MED-Midwest Medical Edition-April/May 2012

Vol. 3 Issue 3

2012 April May

Personalized Medicine

South Dakota and the Upper Midwest’s Magazine for Physicians and Healthcare Professionals

Contents Midwest Medical Edition

April / May 2012

Regular Features 2 |

From Us to You

5 |

Meet a MED Advisor – Daniel Todd, MD

29 |

The Grapevine: ‘Chasing’ a Historic Zinfandel

30 |

Complementary Therapies: Hypnosis

36 |

News & Notes: News from around the region

37 |

Learning Opportunities: Upcoming Symposiums, conferences, CME Courses

In This Issue 5 |

Personal Health Records

6 |

Data, Data Everywhere

By Dave Hewett

9 |

Avera Receives Environmental Awards

10|

Former Med X-Ray Docs Join Local Hospitals

12 |

Securing and Protecting Electronic Medical Records

By Lizabeth Brott

18 |

Go Mobile or Go Home

By Tana Tipton

21 |

Farewell to the Institution: USDSM’s Dean Parry Looks Back

23 |

Anderson to Lead Family Physicians

24 |

Sensory Processing Disorders Through the Lifespan

By Theresa Parish

25 |

Survival Story Featured at National Conference

26 |

Heart Hospital Installs 4D Flash CT

34 |

Smoothing the Path Achieve and the Developmentally Disabled

In Review Musicophilia

Personalized

Medicine The Avera Institute for Human Genetics

Genetics and genomics are shaping the future of medical care and the Avera Institute for Human Genetics is on the leading edge of that movement. This six-year-old lab is not only conducting breakthrough research on pharmacogenetics and behavior, but they have even attracted the attention of international researchers. With high-throughput capabilities, experienced leadership, and the ability to craft their own gene arrays, the AIHG is poised to take an even bigger role in the quest to personalize medicine.

By Oliver Sacks, MD

page

32

Cover photo credits:DNA strand: Comstock/Thinkstock • AIHG lab photos: Kristi Shanks

page

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Cover Feature

From Us to You

Staying in Touch with MED

A letter from the VP

O

ne of the perks of producing the area’s only local medical community magazine is the opportunity to get involved with organizations that are having a real impact on the health of our community. Organizations like the American Heart Association, which sponsors the Go Red for Women movement. As a member of this year’s Go Red Executive Leadership Team, I had the chance to help raise funds and awareness – and represent MED – at the annual Sioux Falls Go Red for Women luncheon. Not only was I proud to be helping fight the number one killer of women in our community, but I also had a great time. (See photo – that's me on the far right) Thanks to everyone who served this great cause with me, and thanks to all of you health professionals who are helping to fight heart disease and heal damaged hearts in our region every day. Our hearts go out to all of you! — Steff

MED Magazine, LLC Sioux Falls, South Dakota

Publisher

VP Sales & Marketing Editor in Chief Design/Art Direction Cover Photo & Design Photographer Web Design Contributing Editor

Steffanie Liston-Holtrop Alex Strauss Corbo Design Darrel Fickbohm Kristi Shanks 5j Design Darrel Fickbohm

Contributing Writers Heather Boysen Lizabeth Brott Dave Hewett Richard Klein Theresa Parish Tana Tipton

Steffanie Liston-Holtrop

Staff Writers

Liz Boyd Caroline Chenault John Knies

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109

A letter from the Editor

Website MidwestMedicalEdition.com

T

his issue of MED is one of contrasts. on the one hand, there are the futuristic concepts of genomic medicine, mobile websites and EHR security… On the other hand, the medical school is saying goodbye to a man who has shaped three decades of medical students.

On the one hand, there is advanced new equipment like Avera’s new 4D Flash CT scanner… On the other hand, the local organization Achieve is proving that sometimes the ‘low tech’ hands-on approach is the surest ways to improve medical care.

On the one hand, MED is devoted to bringing you timely, local relevant health news… On the other hand, MED invites you to share your hobbies, talents and opinions with your colleagues in these pages. (Thank you, Dr. Klein, for this month’s book review!)

We hope you will enjoy the contrasts in this issue and that the contrasts in your own practice and personal life will make both richer, more successful and more interesting. —Alex

2012 Advertising / Editorial Deadlines Jan/Feb Issue December 5

June Issue May 5

November Issue October 5

March Issue February 5

July/August Issue June 5

December Issue November 5

April/May Issue March 5

Sep/Oct Issue August 5

Reproduction or use of the contents of this magazine is prohibited.

Alex Strauss

e Woruits! t

t ccep We aader re s i o n is subm

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com.

Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com.

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

2

Midwest Medical Edition

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Healthcare Groups Issue New Guides to Using

Personal Health Records

A talk with MED Advisor

Dan Todd, MD Otolaryngologist

Brochures will help consumers and clinicians better utilize PHRs to manage their healthcare Key healthcare organizations are teaming up to help take the mystery out of using personal health records (PHR) by rolling out two new informational brochures to help promote the understanding and use of PHRs among consumers and clinicians. The new brochures: “Your Personal Health Record,” and “A Clinician's Guide to a Personal Health Record,” will be available online at BCBS.com.

PHRs are online tools for making more informed healthcare decisions and enhancing care coordination. The brochures, which include screenshots of PHRs, user testimonials, and an informative Q&A, were created through a collaboration of healthcare groups including the Blue Cross and Blue Shield Association (BCBSA), the American Health Information Management Association (AHIMA), the American Cancer Society (ACS), the American College of Physicians IA CL IN IC

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(ACP), the American Diabetes Association (ADA), the American Heart Association (AHA), the American Osteopathic Association of Medical Informatics (AOAMI), and MGMA-ACMPE. As recent reports show, when more healthcare data is available to consumers, their caregivers and doctors, it can help improve the coordination of care. By making these brochures available, key healthcare stakeholders hope to increase the adoption and use of PHRs by showing consumers how they can use PHRs to store health information such as medical conditions, allergies, medications, and doctor or hospital visits in one convenient and secure place. For clinicians, the brochures describe the benefits of using PHRs to help them deliver quality care to their patients and make their practices run more efficiently.

With PHRs, individual patients and their designated caregivers can take charge of their healthcare choices by viewing and managing their own health information.

PHRs also enable patients to quickly and readily share healthcare information with their providers, which allows for better tracking of chronic diseases and helps their provider determine the most appropriate treatment plan.. ■

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cfm or http://www.mgma.com/ phrguide/.

Q: You are an otolaryngologist but you spend a lot of your time on allergies.

Why? I did my residency at the University of Missouri where they were doing sophisticated allergy work. We had a lot of patients and we did allergy skin tests and allergy shots. They also had a strong early sinus surgery program which is where I started doing endoscopic sinus surgeries. Some patients have an allergist, a plastic surgeon, and a sinus surgeon. But you shouldn’t really need three doctors for one nose.

Q: Here on the brink of allergy season, is there anything new on the horizon?

Allergy drops are beginning to gain acceptance as an alternative to allergy shots. Like the shots, allergy drops rely on desensitization. Frankly, I think part of the resistance from the medical community is because of the money made on allergy shots. But the drops are effective and easier for certain patients, especially children.

Q: A runny nose is annoying, but what about life-threatening allergies like food allergies?

Food allergy desensitization is an up and coming thing. Because of the risk of a serious reaction, this has to be done in an intensive care setting. But it has been very successful where it has been used in some large centers, particularly for common allergies like peanuts. The patient will likely never be able to eat a lot of peanuts, but if he does happen to eat a couple, he is much less likely to die.

Q: You also do sinus surgery.

Anything new there?

Drug eluting stents that are left in the sinus cavity have proven to be helpful in keeping polyps from reforming after sinus surgery. It is great to have all of these tools in our bag, to help people solve their sinus and allergy problems in whatever way is best for them.

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April / May 2012

MidwestMedicalEdition.com

5

Data, Data

Everywhere

By Dave Hewett , President/CEO, SDAHO

H

ealth care is awash in data. From what is charged to what is paid for care; from how well procedures are performed to how satisfied our patients are with the services they are provided; from how safe patients are while under our care to how well they recuperate – there’s a number or numbers for it.

