MED-Midwest Medical Edition-December 2016 by MED- (Midwest Medical Edition)

2016

DECEMBER

16 Vol. 7 No. 8

the in YEAR REVIEW the in

YEAR REVIEW

2 2016 016 Risky Business: Insecure Mobile Messaging

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MIDWEST MEDICAL EDITION

Vol. 7 No. 8

Contents VOLUME 7, NO. 8 ■ DECEM B ER 2016

REGULAR FEATURES

Messaging Risky Risky Busines Busines Insecur InsecureeMobile Mobile Messag Doctor’ Messaging s Inventions:s:Spawns New Compa ny ing Doctor Doctor’’ssInventi Inventio onn Spawn Spawnss New New Compa Company ny Groundbreakin gs in the Black Hills Ground Groundbreakin breakings gs in in the theBlack Black Hills Hills

5 | MED on the Web Ergonomics at work, Understanding Lean Construction, Invitation to post your events

THE SOUT H DAKO TA REGIO N’S PRE M IER PUBL ICATI ON FOR HEALTHCA RE PROF ESSIO NALS

7 | NEW! Hometown Advantage

Featuring area physicians who’ve come home to practice. This month: Greg Gerrish, MD, Sioux City

page 12

10 | N ews & Notes – New providers, awards, accreditations and more 30 | Learning Opportunities Upcoming Fall and Winter

ON THE COVER

CME opportunities and conferences

IN THIS ISSUE Partnerships: Is There Life After Death? How to ensure your business survives if something happens to your partner ■ By Dave Starr

20 | 22 |

Anesthesiologists Treating Chronic Pain Patients ■ By Jeremy Wale

Insecure Mobile Devices: Is Your Practice at Risk?

vera Opens New Sioux Falls A Health Center and Freestanding ED

22 |

I HS to Fund Extended Telemedicine for Native Americans

25 |

Sanford Immunotherapy Trials:

■ By Sarah Conway Balancing HIPAA compliance and text messaging

of Pediatric Thyroid Diseases

26 | Holm Inducted into South Dakota Hall of Fame “Prairie Doc” says he’s “taken aback” by the honor

27 | Thoracic Surgeon Brings New Procedures to Black Hills ■ By Alex Strauss 29 | Madison Regional Health marks first year in new facility

30 | Too Busy for the Gym? Try Calisthenics An easy option to stay in shape during one of the busiest times of the year ■ By Corey Howard

IN OUR ANNUAL LOOK BACK AT THE YEAR, WE REVISIT CUTTING EDGE THERAPIES AND CLINICAL TRIALS NEWLY AVAILABLE IN OUR REGION. WE MEET DOCTORS WHO HAVE FOUGHT THEIR OWN HEALTHCARE BATTLES AND THOSE WHO HAVE PASSED THEIR LOVE OF THE PROFESSION ON TO THEIR CHILDREN. AND WE LEARN HOW

New immunotherapy study centers on colorectal cancer

25 | Diagnosis and Management

2016 Risky Business: Insecure Mobile

4 | From Us to You

8 |

IEW ththe eYYEEAARRininRREEV W VIE

Local Doctor’s Invention GIves Rise to Sanford Vascular Innovations ■ By Alex Strauss

Regional Health Breaks Ground on New Projects in Sturgis and Custer

TECHNOLOGY IS EXPANDING THE REACH OF AREA EXPERTS.

2016 THE YEAR

IN REVIEW

From Us to You Staying in Touch with MED

Happy Holidays from MED!

ELCOME TO OUR ANNUAL end-of-theyear wrap of the news and events that defined our wide and diverse medical community in 2016. As you take this little stroll down “memory lane” with us in our Cover Feature, we hope that it will inspire you to begin considering topics and stories you would like to see in these pages in the coming year. MED is locally produced in Sioux Falls by local people. We get our medical care here and many of our readers are also our friends. We are committed to bringing you the most timely, relevant and engaging medical community news and features so that MED will be one of the most valuable items in your mailbox (or your Inbox). To do that, we need your input. If you are . . .

