MED Magazine April/May 2019

Exclusive Online Content State’s First Clinic-Based Food Bank

JULIE REILAND, MD, AND AVERA’S BREAST CARE INNOVATORS THE EVOLUTION OF IORT

THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

APRIL MAY

How to Protect Your Online Reputation

VOL. 10 NO. 3

2019

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VO LU M E 1 0, N O. 3 ■ A P R I L / M AY 2019

Inside This Issue

CONTENTS

FROM US TO YOU

I

PAGE 6 | [TECHNOLOGY] TIPS FOR PROTECTING YOUR ONLINE REPUTATION

JULIE REILAND, MD, and AVERA’S

have a beautiful Spring here in the South

PAGE 8 | THIS MONTH ONLINE The 2019 Go Red Event, MED’s NEW Job Board, and a roundup of exclusive content available only on the website.

Dakota region! We are kicking things

How Avera’s holistic approach to breast care, including IORT and oncoplastic surgery, protects quality of life while saving lives.

PAGE

10

off with this colorful issue of MED, the region's premier source for medical community news, features and events.

In this month's cover article, we discuss the evolution of IORT for breast cancer

PAGE 16 | [INTERVIEW] Jill Weimer,

with two members of Avera's breast care

PhD, on Women in Research

team. Our thanks to breast surgeon Julie

PAGE 17 | Clinic-Based Food Bank Supports Vulnerable Patients Believing that “food is medicine”, a Rapid City clinic serves food-insecure patients with the state’s first clinic-based pantry

BREAST CARE INNOVATORS

May flowers, we are sure to

■ By Dean McConnell

PAGE 12 | NEWS & NOTES New positions, promotions, awards, & more

ON THE COVER

F APRIL SHOWERS bring

■ By Alex Strauss

Reiland, MD, and to radiation oncologist Kyle Arneson, MD, for the illuminating conversation.

This issue also features articles on technology, research, outreach, education, and an advanced procedure that led to a

PAGE 18 | Black Hills Doctor Saves Man’s Frostbitten Fingers with Clot Buster

dramatic outcome. Be sure to check out

PAGE 20 | Driver’s Education Eye Bank Program Demystifies Organ Donation for New Drivers

MED readers want to hear it! Contact us

■ By Alex Strauss PAGE 23 | Upcoming Events Conferences, Symposiums and Spring events

the upcoming Spring events in the back.

Do you have a great story to share? with your thoughts and ideas any time at Info@MidwestMedicalEdition.com.

All the best!

—Alex & Steff

ON THE COVER: Julie Reiland, MD, and Avera’s Breast Care Innovators Back row: Breast Surgeon Wade Dosch, MD, and Radiation Oncologist Kyle Arneson, MD Front row: Breast Surgeon Tricia Merrigan, MD, Radiation Oncologist Carolyn Savioz, MD, and Breast Surgeon Julie Reiland, MD. Photo courtesy Avera

4

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ISSUE

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[ INTERVIEW ]

Protecting Your Online Reputation

BY DEAN MCCONNELL

T

HE INTERNET PROVIDES many forums where patients can publish comments about their medical care, and this

can include negative comments.

Patient complaints often share one

• Remember that a negative

• Before responding, cool off.

comment is only one patient

Let it sit overnight and ask a

from your practice. A majority

trusted colleague to review

of the other patients are most

your response.

likely very happy.

• Be careful about HIPAA. Do not

• While action is often prudent,

include treatment or payment

common denominator—a breakdown

it needs to be measured and

information or provide patient

in the physician-patient relationship.

appropriate to the context.

names or identifying information

What is the best way to deal with negative online comments?

RECOGNIZE THAT THE PATIENT IS UNHAPPY •N egative comments invoke defensive

in your response.

RESPOND POSITIVELY • Don't fall into the trap of joining an insult contest. A belligerent commenter may be hoping to

reactions. Despite these normal

engage in a public debate in

reactions, the patient’s concerns

which they are not bound by

must be addressed in a professional

any rules.

manner.

• Acknowledge that the patient is not satisfied, that patient satisfaction is important, and ask to take the conversation offline to address the issue.

• People will often say things online that they would never say face-to-face. A phone call

• Sometimes (e.g., when a negative comment appears on your own practice website), an online response may be called for.

Ignoring a complaint might indicate that you are not attentive or concerned.

• Don’t simply delete adverse comments from your website.

An author may re-publish —and embellish—a neglected complaint on other sites.

REACT APPROPRIATELY • Patient complaints always

provides a better chance of

have a basis in a perception.

connecting with the patient

An explanation and an apology

and solving the problem.

may be all it takes to resolve

• Tailor the response to the specific complaint and send it

the situation.