It wasn’t long ago that most of our information was cost related. Now it’s that plus so much more – patient satisfaction, following best practices, hospital readmissions, mortality, patient safety, etc. For now most

6

of those numbers are impacting the institutional providers including hospitals, nursing facilities and home health agencies. But we also know that the Physician Quality Reporting System (PQRS) is in its formative stages with a de facto requirement that all physicians be participating in that program by 2015. (That’s when nonparticipating physicians will see their Medicare reimbursement cut 2 %.)

So how are we doing so far? A composite analysis of hospital data suggests that South Dakota has achieved above average scores in most all of the major categories

and ranks in the top quartile among all states.

The numbers are important because the public is looking and they can impact reimbursement. In this more transparent world, our challenges are twofold: first, what numbers we should be concerned about and focused on; second, who should be monitoring and working on improving these numbers.

First, the “what”. There are literally hundreds of quality and patient safety indicators.

They tend to be lumped into four or five categories (see below). First, I propose that an

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MED Quotes

The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.~Thomas Edison organization can only be effectively working on four or five of those indicators at once and the selection of those indicators is influenced by an indicator’s relative public prominence and its impact on how the provider is viewed by the public and paid by third party payers.

I’m also going to look inside each of the general categories and find those areas that offer me the greatest opportunity for improvement. For example, if I know that 30% of my quality incentive payment is based on patient satisfaction I will focus on improving my HCAHPS score. To improve that number I will select those measurable areas (communication with physician, quietness of the room, etc.) where my scores are lowest relative to others.

Second, the” who”. You guessed it, it starts with physicians. Study after study show that numbers improve when physicians lead a team effort focused on the goals at hand – reducing readmissions, improving patient satisfaction, following best practices, and improving patient safety numbers. But it is the emphasis on “team” and a thorough understanding and commitment to the metric that makes improvement happen.

One other observation about the graphs. Notice please just how little variation there is between what passes for “average”, the top 10%, and South Dakota’s numbers. In most cases improving numbers is not about wholesale change. Rather, it’s about team effort to improve what we do at the margins. The new health information system affords us that opportunity. ■

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April / May 2012

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7

Avera Receives

Environmental Awards

Avera McKennan Hospital & University Health Center has received two Green Globe awards for its efforts in maintaining sustainability and overall environmental performance of the Prairie Center, located on the Avera McKennan campus. The Prairie Center is home to the Avera Cancer Institute and the Avera Surgery Center.

“We started pursuing this certification as part of the planning process of the Prairie Center,” says Garrett Peters, director of Facility Development at Avera McKennan. “Green Globes was a good fit for how we wanted to pursue acknowledgement of our efficient, sustainable building.”

Green Globes is a revolutionary green building guidance and assessment program that offers an effective, practical and affordable way to advance

April / May 2012

the overall environmental performance and sustainability of commercial buildings. Essential elements of the Green Globes system include: uC omprehensive environmental assessment protocol

u Software tools that speed and simplify online assessment

u Best practices guidance for green construction and operations

u Qualified assessors with green building expertise

u Rating/certification system Green Globes software tools and ratings/certification measures environmental impacts on a 1,000-point scale in multiple categories, including: • Energy • Indoor Environment • Site • Water • Resources • Emissions

• Project/Environmental Management

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After achieving a threshold of at least 35 percent of the total number of 1,000 points, new and existing commercial buildings can pursue Green Globes certification that assigns a rating of one to four globes. Thirdparty assessors (with expertise in green building design, engineering, construction and facility operations) interface with project teams and building owners during the assessment process by reviewing building documentation and conducting on-site walk throughs.

While the Green Globes are similar to LEED certification, Peters says Avera McKennan chose to pursue Green Globes because it was an established program for healthcare buildings. The LEED healthcare program is a new initiative which was not in place until construction on the Prairie Center was near completion. ■

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Former Med X-Ray Doctors

Join Local Hospitals The dissolution of Medical X-Ray Center, PC, in Sioux Falls has netted both Sanford Health and Avera large groups of new radiology providers. Both hospitals announced their new doctors in March.

Sanford added 13 former Med X-Ray radiologists, expanding the Sanford radiology group to 21 physicians, 10 of whom are fellowship trained. Sanford says it expects to add another five radiologists before the end of the year.

At the same time, Avera announced its new doctors by announcing the addition of ‘Avera Medical Group Radiology Sioux Falls’ to its team. The group includes twenty physicians and a physician assistant.

In addition to the new providers, Avera also assumed ownership of the Avera Veradia Vein Center located in Plaza 2 on the Avera McKennan campus and the former Midwest Regional PET-CT Center on Sharon Avenue in Sioux Falls. Both had formerly been operated by Med X-Ray. Shannon Gray, manager of the newly named Avera Pet-CT Center, says the staff will remain the same, including physicians who serve on a rotating schedule, and CT technologists from Avera McKennan.

Med X-Ray had been operating as an independent private practice in Sioux Falls since 1961 and included more than 30 physicians. ■

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Where are they now?

Sanford Radiology Physician Group Bryan Barness, MD John Reinschmidt, MD Patsy Uken, MD Chris Fischer, MD David Ellis, MD Robert Crank, MD Charles Flohr, MD David Bean, MD Gary Famestad, MD Cameron Stokka, MD Thomas Free, MD Edward Czarnecki, MD Lisa Hinckley, MD Khalil Yousef, MD Terry Yeager, MD Janet Dubois, MD Susan Duffek, MD Thomas Cink, MD Melinda Talley, MD Chris Fischer, MD Fred Lovrien, MD Julia Prescott-Focht, DO

Avera Medical Group Radiology, Sioux Falls Josie Alpers, MD Jeffery Baka, MD Matthew Casey, MD Sabina Choudhry, MD Daniel Crosby, MD Christopher Gregory, MD Matthew Helgeson, MD Ryan Jepperson, MD Joseph Jordahl, MD Michael Kihne, MD Jonah Luzier, MD Thomas Masterson, MD Patrick Nelson, MD Brad Paulson, MD Matthew Pardy, MD Joshua Plorde, MD Daryl Rife, MD Andrew Soye, MD Randal Welter, MD Suzanne Woodward, MD Derek Sitter, PAC

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We honor a legacy of care.

The Year of the Nurse at Sanford Health.

They’re called to be caregivers, advocates and leaders. The backbone of our organization. Humble heroes always putting their patients first.

And we are grateful for all they do at the bedside, in the clinic, in the corporate offices, in research and in our communities.

At Sanford Health, we show our appreciation. This day. Every day.

The Year of the Nurse at Sanford Health. yearofthenurse.sanfordhealth.org

April 2/12 / May 100-11395-3255

2012

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11

Securing and Protecting Electronic Medical Records

By Lizabeth F. Brott, J.D.

U

se of electronic medical records (EMRs) is steadily increasing. The National Center for Health Statistics estimates that in 2011, fifty-seven percent of office-based physicians were using some type of medical record system that was all or partially electronic (excluding billing systems). This estimate compares to only eighteen percent in 2001. By state, percentages ranged from a low of forty percent in Louisiana to a high of eighty-four percent in North Dakota. Average EMR usage in South Dakota was fifty-five percent.1 If your office has adopted or is considering an EMR, it’s important to address the privacy and cyber liability risks associated with this technology. Network security, internet viruses, and electronic data breaches are relatively new issues for many medical practices. But failure to safeguard against these risks can result in dire consequences for medical practices and patients alike.

Concerns regarding EMRs and patient privacy are not unfounded. A recent study of large healthcare organizations found ninetysix percent of respondents had experienced at least one data breach in the preceding 24-month period. The top three causes of breaches were: lost or stolen computing devices, third-party error (e.g., by a business associate), or unintentional employee action.2 Fortunately, there are steps you can take to reduce the likelihood of a data breach.