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT

SALES & MARKETING Steffanie

Liston-Holtrop

Steffanie Liston-Holtrop, MED Marketing Director Erika Tufton, and Alex Strauss geared up for wintry weather

EDITOR IN CHIEF Alex Strauss

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MARKETING DIRECTOR Erika Tufton PHOTOGRAPHER studiofotografie WEB DESIGN Locable

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• A healthcare professional with a story to tell, news to share, or a bone to pick • An expert with advice or services of interest to healthcare professionals • A hospital administrator, PR specialist, or clinic manager with information

CONTRIBUTING WRITERS Sarah Conway

Corey Howard

or news to tell

Dave Starr

. . . we want to hear from you! Please drop us a line at Info@MidwestMedical Edition.com or 605-366-1479 with your thoughts, ideas, and story suggestions any time. Now, settle in somewhere warm and enjoy your complimentary issue of MED, our gift to you. See you in the New Year! —Alex and Steff

STAFF WRITERS Liz Boyd Caroline Chenault John Knies

APRIL / MAY

2016

MARCH

JANUARY FEBRUARY

Vol. 7 No. 1

Jeremy Wale

Vol. 7 No. 2

Vol. 7 No. 3

Midwest Medical Edition

Midwest Medical Edition THE

RISK

HIGH DEDUCTIBLE HEALTH PLANS

of Filing Cabinets

Why Cybercriminals

CONTRACT TIPS

and Your Bottom Line

Employment

When

TARGET EHRS UPCOMIMG CME Opportunities

Pediatric Dysphagia

More Than Just “Picky”

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

Clinical Trials The Lifesaving Power of Increased Treatment Options

The ‘New” Dakota Lions Sight & Health

Providers arePatients

A Local Solution

Insights from the other side

Avera Advances Rural Cancer Care

Outsmarting the

for TELEMEDICINE

The South Dakota Region’s Premier Publication for Healthcare Professionals

CRYPTOKILLER Family Law Q & A for Medical Professionals

Spring Conference

C A L EN DA R THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

NEW

CANCER TECH for SD Hospitals

Regener

Medic

Stem Cell Therapy in Spinal Sur

THE SOUTH DAKOTA REGION FOR HEALTHCARE

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2017 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5

MORE than a magazine

June Issue May 5

A Medical Community Hub!

July/August Issue June 5 Sep/Oct Issue August 5

This month only on the Web

November Issue October 5

Winter Weather Fall Prevention

December Issue November 5

More than 800 workplace fatalities in 2014 were due to slips, trips, and falls. Here’s how to make sure neither you nor your patients fall victim to these common winter accidents.

CONTACT INFORMATION Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com

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NOVEMBER

2016

SEPTEMBER OCTOBER

JULY AUGUST

JUNE

2016

2016 Vol. 7 No. 4

BEST vs RECOMMENDED Cybersecurity Practices

Med Ed from the

Prairie to Persia Functional Movement Screening

Virtually Ideal

rative

cine

Avera’s Expanding eCare Empire

Do You Really NEED “Document Management”?

rgery at Orthopedic Institute

N’S PRE M IER PUBLICATION PROFESSIONALS

Vol. 7 No. 7

Vol. 7 No. 6

Vol. 7 No. 5

Heart & Stroke Care

Awards

A Talk with

SDSMA’s Recent Past President

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Family Bonds,

Healthcare Beneﬁts Conversations About Growing Up in Medicine on the Northern Plains

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6/16/16 11:40 AM

Expansion

in Rapid City & Watertown Your Guide to

CHARITABLE GIVING

Taking the Pain Out of Office Purchasing

Healing

Hearts in the Hills

Important “Firsts” for Rapid City Cardiologists

THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

Insecure Mobile Devices

Is Your Practice at Risk?

