept offers of money or gifts for free medical care.

• DO review your Medicare claims for errors and problems, including things like fake charges, double billing or other fraudulent activity, and waste or abuse.

• DO visit http://www.medicare.gov/ fraud to learn more about how you can pro-

tect yourself from Medicare fraud.

• DON'T give your Medicare card or Medicare number to anyone except your doctor or people you know should have it.

• DON'T accept medical supplies, equipment or genetic testing kits from door-todoor salesmen or solicitors at a mall or fair.

• DON'T let anyone persuade you to receive health care services you don't need, such as genetic testing. Only make these decisions with your doctor.

Reporting Medicare Fraud If you think you may have spotted fraud, you should report it right away. No matter how minimal the information you share is, it could be the missing piece to stopping the next fraud scheme. If you are a victim of fraud, know that you won't be penalized or lose your coverage for reporting it. Even if you are not a victim, it's important to report any fraud scams you encounter to Medicare.

Report suspected fraud by calling 1-800MEDICARE or going online through the Office of the Inspector General.

I n fo r m a t i o n p rov i d e d by t h e U . S .

Department of Health & Human Services.

HEALTH GUIDE

www.havredailynews.com

October 2019

5

4 Tips for Higher-Quality Sleep (StatePoint) Sleep is essential to good health.

Unfortunately, over a third of Americans are not getting enough sleep, according to the Centers for Disease Control and Prevention.

Over time, sleep deprivation can take a toll on one’s overall wellness.

“Like air, water and food, sleep is like fuel for your body,” said Dr. Janet Kennedy, sleep specialist at Leesa, a mattress company on a mission to help consumers get better sleep.

Do you have trouble getting to sleep or staying asleep? If you’re feeling more wired than tired at bedtime, it may be time to improve your sleep routine. Check out Kennedy’s suggestions for a better night’s rest: • Cool down: If your first quiet moment to relax comes when you get into bed, your mind will race to try to get all its thinking done. Shut down phones and other devices at least one hour before bed and set an even earlier cutoff time for work. Much the way the body needs a cooldown period after exercise, your mind needs a cooldown period to process the day and unwind before transitioning into sleep mode.

• Make a routine: Bedtime routines are important, but they don’t have to be elaborate. It helps to create a series of steps to be done in a consistent order. This could include stretching, breathing exercises or journaling.

“I recommend keeping it simple and ending by reading fiction,” Kennedy said.

“Reading is one of the most powerful sleep associations I have found. It gives the mind a place to go while the body settles down and tells you when it’s ready to sleep.”

• Create a sanctuary: Your bed should be a place you feel lucky to be. That means setting it up for ultimate comfort. No matter what type sleeper you are, your pillows and mattress should properly support and align the neck and spine so your body will relax quickly, instead of struggling to find a comfortable sleeping position. Temperature control is also important for drifting into sleep.

Pillows and bedding should stay cool through the night. Look for a mattress designed to offer superior support as well as breathability and temperature regulation, such as those from Leesa. The brand also offers hybrid pillows made with fibers featuring a ventilated gel comfort layer. Customizable, they are designed to keep sleepers cool and comfortable.

• Don’t struggle: If you aren’t falling asleep as quickly as you want, or if you are struggling with insomnia, stop trying to fall asleep. The body knows how to sleep and will sleep when it’s ready. Wait until you are very sleepy before going to bed and then read, listen to an audio book, or do something quiet to distract your mind until sleep comes to you.

State Point Sleep is meant to restore the mind and body, not cause stress, so if you’re having trouble getting enough of it, it may be time to tweak your nighttime routine.

Technology advances benefit women undergoing breast cancer treatment (BPT) One out of eight women will get breast cancer in her lifetime. It's a staggering statistic, but one made less ominous by the fact that finding breast cancer early makes it easier to treat or cure.

Thanks to technological advances in detection and new treatment approaches, women diagnosed with early-stage breast cancer have options. For instance, they can opt to keep their breast, with less invasive surgery and breast-conserving treatment, or BCT. BCT focuses on removing only the tumor, allowing women to keep their healthy breast tissue. Being aware of these choices can help women who are grappling with a breast cancer diagnosis resist the impulse to panic, and instead take a deep breath, press the proverbial pause button and calmly create a plan of action.

Most women diagnosed with early-stage breast cancers choose to have BCT rather than mastecto-

my. In fact, the American Cancer Society estimates that 59 percent of women with an early breast cancer diagnosis — Stage 1 or 2 — undergo breast-conserving surgery versus 36 percent of women who decide to have a total mastectomy.

Research has shown that breastconserving surgery — typically a lumpectomy — followed by radiation therapy is as effective as a mastectomy in decreasing the risk of local cancer recurrence for most women.* Lumpectomy entails removal of just the tumor and surrounding tissue, while mastectomy necessitates removal of the entire breast.

The goal of breast-conserving surgery is to remove all detectable cancer cells. Precision in locating the tumor may increase the probability of complete cancer removal, which can help reduce the chances of needing a second surgery.

Previously the process of pin-pointing the location of the tumor could only be done in an invasive man-

ner with a wire inserted into the breast on the same day as surgery.