• Sometimes patients are right.

via a private, secure medium

Maybe they had a bad interaction

such as a letter or phone call

with your staff. Take this

(secure email is also okay, if the

opportunity to evaluate the

patient has set up an account

practice and improve it.

with your practice). It should be documented like any other patient communication.

• Try to understand the situation from the patient’s perspective and consider whether there is some concession you can live with.

Dean McConnell, JD, is Senior Legal Counsel with COPIC, a leading provider of medical professional liability insurance.

6

MidwestMedicalEdition.com

• Patients who have been heard will sometimes remove their own negative comment or, better yet, post a positive one about the doctor listening and addressing the problem.

• Maybe a patient is just not the right fit for your practice and you can provide him or her with a referral to a colleague that might be a better fit.

RALLY THE TROOPS Certain activities help build a positive presence online. Suggested efforts include outreach to patients to build a good following online or asking patients to post reviews. When there is a negative comment, it will look like an outlier and provoke positive responses from your followers. ❖

THE

PATH IS WAITING.

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Schedule an appointment today.

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April / May 2019

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7

THIS MONTH ONLINE Highlighting content and opportunities available exclusively at MidwestMedicalEdition.com

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Research Done Right An Interview with Sanford’s President of Research and Innovation

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In the wake of a first-of-its-kind rotator cuff stem cell trial, David Pearce talks to MED about why he believes that the clinical trial process and FDA approval is so

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If You’re Happy and You Know It Sioux Falls Ranks Among America’s Happiest Cities

By Alex Strauss A new WalletHub study places Sioux Falls in the top 15 happiest cities in the union. Find out where we stand on rates of depression, sleep, sports participation, divorce, income and more.

How Technology Can Help Caregivers Manage Senior Loved Ones From Afar

By Claire Wentz From helping an elderly loved one schedule doctor’s appointments to making sure they stay on top of their Medicare coverage, long-distance caregiving can be a challenge. Luckily, new technology can help.

Never miss an event! Check out MED’s online calendar for a complete listing of Spring conferences and symposiums. MidwestMedicalEdition.com

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MED

Sport Their Red Women

Digital Partners

AT AHA’s Annual

Go Red EVENT AN IDEA that started fifteen years ago to raise awareness of heart disease among women has grown into a national movement. It’s a movement that MED is proud Steff and fellow Board member Sarah Kurtenbach encourage participants to “open their hearts” in support of heart disease education and research.

to once again support this year as a Go Red sponsor.

The annual Go Red for Women Event took place in Sioux Falls at the Sioux Falls Convention Center on March 5th. The evening included a silent auction, social hour, dinner, and a program. Once again this year, it brought together local heart disease survivors, providers, and supporters to promote healthy lifestyles, build awareness and raise funds for research and education.

MED’s Steffanie Liston Holtrop, a

Steff (far left) and Med Digital Media Director Alyssa McGinnis (far right) with the Sanford Heart Team

member of the GoRed Executive Leadership Team, and MED Digital Media Director Alyssa McGinnis were sporting their red, along with many other familiar

BECAUSE D...

YOU ASKE

faces. See more photos from this year’s event on the MED website.

“How do I access the digital version of MED Magazine?”

If you have tried to read the digital issue of MED Magazine from the website lately, you were invited to first join the free VIP list. MED’s popular digital issue is now reserved exclusively for those on MED’s VIP email list. VIPs not only get access to every digital issue, but they also receive twice-a-month summaries of local medical news and calendar events. If you are already on the list, you’ll find a link to the digital issue in every email from MED. Be sure to bookmark the page so you can find it easily! (And if you lose the link, just search your email)

January / February 2019

9

Breast surgeon Julie Reiland, MD, and Radiation Oncologist Kyle Arneson, MD, position the tube for delivering IORT to a breast cancer patient.

JULIE REILAND, MD, AND AVERA’S BREAST CARE INNOVATORS THE EVOLUTION OF IORT The Mobetron linear accelerator delivers electron-based IORT.

S

INCE 2011, JULIE REILAND, MD,

and her partners

at Avera Medical Group Comprehensive Breast Care have treated nearly 200 patients with electron-based intraoperative radiation therapy (IORT), making them one of the highest-volume centers for this technique in the country. In appropriate patients

with small, non-aggressive tumors, IORT may allow for a single “one-and-done” dose of radiation. In other cases, post-surgery radiation can be dropped to just three weeks instead of the usual six with a “boost” of IORT. The American Society for Radiation Oncology now recommends IORT as a standard treatment for breast cancer. By combining it with oncoplastic surgery, Reiland and her team have achieved some remarkable results and added to the understanding of how this approach can preserve both lives and quality of life. She and her colleague

KYLE ARNESON, MD, of Avera Medical Group Radi-

ation Oncology, spoke with MED about the evolution of Avera’s innovative, holistic approach to breast cancer care.

