MED July/August Issue 2018

The Subtle Signs of Hearing Loss Big Leap for Orthopedics in Brookings

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HOME IS WHERE THE OPPORTUNITY IS CATHERINE HAJEK, MD Sanford Geneticist

THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

JULY AUGUST

Rural Parkinson's Patients Go Big and Get Loud

VOL. 9 NO. 5

2018

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From Us to You

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HERE WAS A TIME when young

people from our region who hoped to practice medicine in a specialty other than primary care saw few opportunities in their home area. Many left for medical training in other states and never came home. Others trained here in South Dakota and left to find specialty positions in other markets.

But the tide is turning. Young doctors like Sanford medical geneticist Catherine (Cassie) Hajek, MD, can now find work in South Dakota in a much wider range of subspecialties. Her experiences (and her thoughts on the rising popularity of direct-to-consumer genetic testing) are the focus of this month’s cover feature.

Also in this issue...expert advice on the connection between care-team communication and patient care, a fascinating look at how “going big” and “being loud” can slow degeneration in Parkinson’s sufferers, and how to recognize the subtle signs of hearing loss in your patients. If you have ever wondered how to utilize free media coverage to reach more people, we have some tips to get you started.

And, of course, we have all the news and a list of upcoming summer and fall events.

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16

8 | Are You Missing the Subtle

Signs of Hearing Loss in Your Patients?

REGULAR FEATURES 4 FROM US TO YOU 12 N EWS & NOTES Here’s what’s happening around the region this summer.

31 U PCOMING EVENTS conferences, CME events, golf tourneys and more

■ By Mandy Rounseville-Norgaard

10 | Big and Loud New Program Helps Rural Patients Break Through the Limits of Parkinson’s Disease

21 | New Robot Brings Unprece-

dented Personalization and Accuracy to Orthopedic Surgery in Brookings

On the cover: Sanford medical geneticist Catherine Hajek, MD, in the Imagenetics building in Sioux Falls. Photo courtesy Sanford Health.

5

Can We Talk?

RAISING YOUR CARE TEAM COMMUNICATION GAME CAN IMPROVE PATIENT SAFETY OUTCOMES

BY BETTY VANWOERT

W

HAT SKILLS MAKE A GOOD CLINICIAN? Many of us answer by listing technical or organizational skills or indications of satisfaction like, “Patients and families always say great things about them.” Rarely do we think of communication skills as clinical skills. Yet failure to communicate critical

information in a timely manner, or to speak up about a concerning observation, can lead to devastating patient outcomes.

COMPLEXITY LENDS ITSELF TO POOR COMMUNICATION It may not look like it to those of us practicing inside the system, but healthcare is complex.

Team members tend to overlook this complexity when processes become routine or familiarity with co-workers leads to assuming

“

FAILURE TO COMMUNICATE CRITICAL INFORMATION IN

A TIMELY MANNER . . . CAN LEAD TO DEVASTATING PATIENT OUTCOMES.

”

I know what the other person thinks or wants.

Patient care situations that once seemed exceptional are now standard: ◆ Multiple team members within

the same organization now provide care to the same patient. ◆ Many patients receive care at

satellite locations or increasingly via telemedicine. ◆ Referrals are made to multiple

practitioners, labs, diagnostic centers or specialty facilities.

access to clinical records makes timeliness of entries even more critical.

Follow-up documentation for consultations, referrals and patient-related messaging between clinicians can be high-risk processes, as team members may assume that the other party will be responsible to communicate with the patient. Patients, for their part, also assume they’ll hear from someone and get confused when they don’t. This can happen to patients during transitions of care across outpatient services, hospitalization, and home.

Involvement of more than one physician or healthcare facility caring for a patient multiplies opportunities for communication breakdowns. Assessment tools, such as the SAFER Guides at HealthIT.gov can help organizations easily review their EHR practices and find ways to improve with this aspect of team communication.

allowing casual, presumptive communication

ENHANCING YOUR COMMUNICATION CULTURE, TOOLS AND PROCESSES

to become the norm can lead to the cracks

Communication awareness, tools and pro-

that patients—and their safety—fall through.

cesses can enhance collaboration, strengthen

Making assumptions is a human reaction to working in a complex environment. But

THE EHR ADDS COMPLEXITY, CHALLENGES

6

real-time documentation of events. Remote

transitions of care and improve inefficient workflows. Improving communication is an often-untapped opportunity to increase cli-

A great deal of team communication about

nician effectiveness as well as patient safety.

patients happens within the electronic health

The primary risk management objectives for

record (EHR), which provides invaluable

any organization are effective communication

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◆ Do you educate or mentor care team members on

promise patient care, and effective policies, procedures

communication skills? Initial education is the first

and protocols that all staff follow consistently.

step. Then, sustain positive communication skills by

Periodic review of your communication systems and processes can help ensure identification and promote

formally recognizing proficient communicators and have them mentor new team members.

resolution of potential problems. These questions will help to assess your organization’s current baseline of communication fitness:

◆ Do you meet across traditional silos with commu-

nity health providers to identify and repair communication issues? AHRQ’s TeamSTEPPS® can

◆ Do you operate under informal practices that have

be valuable, as it offers customizable best practices

evolved over time? Risks increase when team

and is easy to use, is publicly available, and has

members operate under differing practices or

been researched and field-tested by high reliability

understandings. Convert informal practices into

organizations for over 35 years. ❖

formal policies and procedures. ◆ Do you ensure that every care team member is

empowered to speak up and bring issues to the forefront for resolution? Implement a culture where everyone learns from patient concerns and incidents where communication gaps occur. ◆ Do you proactively set follow-up and communica-

tion expectations with clinicians on both sides of referrals and consults? Clinicians on each side should include in their documentation who has responsibility for follow-up care and communication with the patient.

July / August 2018

Betty VanWoert, RN, BSN, CCM, CPHRM, is a Senior Risk and Patient Safety Consultant, MMIC This article is reprinted by permission from the Spring/Summer 2018 issue of Brink magazine, published by Constellation.

7

Are You Missing the Subtle Signs of Hearing Loss in Your Patients?

BY MANDY ROUNSEVILLE-NORGAARD

A

LTHOUG H NE ARLY

◆ Patient reports rapid onset of

27 million Americans

hearing loss in one or both ears

age 50 and older have

that occurs within a 72-hour

hearing loss, only 1 in

period.