Today, breast conserving surgery is easier and less stressful for the patients with the wire-free SCOUT Radar Localization System, which uses safe, non-invasive, radar technology for precise guidance during the surgery. With this approach, a tiny, passive reflector about the size of a grain of rice is placed at the tumor site at any time prior to surgery. On the day of the surgery, the surgeon uses the system to activate the reflector, which enables the surgeon to precisely locate and remove the tumor. If tumors are located accurately the first time, it is more likely that any additional treatments can occur faster. What's more, the ability to strategically plan the incision may result in better cosmetic outcomes.** Another benefit of this wire-free approach is that it helps decrease patient wait time on the day of surgery, making the experience less stressful for women and their fami-

lies. "Surgeons tell us that their patients are impressed with the benefits offered by this technology, including shorter procedure times and decreased anxiety," said Nicole Priest, MD, Chief Wellness Officer at Merit Medical, the company behind the system. "My entire career has been about helping people improve their health by making positive, impactful choices," Priest said, "and that is exactly what women do when they know their treatment options and have breast conserving surgery at one of the 520 hospital systems across the country that have this system on board."

There are other tumor localization systems, but none with the extensive track record of SCOUT. "Since it was introduced, SCOUT has been used in the treatment of close to 100,000 breast cancer patients," Priest said. When surveyed, 97 percent of women said they would recommend the technology to other women.

SCOUT, as well as Merit's b ra c hy t h e ra py sys t e m , SAV I Brachy, are pivotal parts of the paradigm that help women with an early breast cancer diagnosis. In addition to its role as a tumor localization tool, SCOUT is also used to tag lymph nodes and tumors prior to neoadjuvant therapy, which is chemotherapy administered prior to surgery. And SAVI Brachy delivers radiation directly to the lumpectomy site where the radiation is needed most, helping to spare surrounding healthy tissue. * American Cancer Society.

Cancer Treatment and Survivorship Facts & Figures, 2014-2015. Atlanta: American Cancer Society; 2014 ** Cox, C. et al. A Prospective Single Arm, Multi-Site Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Localization of Non-Palpable Breast Lesions during Excision.

Ann Surg Oncol 2016 Oct;23(10):316874.

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Making the most of the Medicare Annual Election Period (StatePoint) Medicare Advantage plans are increasingly popular, offering robust benefits including vision, health, dental, drug coverage and more.

For the more than 22 million people with an MA plan, the Medicare Annual Election Period, or AEP, running from Oct. 15 to Dec. 7, is the only time each year when they can shop for alternate plans.

“Health care is one of the most important investments you’ll ever make,” said Brian Evanko, who heads Medicare for Cigna, which serves more than 3 million Medicare customers nationwide through its various plans. “For those unsatisfied with their MA plan, the AEP provides a valuable opportunity to shop for a new one that better meets their specific needs.”

Weighing your options this AEP? Consider the following tips from Cigna:

• Review changes. In late September, health plans send their current MA customers a document known as the Annual Notice of Change with information about plan changes for the upcoming year, including costs, benefits, available doctors and facilities. Don’t overlook this important document in the mail. It can help you determine if you need to change plans.

• Weigh extras. When comparing plans, pay attention to extra benefits not available in Original Medicare and consider whether you’re likely to use them. Some of the most popular are dental, vision, hearing and nocost access to fitness programs. Others

might include over-the-counter drug coverage and no-cost transportation to doctors and pharmacies.

• Consider other factors. Beyond cost, consider the doctors and facilities included in any given plan, making sure it includes your favorite physician. Check drug coverage, prices on your regular maintenance medications and whether it’s easy to see specialists. Also pay attention to co-pays, how much you’re required to pay out-ofpocket for doctor visits, and the deductible.

Are they affordable?

• Know yourself. Learn as much as you can about the different plan types and choose one that best suits your budget, lifestyle and health status. Of course, priorities change, which could prompt a need for a plan change.

• Don’t forget prevention. Many MA plans cover health screenings beyond those covered by Original Medicare. Talk to your doctor about which screenings are important for you given your age and health status.

Some MA plans may even provide rewards, such as gift cards, for completing certain screenings.

• Get assistance. Plan Finder, found at medicare.gov/find-a-plan, is an online tool available through the Centers for Medicare & Medicaid Services that helps you compare premiums, costs of medications and more.

You can see how plans are rated from one to five stars based on different quality measures. Additionally, many insurance plans offer seminars at no cost and with no obligation to sign up. You can also check health

State Point “Medicare is a great program, but it can be complicated, especially for those who are new to it,” Evanko said. “Seek out third-party resources and talk to friends and family who have been through the process, asking questions until you understand your options.” plans’ websites or call their customer service for more information. Local and state agencies on aging also connect older adults and caregivers with resources.

Protecting Yourself from Medicare Fraud (BPT) Every year, many seniors are targeted by scammers who want to steal their Medicare numbers to do things like rack up fake health care charges and commit identify theft. These scams hurt seniors and other people eligible for Medicare, cost taxpayers money, and result in higher health care costs for everyone. The good news is that you can protect yourself from fraud and help Medicare stop scammers in their tracks.

How to Spot Medicare Fraud The first step in protecting yourself from Medicare fraud is knowing how to spot it.

Over time, scammers have become very sophisticated and advanced. One of the latest scams you should look out for concerns genetic testing. Scammers are offering "free" genetic tests and claiming Medicare will cover it — so they can get your Medicare number and use it to commit fraud and identity theft. Other Medicare scams include offers for free or reduced-price medical equipment, consultations or health services. These scams can happen anywhere, including through telemarketing calls,

health fairs and even knocking on doors.

Last year, the Centers for Medicare & Medicaid Services removed Social Security numbers from all Medicare cards. Even with this change, people with Medicare should still guard their Medicare card and treat it like a credit card, check Medicare claims summary forms for errors, and be wary of any unsolicited requests for your Medicare number. Medicare will never call beneficiaries to ask for or check Medicare numbers.