By Sarah Conway

N A MAY 2016 STUDY BY THE PONEMON

Institute, 89% of the healthcare organizations surveyed had at least one data breach involving the loss or theft of patient data in the 24 months prior to the survey. Nearly half of those had more than five breaches. When asked what type of security incident worries them the most, 30% said the use of insecure mobile devices. With the growth of BYOD environments, mobile devices have become an essential tool for communication. Workflow is critical and text messaging is a logical communication medium to choose. It’s quick, easy and universally available. However, there are security and compliance risks that must be addressed when allowing texting to be used in your organization. The key thing to determine is whether or not messages contains PHI. The US Department of Health defines PHI as individually identifiable health information that is transmitted or maintained in any form or medium (electronic, oral, or paper) by a covered entity or its business associates. Technology, such as text messaging, that is used for accessing, transmitting or receiving PHI electronically is covered by the HIPAA Security Rule. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of ePHI. Violations can result in substantial penalties.

Sarah Conway is the Business Development Manager at Golden West Technologies.

In order to help mitigate the risk to your organization from a texting security incident or compliance violation, consider implementing the following.

1 Include text messaging in your organization’s overall risk analysis and management strategy.

2 Determine what information is acceptable to text and train your staff accordingly.

3 K eep an inventory of mobile devices (both personal and provider owned) and ensure devices are using passcodes.

4 I f you haven’t done so already, consider using a

vendor supplied secure text messaging app that is HIPAA and HITECH compliant. These apps allow you to send ePHI to contacts inside and outside your organization. Your answering service may also use it to communicate detailed information to the on-call physician.

A HIPAA compliant secure messaging service should provide you:

● Separation of healthcare texting from personal texting

● Encryption of messages ● Special authorization and authentication requirements to access messages

● No storage of messages on the actual device ● Remote disabling of the app on lost or stolen devices

● No PHI in screen notifications ● Ability to access device to device or with a secure web application

● Persistent message alerts and

synchronization on all devices

● Availability on both WiFi and 3G/4G networks ● Elimination of pager expense by consolidation of devices

You can never eliminate all risk but you can certainly take measures to mitigate it. Through planning and partnership, you can continue to incorporate texting into your workflow while still maintaining compliance and security. ■

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HOMETOWN ADVANTAGE What brings physicians back to the region to practice? For GREG GERRISH, the son of a Watertown surgeon, both the “what” and the “where” of his career path were pretty easy decisions. Gerrish was hooked on surgery from as early as 8th grade when he attended one of his dad’s cases. As for location, just two years into his five-year training at Hennepin County Medical Center in Minneapolis was enough to convince him that home was where his heart was. “I signed on to come back three years before I was even done,” he says. “They knew they wanted me to come

December 2016

back and I knew that I wanted to come back, so we made a deal.” In addition to being close to family and friends and enjoying the slower pace that a smaller town offers, Dr. Gerrish also sees Watertown as an ideal place to practice the full scope of general surgery. “In a city, there are not nearly as many opportunities to practice straight general surgery, so most surgeons end up focusing on a particular area,” says Gerrish. “But here, I can do it all.

MidwestMedicalEdition.com

Everything from thyroid to breast to abdominal, skin, burns, trauma, endoscopies. You name it.” Being two of seven surgeons in Watertown has also brought Dr. Gerrish and his dad, who works for Brown Clinic, closer together. “If my dad has an interesting case, I might scrub in,” he says. “For anyone else, it might be like fixing the car in the garage with their dad. We don’t fix cars so surgery is our ‘shop talk’.”

PARTNERSHIPS Is There Life After Death?

By Dave Starr AVE YOU thought

about what will happen to your business when your partner dies? If no other arrangements have been made, the partnership will no longer exist as a legal business organization except for the purpose of winding up its affairs. When a partner dies, the survivors have only two alternatives: they must either liquidate or reorganize. Liquidation usually is not a good solution. The business generally will have to be sold quickly and for only a fraction of the value it had as a “going concern.” In most cases, good will is lost entirely. Physical assets may bring little more than one-fourth of their true value. REORGANIZATION SCENARIOS Reorganization generally is a better answer. The reorganization of a partnership usually follows one of four scenarios:

1 Your partner’s heir(s) become new partners. This plan may or may not work. One or more of the heirs might be a minor, and few of the heirs, if any, will have been regular employees of your business. They may not have the knowledge and experience needed to be a partner.

2 Your partner’s heir(s) sell their interest to someone else.

This means you may not have a say in who your new partner will be.