7 actually use a hearing aid.

Aging and chronic exposure to loud noises are significant factors that contribute to hearing loss. Other factors, such as excessive earwax, can temporarily prevent the ears from conducting sounds as well as they should.

Hearing loss has been linked to depression, dementia, reduced job performance, stress, irritability, social isolation, and even an increased risk for falls. If you, the patient, or the patient’s family members notice any of the following signs, it is best to refer him

◆ Patient turns up the TV too loud,

or family/friends complain about how loud the TV volume is ◆ Patient reports trouble hearing in

noisy situations ◆ Patient complains about other

people “mumbling” ◆ Patient reports persistent ringing/

buzzing in the ears (tinnitus) ◆ Patient reports feeling of unsteadi-

ness or being off-balance ◆ Patient reports feeling as though

or her to a local audiologist for a diag-

the room is spinning around them,

nostic hearing evaluation.

or they are spinning

Common signs of hearing loss include: ◆ Patient regularly asks to have

things repeated ◆ Patient avoids social settings

◆ Patient reports their ears feel “full”

Frequently, hearing sensitivity changes very gradually, and individuals compensate for the decreased hearing

hearing in one ear compared

patient’s quality of life. Therefore, even

to the other

if your patients aren’t complaining about

◆ Patient has experienced a significant

heath event (i.e. stroke, heart attack)

WEB EXTRA

been linked to depression, dementia, reduced job performance, stress, irritability, social isolation, and even an increased risk for falls.

”

For this reason, hearing loss may go unnoticed until it is affecting your

exposed to ototoxic medications

Hearing loss has

with other available cues.

◆ Patient has significantly better

◆ Patient has been prescribed or

“

their hearing, any patient over the age of 40 should have a baseline hearing test.

Consider referring your patients for a hearing evaluation as part of their overall health and wellness plan. ❖

Mandy Rounseville-Norgaard, AuD, is a Sioux Falls native who practices audiology at Sioux Falls Audiology Associates.

Read More

❱G o online for tips on communicating with hard-of-hearing patients 8

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July / August 2018

9

Big and Loud NEW PROGRAM HELPS CANTON PATIENTS BREAK THROUGH THE LIMITS OF PARKINSON’S

DISEASE

BY ALEX STRAUSS

A “

We know that Parkinson’s is degenerative but we also know that these patients were able to maintain in other area, so why not with the voice?”

They think they are over-exaggerating, but they are actually moving normally.

” 10

MONG THE MANY devas-

intensive 16-session program over the course

tating effects of Parkinson’s

of a month, Zweifel works with patients on

Disease, the loss of the ability

a single goal—speaking louder.

to communicate clearly and

“It is the concentration on this one thing–

move normally are two of the most chal-

being loud—that does the trick,” says Zweifel.

lenging for both patients and families.

“Parkinson’s patients often think they are

As Parkinson’s progresses, nearly 90

speaking normally when in reality they are

percent of patients experience changes in

speaking very softly. Having them concen-

their voice, including reduced volume,

trate only on being loud improves not only

hoarseness, slurring, and a tendency to speak

volume but articulation, pitch range, and

in a monotone. Although most Parkinson’s

even swallowing.”

patients report having problems with com-

Just as importantly, more than 30 years

munication as a result of these changes, only

of research on the LSVT Loud method shows

3 to 4 percent ever receive speech therapy.

that patients are typically able to maintain

Until recently, even those who did have

their improved communication skills for up

therapy rarely experienced lasting results.

to two years after therapy.

Few people are more familiar with the problem than Speech-Language Pathologist

“We are seeing wonderful quality of life outcomes,” says Zweifel.

Candace Zweifel, MA, CCC-SLP, who provides speech therapy at Sanford facilities in Vermillion and Canton.

“I was running these people through traditional speech therapy for speech and voice changes,” says Zweifel. “But three to six months later, they were showing decline.

We know that Parkinson’s is degenerative but we also know that these patients were able to maintain in other area, so why not with the voice?”

Zweifel’s search for a better alternative led her to the Lee Silverman Voice Treatment

LSVT Big • Faster walking, bigger steps • Improve balanced • Increased trunk rotation • Improvements in activities of daily living • Improve UPDRS motor score

Loud Program, or LSVT Loud, the first speech treatment with Level 1 evidence and estab-

In fact, the results with LSVT Loud were

lished efficacy for treating voice and speech

so dramatic that physical therapists working

disorders in Parkinson’s.

with mobility issues in Parkinson’s patients

Zweifel became LSVT Loud certified in

began to take note and the LSVT Big pro-

2014 and now helps make it possible for rural

gram was born. Canton Physical Therapist

patients to get this specialized therapy with-

Becky Berentschot was certified in the

out having to travel far from home. The

method last fall and has been using it with

concept is deceptively simple: During an

her Parkinson’s patients since January.

MidwestMedicalEdition.com

Zweifel

LSVT Loud

Berentschot

“Basically, LSVT Big took the concept

big and sit down big,” says Berentschot.

of LSVT Loud and adapted it for move-

“They think they are over-exaggerating,

ment,” explains Berentschot. “Parkinson’s

but they are actually moving normally.”

patients develop slower, smaller move-

As with LSVT Loud, patients attend

ment patterns as the disease progresses.

four 60-minute session a week over the

Just like with soft speech, they may think

course of a month and are trained to do

they are walking at a normal speed when

additional daily “homework” exercise.

they are really walking very slowly.”

LSVT Big can be adapted for both gross

The dramatic depletion in dopamine

and fine motor skills. In addition to

among Parkinson’s patients robs them of

increasing mobility, it has also been

their ability to execute automatic, smooth

shown to improve balance, increase trunk

movements. Berentschot helps patients

rotation, and make daily living easier for

“recalibrate” their concept of normal

Parkinson’s patients.

movement by teaching them to do everything bigger.

“People see such wonderful results,” says Zweifel. “They don’t mind putting in

“We walk big. We move our arms big.

the work and keeping up with it.” ❖

If you sit in the chair, you pull the chair out

WEB EXTRA

80%

of patients maintain treatment improvement in their voice for 12 to 24 months

90%

of patients improve vocal loudness after treatment

100% of patients report improved communication ability

Read More

❱ L earn more about LSVT Big and Loud therapies and research.