To protect yourself from Medicare fraud, keep these things to "do" and "don't do" in mind: • DO protect your Medicare number and treat your Medicare card like it's a credit card.

• DO remember that nothing is ever free.

Don't accept offers of money or gifts for free medical care.

• DO review your Medicare claims for errors and problems, including things like fake charges, double billing or other fraudulent activity, and waste or abuse.

• DO visit http://www.medicare.gov/ fraud to learn more about how you can pro-

tect yourself from Medicare fraud.

• DON'T give your Medicare card or Medicare number to anyone except your doctor or people you know should have it.

• DON'T accept medical supplies, equipment or genetic testing kits from door-todoor salesmen or solicitors at a mall or fair.

• DON'T let anyone persuade you to receive health care services you don't need, such as genetic testing. Only make these decisions with your doctor.

Reporting Medicare Fraud If you think you may have spotted fraud, you should report it right away. No matter how minimal the information you share is, it could be the missing piece to stopping the next fraud scheme. If you are a victim of fraud, know that you won't be penalized or lose your coverage for reporting it. Even if you are not a victim, it's important to report any fraud scams you encounter to Medicare.

Report suspected fraud by calling 1-800MEDICARE or going online through the Office of the Inspector General.

I n fo r m a t i o n p rov i d e d by t h e U . S .

Department of Health & Human Services.

HEALTH GUIDE

www.havredailynews.com

October 2019

5

4 Tips for Higher-Quality Sleep (StatePoint) Sleep is essential to good health.

Unfortunately, over a third of Americans are not getting enough sleep, according to the Centers for Disease Control and Prevention.

Over time, sleep deprivation can take a toll on one’s overall wellness.

“Like air, water and food, sleep is like fuel for your body,” said Dr. Janet Kennedy, sleep specialist at Leesa, a mattress company on a mission to help consumers get better sleep.

Do you have trouble getting to sleep or staying asleep? If you’re feeling more wired than tired at bedtime, it may be time to improve your sleep routine. Check out Kennedy’s suggestions for a better night’s rest: • Cool down: If your first quiet moment to relax comes when you get into bed, your mind will race to try to get all its thinking done. Shut down phones and other devices at least one hour before bed and set an even earlier cutoff time for work. Much the way the body needs a cooldown period after exercise, your mind needs a cooldown period to process the day and unwind before transitioning into sleep mode.

• Make a routine: Bedtime routines are important, but they don’t have to be elaborate. It helps to create a series of steps to be done in a consistent order. This could include stretching, breathing exercises or journaling.

“I recommend keeping it simple and ending by reading fiction,” Kennedy said.

“Reading is one of the most powerful sleep associations I have found. It gives the mind a place to go while the body settles down and tells you when it’s ready to sleep.”

• Create a sanctuary: Your bed should be a place you feel lucky to be. That means setting it up for ultimate comfort. No matter what type sleeper you are, your pillows and mattress should properly support and align the neck and spine so your body will relax quickly, instead of struggling to find a comfortable sleeping position. Temperature control is also important for drifting into sleep.

Pillows and bedding should stay cool through the night. Look for a mattress designed to offer superior support as well as breathability and temperature regulation, such as those from Leesa. The brand also offers hybrid pillows made with fibers featuring a ventilated gel comfort layer. Customizable, they are designed to keep sleepers cool and comfortable.

• Don’t struggle: If you aren’t falling asleep as quickly as you want, or if you are struggling with insomnia, stop trying to fall asleep. The body knows how to sleep and will sleep when it’s ready. Wait until you are very sleepy before going to bed and then read, listen to an audio book, or do something quiet to distract your mind until sleep comes to you.

State Point Sleep is meant to restore the mind and body, not cause stress, so if you’re having trouble getting enough of it, it may be time to tweak your nighttime routine.

Technology advances benefit women undergoing breast cancer treatment (BPT) One out of eight women will get breast cancer in her lifetime. It's a staggering statistic, but one made less ominous by the fact that finding breast cancer early makes it easier to treat or cure.

Thanks to technological advances in detection and new treatment approaches, women diagnosed with early-stage breast cancer have options. For instance, they can opt to keep their breast, with less invasive surgery and breast-conserving treatment, or BCT. BCT focuses on removing only the tumor, allowing women to keep their healthy breast tissue. Being aware of these choices can help women who are grappling with a breast cancer diagnosis resist the impulse to panic, and instead take a deep breath, press the proverbial pause button and calmly create a plan of action.

Most women diagnosed with early-stage breast cancers choose to have BCT rather than mastecto-

my. In fact, the American Cancer Society estimates that 59 percent of women with an early breast cancer diagnosis — Stage 1 or 2 — undergo breast-conserving surgery versus 36 percent of women who decide to have a total mastectomy.

Research has shown that breastconserving surgery — typically a lumpectomy — followed by radiation therapy is as effective as a mastectomy in decreasing the risk of local cancer recurrence for most women.* Lumpectomy entails removal of just the tumor and surrounding tissue, while mastectomy necessitates removal of the entire breast.

The goal of breast-conserving surgery is to remove all detectable cancer cells. Precision in locating the tumor may increase the probability of complete cancer removal, which can help reduce the chances of needing a second surgery.

Previously the process of pin-pointing the location of the tumor could only be done in an invasive man-

ner with a wire inserted into the breast on the same day as surgery.