10

MidwestMedicalEdition.com

MED: What led to the

Also, we don’t have to go through any

development of IORT?

tissue to reach the bed, so we are able

JR:

to spare the skin.

About 85 percent of breast cancers recur within 2 cen-

timeters of the original tumor. So we started to think, maybe we don’t have

JR:

X-rays lose energy the further out they go. With the

linear accelerator, we can dial in

to irradiate the whole breast. At first,

exactly when the electrons drop off

we were delivering accelerated partial

their energy into the tissue. The elec-

breast irradiation with brachytherapy

trons come from above and go 2 or 3

by putting balloon catheters in the

centimeters deep in a six-inch radius.

breast. But you have to keep a space

It’s like dropping a bomb. We put a

open for that, so it left patients with

copper plate below the breast so no

a deformed breast. IORT is the next

electrons go further than we want

evolution because it does not require

them to.

that space.

MED: Why would a patient

Breast surgeon Tricia Merrigan, MD, discusses breast cancer treatment options with a patient.

MED: Can you explain the IORT procedure?

JR:

The tumor must be smaller than 2 centimeters. Once

we’ve removed it, we loosen up all the tissue around the defect and pull it

MED: There are different

consider lumpectomy and

approaches to breast cancer

IORT over mastectomy?

together into one tight circle and bring

radiotherapy. How did Avera

JR:

This is exactly the way I repair the

settle on IORT with the Mobitron?

JR:

In 2011, we received a 2.5

Some women come in and say ‘I want the breast gone

so I don’t have to worry about it again’.

the radiation tube over that circle. breast when I’m doing oncoplastic surgery anyway, so it is a beautiful

million dollar grant and

But your risk comes from your tumor

Avera said ‘you pick the machine that

biology, not your surgery type.

you want to buy’. One device delivers

Lumpectomy with radiation has about

electrons and the other delivers low-

a 10 to 15 percent chance of recurrence

dose X-rays. I knew that we had been

at 10 years compared to a 10 percent

using electrons every day since the

chance with mastectomy. To me, it

to the surgery time just because of the

1960s, so I decided that my best bet

just doesn’t make sense to be remov-

preparation.

was to use the best energy source that

ing breasts on both sides for a five

we knew about. So that’s what we did,

percent benefit. If you keep your

even though the Mobitron was six

breasts and you don’t have significant

times the price of the other machine.

risk factors, you have a ½ percent

KA:

chance per year of developing another

Treating cancer with electrons has a very long

track record. It has been battle-tested in the clinic for decades, although it is fairly new to bring it into the OR. Using electrons allow us to define that tumor bed very specifically, keeping radiation away from skin, lungs, and heart.

MED: How is electron-based IORT

combination.

KA:

It only takes about two minutes to deliver the

radiation, but it adds about 30 minutes

MED: What kind of outcomes are you seeing?

KA:

Ultimately time will tell.

We have to follow these

breast cancer in either breast. And you

patients for multiple years in order to

have the benefit of feeling good about

show the value for breast cancer con-

yourself and how you look.

trol. At this point, everyone is very

When I explain this to eligible

pleased with the cosmetic outcomes

patients, there are very few who don’t

and with the convenience of this

take me up on the “one-and-done”

approach.

option. We recently completed our

JR:

100th single-dose case.

KA:

I tell patients that, here

We have three trials running because we want all of our

patients to be part of a protocol. We

at Avera, they have sev-

want to be good stewards of the tech-

eral good options. We are always

nology. Even now, I have patients who

Our ability to shape the

working together as a team to maxi-

come in and say ‘I feel kind of guilty,

beam and to control the

mize the benefits and minimize the

I feel like I never had breast cancer.’

depth of the electrons allows us to be

risks. IORT can maximize that risk to

Their breasts are lifted and perky and

very specific and target that critical 2

benefit ratio, especially for rural

there is none of the hardness and tan-

centimeter area around where the

patients who may be looking at weeks

ning of the skin that you can get with

tumor was with a full dose of radiation.

of travel for treatment.

radiation. ❖

different from other approaches?

KA:

April / May 2019

11

Happenings around the region

News & Notes

South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska

AVERA Four Avera hospitals earned spots in the Top 100 Rural & Community Hospitals and three South Dakota Avera facilities have been named in the Top 100 Critical Access Hospitals. iVantage Health Analytics and The Chartis Center for Rural Health named Avera Queen of Peace (Mitchell), Avera Sacred Heart (Yankton), Avera St. Luke's (Aberdeen) and Avera St. Mary's (Pierre) as top rural hospitals.