July / August 2018

11

Happenings around the region

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska

AVERA BOB SUTTON Bob Sutton has been named as the new President and CEO of Avera Health. Sutton succeeds John Porter, who is retiring after 44 years of leadership to the organization. Sutton, of Sioux Falls, has 25+ years of professional leadership experience, most recently as Avera Executive Vice President of Human Resources. He has been with Avera since 2013 and has served in roles that include Regional President and CEO of Avera St. Mary’s Hospital in Pierre and Senior Vice President of Community Relations.

Born and raised in South Dakota, Sutton holds a Master’s of Public Administration degree from The University of South Dakota in Vermillion, and a Bachelor of Arts in Political Science, also from USD. He and his wife, Lori, have two grown children, Madison and Matthew.

12

DEANNA LARSON Deanna Larson, Chief Executive Officer of Avera eCARE® based in Sioux Falls, SD, has been named Woman of the Year by the American Telemedicine Association (ATA). Larson began her career as an RN and was named to a corporate role in quality assurance in 1996. In 2006, she was assigned administrative oversight for Avera eCARE which, at that time, involved extending ICU care and physician consults through interactive video and computer monitoring.

Under Larson’s leadership, Avera eCare established telemedicine for emergency room care and pharmacy as well as programs to serve long-term care, correctional facilities, schools and more. Larson accepted this national award April 29 at the ATA18 International Conference & Expo in Chicago.

Avera Marshall Regional Medical Center in Marshall, Minnesota received the Innovation of the Year in Patient Care Award from the Minnesota Hospital Association (MHA) for its work in preventing suicide. Avera was among early facilities nationwide to launch a Zero Suicide program in 2015, and Avera Marshall Regional Medical Center’s Behavioral Health program has been involved in this initiative from the beginning. Efforts have included consistent staff training of key elements including screening assessments, safety planning, consistent and standardized use of assessment tools, and post-discharge calls. Avera Marshall attended Minnesota’s Zero Suicide Academy after being recognized as the first hospital in the state to launch a Zero Suicide Initiative and to share lessons learned with participants.

Avera Holy Family Hospital in Estherville, Iowa, has begun construction on a new Emergency Department, which includes a building addition of 6,800 square feet and 3,000 square feet of renovated space in the existing building. The new ED will feature two private trauma rooms and four private treatment rooms, a nurses station, physician consult space and a family conference area. The new space will also include a dedicated registration area for emergency, surgery and same-day services, a decontamination room, and an ambulance garage with direct access to the ED. Avera Holy Family Hospital conducted a capital campaign that raised $1.26 million in pledges and donations in just 7 months.

The project is expected to be done by next spring.

Avera eCARE recently earned The Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation by demonstrating continuous compliance with nationally recognized standards.

During the review, a team of Joint Commission surveyors with expertise in ambulatory healthcare, evaluated Avera eCARE’s compliance with ambulatory care standards related to a variety of areas, including: • Emergency Management • Leadership • Provision of Care, Treatment and Services • Performance Improvement • Patient Rights

MidwestMedicalEdition.com

BLACK HILLS Regional Health Rapid City Hospital has earned the US Environmental Protection Agency's ENERGY STAR certification, honoring the hospital as a leader in energy efficiency. Regional Health has taken a number of steps to reduce its impact on the environment. Hospital lighting was upgraded to efficient LED power. Occupancy sensors were installed to automatically turn off lights when rooms are empty. The hospital also reduced water consumption and undertook other measures to save energy and preserve resources. Buildings that earn the EPA's ENERGY STAR use 35 percent less energy and generate 35 percent fewer greenhouse gas emissions than similar buildings across the nation.

Regional Health Rapid City Hospital has received the American Heart Association/American Stroke Association Get With The Guidelines Stroke Gold Plus Quality Achievement Award. Rapid City Hospital met specific quality achievement measures for the diagnosis and treatment of stroke patients. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines. Rapid City Hospital also received the Association’s Target: StrokeSM Honor Roll award for reducing the time between the patient’s hospital arrival and treatment with the clot-busting tissue plasminogen activator, or tPA.

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July / August 2018

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13

• Happenings around the region

News & Notes

Happenings around the region

PATRICK KELLY

Black Hills Energy has donated $10,000 to the Regional Health Custer Hospital and Clinic to support construction of the new facility. Construction began in October 2016 on the new 44,000-square-foot hospital and clinic, located at 1220 Montgomery St. The hospital and clinic opened their doors on April 30, 2018. Of the $21.4 million project cost, Regional Health invested $14.4 million, and the City of Custer committed $4 million over the next 10 years. The remaining $3 million is being raised through community support like that of Black Hills Energy.

SANFORD Sanford nurse Jula Bitz, RN, of the pulmonary unit was recently recognized with a DAISY Award for outstanding nursing. Her nomination called her a nurse who “exemplifies all facets of being a nurse and recognizes the needs of the patient and family.”

Sanford Health and Freudenberg Medical, a global developer and manufacturer for the medical device industry, have entered into a joint research and development agreement to create a device to treat blood clots and blockages within blood vessels. The catheter, which was invented by Sanford vascular surgeon Patrick Kelly, MD, will allow for precise infusion of medications to restore blood flow within arteries or veins. Under the agreement Freudenberg Medical will determine the commercial potential of the device. Once the catheter has been developed, next steps would include early preclinical testing and eventual pursuit of an FDA review to allow the device to be marketed in the US.

A golf entertainment facility planned for the Sanford Sports Complex will be home to an interactive driving range, the Sanford POWER Golf Academy, a restaurant, and a meeting space.

Great Shots is scheduled to open in late 2019.

The 54,000-square foot building will be built on the southeast corner of Benson Road and Westport Avenue. The heated, interactive driving range will be open year-round and include 60 bays spread across three floors, featuring a giant video wall with golf technology by Big Shots and Flight Scope.

The Sanford POWER Golf Academy section of Great Shots will incorporate a putting green, a series of private bays, and the Sanford Sports Science Institute’s golf performance and injury prevention research.

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SIOUXLAND Staff member from UnityPoint Health–St. Luke’s helped kick off the start of Food Truck Fridays in June by handing out flowers. Employees gave each person two flowers—one to keep and one to pass to someone who matters to them.

The event was part of St. Luke’s ‘pay it forward’ initiative and happened to fall on National “Say Something Nice Day”.