Two crucial drivers of information security include having an effective security strategy in place and being proactive in using it.3

✔ comprehensive clinician and staff training

Implementing a strictly enforced electronic security/privacy policy is your first line of defense. Consider including the following in your security policy:

✔ complex passwords and frequent

✔ an initial risk assessment with periodic follow-up assessments (consider using external experts)

✔ regular system testing and security updates

on your security policies and procedures and the importance of protecting patient data

✔ specific policies for use of personal devices including laptops, home computers, mobile devices and social media

✔ use of passwords and encryption for personal devices

✔ agreements with business associates outlining data privacy and security requirements

✔ an incident response plan ✔ varying levels of access for employees on a need-to-know basis required password changes

✔ physical placement of computer screens with special attention to visibility of social security numbers

✔ root cause analyses of major data breaches.

✔ interactions with your EMR should take place over a secure, encrypted network.

1. Hsiao CJ, Hing E, Socey TC, Cai B. Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001-2011.

NCHS Data Brief. November 2011; No. 79. National Center for Health Statistics, Centers for Disease Control and Prevention.

2. Ponemon Institute. Second annual benchmark study on patient privacy & data security. Ponemon Institute Research Report. December 2011.

3. P ricewaterhouseCoopers International Limited. Eye of the Storm—Key Findings from the 2012 Global State of Information Security Survey®.” PricewaterhouseCoopers International Limited. New York; September 2011.

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Midwest Medical Edition

Taking proactive steps to secure your EMR will go a long way toward protecting patient data; however, even the best managed system can be vulnerable to data breaches. Cyber liability insurance can help cover expenses associated with this risk. Most cyber liability policies include protection for: Network and security privacy breaches

— virus attacks, patient identity theft, online and offline data breaches Regulatory fines and penalties — defense costs for governmental investigations (including HIPAA), and payment of regulatory fines and penalties Patient notification and credit monitoring costs — payment of legal and other expenses incurred

to notify patients of an information breach, and payment of credit monitoring costs for persons affected by a breach Data recovery costs — payment for costs of

recovering or replacing data that is lost, erased, stolen, or corrupted. ■ Lizabeth F. Brott, J.D., is Regional Vice President of Risk Management for ProAssurance, a national provider of medical professional liability insurance.

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April / May 2012

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13

1

Personalizing

Medicine The Avera Institute for Human Genetics

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2 4

photos by Kristi Shanks

3

By Alex Strauss

G

enetics and genomics, the complex interactions between genes and their impact on disease, are transforming the practice of medicine. Since the multi-billion dollar global effort known as the

Human Genome Project gave the world its first look at the complete human genome in 2001, few areas of medicine have been untouched by the knowledge.

“The striking part about the Human Genome Project is that we

learned so many things about ourselves that we never knew

1 M olecular geneticist Gareth Davies, PhD, Scientific Director of the Avera Institute for Human Genetics and Professor in the Psychiatry Department at USDSM.

before,” says molecular geneticist Gareth Davies, PhD, Scientific Director of the Avera Institute for Human Genetics and Professor in the Psychiatry Department at USDSM. “We learned, for instance, that we have fewer genes than we first expected. We knew that a microscopic worm has about 10,000 genes, so we were surprised to find that humans only have about 20,000.”

2 P ost doctoral fellow Ueshan Hu and PhD student Erik Ehli with the Affymetrix GeneChip Scanner. When loaded with pre-made arrays, such as the DMET panel, the machine allows the lab to conduct GWA studies such as those being conducted on DNA from the Netherlands Twin Registry.

We also learned that humans share about 50% of their genes of a banana. And from one person to the next, we are 99.9% identical. But, as Dr. Davies and the scientific minds flocking to the field of molecular genetics know, a world of knowledge and discovery – indeed the future of medicine itself – is contained not only in the myriad of genes we share, but also in that mysterious .1%.

April / May 2012

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3 D NA extracted from blood is loaded into the DNA sequencer.

4 G enetics Research Associate Kelly Nelson prepares a DNA sample for sequencing.

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An Economic Success Story The economy may be struggling, but the field of genetics and genomics continues to grow at a phenomenal rate. According to new research sponsored by the American Clinical Laboratory Association, genetic and genomic clinical laboratory testing generates 116,000 U.S. jobs and contributes $16.5 billion annually to the U.S. economy.

“This industry is one of American’s true economic success stories,” says Alan Mertz, ACLA President. “It is not only helping us beat cancer and other diseases, but it is also building strong economic growth in a field of innovation where the U.S. is and always has been the leader.”

The report said that the industry’s ability to innovate and produce cutting-edge genetic testing services and products supports about 44,000 direct jobs and generates about 73,000 jobs in key supplier industries and wholesale trade businesses.

“As we build on the mapping of the human genome, genetic and genomic testing is enabling one of the country’s great medical and economic transformations,” says Jen Bowman, ACLA’s VP of Policy and Regulatory Affairs.”I also think it is important to recognize that a significant amount of that is coming from the small, innovative start-up labs throughout the U.S.” The report goes on to say that, for these economic opportunities to continue, the genetic and genomic clinical testing industry must be able to operate in a business environment that encourages continued research and facilitates profitable business operations.

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“The Human Genome Project has opened up what is essentially a new science for us,” says Davies, whose six-year-old lab was established to the impact of genes on behavioral medicine. “What this has done is allowed us to think about taking a much more personalized approach to medical care.

If we can look at a person’s DNA, we can begin to understand why that person becomes sick. These kinds of questions have excited a whole new generation of scientists and medical students.”

And no wonder. Instead of practicing by the law of averages, administering treatments that work for most, but not all, patients, physicians armed with genetic data may finally be able to accurately predict treatment responses. Custom-tailored treatments have the potential to dramatically improve outcomes in virtually every disease process, from colds to cancer.

“Our lab concentrates on pharmacogenetics as it relates to pain, chemotherapy and depression, but my expectation is that everyone is going to eventually appreciate that this knowledge is going to help every type of patient,” says Dr. Davies. “From diagnosis to treatment to prevention. It is going to be a revolution.”

Clinical Studies Physicians like Dr. Tim Soundy and Dr. Matthew Stanley, psychiatrists with the Avera Behavioral Health Institute, have already joined that revolution. The two have been part of groundbreaking clinical research through the Avera Institute for Human Genetics, in the burgeoning field of pharmacogenetics and psychiatric treatment. One recent clinical study focused on patients at the South Dakota Development Center in Redfield, a residential program for the developmentally disabled, where the average number of medications administered to individual patients is 17.

“Many of these patients are being treated with anti-epileptics, anti-psychotics, etc.,” explains Dr. Soundy. Soundy genotyped

Redfield’s top 50 medication consumers using the DMET chip, a $500 panel of arrays and reagents, to examine the genes for drug metabolism.

“When we sat down as a team and analyzed the results, we found that some of these patients were having toxic side effects because they were not metabolizing their medications properly,” reports Dr. Soundy.

“This is especially troubling in non-verbal patients. We found one patient who, because of his genetic makeup, was on the equivalent of 16 mg of a substance that was supposed to have been 3 mg. Without this technology, you could not know this.”

Dr. Matthew Stanley plans to conduct a similar study on South Dakota Medicaid patients, another population that consumes large numbers of psychiatric drugs. “The neat thing about genetics is that your genes don’t change,” says Dr. Stanley. “So what we learn about your genes today is still going to apply ten years from now.”

Another upcoming Avera research project involves analysis of the genetic makeup of patients in the Drug and Alcohol Treatment Center in Yankton to predict response to anticraving medication. Pending grant approval, Avera will be one of four sites to conduct such research.

The Avera Institute for Human Genetics is also a leader in the genetics of childhood behavioral issues. The lab has amassed a database of young psychiatric patients, along with their parents and siblings, for ongoing genotype studies. New findings on ADHD and genetics have made it possible for Avera doctors to choose the most appropriate ADHD medication for their young patients using a simple mouth swab. And thanks to research published recently by Dr. Davies and his team, they can feel confident that buccal cells are as effective as blood for this type of testing.

“We are doing what a lot of major medical centers are beginning to do,” says Dr. Soundy. “Right now, most psychiatric patients who come into the Mayo Clinic have their genes analyzed for the major pathways

Midwest Medical Edition

for psychiatric drugs. I would eventually like to see every patient who comes into the Avera system, whether they are seeing the family doctor, the pediatrician, the cardiologist, or the psychiatrist, have their genes analyzed.