Avera Hand County Memorial Hospital (Miller), Milbank Area Hospital and Avera Gregory Hospital have been recognized in the Top 100 Critical Access Hospitals. The iVantage Health Analytics’ Hospital Strength INDEX is the industry’s most comprehensive and objective assessment of rural provider performance.

Avera McKennan Hospital & University Health Center in Sioux Falls is expanding its ICU. The ICU has added space for six additional patient beds for a total of 28 private rooms, and each room has doubled in size.

The new ICU includes ceiling-mounted patient lifts, booms that house monitors and keep cords

12

and cables out of the way, state-of-the-art vital sign and cardiac monitors, more advanced beds, and dedicated water lines for each room for acute dialysis, if needed. The ICU is part of $41 million in updates to the Avera McKennan campus.

BLACK HILLS Wellmark Blue Cross and Blue Shield has named Regional Health’s Heart and Vascular Institute a Blue Distinction Center for Cardiac Care. Blue Distinction Centers show expertise in delivering improved patient safety and better health outcomes. Regional Health is one of just two South Dakota healthcare providers to receive this designation. In 2018, Regional Health Rapid City Hospital was designated a Blue Distinction Center for Maternity Care.

Seven contractors and subcontractors who built the new Regional Health Custer Hospital and Clinic have been honored for their craftsmanship. Builders involved in the Regional Health Orthopedic & Specialty Hospital and the Regional Health Sturgis Hospital and Clinic addition also received awards. The builders were honored at the Construction Industry Center’s 64th Annual Meeting and Craftsmanship Awards. The CIC is the building industry organization for the Black Hills and areas of Wyoming, Montana, North Dakota and Nebraska.

BILLIE JO LEWIS Billie Jo Lewis, RN on the medical-surgical unit at Regional Health Orthopedic & Specialty Hospital in Rapid City, has been recognized with a DAISY Award. A national program, the award is presented to nurses across the US who go above and beyond for their patients and community. Lewis was nominated by two patients who recognized her compassion, empathy, kindness to patient families and skill as a patient educator.

WENDY JANKE Wendy Janke, LPN at Regional Health Medical Clinic in Lead-Deadwood, has also received a DAISY Award. Janke was nominated by a patient’s child who recognized her ability to make her father comfortable and to treat him with respect.

Lead-Deadwood Hospital and Clinic presents the DAISY Award twice a year.

MidwestMedicalEdition.com

SANFORD The US Department of Veterans Affairs and Sanford Health will provide pharmacogenetic testing at no cost to veterans as part of a partnership to reduce adverse medication reactions. PHASeR: Pharmacogenomics Action for Cancer Survivorship will provide tests to help determine which medications will be most effective for patients, improving access to appropriate treatments and reducing adverse drug reactions. The program will initially enroll cancer survivors but will expand to up to 250,000 veterans at 125 sites by 2022.

JANE ARNOLD

SIOUXLAND MercyOne Siouxland Medical Center has installed a 128-slice CT system, offering higher image quality and a dual energy scan mode which helps to better portray tissue types. The new CT will provide faster and more accurate diagnosis and treatment. The machine will also reduce radiation exposure and is accessible and accommodates many different body types. “The speed of this new scan will allow us to do more interventional studies in house and to do more procedures in less time," says Radiology Manager, Thomas E. Carmichael.

UnityPoint Health – Sioux City has appointed Jane Arnold, MSA, MA, OTR/L, as the new Ambulatory Vice President of Clinic Operations for UnityPoint Clinic in Sioux City.

In her new role, Arnold will provide executive responsibility for the operations of the eight clinics in Sioux City. Arnold began her career with UnityPoint Health in 2000 as an occupational therapist. Most recently, she has served in a dual role as VP of Hospital Operations for St. Luke’s as well as the Regional VP of Operations for UnityPoint at Home – Sioux City.

RICHARD LAWTON Orthopaedic Surgeon RIchard Lawton, MD, has joined CNOS, PC, in Dakota Dunes, South Dakota. Dr. Lawton attended Emory University School of Medicine in Atlanta and completed his residency at the Mayo Clinic.

He did his fellowship at the Steadman-Hawkins Clinic in Vail, Colorado, where he served as an assistant team doctor for the Denver Broncos, Colorado Rockies, and US Ski Team.

Dr. Lawton had been practicing in Durango since 2002. He specializes in sports medicine and joint replacement.