JOSEPH CARREAU Joseph Carreau, MD, Orthopaedic Surgeon from CNOS in Dakota Dunes, South Dakota, is now offering a bi-monthly clinic in Norfolk, Nebraska, at the Foot & Ankle Doctors PC Clinic. Dr. Carreau is fellowship trained in Sports Medicine. He currently serves as the Orthopaedic team physician to the Wayne State Wildcats.

Dr. Carreau is the third CNOS surgeon to open a clinic in Norfolk. Neurosurgeons Quentin Durward and Hendrik Klopper also see patients there.

OTHER The Sioux Falls VA Health Care System invited veterans in the area to try out telehealth services on June 25th during a visit from a specially-equipped telehealth truck. Staff at the Sioux Falls VA currently provide healthcare to patients using technology such as computers and phones, but not all veterans and their families know what’s possible. During the visit from the telehealth truck, demonstrations helped visitors see how they could use technology to receive healthcare at home, or even in their cars.

July / August 2018

Madison Regional Health System’s therapy department recently became certified in two areas that can help patients with chronic conditions. SASTM or Sound Assisted Soft Tissue Mobilization utilizes specially designed instruments to detect and treat scar tissue, which can produce inflammation and chronic pain. The SASTM method can be used for a number of chronic conditions including plantar fasciitis, shin splints, back pain, neck pain, tendinitis in a variety of areas, carpal tunnel syndrome, trigger finger, frozen shoulder and impingement. Another program MRHS therapy has launched to provide care for chronic conditions is lymphedema evaluation and management.

The Sioux Falls VA Health Care System recently received the Partner for Change Award from Practice Greenhealth, the nation’s leading organization dedicated to environmental sustainability in healthcare. The Partner for Change Award recognizes healthcare facilities that continuously improve and expand upon programs to eliminate mercury, reduce and recycle waste, source products sustainably, and more.

Winning facilities must demonstrate that they are recycling at least 15 percent of their total waste, have reduced regulated medical waste, are on track to eliminate mercury, and have developed successful sustainability programs in many areas.

WEB EXTRA

Read More

❱ F ind the extended version of these and other current news articles on the website.

15

• Happenings around the region

News & Notes

16

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HOME IS

WHERE THE

OPPORTUNITY

IS CATHERINE HAJEK, MD Sanford Geneticist

L

IKE MANY YOUNG ADULTS, Catherine “Cassie” Hajek swore she would never move back home to South Dakota when she left for the big city after high school.

Hajek, an O’Gorman high school graduate and daughter of

two Sioux Falls lawyers, studied engineering at the University of Michigan and became a consultant in Chicago after graduation.

“I loved making things run better and faster and more efficiently, but I just wasn’t satisfied,” she recalls. “I didn’t feel like I was having a personal impact on people.”

When she became a volunteer at the Rehab Institute of Chicago, offering smiles and hand massages in her spare time, Hajek found her true calling: healthcare. Despite considering herself a “big city girl” by this time, she applied to the University of South Dakota School of Medicine, a leader in training primary care physicians, and found that she was drawn to the complexity, variety, and patient continuity of internal medicine.

But she still didn’t plan to stick around.

After earning her MD, Hajek left the state again for a residency in New York City, where she also practiced internal medicine for a year. Eventually,

“ THE OPPORTUNITIES IN HEALTHCARE IN THIS AREA ARE TREMENDOUS. I HAVE NEVER FELT LIKE I WAS SACRIFICING ANYTHING, PROFESSIONALLY,

BY DECIDING TO PRACTICE HERE.”

though, she was drawn back to what she calls “the way medicine is practiced in the Midwest.”

“A lot of times in larger markets, people tend not to use a primary care provider as their primary provider,” says Dr. Hajek. “From an internal medicine perspective, practicing in the Midwest affords you the ability to manage patients more closely and really develop relationships.”

Fortunately for Hajek, primary care physicians are in demand in South Dakota and Sanford was hiring. But a few years into her career in Sioux Falls,

July / August 2018

BY ALEX STRAUSS

17

DEMAND RISING FOR MEDICAL SPECIALISTS

she developed an interest in genomic medicine for its potential to improve primary care and moved to the West Coast to pursue a fellowship in medical genetics at UCLA. When Hajek came back home for the third time, with new knowledge and interests in cardiogenetics, cancer predisposition, connective tissue disease, and neurogenetics, she was once again afforded the opportunity to do highlevel work in the specialty of her choosing, right where she wanted to be.

“Sanford Imagenetics was just beginning to integrate genomics into primary care in the region,” says Hajek. “If you had asked me when I was a resident if I would someday do a genetics fellowship, I would have said you

According to this year’s annual report from national physician placement service

were crazy. But what we are doing here at Sanford is very rare across the country. I knew it was a huge opportunity that I would be unlikely to find elsewhere.”

LAND OF OPPORTUNITY Today, there are a growing number of opportunities for new and experienced

Merritt Hawkins, while

doctors in the South Dakota region in a range of subspecialty areas rarely

primary care physicians

seen in other small cities. In addition to medical genetics, less common spe-

are still in short supply nationally, hospitals and health systems are shifting their recruiting efforts to medical specialists.

The report indicates that 74 percent of the company’s recruiting assignments in the last year have been for

cialties like nuclear medicine, wound care, hand surgery, hyperbaric medicine, physical medicine and rehabilitation, sleep medicine, as well as many pediatric subspecialties are all represented in our region now.

“I don’t think it is a bad idea to leave the area and try something different and know what’s out there. I have practiced in huge academic centers and community hospitals and I’m glad I did,” says Hajek.

“But the opportunities in healthcare in this area are tremendous. There are a ton of resources and people here are innovative and willing to take chances on new ideas. It makes for a great work environment. I have never felt like I was sacrificing anything, professionally, by deciding to practice here.”

And an increasing number of doctors are coming to the same conclusion.

As the opportunities expand, it is becoming easier for health systems like Sanford to entice these clinicians to the area, even if they didn’t grow up here.

“We have had the opportunity to recruit people to Sioux Falls from places

specialists—an increase

like the NIH and Johns Hopkins,” says Hajek. “These physicians see the poten-

of 7 percent in the last

tial and the resources and the opportunities here. Then they see the town

three years.

In contrast, the number of searches the

and recognize that it is also a great place to live and raise a family.”