Drug metabolism is a good place to start.”

Small Lab, Big Capabilities This relatively new lab of just six researchers is already making a name for itself internationally. With its high throughput gene analysis capability and expertise, the AIHG has signed an exclusive agreement to conduct ongoing longitudinal studies of DNA from the Netherlands Twin Registry at the University of Amsterdam. These genome-wide association (GWA) studies involve the examination of thousands of samples for common genetic variants to determine if those variants are associated with particular traits.

“Many common diseases that have a genetic component like schizophrenia, diabetes, ADHD, etc., are the result of not just one gene, but many, as well as the environment,” says Dr. Davies. “When we do GWA studies, we have to test many, many samples to give us the statistical power we need to verify our results. We are very excited to have been chosen as the designated lab by the Netherlands Twin Registry.”

The lab’s relationship with the Netherlands Twin Registry, the largest registry of twin DNA in the world, has made possible some of its most important research to date. Contrary to the long-held belief that identical twins share identical DNA, Dr. Davies and his colleagues have recently shown that twin DNA can have differences in the number of copies of certain genes and that these numbers can have a dramatic impact on behavior.

“We call this Copy Number Variation.

We found that in identical twins with different behavioral problems, one twin might have two copies of a particular gene and the other might have three,” explains Dr. Davies, whose breakthrough research has just been

April / May 2012

approved for publication in the European Journal of Human Genetics.

More research like this is coming. Using state-of-the-art equipment, the AIHG is capable of designing ‘made-to-order’ genetic tests for any group of genes, giving clinical researchers at Avera and elsewhere the tools to design and implement a virtually unlimited range of genetic studies.

Child and adolescent psychiatrist Timothy Soundy, MD, AIHG Director Ryan Hansen and Gareth Davies, PhD.

A Bright Future According to the American Clinical Laboratory Association, Labs like the Avera Institute for Human Genetics can expect to stay very busy for the foreseeable future.

[See sidebar] As clinicians press for genetic tests that will help them tailor their patient care, labs like this one are seeing phenomenal growth. Davies says he gets as many as ten inquiries a week from people who want to work in the AIHG, a significant challenge in a field where necessary equipment is often outdated within a few months of purchase.

“I would love to hire everyone who applies, but I need to be able to fund it,” says Davies. “We are growing as fast as we can.”

In the meantime, Dr. Davies says his Avera team is as capable as any he worked with at Oxford or NIH, and is up for whatever challenges lay ahead. One of those challenges is already on the horizon. Now that the human genome has been sequenced, a new race is on to create fast, affordable individual genome mapping.

“When the human genome was sequenced, it took thousands of machines from all over the world tens of billions of dollars,” says Dr. Davies. “Now, I believe we are getting to the stage where, in the next few years, it will cost just $1000 to sequence one person’s genome. I used to tell my students ‘not in my lifetime, but in yours.’ But now I believe it will be much sooner.”

“When that happens, it is going to completely revolutionize the practice of medicine.” ■

MidwestMedicalEdition.com

17

Go Mobile or Go Home

By Tana Tipton

A

lmost 8 0 percent of physicians recommend patients go online for help managing their health conditions. That’s good news if your marketing efforts have been spent enhancing your organization’s website with wellness tools and apps. It’s bad news if you don’t have a mobile version of your website, because you’re missing an opportunity to engage your patients.

There are 530 million mobile web users.

Many are patients accessing your website from their phones, whether or not your site is mobile-optimized. Without a mobile version of your site, graphics are difficult to see, text discouraging to read and links impossible to tap. That’s a problem since today’s patients want a clear path to relevant, credible health information.

If you don’t provide a positive mobile experience, it’s time to change. According to a Morgan Stanley report, more people will access the web from mobile devices than from computers as early as 2015.

Fortunately, your efforts to build-up your main website were not in vain. With smartphone adoption booming, you simply need both. Plus, mobile sites are cost-effective to create since they’re a simplified version of your full site.

Follow these tips for optimizing your mobile site ♦ Use one-touch phone numbers.

Visitors to your mobile site are already on their phone, so this is essential. Phone numbers should require just a tap to call. Have safety information at the top of your Contact Us page, like calling 911 for an emergency.

♦ Keep content short. Don’t list your board of directors, annual reports, history or other lengthy content on your mobile site; it’s not conducive to reading on a small screen. List helpful information like locations, maps and directions. ♦ Link to your main site. Make it easy to access information that’s not included on your pared-down mobile version, such as bill pay, job listings or volunteer opportunities. ♦ Limit pictures or images. They take too long to load. Focus on strong branding and easy-to-scroll text pages with big buttons. ♦ Employ mobile-friendly apps.

With more than 9,000 consumer health apps in the iTunes store alone, there’s plenty of inspiration to get creative with apps for your mobile site. Look at your most visited pages and create apps that

solve problems for patients and quickly get them to the information they need. ♦ Include Facebook and Twitter buttons. Users already interact with most social media sites via their phone. Only link to these social sites if you routinely update them with dynamic content and proactively monitor activity. ♦ Add search functionality. A search bar allows users to easily find more information and gives you flexibility to not display every component and page from your main site. However, it can be a lot of work—if you commit to adding search functionality, the bulk of the content on your full site should be searchable on your mobile site. ■ Tana Tipton is a Marketing Specialist with CQuence Health Group.

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20

Midwest Medical Edition

Farewell to the

Institution

After 36 years devoted to the University of South Dakota’s School of Medicine, Dr. Rodney Parry is hoping to finally get some time for himself.

I

t was 1976 and Dr. Rodney Parry was just finishing his pulmo-

nary medicine residency at the Mayo Clinic when the University of South Dakota School of Medicine was transitioning to a 4-year medical school. Chair of Internal Medicine, Dr. Robert Talley, approached Parry, who’d grown up in Canistota, about the possibility of joining the growing medical school faculty and moving back home.

“I was intrigued with the idea of teaching and being part of the medical school,” recalls Dr. Parry. “But the truth is, Dr. Talley misled me. He told me that, as part of the medical school faculty, it was going to be important for me to have some time in my schedule just to think and to plan.”

“But it didn’t quite work out that way,” he laughs.

In fact, Dr. Parry hit the ground running as USDSM’s head of pulmonary medicine and the only lung specialist in eastern South Dakota. At the same time he was developing the school’s pulmonary medicine curriculum, Dr. Parry was also treating veterans with pulmonary conditions like bronchitis and emphysema in his half-time job at the

The new Simulation Center named for Dr. Parry will be housed in the USDSM Health Science Center/Wegner Library building in Sioux Falls.

VA Hospital. It was under Dr. Parry’s guidance that the hospital first began using portable oxygen.

“I remember that people were very worried at first that it would be a fire hazard,” he recalls. “But with their help, we were able to develop a good pulmonary medicine program there.”

Soon, Dr. Parry found himself developing pulmonary medicine programs for both McKennan and Sioux Valley Hospitals. When Dr. Talley invited Dr. Parry to serve as his assistant in the early 1990’s, the newly-created position did not even have a title. They decided call him the Executive Dean, a position he held until he become Vice President and Dean upon Dr. Talley’s retirement in 2004.

A Proud Tenure

Since that time, there have been many changes at the USD Sanford School of Medicine (including the name change in 2006) of which Dr. Parry is proud.

Class sizes have expanded in recent years from 50 to 56. The school has also added valuable and unique new programs, including a new rural medicine track which starts in the summer of 2012, an MD/PhD program, a pediatric residency, a cardiac fellowship which starts this year, and a geriatric fellowship which will produce its first graduates this fall. A residency program focused on ‘rural surgery’ is now in the works.

As VP and Dean, Dr. Parry also oversees the school’s growing Health Sciences curriculum.

Continued on pg. 22

April / May 2012

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21

Farewell to the Institution continued from Page 21

“Frankly, I am very proud that were able to get this organized as a school,” says Dr. Parry. “Health Sciences includes ten different programs, including a health science undergraduate degree.