SOUTH DAKOTA MEDICAL GROUP MANAGEMENT ASSOCIATION

SPRING CONFERENCE

April 24-26, 2019 @ the Hotel Alex Johnson in Rapid City It starts with US – Refill your leadership cup at this valuable and interactive session. Join us as we look at our roles from the entire practice realm within healthcare – we’ll learn to address and take a proactive stance in challenging physician behaviors, take a deeper dive into internet security and safeguarding your practice, keeping patient perspective within our roles, as well as how to find and keep your rhythm as life gets challenging.

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

April / May 2019

13

• Happenings around the region

News & Notes

Happenings around the region

DANIELLE PRINCE Danielle Prince, MD, has joined UnityPoint Health – St. Luke’s Siouxland PACE as Associate Medical Director. Dr. Prince earned her medical degree at Creighton University in Omaha and completed her family medicine residency at the Siouxland Medical Education Foundation in Sioux City. She is board certified through the American Board of Family Medicine. Previously, Dr. Prince worked as a family physician and as Chief Medical Informatics Officer at Mercy Medical Center.

She continues to work as a hospitalist at UnityPoint Health – St. Luke’s.

Five UnityPoint Health hospitals are listed in the Chartis Center for Rural Health 2019 Top 100 Critical Access Hospitals.

Greater Regional Health (Creston), Loring Hospital (Sac City), Cherokee Regional Medical Center, Humboldt County Memorial Hospital and UnityPoint Health – Jones Regional Medical Center (Anamosa) are 5 of the 15 Iowa hospitals to make the Chartis list. UnityPoint Health – Trinity Regional Medical Center (Fort Dodge) is one of four Iowa hospitals on Chartis’ Top 100 Rural and Community Hospitals list.

14

UnityPoint Health – St. Luke’s and Cardiovascular Associates, PC, (CVA) has been granted a three-year term of accreditation by the Intersocietal Accreditation Commission (IAC) in Echocardiography in the area(s) of Adult Stress and Adult Transthoracic.

This marks the fifth consecutive three-year accreditation awarded St. Luke’s and CVA since 2008.

Comprised of a detailed self-evaluation followed by a thorough review by a panel of medical experts, the IAC accreditation process asses both the critical operational and technical components of the applicant facility, including representative case studies and their corresponding final reports.

ASHLESHA KAUSHIK Ashlesha Kaushik, MD, FAACP, with UnityPoint Clinic Pediatric Infectious Disease, has been appointed to the American Academy of Pediatrics Iowa Chapter Committee on Immunizations and is the American Academy of Pediatrics Iowa Chapter Infectious Disease Champion. Dr. Kaushik is the only pediatric infectious disease specialist in Siouxland. She is a member of the New York Academy of Medicine and the Midwest Society for Pediatric Research and has been elected as an overseas fellow of the Royal Society of Medicine, UK.

INDEPENDENTS & THE VA

Prairie Lakes Healthcare System (PLHS) is among the Top 20 Rural Community Hospitals in the nation as determined by iVantage Health Analytics. PLHS was recently notified of the designation by the National Rural Health Association (NRHA). PLHS serves a ten county region in eastern South Dakota and western Minnesota. PLHS provides care at its hospital in Watertown as well as specialty services that are uncommon in similar rural settings.

Pioneer Memorial Nursing Home has again received a Five-Star Quality Rating from the Centers for Medicare and Medicaid Services (CMS). The scoring system includes a nursing home’s most recent state health inspections, quality measures and staffing levels.

Pioneer Memorial Nursing Home is a 52-bed skilled nursing facility in Viborg.

VA Black Hills Health Care System held a public open house in March to showcase this year’s creative arts competition submissions. The competition includes 51 categories in the visual arts division that range from oil painting to leatherwork to paint-bynumber kits. There are 100 categories in the performing arts. A panel of local artists judge entries based on creativity, skill, originality, and overall presentation.

Select winners at the local level are invited to compete at the National Veterans Creative Arts Festival.

The South Dakota Association of Healthcare Organizations (SDAHO) is focusing on the state’s nursing home crisis at the Annual Post-Acute Care Conference in Sioux Falls April 24 to 25 (see the calendar). This year’s conference will focus on innovation, starting with the keynote speech on healthcare consumer technology. Other sessions include an introduction to remote patient monitoring, a digital device being used in assisted living, and the use of pharmacogenetics in post-acute care.

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ARIEN KLÄMM LifeScape’s Children’s Occupational Therapist and Assistive Technology Coordinator, Arlen Klämm, has joined the Clinician Task Force (CTF). The task force, comprised of 45 members across the US, was formed in 2004 to help ensure that coverage policies for seating and wheeled mobility devices are based on clinically relevant information. Klämm is the first certified Seating and Mobility Specialist in South Dakota and one of only 122 in North America. He is also an Assistive Technology Professional (ATP).