Hajek herself has a three-year-old son and regularly takes advantage of family-friendly activities like riding the Sioux Falls bike trails.

firm conducted for

MAKING AN IMPACT

primary care doctors

to feel as though she is making a significant impact in the up-and-coming

Not only is Dr. Hajek able to pursue her interests here, but she says she is able

dropped by 32 percent in

field of medical genetics. “It is a really exciting time and it is fascinating to

the same period. The

see how much has changed even from the time I did my fellowship in 2014,”

company says this is likely due, in part, to advanced practice providers taking on more

says Hajek. “This is a field in which there is something new to learn and some new challenge almost every day.”

Right now, one of the biggest challenges for doctors like her is helping patients navigate their way through increasingly popular direct-to-consumer genetic tests. Hajek’s feelings about these tests are mixed.

“It is a positive thing that people are embracing the technology, and when

of the primary care

they bring these tests to us, it can be a good way to engage. But the thing

responsibilities.

people have to understand is that these tests only tell part of the story,” says Dr. Hajek. “The technology itself is usually fine. But if someone comes to us

18

MidwestMedicalEdition.com

with a test that says they have a certain percent risk for whatever disease, we don’t have a good way of translating that clinically.”

Because so many other factors also play a role in disease risk, including family history, lifestyle, exposures, and gene-gene interactions, Hajek says it is critical for people who undergo direct-to-consumer genetics tests to have the results verified and interpreted by a genetic medicine specialist.

“There are so many areas where genetics can have a relevant clinical application. Pharmacogenetics, for example, and even disease risk,” says Dr. Hajek. Among her duties is to help develop genetic resources for primary care doctors and to keep Sanford’s EMR system up-to-date with current genetic information. “One of the biggest things we can do with this information in primary care is in prevention. But we are just on the cusp of having an impact in the clinical setting.”

“This is the thing I am wrestling with on a daily basis: How do we make genetic information relevant to our patients so that we can provide better care for disease? How can we use it to do a better job with patient care?”

Although she does not rule out the possibility of pursuing additional

Hajek says she is glad to be raising her young son close to family in Sioux Falls.

training some day, as the field of medical genetics, and her own career, continue to evolve, Hajek says she is gratified to be able to explore these important questions right now without having to travel any further afield.

“I love helping to make this information accessible and usable so that others don’t have to be a geneticist to apply it,” she says. ❖

July / August 2018

19

“ WE HAVE BEEN ABLE TO DECREASE THE LIKELIHOOD OF NEEDING SURGICAL INTERVENTION TO MAKE A DIAGNOSIS.”

[ INTERVIEW ]

Tackling Idiopathic Lung Disease in the Black Hills

R

APID CITY PULMONOLOGIST Muhammad Alsumrain, MD, is bringing higher level knowledge on a range of complex and rare lung disorders to Regional Health. In 2016, Dr. Alsumrain spent a year pursuing fellowship training in interstitial lung disease and

pulmonary vasculitis at the Mayo Clinic, the only institution that offers this unique training as a formal fellowship. We asked him to share his experience, and what it could mean for Black Hills residents, with MED.

MED: What constitutes “interstitial

older people. Farmers tend to

lung disease” and how is it

be prone to a condition called

diagnosed?

hypersensitivity pneumonitis which is another type of ILD. The

MA: Interstitial lung disease is

prevalence of granulomatosis with

subdivided into idiopathic

polyangiitis, which is one type of

interstitial pneumonia (IIP), drug

pulmonary vasculitis, is estimated

induced ILD, connective tissue

to be 3 in 100,000 in the US. People

disease associated ILD (CTD-ILD),

with connective tissue disease are

and ILD associated with environ-

prone to develop interstitial lung

mental exposures such as

disease more than others.

hypersensitivity pneumonitis or occupational exposure such as

MED: Why did you decide to pursue

pneumoconiosis. In the past, we

additional training in these diseases?

often had to send patients for surgical lung biopsy to confirm the

MA: I love the challenge of

diagnosis. But with more under-

diagnosing these diseases and I

standing of the different

thought I would like to learn

radiographic findings and ordering

more about this specialty. There

the right blood tests, we have been

are very few centers in the world

able to decrease the likelihood of

that draw as wide a spectrum of

needing surgical intervention to

patients with these disorders as

make a diagnosis.

Mayo Clinic. I was exposed to a large number of patients with

MED: How common are these

all types of interstitial lung

conditions?

disease and the rare diseases of pulmonary vasculitis such as

20

MA: The ILD is a wide subject so it

microscopic polyangiitis and

is hard to comment in general

granulomatosis with polyangiitis

about the incidence; however,

(Wegener’s disease) and I gained

subtypes like Idiopathic pulmo-

a lot of experience. I also had the

nary fibrosis (IPF) incidence

opportunity to participate in

estimates range from 7 to 16 cases

multiple clinical trials during

per 100,000. IPF usually occurs in

the training. ❖

MidwestMedicalEdition.com

[ T E C HN O L O G Y ]

New Robot Brings Unprecedented Personalization and Accuracy to Orthopedic Surgery in Brookings

BY ALEX STRAUSS

E

ARLIER THIS SPRING,

—including implant size, orientation,

reassess, tilt the component a little

Brookings Health System

and alignment—which can then be

bit, release tendons or ligaments if we

became the second facility

validated and even fine-tuned in the

have to, etc.”

in South Dakota to offer

operating room.

“We are looking to not only start

robotic-arm assisted total

“For me, it’s very personal,” says

with good tires and to put them on,

knee, partial knee and total

Dr. Mayer. “I want the best outcome

but to also ensure that they are

Stryker’s

for every patient, every time. Now, we

well-balanced.”

Mako System. By adding the system,

can take a patient whose knee doesn’t

By allowing the surgeon to estab-

they got more than just an advanced

straighten the last 8 degrees and I

lish a virtual “boundary” around the

new piece of equipment—

can do the case and see

cutting field, the Mako system not

they also got an enthusiastic

that they are better but

only reduces the risk of cutting errors,

new surgeon.

they still can’t straighten

but also requires less retraction of the

“I initially saw this tool

the last 4 degrees. And

tissues for reduced postoperative pain

in March 2016 at a confer-

I can say, let’s take

and faster recovery.

ence and was blown away,”

another ½ mm off the

“It’s amazing for a town this size

says orthopedic surgeon Dr.

end of the femur and

to have access to this technology.