This is a degree for people who want to be involved in health care, but aren’t certain exactly what they want to do. It may be used to prepare for a PT or a PA program. Or it could be used by prepare for education as a radiology tech or some such. So I think it meets the needs of many people.”

During Dr. Parry’s tenure, the school’s Physical Therapy program began offering a doctoral degree, and the Nursing program, which had offered only an associate degree, now offers a bachelor’s degree program. But Dr. Parry says the most significant change at the USD Sanford School of Medicine has been the dramatic transformation in the curriculum for medical students.

Instead of a curriculum centered on subjects like anatomy and physiology, students will study organ systems, beginning with skin and skeletal in their first year. And instead of two full years of basic science classes, students will begin getting clinical experience in the middle of their sophomore year. They will also spend a year participating in ‘longitudinal care’, following their patients from clinic to hospital, as needed.

“This allows students to get more clinical exposure, allows for more small group interaction and gives them more experience with longitudinal care, which we believe is a more practical preparation for the kinds of situations they will face,” says Dr. Parry. “This should allow them to feel more comfortable practicing in a community of any size.”

Beyond the medical school, Dr. Parry has been a leader in treating Cystic Fibrosis. He served on the national Cystic Fibrosis advisory committee and helped in the development of Sanford’s nationally-recognized Cystic Fibrosis Research Center.

Looking Forward

In his retirement, Dr. Parry says he hopes to find a little of that ‘time to think and plan’ that he was promised so many years ago. He and his wife, Ruth, plan to stay in Sioux Falls near their grandchildren and he would like to indulge in his hobbies of gardening and travelling.

The Sanford School of Medicine will honor Dr. Parry’s years of service by naming a new Simulation Center after him. The “Rodney R. Parry, MD, Clinical Skills and Simulation Center”, located in the lower level of the medical school library building in Sioux Falls, will feature advanced simulation technology for teaching and testing students. The Center will be a shared facility with the VA Hospital. Construction began in March.

The school’s new VP/Dean, Dr. Mary Nettleman, will assume her duties April 2nd. ■ An open house will be held in Dr. Parry’s honor on Friday, April 20th from 4:00 to 5:30 pm in Room 106 of the Health Science Center in Sioux Falls.

22

Midwest Medical Edition

MED Quotes

Man may be the captain of his fate, but is also the victim of his blood sugar. ~Wilfrid G. Oakley

Anderson to Lead SD Family Physicians Canistota Family Physician Susan Anderson, MD, with Sanford Clinic has

been elected by her peers to serve as President of the South Dakota Academy of Family Physicians, a group of over 290 Family Physicians from the state.

Dr. Anderson has served on the Board of Directors for 4 years, three of those as Vice President and she most recently held the position of President Elect.

The SDAFP is a constituent chapter of the American Academy of Family Physicians, which is a national organization

comprised of 94,000 members in 50 states, D.C., Puerto Rico, the Virgin Islands and Guam. The Academy was founded in 1947 to promote and maintain high quality standards for family doctors. The South Dakota Academy was established in 1951 to carry out the mission of the AAFP at the state level.

Dr. Anderson attended medical school at USD in Vermillion and completed residency at the Sioux Falls Family Medicine Residency where she served as chief resident. Currently, she is Associate Professor

of the Department of Family Medicine and the Director of Introduction to Clinical Medicine at the USD Sanford School of Medicine.

Dr. Anderson practices with the Sanford USD Physicians Clinic in Sioux Falls and has an outreach clinic in Canistota. She is also the Medical Director of the Canistota Good Samaritan Center, a member of the Society of Teachers of Family Medicine, and president of the Canistota School Board.

The office of President is a one-year term which began in February. ■

Diagnosis in a flash.

Introducing Avera Heart Hospital’s new FLASH CT scanner.

“This new CTallows us to scan the heart in one heartbeat using the lowest possible dose necessary.

David A. Nagelhout, MD, FACC, DSCCT

Mark R. Gordon, MD, FACC

- Drs. Nagelhout and Gordon, North Central Heart Institute

n Speed. The Somatom Definition FLASH scans

a 6-feet-6-inch tall person in five seconds. n Safety. Our registered CT technologists can increase

image quality while reducing the amount of dose radiation. n Quality. The FLASH CT scanner offers the clearest images

possible with the highest resolution.

Physicians can order a FLASH CT scan for their patients by contacting the hospital. The new CT will also be used for Planet Heart screenings to help assess risk for heart and vascular disease. If you have any questions, call the radiology department at (605) 977-7323.

www.AveraHeartHospital.com

STATE OF THE ART ...with Heart.

April / May 2012

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23

Sensory Processing Disorders Through the Lifespan

By Theresa Parish, OTR/L, CEES

T

imes are changing and people are hearing more and more about sensory processing disorders. Parents, teachers, and caregivers of individuals from birth to death are taking the initiative to take sensory processing treatment into consideration to improve the lives of the people in their care. In infancy, parents may be dealing with an inconsolable baby, a fussy eater, or a baby that doesn’t sleep. In a school setting, there may be some challenging behaviors that get in the way of the goal of teaching. Sitting still, paying attention, and even temper tantrums are

impeding children from learning skills and knowledge.

As these children age, they may have more difficulty in certain environments and learning disabilities emerge. Children and teens often get diagnosed with ADHD or even Bipolar disorder. Some of these children become violent and end up in juvenile detention centers, psychiatric wards, or even out on the streets. Adults with sensory processing disorders have difficulty with relationships, maintaining employment, and even with participating in their activities of daily living skills.

Our sensory processing abilities decline

naturally through the aging process. Difficulties are often noticed in assisted living facilities and nursing care facilities especially with individuals that have dementia or Alzheimer’s disease.

So what does all this have to do with you as a health care professional? Everything. People are searching for answers to why these challenging behaviors are happening, and they will be looking to you to get them the help they need. It all begins with awareness that the basis for all behavior is sensory processing, and if you can make an impact there, many people’s lives will be forever changed.

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24

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Midwest Medical Edition

Survival Story Featured at

National Conference Medications may help, but at times they are just a Band-Aid. For an individual, a referral to an occupational therapist who is a specialist in sensory processing disorders is very beneficial. Treatment includes adding the power sensations laced throughout a person’s day to enhance brainstem chemicals that affect our ability to respond to incoming sensations instead of reacting. This is easy to do once there is an understanding of the techniques and benefits. However, it takes a “village” to make a lasting change. So we all must work together.

Change can be very difficult, but with an understanding of what is going on and the steps to help alleviate the behaviors, lasting impact can be gained. All brains benefit from sensory processing input, therefore, it is easy to treat everyone with sensory techniques and improve their well-being.

To help an individual within a classroom, the teacher can be educated on what can be done differently to impact the student or students having difficulty. These techniques can be utilized in the entire classroom, thus impacting the learning success for all students. Challenging behaviors will be reduced which keep students, aides and teachers safe from harm. To impact an entire school, all teachers and aides can be educated.

Programs for educating staff and caregivers at schools, daycares, nursing care facilities, teen help centers, and developmental disability centers are available. It all begins with awareness of how Sensory Processing Disorders impact people’s lives and identification of a need for an individual being served or for the entire facility to be trained. As a healthcare professional, you can be that link to an occupational therapist who can help. ■

A Watertown man’s story of heart attack survival landed him in the spotlight in front of some of the nation’s top heart doctors and researchers.

Pictured from left to right: Shelley Stingley, Helmsley Trust; Jodi Doering, South Dakota Mission: Lifeline Director; Walter Panzirer, Helmsley Trust; Craig Kruse, Watertown Fire/Rescue paramedic; Star Jones; and Mick Stanton.

Watertown realtor Forrest “Mick” Stanton was one of South Dakota ‘Mis-

Falls, SD.

sion: Lifeline’s’ first success stories. After suffering a heart attack in Henry, S.D., last summer, he was transferred to Prairie Lakes Hospital in Watertown. Within 19 minutes of arrival, Stanton had two blockages in his heart opened, epitomizing the goal of the ‘Mission: Lifeline’ program.