3 Your partner’s heir(s) buy your interest in the business. In most cases, the heirs simply can’t afford to buy the business. Even if they can afford to buy, they may not be willing to pay a price adequately reflecting the value of the business. 4 Your partner’s heir(s) sell their interest to you. This would be an ideal solution if the surviving partners can raise a sufficient amount of cash and if they can agree on the terms of the purchase with the heirs. The best solution is to plan ahead for the sale of your business upon the death of a partner. This can be accomplished with a buy-sell agreement. A properly structured buysell agreement can establish the business value and ensure the continuation of the business by the surviving owners. In addition, the agreement generally establishes a pre-determined price for the business, as well as provides the money to actually buy the business from the heirs. VALIDATE YOUR BUSINESS Many business owners have a difficult time determining a realistic fair market value for their business. Partners can use a number of valuation methods to estimate the value of their interest in the business. No one method will work in every case but one, or a combination of several, should serve the needs of most business owners. No matter which method you use to value the partnership,

there is one important factor you should keep in mind: The buy-sell agreement should make provisions for future valuations of the business – either through periodic updating or use of a formula. That is because a fair market value that is “just right” today may be too low next year and entirely inadequate in five years. When partners devote the bulk of their time, effort and ability to the operation of a business, its fair market value usually continues to increase. This constant appreciation should be taken into consideration when valuing the business.

PLAN FOR THE FUTURE Planning today for the future of your business helps protects you, your partner and your families. You know exactly what will happen if a partner dies . . . the purchase price, the funding arrangements, etc. It allows you to continue in business and provides the partner’s heir(s) with immediate cash. There may be life after death for partnerships – when partners plan ahead. ■ Dave Starr is Regional Managing Director with Principal Financial Group in Sioux Falls.

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Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes BLACK HILLS

The Regional Medical Clinic Aspen Center is pleased to welcome Ebima Okundaye, MD, to their Nephrology Department. Dr. Okudaye earned his medical degree in Nigeria and went on to completed his Fellowship in Nephrology and Hypertension in Queens, New York. Rapid City Regional Health is pleased to name Surgeon Mark L. Harlow, MD, as the President of Medical Services. In his new position, he will be responsible for medical directors and the hospital-based physicians. Dr. Harlow is a retired Major of 12 years with the US Army Medical Corps. He served as the Chief of the Department of Surgery and the Chief of Orthopedic Surgery at Rapid City Regional Health previously.

SANFORD The Look Good Feel Better for Teens program was offered at Sanford Children’s hospital for the first time on November 7th. The program is a national program that teaches teens to manage the appearance side effects, such as hair loss, of their cancer treatment. Information on fitness, nutrition and how to deal with cancer-related social situations was also provided by Sanford Health. The Look Good Feel Better for Teens Program helps to add a sense of normalcy to cancer patient’s lives.

The Sanford Heart Hospital and University of South Dakota Sanford School of Medicine have been approved by the Accreditation Council for Graduate Medical Education for an interventional cardiology fellowship program. Fellows selected for the USD Sanford School of Medicine program will receive education and training from faculty and Sanford Health cardiologists who developed the program. This new program is one of just 147 interventional cardiology fellowship programs approved by ACGME for physician specialty training in the United States. Just one position will be available annually.

Cardiologist Naveen Rajpurohit, MD, has joined Sanford Heart Hospital. One of the first graduates of the Sanford Cardiovascular Disease Fellowship Program, Dr. Rajpurohit specializes in cardiac imaging and has board certifications from the American Board of Internal Medicine, American Board of Cardiology, National Board of Echocardiography, Board of Cardiovascular CT and American Society of Nuclear Cardiology. He completed his residency in internal medicine at the University of Missouri. A Sanford Research scientist studying kidney development has received $1.45 million from the National Institutes of Health to further explore how certain cells of the organ develop. Kameswaran Surendran, PhD, secured the award under the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. Findings from this study, according to Surendran, could provide more information on genetic mutations that alter collecting duct cell functions and subsequently identify new therapy options for diseases in these cells.