Today, breast conserving surgery is easier and less stressful for the patients with the wire-free SCOUT Radar Localization System, which uses safe, non-invasive, radar technology for precise guidance during the surgery. With this approach, a tiny, passive reflector about the size of a grain of rice is placed at the tumor site at any time prior to surgery. On the day of the surgery, the surgeon uses the system to activate the reflector, which enables the surgeon to precisely locate and remove the tumor. If tumors are located accurately the first time, it is more likely that any additional treatments can occur faster. What's more, the ability to strategically plan the incision may result in better cosmetic outcomes.** Another benefit of this wire-free approach is that it helps decrease patient wait time on the day of surgery, making the experience less stressful for women and their fami-

lies. "Surgeons tell us that their patients are impressed with the benefits offered by this technology, including shorter procedure times and decreased anxiety," said Nicole Priest, MD, Chief Wellness Officer at Merit Medical, the company behind the system. "My entire career has been about helping people improve their health by making positive, impactful choices," Priest said, "and that is exactly what women do when they know their treatment options and have breast conserving surgery at one of the 520 hospital systems across the country that have this system on board."

There are other tumor localization systems, but none with the extensive track record of SCOUT. "Since it was introduced, SCOUT has been used in the treatment of close to 100,000 breast cancer patients," Priest said. When surveyed, 97 percent of women said they would recommend the technology to other women.

SCOUT, as well as Merit's b ra c hy t h e ra py sys t e m , SAV I Brachy, are pivotal parts of the paradigm that help women with an early breast cancer diagnosis. In addition to its role as a tumor localization tool, SCOUT is also used to tag lymph nodes and tumors prior to neoadjuvant therapy, which is chemotherapy administered prior to surgery. And SAVI Brachy delivers radiation directly to the lumpectomy site where the radiation is needed most, helping to spare surrounding healthy tissue. * American Cancer Society.

Cancer Treatment and Survivorship Facts & Figures, 2014-2015. Atlanta: American Cancer Society; 2014 ** Cox, C. et al. A Prospective Single Arm, Multi-Site Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Localization of Non-Palpable Breast Lesions during Excision.

Ann Surg Oncol 2016 Oct;23(10):316874.

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Alzheimer’s and Dementia: The 10 warning signs you need to know

It’s not just insulin: Diabetes patients struggle to get crucial supplies

(StatePoint) Recognizing and taking steps to address the warning signs of Alzheimer’s and other dementias can be extremely challenging -especially in the early stages. It’s easy and common to dismiss cognitive changes in oneself or a family member as “normal aging.”

“Alzheimer’s is not a normal part of aging,” said Dr. Keith Fargo, director, scient i f i c p ro g ra m s a n d o u t re a c h a t t h e Alzheimer’s Association. “With normal aging, you may forget where you parked your car — that happens to all of us. But if you get in your car and get lost coming home — that’s not normal.”

Alzheimer’s is a fatal progressive disease that attacks the brain, killing nerve cells and tissue, affecting an individual’s ability to remember, think, plan and ultimately function. Today, more than 5 million Americans are living with Alzheimer’s. By 2050, that number is projected to skyrocket to nearly 14 million.

To help families identify signs early on, the Alzheimer’s Association offers 10 Warning Signs and Symptoms, a list of some common signs that can be early symptoms of Alzheimer’s or other dementias: 1. Disruptive memory loss. Forgetting recently learned information, asking the same questions over and over and increasingly relying on memory aids.

2. Challenges in solving problems.

From Kaiser Health News and National Public Radio

By Bram Sable-Smith In the first three months after getting his Dexcom continuous glucose monitor, Ric Peralta said, he reduced his average blood sugar level by 3 percentage points.

“It took me from not-very-well-managed blood sugar to something that was incredibly well managed,” said Peralta, a 46-yearold optician in Whittier, California., who was diagnosed with Type 1 diabetes in 2008.

Peralta was so enthused that he became a “Dexcom Warrior,” a sort of grassroots spokesman for the product. It became hard to imagine life without his new monitor, a device that lets him track the trends in his blood sugar 24 hours a day on his smartphone. And yet, he has spent weeks at a time without the device over the past year because of insurance restrictions. Physician groups and patients consider those rules burdensome, but insurers defend them as necessary.

Diabetes activists and legislators have started to focus attention on the surging price of insulin, leading to legislative pushes, lawsuits and congressional hearings. But insulin isn’t the only thing people with Type 1 diabetes are struggling to get. Managing the condition requires other essential, often lifesaving medical supplies. And patients frequently face hurdles in getting access to those supplies — hurdles put in place by insurance companies.

Changes in one’s ability to develop and follow a plan or work with numbers, such as having trouble following a familiar recipe or keeping track of monthly bills.

3. Difficulty completing familiar tasks.

Difficulty completing daily tasks, such as organizing a grocery list or remembering the rules of a favorite game.

4. Confusion with time or place. Losing track of dates, seasons and the passage of time.

5. Trouble understanding visual images and spatial relationships. Vision problems, which may lead to difficulty with balance or trouble reading.

6. New problems with words in speaking or writing. Trouble following or joining a conversation or a struggle with vocabulary.

For example, calling a “watch” a “handclock.”

7. Misplacing things and losing the ability to retrace steps. Putting things in unusual places and being unable to go back over one’s steps to find them again.

8. Decreased or poor judgment. Changes in judgment or decision-making when dealing with such matters as money and grooming.

9. Withdrawal from work or social activities. Changes in the ability to hold or follow a conversation can result in a withdrawal from hobbies or social activities.