Because of his experience, Stanton was invited by the national office of the American Heart Association (AHA) to share his heart attack survival story at the AHA Scientific Sessions in Orlando. The annual Scientific Sessions is the country’s largest gathering of scientists and healthcare professionals devoted to the science of cardiovascular disease and stroke.

The immediate treatment received by Stanton at Prairie Lakes Hospital was made possible by a grant from the Helmsley Charitable Trust and the AHA’s ‘Mission: Lifeline’ program. In April, 2010 the Helmsley Charitable Trust awarded the AHA an $8.4 million grant to build a STEMI system of care in the

April / May 2012

MidwestMedicalEdition.com

Theresa Parish is an ergonomic and loss control specialist/sensory processing specialist with RAS, a provider of workers’ compensation in the Upper Midwest, headquartered in Sioux

state of South Dakota. ‘Mission: Lifeline’ is using the grant to purchase equipment, implement processes, and close communication gaps that separate heart attack patients from timely access to appropriate treatments.

Part of the grant funding was used to outfit ambulances throughout South Dakota with electrocardiogram (EKG) monitors that have the ability to transmit EKG readings to designated STEMI-receiving hospitals.

Prairie Lakes Hospital has been designated a STEMI-receiving hospital because of its ability to provide life-saving treatment to patients suffering heart attacks.

The ambulance Stanton was transferred in was equipped with this technology and his EKG reading was transmitted to Prairie Lakes Hospital where it was read by interventional cardiologist Dr. Salem Maaliki.

This enabled Dr. Maaliki and the cath lab team to be ready for Stanton when he arrived and restore blood flow to Stanton’s heart well under the 90 minute recommended timeframe set by the Society for Cardiovascular Angiography and Interventions. ■

25

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Heart Hospital Installs 4-D Flash CT Scanner New Imaging Technology Increases Speed, Reduces Dose The Avera Heart Hospital has installed a Siemens SOMATOM Definition Flash CT, one of the world’s fastest computed tomography (CT) scanners with the lowest possible radiation dosage. The new CT will aid in improving diagnosis and treatment of heart and vascular disease.

The effectiveness of CT has led to an increase in the number of scans being performed, which means more exposure to radiation. Avera Heart Hospital chose the new Flash CT because it is designed to reduce radiation exposure.

The machine has features that help shield organs and areas of the body that are more sensitive to radiation.

In less than one second, the new CT can produce high-definition images of

26

the heart including the smallest blood vessels. These high resolution images can reduce the need for more invasive studies, decrease the time to diagnosis, speed urgent medical care and shorten hospital stays. ■ Other benefits of the Flash CT: • Patients receiving a calcium score will receive a reduction in radiation dose of approximately one-third • Radiology technologists can perform an exam on a 6-foot-6-inch tall person in about 5 seconds • Patients with irregular or fast heart beats may not need to take beta blockers (mediations that slow their heart rate) before a Coronary Angiogram CT scan.

Midwest Medical Edition

April / May 2012

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27

Grape Expectations

‘Chasing’ a Historic Zinfandel

By Heather Taylor Boysen

M

y husband and I recently visited the beautiful state of California for a quick Valentine’s Day vacation and I was lucky enough to visit some well-know (and not-so-well-known) wineries during our brief four day sojourn.

Since we cannot commute to most winegrowing regions regularly, (I have a business to run and children to get to school) I often meet with sales people from wineries around the country. They come to our store, armed with samples and information, and intent on placing their products on our shelves.

“ . . . seeing the gnarly old vines, and learning the amazing history of this place was worth the entire trip.”

Although not all of the wines are my ‘cup of tea’, I have made many friends in the wine industry from across the U.S., many of whom are anxious for us to visit their facilities.

But this trip was different. Instead of scheduling tastings at wineries with which

April / May 2012

we already do business, I took advice from friends who are extraordinary collectors and have a wine cellar that would be coveted by most oenophiles. My husband and I were invited to their wine tasting party and were blown away by the samples we tasted. So I asked permission to photograph the bottles and made it my mission to visit at least a couple of these wineries and invite them to let me carry their wines in our shop.

Our first visit was to a winery that has been in production for five generations. The history of this winery and its founding family is impressive. According to the Chase family, “In 1874, Sarah Ester Chase Bourn, wife of a wealthy businessman, purchased a small vineyard in Napa Valley. Upon the death of her husband, management of the estate was turned over to her son William Bourn II, who was as industrious as his mother. William perpetuated Sarah’s impact on the area by selling the family grapes to Napa Valley’s first winemaker, Charles Krug. It was the start of what would become a long-standing family tradition.

Not content to only sell grapes, William wanted to produce wine and create a place to do so for himself and his neighbors. The answer was to build a co-op for wine production and storage. In 1888 he built Greystone Cellars, the historic and formidable stone building at the northern end of St. Helena.

In 1903 William’s sister, Maude and her husband William Alston Hayne planted the eponymously named vineyard with Zinfandel, and other varietals. Today, the Zinfandel vines still thrive. The head-pruned Zinfandel vines are dry-farmed in the sandy-gravelly soil that produces Napa Valley’s most exuberant and robust Zinfandel grapes.”

We called the winery to ask if we

MidwestMedicalEdition.com

could come to visit. I was absolutely itching to see Zinfandel vines that were over 100 years old! Unfortunately, they were moving barrels out of the barrel room that day and suggested that we might prefer to come later in the afternoon when they were done with the move. I don’t care if its grapes or corn, when a farmer has work to do, guests must wait!

Walking though their vineyard, seeing the gnarly old vines, and learning the amazing history of this place was worth the entire trip. The tasting itself reaffirmed what I had learned from my friends: These were truly very special wines. And you wouldn’t have to ransom your first born to buy a bottle!

The tasting was spectacular and I hadn’t been wrong in my enthusiasm for this wine when we tasted it back home. We are now in the process of working with the folks at Chase and one of our local distributors to bring their wine to South Dakota. Small case production, top level juice, and five generations of wine making is a trifecta in the wine world! ■

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The concept of complementary or alternative

therapies

has been gaining momentum nationwide in recent years, as patients search for new ways to maintain or regain their health in the face of rising healthcare costs. As a result, the number of alternative medicine practitioners and programs in the South Dakota region has also grown dramatically. Some are offered within a traditional healthcare setting such as a medical clinic or hospital. Others are stand-alone

C o mp l e m e n ta r y

T h e r ap i e s

businesses. In this new column, we will take a closer look at some of the new (and sometimes ancient) therapies being offered in our region and meet the people who practice them.

Name

Rebecca Weiner, CCH Title

Consulting Hypnotist and Anxiety Relief Spe0cialist, in practice for 8 years

Business

Heal with Hypnosis, Sioux Falls MED: Many people still associate hypnosis with mind control and secrecy, but you say the hypnotic state is something most of us have experienced.

What do you mean?

RW: Hypnosis is actually a state that many of us are in several times a week or even several times a day. When you are immersed in a project and so focused that you fail to notice things going on around you, that’s a hypnotic state. When a person undergoes hypnosis in my office, he is in control the entire time. It is really

help overcome all sorts of psychological

we experience an event, a file is created

problems, but I specialize in helping

in the mind. When we create boredom

people with generalized anxiety, panic

around an event that had strong emotion

attacks, specific phobias and traumatic

attached to it, the file becomes neutral-

stress disorders. These conditions are

ized and so does the anxiety that went

very common. According to the National

along with it.

Institute of Mental Health, anxiety is the number one mental health issue in the US. Statistics show that about every other person has suffered from depression and every 3rd patient has anxiety. I have had very good success with these kinds of issues.

MED: How does hypnosis work?

talk to themselves in more positive ways.

RW: My process is pretty unique in that

unhealthy or dangerous in any way.

MED: Are there certain types of problems that lend themselves to being helped by hypnosis?

RW: Clinical hypnosis can be used to

medication?