The following Sanford nurses have been recognized with DAISY awards in recent months: Janelle Maag RN, Medical Oncology

Michelle Vandemark MSN, RN, Nurse Practitioner, Neurocritical Care Hillary Determan, RN, Pediatric Intensive Care Unit

SIOUXLAND Mona Singh, MD, received recognition from the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) for providing quality care for her patients with diabetes. Dr. Singh works at Mercy Internal Medicine and Pediatrics and received this recognition by submitting data that demonstrated performance that met the criteria for the program’s key diabetic care measures.

Barb Black, Director of Radiology Services at Mercy Medical Center-Sioux City, has been named the recipient of the annual Catherine McAuley Excellence Award for 2016. The award is in honor of the Founder of the Sisters of Mercy and Black was chosen for her values and her warm and gentle heart. Black, who is also celebrating 25 years of service with Mercy Medical Center, received the award at Mercy’s Employee Recognition Open House on October 11th.

OTHER Midlands Clinic, PC, in Sioux City hosted an open house and ribbon cutting at their new location in Sioux City in November. Midlands clinic opened their additional location, Midlands Cosmetic Dermatology & Skincare, in June in the Central Professional Center across from Southern Hills Mall.The clinic provides treatments for all cosmetic and medical conditions of the skin. MACRA, the Medicare Access and CHIP reauthorization Act of 2015, is set to transform the way the federal government delivers and pays for healthcare. To assist practices with these changes, QPP Resource Centers will be established as early as November 2016 to answer questions and provide direct technical assistance and support at no cost to practices with 15 or fewer clinicians. If you would like to be notified of the QPP Resource Center serving your practice, visit the HealthPoint website.

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16 the YEAR in REVIEW

2016

WAS A YEAR OF GROWTH AND EXPANSION FOR THE SOUTH DAKOTA REGIONAL MEDICAL COMMUNITY. HEALTHCARE INSTITUTIONS ACROSS THE REGION NOT ONLY BUILT NEW FACILITIES AND ADDED NEW STAFF, BUT ALSO BEGAN OFFERING CUTTING-EDGE NEW SERVICES AND TECHNOLOGIES.

6 PEDIATRIC DYSPHAGIA

jan/feb

More Than Just “Picky”

Feeding and swallowing problems are a daily reality and a source of anxiety for as many as 25 to 50 percent of babies or young children and their families. For these children, mealtimes are often fraught with emotion and marred by coughing, choking, gagging, retching and crying. And yet, pediatric dysphagia, especially in its less severe forms, is often dismissed as “picky” eating by both parents and medical professionals, many of whom believe that a child will grow out of it. “We start to get concerned if a child is eliminating an entire food group, such as no fruits or no vegetables,” says LifeScape SpeechLanguage Pathologist Heather Hewitt, who works closely with kids with various types of dysphagia. “Or they may be eliminating a particular texture such as any food that is crunchy or wet. Sometimes the problem is that they are not really able to manipulate it around in their mouth.” Because feeding challenges are unique to each child, there is no one-size-fits-all therapeutic solution. In recognition of this, the feeding and swallowing program at LifeScape, is multidisciplinary, involving the skills and expertise of speech-language pathologists, occupational therapists, and child psychologists to address individual problems from every angle. In some cases, a dietician may even be called in to help. “No one approach is the right way to manage feeding and swallowing issues. I think we do a good job of finding what works,” says LifeScape Therapy Manager Melissa Carrier-Damon, a SpeechLanguage Pathologist. Although most of these issues occur in babies and toddlers, the LifeScape team also works with older children and even young adults using a range of cutting edge techniques such as VitalStim, Beckman Oral Motor, and Sensory Oral Sequential (SOS). Often, therapists use a combination of these approaches and others, along with plenty of positive reinforcement and parental support, to encourage children to try new things, push themselves, and learn to embrace and even enjoy their mealtimes. “It is so important for the child emotionally, socially, and nutritionally and it’s really important for the family,” says says LifeScape SpeechLanguage Pathologist Heather Hewitt. “This is important for development in general. We want eating to be a happy and fun time.” For many children and their families, therapy means that mealtimes are no longer frustrating and tear-filled. Picky eaters have broadened their diets and become healthier and parents have learned how to more effectively reinforce better eating habits. Even children who were never expected to eat orally are eating and drinking regular diets after spending time in therapy for their dysphagia at LifeScape.