10. Changes in mood and personality.

Mood and personality changes, such as con-

State Point It’s important to note that exhibiting one or more of these 10 warning signs does not mean someone has Alzheimer’s. In fact, these signs may signal other — even treatable — conditions. However, it’s important to talk to your doctor to understand what is driving cognitive changes so you can better manage the condition — whatever the diagnosis. fusion, suspicion, depression, fearfulness and anxiety.

To learn more about Alzheimer’s disease

and to find resources, visit alz.org, the website of the Alzheimer’s Association or call its 24/7, free Helpline at 800-272-3900.

A life-changing device Peralta learned about the latest version of the Dexcom continuous glucose monitor from the mother of one of his patients. He visited the company’s website and, within two weeks, the device was shipped to his front door.

“I still didn’t 100 percent appreciate exactly how it was going to change my life,” Peralta said. “It was amazing.”

Typically, people with Type 1 diabetes check their blood sugar by drawing a drop of blood from a finger and placing it on a disposable test strip that’s read by a blood glucose meter. Doctors suggest checking blood sugar this way between four and 10 times a day. These readings are crucial for helping people with diabetes manage their blood sugar — keeping it from getting too low, which can lead to sudden seizures and loss of consciousness, as well as from getting too high, which can cause vision loss and nerve damage and can even, over time, lead to amputations.

Instead, Peralta’s continuous glucose monitor gave accurate blood sugar readings every five minutes. That’s 288 readings a day, or about 278 more readings than even the most conscientious patients get the oldfashioned way.

“When I had to do the old-fashioned finger prick test, I was only doing that right before I ate, so I could see how much (insulin) I was supposed to take,” Peralta said.

People with Type 1 diabetes have to take multiple daily shots of insulin to keep their blood sugar within the normal range because their bodies stop producing the naturally occurring hormone.

Allison Zaucha for NPR Ric Peralta and his wife, Lisa, check his blood sugar. Both are both able to check Ric's blood sugar levels at any time, using the Dexcom app and an arm patch that measures the levels and sends the information wirelessly.

“I didn’t realize that I had rather severe (blood sugar) peaks and valleys in between my mealtimes,” Peralta said.

Tighter control of blood sugar can reduce the risk of heart disease, kidney failure and nerve damage. For Peralta, it also offered peace of mind.

The monitor sounds an alarm when his blood sugar gets dangerously low; Peralta said his co-workers have started bringing him sugary snacks when they hear the alarm, to help him raise his blood sugar back to normal. When he takes his family on road trips — a favorite activity — he no longer has to worry about the possibility of passing out while driving.

“It even syncs with my car so I can just say, ‘Siri, what’s my blood sugar?’ And it will come over the car stereo system,” Peralta said. “I’m safe for my family.”

Prior-authorization requirements When common chronic conditions such as diabetes are well-controlled, it prevents worsening disease and saves money for the health system and the patient.

But Peralta said his efforts to use this

■ See Diabetes Page 9

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Diabetes: Monitor, supplies require prior authorization from insurance provider ■ Continued from page 3 new tool consistently to manage his diabetes have been stymied by insurance problems that began about a year ago.

The newest Dexcom continuous glucose monitor has three parts: a sensor that measures glucose levels, a transmitter that sends out the sensor’s readings wirelessly and a receiver that displays those readings on a screen.

For each of these parts, Peralta needs “prior authorization” — a requirement that his physician get approval from his insurance company before prescribing the device.

The Dexcom sensors last about 10 days each, and Peralta’s insurance allows him to buy a three-month supply at a time. But he also has to get prior authorization for each supply, meaning every three months his doctor needs to reconfirm with his insurance company that the sensors are medically necessary. Same goes for the device’s transmitters — which last about six months each.

“I have to jump through hoops and they have to jump through hoops to get information from my insurance to get authorization,” Peralta said in frustration, adding that “for the last year, basically every time there’s been something that’s gone wrong.”

“Prior authorizations are in place to protect patients, to improve safety and to try to make sure that the care they receive is as safe as possible and also as affordable as possible,” said Kate Berry of the trade group America’s Health Insurance Programs.

But to Peralta, the requirement is a bur-

den.

The most recent snafu happened in March. Peralta ordered a new supply of sensors directly from Dexcom but said the company submitted a request for approval of a new transmitter as well. And because his insurance approves the sensors and transmitters on different authorization timelines, the whole claim was denied.

Peralta estimates he spent four hours on the phone with Dexcom and his insurer over the next month and a half to sort it all out.

During that time he had to revert to fingerstick tests.

“It’s maddening,” Peralta said. “If I do not have my proper management of this disease, I’m going to die from it. And they’re making it as difficult as possible.”

A burden on doctors, too Prior authorizations have become a major concern of physicians across the U.S. health care system, as evidenced by a December survey by the American Medical Association.

Of the 1,000 physicians surveyed, 91 percent said prior authorizations “have a negative impact on patient clinical outcomes”; 75 percent said the requirements “can at least sometimes lead to patients abandoning a recommended course of treatment”; and 28 percent said the prior-authorization process had “led to serious or life-threatening events” for their patients.

“In my practice, we have five individual

physicians, and we hired five full-time employees whose primary duty is obtaining prior authorization and dealing with insurance companies,” said Dr. Bruce Scott, an otolaryngologist from Kentucky and speaker of the AMA House of Delegates.

“Prior authorization is a burden on providers and diverts valuable resources,” Scott said. “That’s a problem.”

The AMA has even created a website that catalogs stories of patients and providers who say they’ve struggled to gain access to important medical products and procedures because of problems with getting prior authorization from insurers — everything from pain medication for a cancer patient to X-rays in the ER. Scott said the AMA doesn’t expect insurers to completely do away with requirements for prior authorization, “but we believe that it should be focused and that it should be betterplanned.”