RW: Physicians need to know that hypnosis will not interfere with any changes in medication. In fact, I don’t ever suggest that a patient stop treatment

I focus on a technique called ‘regression’.

with their medical provider. That is a

It is a desensitization process during

conversation they need to have with the

which you go over and over things with

other professionals in their lives.

the client that have caused them rage or

Hypnosis is simply an additional tool to

anxiety. Essentially, you talk about these

support what the doctor is doing. I get

things until they are bored. Every time

referrals from counselors and

C o mp l e m e n ta r y 30

you see hypnosis as an alternative to

other treatment. It does not require any

more about my teaching people how to It is a very natural process that is not

MED: How can this process complement a patient’s medical treatment? Do

T h e r ap i e s Midwest Medical Edition

psychologists, as well as physicians. Many of my clients have told their doctors that they are doing this and the doctors have been very supportive. That kind of support is important for helping patients make positive life changes.

MED: How can a potential client or a referring healthcare provider identify a “good” hypnotist?

RW: A good hypnotist will follow the ethics and codes established by the National Guild of Hypnotists. They will NOT say that they can cure things in one session. (Most problems require at least 6 two-hour sessions.) And the client needs to have a comfort level with the person they are going to work with. They need to ask ‘how will this work?’, ‘what can I expect?’, etc. The same kinds of questions you would ask your doctor.

MED: Is there anything else you feel the medical community should know about what you do?

RW: There is so much that we still do not know about the brain. For those who are skeptical, I would ask, ‘How can you say for sure that this won’t help?’ You owe it to yourself and your patients to do some exploration.

Professionals like me are always happy to talk with providers about how their therapy might help. Also, in my practice, I always start with a free consultation to

determine whether or not I am a good fit for the client. ■

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31

In Review What You’re Reading, Watching, Hearing

Author Dr Oliver Sacks

Musicophilia Tales of Music and the Brain Reviewed by Richard Klein, MD

D

id you know that when

certain people hear musical chords, they see different colors, and that certain colors represent specific chords? It’s call synesthesia.

Were you aware that Leon Fleisher, a renowned concert pianist, developed a condition called dystonia in which the fourth and fifth fingers of his right hand would curl under, and until he learned pieces written for the left hand, this condition almost ended his career?

These and other fascinating conditions are described in Oliver Sacks’ book, Musicophilia: Tales of Music and the Brain (Alfred A. Knopf, 2007). Dr. Sacks is a professor of Neurology and Psychiatry at Columbia University School of Medicine. He is probably best known for his book “Awakenings”, which was later made into a movie.

In his inimitable style, he describes many

32

neurologic and psychiatric conditions, both normal and pathological, related to aspects of music. How are we able to distinguish the sound of a clarinet from that of a flute or an oboe? This is called timbre, and is a different characteristic from melody, pitch, contour and rhythm. Not only can we distinguish these different sounds when we hear them, but when we remember a piece of music, the timbre rings true.

Dr. Sacks explains to us exactly how this happens. He uses case reports of his own patients, and many who are referred to him.

Case reports are always fun to read, but at times, his explicit details become a little tedious. All in all, however, this book is very entertaining, and I am sure you will find it enjoyable and enlightening. ■

Wruitse! to

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Dr. Richard Klein is a urologist practicing in Sioux Falls.

Midwest Medical Edition

victories

For all the

you seek

Head and neck treatment at Sanford Cancer We offer a team approach to head and neck cancer treatment.

Our expert team delivers superior survival rates and restorative surgical options that provide the best quality of life outcomes.

We are proud to help patients recognize victories through every stage of their cancer journey.

For mastery, innovation and personalized care.

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100-11395-3072 2/12

Our team: Jennifer Schmidt, RN, Navigator Laurie Gromer, CNP Chad Spanos, MD Bonnie Tschetter, LPN John Lee, MD

Smoothing the Path Treatment for Patients with Development Disabilities Is Not Just a Stress on the Patient

A

By Liz Boyd ny physician who has ever provided medical care for a patient with a developmental disability knows that it can present some unique challenges. Depending on the disability, the patient may be fearful, confused, resistant or even belligerent toward their doctor or healthcare provider – even when the care is badly needed.

In addition, patients with disabilities may have trouble communicating, making or keeping appointments, interacting appropriately with other patients and staff, or complying with treatment recommendations.

It can be a frustrating situation for both patient and provider.

“One basic problem I see with patients that have developmental disabilities is that they may not be able to tell the doctor how they’re doing or may not be able to tell the complete story,” observes Sioux Falls family physician Patty Peters, MD, who knows the frustration of caring for such patients.

This is where the professionals at South Dakota Achieve can help. The 54-year-old Sioux Falls-based non-profit provides services to adults with disabilities ranging from support to live independently, communicate, expand their social network, find work, and live healthier lives. In addition to supporting healthy eating and exercise, this includes making sure the people they support have regular checkups, routine tests, and needed medical care.

“What we have found is that it is sometimes hard to find doctors or dentists who are willing to provide services to people with disabilities,” says Achieve’s Director of Health Services, Liz Blais. “It may be hard

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Achieve provides basic health care services to the people it supports.

Here, Ashley Hoss, RN, asseses David Johnson.

to communicate with these patients or hard to calm them. Unfortunately, most physicians get little or no training in how to deal with these kinds of challenges.”

Fortunately, people supported at Achieve can get many of their day-to-day healthcare needs met in house. A staff of 17 nurses and restorative technicians provide services such as physical therapy, dietary consultation, stretching and mobility exercises, medication monitoring, treatment for everyday illnesses and help with eating disorders. But when any of their more than 468 people supported from 22 counties do need medical care beyond what Achieve staff can provide, the company

has developed systems to make the whole process easier and more productive for everyone involved.

“We have support people who can help make that medical appointment, then go with the person to that appointment and be right there to help the doctor understand what their needs are,” says Blais. “With that kind of support, not only do patients get the care they need, but doctors get paid for their time since there are fewer missed appointments, etc.”

“I have found it very helpful to have an Achieve support person there at the appointment,” says Dr. Peters. “For one thing, that person knows the patient well and

Midwest Medical Edition

MED Quotes

Bankers Trust Company of South Dakota

Time is generally the best doctor. ~Ovid I can trust what they tell me about how the patient is really doing at work or at home. Also, the patient often feels more at ease with a familiar person in the room, so that can help the interview and exam go much more smoothly. I always feel that I can do a better job with that patient because that support person is like family to them.”

Because unfamiliar situations can be especially stressful for people with developmental disabilities, they sometimes need support to ‘build up’ to a healthcare appointment. Blais says this desensitization process can be as simple as an Achieve staff member sitting with the person in the waiting room or accompanying them to the exam room a time or two before the actual appointment takes place. This simple approach can not only ease fear for that first appointment, but may also help that patient form a comfort level with the provider that will keep them coming back.

“We want to reach out and form partnerships with physicians in the community,” says Blais. “Our goal is to educate and promote understanding.” ■

Providing Experienced & Personalized Trust Services • • • •

Asset Protection Product Knowledge Comprehensive Solutions Personal Service

5032 S. Bur Oak Place Suite 131 Sioux Falls, SD 57108

(605) 338-5033

7:00 p.m. . Saturday, April 14, 2012 Sioux Falls Orpheum Theater

· Rick Holm, MD, with the Hopeful Spirit Chorale. · Dennis Knutson, MD, with the Augustana Flute Choir. · Terri Peterson-Henry, DO · Marian Petrasko, MD · Ronald Rossing, MD · Kirke Wheeler, MD · The Crabgrass Crew · Dr. Jack Billion, Master of Ceremonies

Tickets: $18 • Reserved Seating • Reception Follows Call (605) 782-8500 or go to www.cchs.org - Let’s Talk!

Medical-Based Summer Camps for Kids!

Insurance may apply!

• Dates: May 21-24 • Time: 9:00-11:00 am

A camp using Augmentative & Alternative Communication devices.

- Breakfast Club

• Dates: June 4, 7, 11, 14, 18, 21, 25, 28 • Time: 7:45-9:00 am

For children that are picky eaters.

- Power Mobility Camps • Call for more information

Mobility skills with the latest technology in power wheelchairs.

April / May 2012

MidwestMedicalEdition.com

Call (605)782-2400 for more details or to register!