■ Paulette Davidson, FACHE,

CMPE, MBA, is selected as Regional Health’s new Chief Operating Officer and Ronald Amodeo becomes the new Innovation and Growth Officer.

■ Dr. John (Jack) Wempe, a

30 year Army veteran, becomes the new Chief of Staff for the Sioux Falls VA Health Care System.

News Flash the

YEAR in

REVIEW

march

16 CLINICAL TRIALS

The Lifesaving Power of Increased Treatment Options

Biomedical research studies conducted on human participants are universally known in the profession as “clinical trials”. But for the President of Research at Sanford Health, the term is just too limited. “I prefer the phrase ‘increased treatment options’, because that’s what clinical trials really are,” says David Pearce, PhD, Senior Scientist with Sanford Children’s Health Research Center and director of the Pearce Lab. “Biomedical science and medicine are always advancing. When you are treating a patient, you have the standard of care. But [through clinical trials] you also have the ability to offer them the most up-todate technology or intervention for their malady that may eventually become the standard of care.” While bench research can take place almost anywhere innovative thinkers and a well-equipped laboratory exist, clinical trials require a sufficient number of eligible human participants and, often, significantly more funding. Less than a decade ago, there were few of these “increased treatment options” available in the South Dakota region. But as the area’s population has grown and the number of qualified physician scientists and researchers has increased, institutions like Sanford have committed more resources to clinical trials and have been rewarded for their efforts. “Sanford has expanded Sanford Research because there was a feeling that our research needs to impact patients,” says Dr. Pearce whose own research has focused on the molecular basis of inherited pediatric neurodegenerative diseases. “We have basic and translational research, but we have also invested in advancing our clinical research.” The effort got a major boost when Sanford was admitted into an elite group of 34 healthcare institutions that are part of the National Cancer Institute’s Community Oncology Research Program. NCORP sites participate in NCI cancer prevention, control, screening and posttreatment surveillance clinical trials. Sanford Health’s large footprint means that many of the region’s cancer patients are able to take part in large-scale national trials they might never have been able to access just a few years ago . Clinical trials lead to more clinical trials in a sort of snowball effect. An institution’s involvement in NCORP-style community based clinical trials can, as they have in Sanford’s case, open the door to what Dr. Pearce calls commercial trials. A growing number of pharmaceutical companies and device manufacturers now look to South Dakota as a good place to run an FDA trial. “Reputation is everything in research,” says Dr. Pearce.

News Flash the

YEAR in

REVIEW

■ South Dakota Lions Eye and TIssue Bank joins forces with North Dakota eye bank and becomes Dakota Lions Sight and Health

■ Cornelius Boerkoel, MD, PhD,

joins Sanford Health as the executive director of the Sanford Imagenetics Research Center on Genomic and Molecular Medicine.

■

Sioux Falls-based medical supply distributor Kreisers, Inc. is one of a trio of companies joining forces to form one large distribution company known as Concordance Healthcare Solutions.

16 WHEN PROVIDERS ARE PATIENTS

april/may

Insights from The Other Side

Many healthcare providers believe they know what it is like to be a patient. For some, experiencing a life-altering medical condition can show them how much they really do not know. In this story, we meet providers who were changed by their experiences as patients. Orthopedic surgeon Steven Meyer, MD, with the CNOS Clinic in Dakota Dunes, South Dakota, ad lived with pain in his shoulders for more than 10 years. Over the last three years, he had both shoulder joints replaced. “The greatest thing about it is that I’m re-enthused about what I do for a living,” says Meyer. “It makes me feel incredibly blessed to be able to be an orthopedic surgeon – I know the impact I have on people’s lives.” And Dr. Meyer says his experience has been as good for his patients as it has been for himself. “Now, I can look at people and say I know exactly what that’s like. It’s given me a greater sense of empathy, and enhanced my understanding. It helps me relate to patients, and helps my patients relate to me.” Stephanie Broderson, MD, with Sanford Family Medicine in Sioux Falls, was 28 weeks pregnant when she learned that her kidneys were failing. After a decade of declining kidney function, she received a donor kidney from her stepdaughter. Today, the healthy and pragmatic Iowa native says she has little patience for patients who neglect their health and offers tough love, born of experience, for the rest. “My motto is ‘no whining’,” she says. “I had to do chemo. I had to do a kidney biopsy and a bone marrow biopsy. I was chronically ill and had to take medication. And I underwent a major surgery. So I understand how tough it can be.” Sioux Falls Audiologist Robert Froke, MA, CCC-A, was left with moderate hearing loss after a bout of a flu-like illness. Like his patients, Froke says he “played the denial game”, telling himself that everyone around him was mumbling. “Then suddenly I caught myself. I thought ‘You hear this all the time from your patients!’ So I decided I had better get real about it.” After an MRI ruled out a tumor, Froke began using a set of RIC (receiver in canal) digital hearing aids. “This has really helped me help my patients,” he says. “Now, I can be one step ahead of people in terms of my counseling and tell them, yeah that’s normal. That is to be expected as far as your adjustment to your hearing aids or to hearing the world again.”