The American Association of Clinical Endocrinologists — an organization of the physicians whose specialty is often associated with diabetes treatment — goes further.

“We feel that physicians that are specialists in endocrine disease should not be required to fill out prior authorizations for endocrine treatments,” said Dr. Scott Isaacs, an endocrinologist from Atlanta and a member of the board of directors of AACE. “It’s a huge burden for the patients trying to get this sorted out. Sometimes it’s red tape; sometimes it’s a true denial,” Isaacs

said. “It’s a huge burden for the doctors as well, and the doctors resent it.”

Berry, of America’s Health Insurance Programs, acknowledges there’s room for improvement in the prior-authorization process. In fact, in January 2018, the AMA and AHIP signed a consensus statement identifying five areas for improvement. It was cos i g n e d by t h e A m e r i c a n H o s p i ta l Association, the American Pharmacists Association, the Blue Cross Blue Shield A s s o c i a t i o n a n d t h e M e d i c a l G ro u p Management Association.

Who bears the greatest burden?

For Peralta, the ultimate burden of getting all these prescriptions filled falls on him and other patients like him.

After his latest mix-up with the sensors in March, he discovered the battery in his transmitter had died.

Peralta made another frustrated call to Dexcom, and recently got a complimentary transmitter to get him back on the system while his formal order goes through the approval process.

“I’m quite nervous about what’s going to happen again in two months when I am needing to call in orders again,” Peralta said.

“Am I going to have to go through this whole thing over again?”

—— This story is part of NPR’s reporting partnership with Kaiser Health News.

Follow the data — to medical offices, motels and even animal shelters — to prevent suicides Maureen O’Hagan Kaiser Health News HILLSBORO, Ore. — On Kimberly Repp’s office wall is a sign in Latin: Hic locus est ubi mors gaudet succurrere vitae. This is a place where the dead delight in helping the living.

For medical examiners, it’s a mission.

Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, isn’t a medical examiner; she’s a microbiologist with a Ph.D. And as the Washington County epidemiologist, she was most accustomed to studying infectious diseases like flu or norovirus outbreaks among the living.

But in 2012 she was asked by county officials to look at suicide. The request led her into the world of death investigations and also appears to have led to something remarkable: In this suburban county of 600,000 just west of Portland, the suicide rate now is going down. It’s remarkable because national suicide rates have risen despite decades-long efforts to reverse the deadly trend.

While many factors contribute to suicide, officials here believe they’ve chipped away at this problem through Repp’s initiative to use data — very localized data that any jurisdiction could collect. Now Repp’s mission is to help others learn how to gather and use it.

New York state has just begun testing a sys t e m l i ke h e rs. H u m b o l d t C o u n t y, California, is implementing it. She’s gotten inquiries from Utah and Kentucky. Colorado, meanwhile, is using its own brand of data collection to try to achieve the same kind of turnaround.

Following the Death Investigators Back in 2012, when Repp looked at the available data — mostly statistics reported periodically to the federal Centers for Disease Control and Prevention — she could see that suicide was a big problem and that rates were highest among older white men.

But, beyond that, the data didn’t offer a lot of guidance. Plus, it lagged two years behind.

She returned to her bosses.

“I can tell you who has the highest suicide rate, but I can’t tell you what to do about it,” she recalled telling them. “It’s too broad.”

So she turned to the county medical examiner’s death investigators. They gather information at every unnatural death scene to determine the cause — say, drowning or gunshot) and manner — homicide, suicide and accident. It’s an important job, but a grim one, and it tends to attract unusual personalities.

Repp mustered the courage to introduce herself to one of the investigators, Charles Lovato. “I said, ‘Hi, my name is Kim and I was hoping to go on a death investigation with you.’ And he’s like, ‘You’re that weirdo that does outbreak investigations, aren’t you?’ And I’m like, ‘You’re the weirdo that does death investigations.’”

The gambit worked. Repp accompanied Lovato on his grim rounds for more than a year.

“Nothing can prepare you for what you’re going to see,” she said. “It gave me a very healthy dose of respect for what they do.”

She studied the questions Lovato asked friends and family of the deceased. She watched how he recorded what he saw at the scene. And she saw how a lot of data that helped determine the cause and manner of death never made it into the reports that state and federal authorities use to track suicides. It was a missed opportunity.

Collecting Data on the Dead to Save Lives Repp worked with Lovato and his colleagues to develop a new data collection tool through which investigators could easily record all those details in a checklist. It included not only age and cause of death, but also yes/no questions on things like evidence of alcohol abuse, history of interpersonal violence, health crises, job losses and so on.

In addition, the county created a procedure, called a suicide fatality review, to look more closely at these deaths. The review is modeled on child fatality reviews, a nowmandatory concept that dates to the 1970s.

After getting the OK from family members, key government and community representa-

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www.havredailynews.com insurance, so that’s why we offer that,” she said.

She added that Sweet Medical Center partners with a laboratory in Billings to help with getting the labs done at a reduced price. She said this allows more people to be screened before serious health issues occur.

One of the biggest health concerns for the area is mental health, Rucinsky said.

Chinook and Harlem are secluded areas and they are far away from larger areas, which makes it difficult to utilize resources for mental health, she said. But Sweet Medical Center does have a number of counselors and treatments available to help people with mental health concerns or issues.