CHILDREN’S CARE HOSPITAL & SCHOOL www.cchs.org 35

News & Notes Happenings around the region

Prairie Lakes Alison Gilbertson has been named director of the Prairie Lakes Healthcare Foundation. As director, Gilbertson will work to fulfill the organization’s mission to support and advance the health services available to the Watertown area through Prairie Lakes Healthcare System. She will be responsible for the management of dayto-day operations of the foundation.

Gilbertson was executive director of Golden LivingCenter in Lake Norden, S.D. since 2008. Gilbertson holds a master’s degree from the University of South Dakota and a bachelor’s degree from South Dakota State University.

The National Kidney Foundation, Inc., (NKF) serving Minnesota, the Dakotas and Iowa, is honoring Tina Melanson, MD, FNKF, of Prairie Lakes Healthcare System with the 2012 Friend of the Foundation Award.

Dr. Melanson presented the award at the annual Feast of the Great Chefs in Sioux Falls on Sunday, March 11, 2012. Dr. Melanson is board certified in Nephrology and Internal Medicine. She practices nephrology at Prairie Lakes Healthcare System in Watertown and serves as medical director of the Prairie Lakes Dialysis Units. Dr. Melanson has led the way to establish the first annual Watertown Kidney Walk, Fun Run and Bike-a-Thon to be held in May.

Regional Special treatment for head and neck lymphedema is now available at Regional Rehabilitation Institute. Head and neck lymphedema can affect vision, eating, speaking and breathing. Therapy includes manual lymphedema drainage, compression garments for day and/or night, compression mask, facioplasty support or taping and decongestive exercises.

Therapists will also teach the patient to perform necessary techniques themselves at home. For more information regarding this program or other Regional Rehabilitation Institute programs, please call (605) 719-1100.

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The Children’s Miracle Network (CMN) raised $98,222 during a two-day Radiothon broadcast Thursday, March 8 and Friday, March 9 on New Rushmore Radio Stations Magic 93.9, KAT 98.7, The FOX 100.3 and KKLS 97.5 and 920 AM. The Radiothon took place in the lobby at Rapid City Regional Hospital. With money raised through special events, such as the Radiothon, CMN is able to purchase medical equipment and fund programs for children’s services. One hundred percent of the money raised locally stays in our area.

Sanford Sanford Health nurse practitioner, Lori Wegehaupt, NNP, is receiving the 2012 AANP Nurse Practitioner State Award for Excellence. This award is given annually to a nurse practitioner in each state who demonstrates excellence in his/ her area of practice. A nurse for 26 years, Wegehaupt has worked for Sanford Health her entire professional career. The past 20 of those years, she has served as a neonatal nurse practitioner in the neonatal intensive care unit at Sanford USD Medical Center. Wegehaupt will be recognized at AANP National Conference in Orlando in June.

Clayton Van Balen, MD, F.A.A.F.P. of Sanford Health Occupational Medicine & Walk-in Clinic has achieved the Degree of Fellow of the American Academy of Family Physicians (AAFP).

This fellowship entitles Dr. Van Balen to use the honorary designation, “Fellow of the American Academy of Family Physicians,” or “F.A.A.F.P.” and places him among 29,000 distinguished recipients nationwide since the degree’s establishment in 1971.

AAFP is the national medical association representing nearly 100,300 family physicians, residents and medical students. The AFFP Degree of Fellow recognizes family physicians “who have distinguished themselves through service to family medicine and ongoing professional development.”

Sanford Children’s Specialty Clinic in Sioux Falls has added two new pediatric specialists. Steven Cochran, MD, is a board certified Child & Adolescent Psychiatrist. Dr. Cochran is a graduate of the Loma Linda University School of Medicine and

completed a fellowship at the University of Colorado School of Medicine.

Dr. Catherine Avery is a Pediatric Psychologist. She is a graduate of the Illinois Institute of Technology in Chicago and completed an internship at Pine Rest Christian Hospital in Grand Rapids, Michigan.

OTHER The South Dakota Affiliate of Susan G. Komen is moving its 2012 Race for the Cure breast cancer fundraising event from Vermillion, South Dakota to downtown Sioux Falls on September 30th. Organizers believe the new location will help the event grow by making it easier for more participants from across the state to attend. Seventy-five percent of the funds raised through the race stay in South Dakota for breast health education, breast cancer screening, treatment programs and research to prevent, treat and cure breast cancer. The remaining 25 percent supports national breast cancer research. Since 2008, the South Dakota race has raised more than $800,000.

SEEKING ED MEDICAL DIRECTOR BE/BC Emergency Medicine or BC Primary Care Physician with EM experience ready to lead an advanced Emergency Department currently seeking Trauma III Certification. Yearly volume of 10,000 patient encounters with superior staff and speciality care back-up.

Teaching hospital with excellent compensation and benefit package. Medical Directorship responsibilities plus seven 24-hour shifts per month and three Saturdays per year. NO STATE INCOME TAX. Physician Recruiter Mindy Schwitzer (605) 664-6463 mschweitzer@avera.org Avera Sacred Heart Hospital has positioned itself as a regional health care center since 1897, serving 120,000 residents in 15 counties.

500 West Summit Street ~ Yankton, South Dakota Midwest Medical Edition

Learning Opportunities April / May / June 2012 April 13 Avera Childbirth Educator Workshop 8 am – 4:30 pm Location: Avera Education Center Classroom 3 Information & registration: mckeducation@avera.org, Phone: 322-8950 Website: www.AveraMcKennan.org; click on Events Calendar

April 13 – 14 GI Nursing Conference Location: Sanford Information and Registration: nikki.terveer@sanfordhealth.org Phone: 328-6353

April 19 Living With Grief: End-of-Life Ethics 12:30 pm – 4 pm Location: Avera Education Center Auditorium Information & registration: mckeducation@avera.org Phone: 322-8950 Website: www.AveraMcKennan.org, click on Events Calendar

April 19 7:30 am – 4:45 pm April 20 8:30 am – 5 pm

Pediatric Trauma Conference Location: Sanford Center, Dakota Room Information: nikki.terveer@sanfordhealth.org Phone: 328-6353

Diabetes Update 2012 Location: Avera McKennan Prairie Center Information and Registration: mckeducation@avera.org Phone: 322-8950 Website: www.AveraMcKennan.org, click on Events Calendar

April 21 Sanford Oncology Clinic Oncology Update Location: Sanford USD Medical Center, Schroeder Auditorium Information: nikki.terveer@sanfordhealth.org Phone: 328-6353

April 24 Ophthalmology Education Workshop 5:30 pm – 7:30 pm Location: Avera Education Center, Classroom 3 Information and Registration: mckeducation@avera.org Phone: 322-8950 Website: www.AveraMcKennan.org, click on Events Calendar

April 25 Transplant Education Day 8:30 am – 3 pm Location: Sanford USD Medical Center, Schroeder Auditorium Information: nikki.terveer@sanfordhealth.org Phone: 328-6353

May 1 7:30 am – 4 pm

20th Annual Trauma Symposium: Excellence in Trauma and Surgical Critical Care

May 4 8 am – 5 pm

17th Annual North Central Heart Vascular Symposium

Location: Sioux Falls Convention Center Information and Registration: mckeducation@avera.org Phone: 322-8950

Location: Sioux Falls Convention Center Information: jhatch@ncheart.com www.northcentralheart.com Phone: 605-977-5316

May 11 6th Annual Sanford Sports Medicine Symposium 7 am – 5:15 pm Location: Best Western Ramkota Hotel, Sioux Falls Information and Registration: nikki.terveer@sanfordhealth.org Phone: 328-6333

May 23 1 South Dakota Workers’ Compensation Summit 10:30 am – 7:30 pm Location: Best Western Ramkota Hotel, Sioux Falls Presented by: Howalt McDowell Insurance, May 24 7 am – 5 pm Risk Administrative Services, Inc. Information and Registration: www.workcompsd.com

Save the Date:

June 15 – 16 Black Hills Pediatric Conference Location: The Lodge at Deadwood Registration:childrens.sanfordhealth.org keyword: BH Pediatric Symposium

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.

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Midwest Medical Edition