Mark Mayer, who recently

then reassess. You can

There is nothing on the market even

relocated to Brookings from

make that decision

close to being comparable,” says Dr.

Michigan. Before the move,

during surgery.”

Mayer. ❖

hip

replacements

with

Mayer was routinely driving long distances to use the robot on his patients in

The Mako system also allows Mayer to

Mark Mayer

make subtle adjust-

Michigan. “When I talked to the hos-

ments to the positioning of implants

pital here in Brookings, I said if you

intraoperatively, some-

are willing to buy this robot, I’ll come

thing that is much more

out there. To have access to this tech-

difficult to do with manual

nology any time is fantastic.”

systems.

The Mako system negates the

“With chronic degener-

need for manual templates and cut-

ative problems, ligaments

ting blocks, allowing for a truly

can be tight,” says Dr Mayer.

personalized approach to surgery

“We use preoperative plan-

based on each patient’s diagnosis and

ning to decide on a good

anatomy. The system uses CT-based

starting point for position-

3D modeling to create a comprehen-

ing. Then we go in there and

sive preoperative surgical plan

get objective data and

WEB EXTRA

Read More

❱ S ee photos of Dr. Mayer working with the Mako robot on our website.

July / August 2018

❱G et an inside look on last year’s major expansion in Brookings

21

[ PROF ILE ] “TRULY ONE OF THE JOYS AND THE THING THAT HAS MADE IT EASY TO STAY PASSIONATE AND MOTIVATED IS THAT, IN THE VASCULAR AND CARDIAC ARENA, THINGS ARE CONSTANTLY CHANGING”

Michael Bacharach, MD, Vascular Medicine Specialist

W

H E N VA SCU L AR medicine

and improved heart care in the community

and intervention specialist J.

and became a model for the future, too,” says

Michael Bacharach, MD, left

Bacharach. “The fact that Sanford eventually

the Cleveland Clinic in 1995 to

built their own heart hospital shows that the

join North Central Heart in Sioux Falls, he

In addition to training residents as a

thought I’d stay four or five years and get a

Clinical Professor with the USD Sanford

program going and that I would then go

School of Medicine, Dr. Bacharach holds a

take a chairmanship somewhere,” says

faculty position at Mayo Clinic and has helped

Bacharach.

to give their vascular surgery fellows a more

In fact, he did get a program going, as one of the earliest physician advocates for what

hands-on endovascular experience for the past 12 years.

would eventually be the Avera Heart Hospital.

“For me, it was a chance to engage in some-

But Dr. Bacharach said it was the quality of

thing intellectually challenging and very

the people he was working with and the unex-

rewarding,” says Bacharach. “This is one of

pectedly advanced level of medical care in

the things I am most proud of.”

Sioux Falls that convinced him to stay for the long haul.

Dr. Bacharach’s research involvement encompasses peripheral arterial and aneu-

“This was the beginning of endovascular

rysmal disease with ongoing current trials in

surgery and I knew that surgical partners

carotid stents and endografts for aneurysms.

would be a critical part of the success,”

He has become involved in transaortic valve

says Dr. Bacharach who is board cer-

replacement through the femoral artery, and

tified in cardiovascular disease and

is excited about up-and-coming advances

vascular medicine with a subspecialty

such as trancatheter techniques for valvular

in endovascular medicine. “I was for-

heart disease and acute neural intervention

tunate to have tremendous surgical

for stroke.

partners.”

“Truly one of the joys and the thing that

“The other thing was that,

has made it easy to stay passionate and moti-

although Sioux Falls was a small

vated is that, in the vascular and cardiac

community, it had skilled, well-

arena, things are constantly changing,” says

trained subspecialists and

Dr. Bacharach. “For example, we can now fix

offered advanced procedures.

a PFO (patent foramen ovale) with a small

Both Avera and Sioux Valley

device through a big vein in 30 minutes. That

were open to moving into

22

model had merit.”

didn’t expect the move to be permanent. “I

was unheard of when I was in training.”

new areas of vascular med-

Two of Bacharach’s three young adult

icine and both institutions

children have inherited his love for medicine

were very supportive.”

and are training for medical careers of their

In the end, it was McK-

own. Bacharach says he is happy with his

ennan Hospital that joined

decision to make South Dakota his home and

North Central Heart in the

has only one regret.

formation of The Heart

“In some respects, I feel like I’m running

Hospital, a venture Bacha-

out of time,” he says. “There are so many excit-

rach calls a “wonderful

ing things on the horizon and I don’t want to

success”. “It consolidated

miss any of them!” ❖

MidwestMedicalEdition.com

© 2018 MMIC Insurance, Inc.

Because you help them get back on their feet, every day.

At MMIC, we make it our practice to protect your practice. That’s why we’ve built a responsive team of experts—to help you minimize clinical risks, stay current in the ever-changing health care industry, and keep your practice thriving. And, in the event of a claim, we’re here for you. Because you’re here for them, every day.

Insurance & Risk Solutions | MMICGroup.com

July / August 2018

23

THE PICTURE OF [SKIN] HEALTH:

SCANNER PRODUCES DRAMTIC IMAGES OF SUN-RELATED SKIN DAMAGE

W

HEN IT COMES to the

“With this tool, we can look for

says people of European and Scandi-

skin damage caused by a

skin cancer, fine lines, do pore counts

navian descent, as so many area

lifetime of UV exposure,

and, most impressively, perform a UV

residents are, should know they are

the mirror often does

damage index,” says Dr. Howard.

at special risk.

not tell the full story. That is

“Those can be frightening to look at,

“I think people tend to forget that

because the damage happens in the deeper layers of the skin and may not appear as lines, wrinkles, age spots or even cancer until years—or decades—later.

“There are natural effects of aging, but UV radiation penetrates deep into the skin and causes DNA damage,” says Richard Howard, MD, plastic sur-

“ Much of Europe is as far North as Hudson Bay, Canada. So we have essentially been transplanted into a more sun-intense area than our ancestors were used to.”

geon and owner of The Body Garage Medical Spa in Sioux Falls. “It accelerates the entire aging process.”

To make the point, Howard and his team use UV photography to

24

especially when people think they’re

much of Europe is as far North as

fine. But the UV damage is done. It

Hudson Bay, Canada,” says Howard.

won’t go away.”