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April / May 2019

15

• Happenings around the region

News & Notes

[ INTERVIEW ]

Jill Weimer, PhD, on the Joys and Challenges of Being a Woman in Research JILL WEIMER, PHD,

MED: What do you think attracts women to research and

Sanford’s Senior Director of

what special qualities do they bring?

Therapeutic Development,

JW: Women are naturally inquisitive and many of us like

was the first person hired

the idea of using our passions and interests to answer

when the organization began

questions that can help people. Our natural compassion

building its pediatric research

can be a real motivator. But it can also make it difficult.

program in 2009. Today, the

You have to be able to rein in your emotions enough to

Weimer Lab, which focuses

focus and make critical, scientifically-based decisions. I

on rare pediatric diseases, is

have to make sure I take time to process and channel my

one of about a dozen Sanford

emotions and not be dismissive. I don’t want to become

labs being run by women.

outwardly aggressive with colleagues. As females, this is

Dr. Weimer spoke with MED

something we have to guard against.

about the joys and unique challenges of being a female

MED: What message do you have for younger female

researcher.

researchers?

MED: How did you first get involved in research?

JW: I had an absolutely phenomenal high school science teacher in the little Missouri town where I grew up. He

was a certified scuba instructor who trained us and drove rks better for the info.

JW: Two things. First, there are a lot of support programs and resources out there. At Sanford, we started an organization called Graduate Women in Science in 2010. There is also a Medical Women in Science. NIH even has programs. These are great tools for women at all stages of

us to the Gulf of Mexico. My senior project was focused on

their careers. Second, there is no one right path. You have

how deep sea diving could affect eye development, using

to decide what is right for you, whether that means having

a frog model. We built hyperbaric chambers in our class-

kids right after postdoc or waiting until mid-career. Don’t

room. So I was passionate about basic biomedical research

let anyone tell you that you’re doing it wrong. ❖

very early on.

Join Our Team • Dermatology • Neurology • Pulmonology • • One year track to ownership • No state income tax • Competitive salary • Outstanding benefits • www.YanktonMedicalClinic.com/recruitment

16

MidwestMedicalEdition.com

Clinical Dietician Theresa Real, Mary Beth McLellan, RN, and Dr. Bobbie Schneller check out food labels at the food bank located in the Regional Health Family Medicine Residency Clinic. Photo courtesy Regional Health.

Clinic-Based Food Bank Supports Vulnerable Patients

BY ALEX STRAUSS

L

AST YE AR , A STU DY con-

food at a discount through the Feeding South

ducted in Rapid City uncovered

Dakota distribution center in Rapid City.

a shocking statistic: Some four

Caregivers and others have donated cooking

thousand people in the neigh-

utensils, crockpots, and even a freezer for

borhood of the Family Medicine Residency

meat and produce. Since October, more than

Clinic are “food insecure”. It was a statistic

2,500 pounds of food has been distributed to

the clinic could not ignore.

48 families, including full Christmas meals

“Patients who are food insecure choose

for nine families.

the foods they can afford in the moment,” says

“We used to think our patients were

Dr. Bobbie Schneller, director of the residency

non-compliant,” says Mary Beth McClellan,

program. “Unfortunately, these are often the

Manager of Clinical Operations. “Now, we

foods that are least likely to be healthy.”

understand they were just unable. When they

So last October, the clinic made a bold move

have the right tools, they are very concerned

and opened an in-house food pantry. Patients

about their health and interested in ways to

who answer yes to one of two screening ques-

improve it.”

tions can take home the food they want. The

“Patients are often doing the best they can

clinic’s dietician is on hand to offer advice on

within their means. This is a mindset shift that

choosing and preparing it healthfully.

needs to happen among providers nationwide,”

“Our goal is to give them healthier options,” says Schneller.

Regional Health purchases much of the

WEB EXTRA

“

Patients are often doing the best they can within their means.

”

says Dr. Schneller, who anticipates an eventual decline in obesity and diabetes. “We hope to be the start of something important.” ❖

Read More

Read the full interview on our website.

April / May 2019

17

Bhaskar Purushottam, MD

“

THE DOWNSIDE IS, IF YOU DON’T USE THE APPROPRIATE DOSING, YOU RUN A RISK OF SERIOUS BLEEDING. BUT IN THIS CASE, I THOUGHT THE OPPORTUNITY TO SAVE THE FINGERS OUTWEIGHED THE DOWNSIDES.