She added that at the beginning of this year, the center also started implementing

the medication-assisted treatment program, which is used for substance use disorders such as opioid abuse. She said that Sweet Medical Center has two nurses who are certified in the treatment program and with the implementation of medication-assisted treatment, hopefully more people in the area who struggle with drug abuse can receive treatment.

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Another big health concern for the area is diabetes, she said. She said people need to be more aware of the growing issue of diabetes.

She added that Sweet Medical Center is having a Diabetes Beat Down Race Oct. 19 at the Blaine County Fairgrounds to help raise awareness and funds for fighting diabetes.

Sweet Medical Center hosting premier Diabetes Beatdown Race Derek Hann dshann@havredailynews.com Sweet Medical Center will be hosting its premier Diabetes Beat Down Race Oct. 19 at the Blaine County Fairgrounds to raise awareness and funds to fight diabetes in the area, event organizer and Sweet Medical Center Nurse Practitioner Lindsay Rucinsky said.

“We are just really excited to do this,” she said.

Rucinsky, who is originally from Havre and is a Montana State University-Northern alumni, said that the idea for the event originated from the fact that diabetes is a huge issue in the area and across the state.

She added that promoting education and awareness of diabetes has been a passion of hers for a long period of time. A number of people in her family have been diagnosed with Type 2 diabetes.

Diabetes has a large effect on the region and the Hi-Line community, she said.

Montana has about 96,000 people with diabetes. This is approximately 10.9 percent of the adult population in the state with pre-

dominantly Type 2. She added that with the increased rate of childhood obesity medical professionals are also seeing Type 2 diabetes diagnosed at younger and younger ages.

She said that the main focus of the event is Type 2 diabetes, but added that Type 1 is equally as dangerous and is not preventable.

Type 1 is typically diagnosed in younger children whose pancreas is not functioning properly to create insulin to bring the person’s blood sugar down.

With Type 2, the person’s pancreas is working, but it is not able to produce enough insulin to bring down the person’s blood sugar because of the elevated amount of glucose in the person’s body, she added.

She said that Type 2 and Type 1 diabetes can affect the whole body if not properly treated, such as a person’s eyes, organs and limbs.

She added that a person with Type 1 or Type 2 is also more at risk to different diseases because the person’s immune system cannot keep up.

Type 2 diabetes can be directly affected by exercise and amount and choices of food, she said. She added that if a person is at

Flu vaccine: Jumphead text ■ Continued from page A1 “If a patient is uninsured, Bullhook provides services on our sliding fee scale, or discount, depending on the patient’s family size and income,” Norden said.

Larson said the charge at the Hill County Health Department for children 6 months to 18 years of age is $20; adults 19 and older $25; high-dose flu shot for people 65 and older is $50, and the department will bill the patient’s insurance.

Norden added that the risk of not getting a flu shot can be hospitalization, serious illness or even death, missed work and school, and spreading illness to friends, family and community members.

Larson said it’s especially important that certain people get vaccinated when they are at high risk of having serious flurelated complications or because they live with or care for people at high risk for developing flu-related complications.

High-risk categories include: • Pregnant women • Children younger than 5, but especially children younger than 2 years old

• People 50 years of age and older • People of any age with certain chronic medical conditions • People who live in nursing homes and other long-term care facilities • People who live with or care for those at high risk for complications from flu, including: — Health care workers — Household contacts of persons at high risk for complications from the flu — Household contacts and out of home caregivers of children less than 6 months of age because these children are too young to be vaccinated.

“During the 2018-2019 influenza season, 13,576 cases, 767 hospitalizations and 38 deaths, one pediatric, due to influenza were reported (in Montana) from all but one county in Montana,” Larson said.

For more information, people can go to the CDC website or visit their health care provider or a local health department, clinic or community health center.

risk of diabetes they should be eating a higher amount of protein, lower amount of fat, a balance of carbohydrates. People should also try to stay physically active, at least 30 minutes of moderate to intense exercise a day and stay away from sugary candies, sodas and fast-food.

The race will have three components, a 1-mile competitive run and fun run, and 3-mile and 5-mile competitively timed runs, she said. The organization Competitive Timing out of Whitefish will be giving every competitor a running badge so their times are marked in real time. The races will also be broken up into male and female categories, and the top runner in each category for each race will be given a prize at the end.

“We want it to be special,” she said.

People can preregister for the races by going to the events website at https://run-

signup.com/Race/MT/Chinook/DiabetesBe atdown?fbclid=IwAR1yEVm_8uGXpGxQINf w 5 3 g O CA- 9 C D n 7 g K 6 Z J 7 7 V B x F n i _ D _ FpLTxtATPmU or http://bit.ly/2kGOhLk or go to the Diabetes Beat Down Race Facebook page, she said.

The cost is $20 to register for the 1-mile race or fun run, $25 for the 3-mile race and $30 for the 5-mile race, she said. People can also register at the race. She added that everyone who competes will get a T-shirt, with the names of all the sponsors written on the back, and a “swag” bag.

The event will also have a variety of vendors, such as the Streatery, which will be providing healthy food for the event, she said. She added that the event will also have a number of craft vendors, as well as small local businesses from the area. Sponsors for the event are also invited to have booths, as well.

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Influenza vaccinations recommended with flu season almost here Rachel Jamieson rjamieson@havredailynews.com

Flu season is right around the corner and people can stop by the locations offering vaccinations to reduce the chance of contracting the illness.

Medical Department Manager Desirée Norden of Havre’s Bullhook Community Health Center said Bullhook will be offering influenza vaccines to its patients starting the end of September, beginning of October.