“So we have essentially been trans-

show clients the full extent of their

Like many who grew up in the

planted into a more sun-intense area

own underlying sun damage. UV

Upper Midwest, Howard remembers

than our ancestors were used to. We

light has a wider spectrum allowing

long, sunscreen-less days spent out-

have seen what happens when you

it to reveal surface and subsurface

side in his youth, in the days before

take people from England and trans-

skin conditions (spider veins, hyper-

the damaging effects of the sun were

plant them to Australia: They have

pigmentation, inflammation, etc.)

fully understood. His own VISIA scan

the highest rates of melanoma skin

invisible to the naked eye.

(above) tells the tale and Dr. Howard

cancer in the world.”

MidwestMedicalEdition.com

Although the damage revealed by a VISIA analysis cannot be

help to calm reddened, reactive, blotchy skin.

undone, it’s visible expression may

For people who are already expe-

be slowed down with the right tool

riencing the results of decades of sun

at the right time. The Body Garage

exposure or burns, such as fine lines,

can use the the information gleaned

superficial blood vessels, and liver

from a scan to determine skin type,

spots, Howard says three or four

texture, special needs, etc. to recom-

treatments with a fractional laser

mend a medical grade topical

can help stimulate collagen produc-

product to protect and prevent

tion and revitalize the skin for a more

further damage.

youthful appearance.

Exfoliation procedures such as

The bottom line for the best-look-

dermaplaning, microdermabrasion,

ing skin possible? Protect skin from

or a mild to moderate peel may be

the sun while you are young and

used to help these products pene-

maintain healthy skin care habits as

trate deeper and more evenly by

you age.

accelerating surface cell turnover.

“It’s just like exercise,” says Dr.

To minimize damage from an acute

Howard. “If you quit taking care of

sunborn, LED light treatment can

your skin, you lose the effects.” ❖

WEB EXTRA

Complexion Analysis of Dr. Richard Howard (above), his partner and son Tom Howard, MD, (middle) and his grandson Ben (far left) reveal higher levels of sun-related damage in skin with the longest exposure.

Read More

❱ L earn about collagen induction therapy with platelet-rich plasma at The Body Garage

July / August 2018

❱D rs. Tom and Richard Howard discuss the joys and challenges of a father-son practice

Dr. Tom (left) and Richard Howard with Tom's sons, Sam and Ben.

25

TIPS FOR CHOOSING AN AGENT TO HELP YOU BUY A HOME

BY TRACIE STORO

WEB EXTRA

O

N E TH I N G I S CE RTAI N when you are buying a new home—you should have your own agent representing you through the purchase

process. One of the most obvious reasons is that it does not cost you anything. In most cases, buyer agent fees are paid by the seller.

But an even more important reason to have your own agent is to ensure that you have someone in your “corner” who has been properly educated and fully understands what can be a complex process. Because there are many agents to choose from, you will rest easier when you know you have a good one working for you.

The following is a list of suggested questions to ask as you interview agents to help you buy a new home:

“A GREAT AGENT WILL BE WITH YOU AT THE INSPECTIONS, THE FINAL WALK-THROUGH AND THE CLOSING”

Read More

Check the website for more tips on choosing a buyer's agent.

26

MidwestMedicalEdition.com

1 When are you available?

Ideally, you want to find an agent who is willing to work around

one primary agent throughout

Did your mom ever tell you not

the transaction.)

to room with a friend in college?

to accommodate them. Most

The same advice applies here. If

Open Houses are on the

you have a real estate profes-

weekend so if you want your

sional in your family and you

agent to go with you, find one

wish to give him or her credit,

who is willing to meet you on the

you can request that the agent

weekends.

you ultimately hire give that person a referral fee.

doing for me throughout the process?

5 Do you have a list of

Agents should be there for you

vendors you work with?

7 What happens if I something goes wrong?

If, at any time throughout the home buying process, you no longer want to work with a particular agent, a respectful agent should be willing to release you from the signed contract.

Remember, the agent you find to

Good agents will have good

help you make one of the biggest pur-

throughout the entire buying

relationships with vendors for

chases of your life should be someone

process. You should expect them

“all things real estate”. If you

around whom you feel comfortable

to follow through with the

need to have something done

and can trust is working in your best

mortgage process, getting

either before or after the closing,

interest. There are many great real

inspections done, securing

the agent should be able to

estate agents out there; take the time

warranties and scheduling a

quickly give you one or two

to find one that makes you feel confi-

final walk-through. A great agent

referrals.

dent in buying a home. ❖

will be with you at the inspections, the final walk-

6 Are you part of a Real Estate team?

through and the closing.

3 How will you be

or a relative?

your schedule—not require you

2 What exactly will you be

that you will be working with

4 Is the agent a friend

You’ve undoubtedly heard of the term “two heads are better than

communicating with me?

one”. It just stands to reason that

Agents should be flexible in

agents who are part of a real

their communication styles and

estate team have more expertise

adjust to the communication

and experience among them

method that you prefer.

than a single agent working on his or her own could ever have.

(Even so, you should still expect

Tracie Storo is a Broker Associate with RL Real Estate Group in Sioux Falls.

SOUTH DAKOTA MEDICAL GROUP MANAGEMENT ASSOCIATION

FALL CONFERENCE September 12-14, 2018

@ Arrowwood Resort and Conference Center at Cedar Shores in Oacoma, SD

Join us to hear from local and national experts who will discuss issues in health care and new solutions to challenges. Visit www.sdmgma.org for more information.

For the full schedule or to register, visit our website at

sdmgma.org

Like us on Facebook at www.facebook.com/sdmgma Follow us on Twitter @SDMGMA

July / August 2018

27

How to Work with the Media

( So They’ll Work with You)

BY ALEX STRAUSS

“

he authority you T can establish and the respect you can earn through unpaid media interactions can give you and your practice a competitive edge that simply cannot be achieved through advertising alone.

”

28

N

O MATTER WHO YOU ARE or how great you believe your “pitch” to be, approaching a member of the media (or, in some cases, your own PR department) with an article suggestion (especially if the suggestion would necessitate

interviewing YOU) can be intimidating.

For one thing, you risk the very real possibility that the person to whom you are explaining your great idea will not “get it” or find it valuable enough to want to share with the public. There is also the natural aversion to making oneself vulnerable to scrutiny or criticism. Most people with potentially valuable information to share – including healthcare professionals – conclude that the risks, hassle and extra time involved are just not worth the effort.