” 18

S

BLACK HILLS DOCTOR SAVES MAN'S FROSTBITTEN FINGERS WITH CLOT BUSTER OME QUICK THINKING, trans-

cardiologist Bhaskar Purushottam, MD,

atlantic collaboration, and the

who specializes in vascular medicine.

innovative use of a clot busting

“We were really worried that he could

drug are credited with saving the

lose all of his fingers,” says Dr. Purushottam.

frostbitten fingers of a 58-year-old Rapid

“I knew of this vascular treatment where you

City cook.

put a clot busting drug directly into the

The man showed up at the Regional

vessel, but I had not done it. There are only

Health ED after having been locked out of his

about 60 cases in the literature, so not a lot.”

hotel room for hours in the dead of winter.

Purushottam contacted his former

By the time he arrived, the frostbite was

mentor at Mount Sinai Hospital in New

severe. The case was further complicated

York, who contacted a colleague in Europe.

by the fact that the patient was a lifelong

Together, they helped him come up with a

smoker who suffered from peripheral vascu-

plan of action.

lar disease. Although the team did not know

“I told the patient, ‘Look, I’ve never done

it at the time, he also had an occluded artery

this in Rapid City, but I’m very well trained

in his leg.

and this is very similar to the procedure

The ED doctor called on interventional

we do in the legs’,” says Purushottam. “It is

Frostbitten fingers, pre-intervention

MidwestMedicalEdition.com

essentially an intra arterial thrombolysis. The downside is, if you don’t use the appropriate dosing, you run a risk of serious bleeding. But in this case, I thought the opportunity to save the fingers outweighed the downsides.”

After a few hours of consideration, the patient agreed and the procedure was performed 24 hours after he had entered the ED. Dr. Purushottam accessed the hands through an artery in the groin and used a wire to place a tiny catheter in each frostbitten finger. Dye was injected, followed by a small dose of the clot dissolving drug.

“This drug has been well studied, so we know it does a great job,” says Dr. Purushottam. “But

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instead of using 40 to 70 milligrams as you would for ischemic stroke or heart attack, I barely used 20. You can use so much less because you are taking the medication directly to the clot.”

When the team discovered that the patient also had a clot in his leg, they performed the same procedure to open that blockage, too.

The patient’s remarkable recovery was recorded in daily photographs. Seven days after the proce-

The Physicians Protector Plan, a one of a kind insurance program for physicians, combines professional liability, general liability, commercial property coverage, and much more all in ONE policy.

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dure, he was discharged–with all of his fingers and all of his toes. “It makes me feel so happy for what I do,” says Purushottam. “He still has his fingers and his job.”

“If a patient comes in with frostbite and doesn’t have major complications, this should be considered, if possible,” Purushottam advises. “It appears to be safe and may prevent amputation, especially if performed within 24 hours.” ❖

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Seven days after intra arterial thrombolysis

April / May 2019

19

DRIVER’S EDUCATION

EYE BANK PROGRAM DEMYSTIFIES ORGAN DONATION FOR NEW DRIVERS

BY ALEX STRAUSS

T

HERE ARE FEW MORE pas-

titled “A Legacy of Life”, includes donation

sionate and outspoken fans of

facts, pictures, videos, real talk about his own

Dakota Lions Sight & Health

experience as a recipient, stories of young

than Alan Berdahl. Not only has

donors, take-home materials, and plenty of

Berdahl served as the organization’s Com-

time for Q & A.

munity Outreach Coordinator since 2013,

“Many kids are surprised to find out that

but he is also the father of DLSH medical

hundreds of grafts can come from a single

director John Berdahl, MD, and the recipi-

donor because we recover so many different

ent of donor corneas that saved his sight.

types of tissue,” says Berdahl.

A sufferer of Fuch’s

Last year, he spoke to 67

Dystrophy, Berdahl received

driver’s ed classes, including

new corneal tissue in a sur-

public schools in Sioux Falls

gery his son performed in

and Rapid City and surround-

2014. The former band direc-

ing communities, reaching

tor joined the eye bank in

more than 2,200 young people.

2010 as a distribution spe-

“Until they are 18, their

cialist. When it became clear

parents have to sign off on

that his gregarious person-

organ donation, so I give

ality was wasted in the lab,

them an ‘assignment’ to go

he started speaking to com-

home and talk to their par-

munity groups instead.

ents about this,” says Berdahl.

“The goal is always to

“This is probably the first truly mature decision that

increase number of donors,” says Berdahl. “I realized that one of the key

these kids have to make. This is not an easy

groups we needed to be talking to were people

conversation.”

in driver’s ed because they are going to be

But it may be a conversation that is already

asked about being organ donors when they

making a difference. In 2017, 59 percent of

apply for their license,”

South Dakota drivers registered as a donor or

In 2014, Berdahl developed and launched the first and only eye and tissue donation education program geared specifically for driver’s ed students.