Hill County Public Health Director Kim Larson said the majority of their influenza vaccine is delayed in shipment, however, they had 90 doses as of Sept. 20, when this article was being written.

“If you are wanting a flu shot now, come in on Tuesday’s during our regular hours and we will gladly give you one,” Larson said. “We will have our schedule of clinics out to the community as soon as we can. If you have questions, please call us at 4002415.”

The Hill County Health Department’s hours are 8 a.m. to noon and 1 to 5 p.m.

The Centers for Disease Control and Prevention defines a flu shot as a vaccine against the influenza virus.

The CDC webpage at https://www.cdc.gov/flu/ index.htm provides tips for people to prevent the flu, recognize symptoms, get treatment, and find flu surveillance and activity in the United States.

■ See Flu vaccine Page A2 Havre Daily News/Colin Thompson Influenza vaccine sits on a table at Bullhook Community Health Center.

Blaine County’s Sweet Medical Center offers health services Derek Hann dshann@havredailynews.com Blaine County’s Sweet Medical Center has a number of programs in the area to help increase care for communities across the Hi-Line, Sweet Medical Center Nurse Practitioner Lindsay Rucinsky said.

Sweet Medical Center has two clinics, one in Chinook, located at 419 Pennsylvania St., the Chinook Medical Center, and the other in Harlem, located at 116 Main St. South, inside the Little Rockies Retirement Center.

The Sweet Medical Center was first established in 1988, the same year the center’s founder Lloyd D. Sweet died.

Sweet also helped fund and establish the Sweet Home, a nursing home in Chinook Sweet first established in 1969.

Rucinsky added that Sweet Medical Center is not the Sweet Home and they are completely separate entities.

The Chinook location of the medical center is open Monday through Friday from 7:15 a.m. to 5:45 p.m.

The Harlem clinic is open Tuesday through Thursday from 8 a.m. to 5 p.m.

Sweet Medical Center receives some of its funding from the U.S. Department of Health and Human Services Health Resources and Services Administration, it’s

website says. The center also offers services such as dental, vision and mental health, pharmacy, and transportation assistance for medical services. “(Sweet Medical Center) is committed to helping our patients afford health care,” it added.

The center also offers assistance to patients who may not be able to afford health care, it says.

“We ask every patient to complete our HealthShare Partnership assessment to ensure we’re doing all we can to help,” the website says about applying for the sliding fee scale. “If you know your income is above the 200 percent poverty level listed, simply write declined.”

“If you do qualify for assistance, based on completion of the application and income verification, your appointments will be discounted based on the sliding fee level associated with your household income and family size,” it says.

Rucinsky said one of the long-standing programs the center has is offering laboratory work for patients at a reduced cost. She added that the program is to help people who don’t have insurance afford lab work at a discounted price. The lab indicates the service applies to things like the amount of electrolytes, thyroid and lipids.

“Some people can’t afford that without

www.havredailynews.com tives meet to investigate individual suicides with an eye toward prevention. The review group might include health care organizations to look for recent visits to the doctor; veterans’ organizations to check service records; law enforcement; faith leaders; pain clinic managers; and mental health support groups.

The idea, Repp said, isn’t to point fingers.

It’s to look for system-level interventions that might prevent similar deaths.

“We were able to identify touchpoints in our community that we had not seen before,” Repp said.

For example, data revealed a surprising number of suicides at hotels and motels. It also showed a number of those who killed themselves had experienced eviction or foreclosure or had a medical visit within weeks or days of their death. It revealed that people in crisis regularly turn their pets over to the animal shelter.

But what to do with that information?

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to h e l p . T h a t ’s w h e re D e b ra D a r m a ta , Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

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Adam Wickham for KHN Washington County, Ore., epidemiologist Kimberly Repp poses for a photograph. In 2012, Repp was asked by county officials to study suicide. She accompanied one of the county medical examiner’s death investigators on his grim rounds for more than a year.

“Nothing can prepare you for what you’re going to see,” she says.

From 2012 to 2018, Washington County’s suicide rate decreased by 40 percent, preliminary data shows. To be sure, though, 68 people died by suicide here last year, so preventing even a handful of cases can lower the rate quite a bit.

Taking the Idea Elsewhere Repp cautions that the findings can’t be generalized. What’s true in suburban Portland may not be true in rural Nebraska or the city of San Francisco or even suburban New Jersey, for that matter. Every community needs to look at its own data.

Still, Jay Carruthers, who runs New York’s Office of Suicide Prevention, saw the potential.

“To be able to close the loop and connect (the data) to prevention? That’s the beauty,” he said.

This year, the state is beginning to test a similar system in several counties.

In Northern California’s Humboldt County, public health manager Dana Murguía had been frustrated for some time that local prevention plans weren’t making a dent.

“I said, ‘We don’t need another plan. We need an operations manual.’ That’s what I feel Dr. Repp has given us.”

Humboldt began using a Washington County-style checklist this year, and county officials have identified several unexpected touchpoints, including public parks and motels where people have died by suicide.

Now, those sad facts can become action plans.

In Colorado, a different effort to reduce suicides also began with extensive data analysis. There, they realized that while youth

suicide has understandably been a focus, but the biggest numbers are among older men.

They’ve not only crafted materials specifically for men in crisis, but they’ve also created materials for specialized groups, such as veterans, farmers and construction workers.

“What was unexpected to me was how empowering these data would be to so many different people to make change,” Repp said — including Lovato and the other death investigators. “To know that they’re actually keeping the living alive is really powerful.”

If You Need Help If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Chat, both available 24 hours a day, seven days a week.

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