But the fact is that the media and the public they serve need what you know – now, more than ever. The advantages of timely, relevant health news for consumers are obvious, but this is about more than public service. By way of encouraging more engagement with your local news providers, here are a few things I believe are “in it” for you, the healthcare professional:

MidwestMedicalEdition.com

The Four “Ps” PROVIDE

PROMOTE

Although no news report could ever match the

Appearing in a news segment, being quoted in the

value of personalized, one-to-one human interac-

newspaper or online, or being interviewed on a

tion, when you put a health scare into perspective,

television or radio show, are ideal ways to help

recommend a healthy course of action, or explain

promote your practice and your services, provided

a new treatment option through the media, you

that you do not take it too far by being blatantly

are being a provider on a level that is simply not

self-promotional.

possible within the walls of the office or hospital.

In an increasingly competitive healthcare envi-

And unlike the words you say during an office

ronment, the authority you can establish and the

visit, which research suggests are often misun-

respect you can earn through unpaid media inter-

derstood or forgotten within minutes of the

actions can give you and your practice a competitive

appointment 1, words that are captured in a news

edge that simply cannot be achieved through adver-

article may be broadcast multiple times, repeated,

tising alone.

copied, disseminated online, and even referenced again in future stories.

PARTICIPATE By establishing good relations with your local health

POSITION

news providers, you are opening what can be an

Speaking through the media gives you the oppor-

inestimably valuable channel of communication

tunity to position yourself as an authority, bolstering

between the medical world and the “real” world.

trust and credibility among your own patients, as

Like doctors, journalists want to uncover truth and

well as among those who may become patients in

serve their audiences.

the future.

At a time when the gulf of understanding between

When you demonstrate that you are willing to

patients and providers seems to be widening, in a

provide your expertise, the media responds in kind

very real sense, by accepting and working with the

by presenting you as an expert source. Fortunately,

media, you can help close it. That is the power of

even if you have never been asked to speak to the

physicians and the press, together. ❖

press before, it only takes one good interview (during which you offer clear, concise information) or one newsworthy story idea to put you on their radar.

Reference: [1] O’Hanluain, Daithi, “Patients forget about two-thirds of doctors’ treatment instructions, says neuropsychologist”, European Society of Cataract and Refractive Surgeons, July 2003

NOW ACCEPTING NEW PATIENTS Dr. Mandy Rounseville-Norgaard, Au.D. 4948 E. 57th St, Sioux Falls, SD 57108 Ph. 605-306-3050 July / August 2018

29

[ B E H I ND T HE S C E NE S ]

Meet MED ’s Director of Digital Media & Marketing,

Alyssa McGinnis

OFFICIAL DUTIES Alyssa McGinnis communicates with MED advertisers and prospective advertisers and helps us develop creative and personalized plans for reaching their healthcare clients. (If you advertise with MED you have likely been in contact with Alyssa.) In addition, Alyssa keeps MidwestMedicalEdition.com up-to-date with fresh medical community news and events and helps MED promote them through social media. Ever click on a link in the digital edition of MED? Yep, that is Alyssa’s handiwork, too.

BACKGROUND Alyssa studied TV Production at Brown College in Minneapolis. She worked in the broadcasting department at the Minnesota Timberwolves and freelanced as Data Content Manager at Fox Sports North. In Sioux Falls, she was Assistant Marketing Director at Wireless World, a Verizon retailer.

Alyssa designs and sells t-shirts and wooden signs on the side.

FAVORITE PART OF MED “ I love the challenge of strategizing new ways to let potential clients know about and get business with MED Magazine and MidwestMedicalEdition. com. I also really enjoy meeting MED clients and readers at conferences and events. I never get bored in this job. Every day is different!”

PERSONAL INFORMATION Originally from Buffalo, New York area In Sioux Falls for 7 years Has three girls, ages 4, 3, and 1

30

MidwestMedicalEdition.com

July, September October

Upcoming Events JULY 12 – 14

SEPTEMBER 6

SEPTEMBER 12 – 14

23rd Annual Hot Harley Nights (Make-A-Wish fundraiser)

Addiction and Suicide:

SD Medical Group Management Association Fall Conference

Location: J&L Harley-Davidson & WH Lyon Fairgrounds Information & Registration: HotHarleyNights.com

8:00 am – 3:30 pm

Communities in Crisis (Sponsored by Avera and the US Attorney’s Office) Location: Sioux Falls Convention Center

Location: Arrowwood Resort

by Cedar Shore, Oacoma Information: tmarks@sdmgma.org, 605-336-1965

Information & Registration:

JULY 20

averacontinuingeducation@avera.org

20th Annual Missouri Valley Symposium

SEPTEMBER 27 – 28

8:00 am – 4:00 pm

Location: ASHH Professional Offices Pavilion, Yankton, SD

605-322-8950

6:00 pm, Thursday – 5:00 pm, Friday

SEPTEMBER 19 – 21 SDAHO Annual Convention Location: Sioux Falls Information: sdaho.org

OCTOBER 17

YanktonMedicalClinic.com/MVS

Avera Cancer Institute Oncology Symposium

605-665-6933

Location: Prairie Center,

UnityPoint Health– St. Luke’s 34th Annual Cardiology Conference

Avera McKennan Campus

Location: Delta Hotel,

Information & Registration:

South Sioux City Riverfront

Information:

SAVE THE DATE

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The types of studies conducted at Sanford Health include:

The types of studies conducted at Sanford Health include: Treatment studies

Prevention studies

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Quality of life studies,

to improve the

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studies designed to find better

which explore ways to

standard of care.

to prevent disease.

ways to detect diseases.

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1-87-SURVIVAL to improve the to look for better ways For more information on immunotherapy clinical trials, talk to your doctor or call Sanford Clinical Research at: improve comfort and to prevent disease. standard of care. ways to detect diseases. www.sanfordcancer.org 011000-00485 Rev. 6/18

(605) 328-1368

quality of life for patients.

1-87-SURVIVAL For more information on immunotherapy clinical trials, talk to your doctor or call Sanford Clinical Research at: www.sanfordcancer.org (605) 328-1368 1-87-SURVIVAL For more information on immunotherapy clinical trials, talk to your doctor or call Sanford Clinical Research at: www.sanfordcancer.org 011000-00485 Rev. 6/18

011000-00485 Rev. 6/18

(605) 328-1368