20

THIS IS PROBABLY THE FIRST TRULY MATURE DECISION THAT THESE KIDS HAVE TO MAKE. THIS IS NOT AN EASY CONVERSATION.

”

maintained their donor status. In 2018, that number rose to 61 percent.

“If mom and dad aren’t donors, it is possible that the conversation with their son or

“It’s a no-brainer but no one has ever done

daughter might prompt them to become

it,” says Berdahl. “In Minnesota, they have to

donors,” says Berdahl. “But, in my mind,

spend some time talking about organ dona-

whether or not they become donors is less

tion. But you can’t ask questions of a video.

important than the fact that they had the

Kids ask me questions all the time.”

conversation. If they have the conversation,

Berdalh’s hour-and-a-half presentation,

“

we win.” ❖

MidwestMedicalEdition.com

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21

24th Annual North Central Heart Vascular Symposium

24th Annual

Friday, May 10, 2019 8 a.m. – 4:30 p.m.

Vascular Symposium

Sioux Falls Convention Center 1201 N. West Ave. Sioux Falls, S.D. Hear from vascular experts around the country as they discuss the latest technology and treatment for vascular disease.

Learn more at Avera.org/conferences

19-HHSD-15523

Save the Date

SPRING 2019

UPCOMING EVENTS APRIL 10

APRIL 26

MAY 15

27th Annual Avera McKennan Trauma Symposium

Avera McKennan Diabetes Conference 2019

Avera Caring Professionals Conference

Location: Sioux Falls Convention Center Information and Registration: averacontinuingeducation@avera.org 605-322-7879

Location: Hilton Garden Inn Downtown Sioux Falls Information and Registration: averacontinuingeducation@avera.org 605-322-7879

Location: Sioux Falls Convention Center Information and Registration: averacontinuingeducation@avera.org 605-322-7879

APRIL 11

APRIL 26 & 27

MAY 15, 16 & 17

7:30 am – 4:00 pm

9:00 am – 5:30 pm 2019 Sanford Heart and Vascular Symposium Location: Delta Hotel by Marriott, Fargo Information: LEADCenter-FGO@ sanfordhealth.org

APRIL 25

5:00 pm – 7:00 pm Third Annual Power of Research Event Location: Regional Health Orthopedics & Specialty Hospital, Rapid City Information: komengreatplains.org

APRIL 24 - 25

9:30 am - 6:30 pm, 7:30 am - 12:30 pm SDAHO Post-Acute Partners in Care Conference Location: Ramkota Hotel, Sioux Falls Information: sdaho.org/

APRIL 24 - APRIL 26 8:00 am - 5:00 pm

SDMGMA Spring Conference Location: Hotel Alex Johnson, Rapid City Information and Registration: sdmgma.org

8:30 am – 4:30 pm

8:00 am – 6:00 pm, 8:00 am - 4:30 pm 13th Annual Sanford Sports Medicine Symposium Location: Ramkota Hotel, Sioux Falls Information: 605-312-7808, tryg.odney@sanfordhealth.org Registration: https://www.sanfordhealth.org/classes-and-events/

8:30 am – 4:00 pm

9:00 am – 5:45 pm

2019 Sanford Integrative Health Symposium Location: Sanford Center, Sioux Falls Information: 605-312-3509, priscilla. jurkovich@sanfordhealth.org

MAY 16

8:30 am – 4:00 pm

APRIL 27

UnityPoint Health - St. Luke’s 45th Annual Perinatal Conference

Juvenile Diabetes Research Foundation One Walk

Location: UnityPoint Health – St. Luke’s Auditorium, Sioux City Information: https://www.unitypoint. org/siouxcity/services-professional-education.aspx

9:00 am Registration 10:30 am Start

Location: General Beadle Elementary School, Rapid City Information: ChristyC@bhfcu.net, (605) 312-6438 Registration: www2.jdrf.org

JUNE 6 - JUNE 7 3:30 pm Thursday - 5:00 pm Friday

MAY 10

Avera Sports Medicine Symposium

24th Annual North Central Heart Vascular Symposium

Location: Ramkota Hotel, Sioux Falls Information & Registration: avera. cloud-cme.com

8:00 am – 5:00 pm

Location: Sioux Falls Convention Center Information and Registration: averacontinuingeducation@avera.org 605-322-7879

JULY 12 - 13

7:00 am - 4:30 pm, 7:15 am - 12:15 pm 41st Annual Sanford Black Hills Pediatric Symposium Location: The Lodge at Deadwood Information: sanfordhealth.org/ classes-and-events

VISIT THE ONLINE CALENDAR at MidwestMedicalEdition.com to find more information on these and other upcoming events between issues. You can also add your own event to the calendar for free.

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