■ Avera officially opens the new

Avera Medical Group Family Health Center on the Grassland Health Campus in Mitchell this month.

■ Avera Cancer Institute’s new

Navigation Center makes cancer navigation services available system-wide.

■ Marian Petrasko, MD., PhD, an

interventional cardiologist with Sanford Heart Hospital in Sioux Falls, recently performed his 100th robotic-assisted angioplasty.

june

16 REGENERATIVE MEDICINE

Stem Therapy in Spinal Surgery at Orthopedic Institute

Stem cells, undifferentiated biological cells with the power to differentiate into specialized cells, are a key component of regenerative medicine. These cells, which in developing embryos become all the tissues of the body, can also be found in the bone marrow, adipose tissue, and blood of adults. Globally, scientists are hard at work on the development of techniques that will utilize these powerful cells to heal injuries, regenerate damaged tissues or even produce entirely new organs. “Regenerative medicine might be the biggest advance in healthcare I’ve seen in my thirty years as a physician,” says Walter Carlson, MD, MBA, a surgeon with Orthopedic Institute in Sioux Falls and a Clinical Professor with Sanford USD Medical School. Carlson has been incorporating stem cell therapy into select spinal fusion surgeries for the past two years. Many musculoskeletal conditions have few therapeutic options beyond the conventional approaches, but stem cell therapy–especially when it utilizes the patient’s own cells–offers the promise of less invasive tissue repair, faster healing, and, in some cases, the ability to delay or even avoid joint replacement surgery. “I was looking for ways to improve the quality of the fusions I do in the lower back,” says Carlson, who recently performed his 100th successful, stem cell-augmented spinal fusion. During the spinal fusion procedure, while the patient is under general anesthesia, Dr. Carlson aspirates about 100 cc of the liquid bone marrow (more for a multi-level fusion) and passes the syringe to a technician who performs the centrifugation. Preparation requires only about 20 minutes, after which a concentrated dose of about 15 cc is applied to a scaffolding product at the graft site, enhancing the environment to encourage consolidation of the bone. “This is not the fountain of youth or the Holy Grail,” cautions Dr. Carlson. “But even at three to six months, I’m seeing a nice development of bone where I want it to be to help to stabilize and fuse the spine. This has been the experience of others around the country, as well, and the literature now supports the idea that stem cell supplementation in lumbar fusion is equal to or better than other techniques.” Eventually, many of these patients do end up needing surgery. Although stem cell therapy has not been proven to be more effective in the short run than other nonsurgical approaches, it does offer one very distinct advantage. “In addition to reducing inflammation and pain and improving function, there is also the hope that stem cells might actually help restore some of the patient’s tissues back to a more normal state,” says Dr. Carlson.

News Flash News

YEAR in Flash

the

REVIEW

■ South Dakota Lions Eye and TIssue Bank joins forces with North Dakota eye bank and becomes Dakota Lions Sight and Health

■ Cornelius Boerkoel, MD,

PhD, joins Sanford Health as the executive director of the Sanford Imagenetics Research Center on Genomic and Molecular Medicine.

■ Sioux Falls-based medical

supply distributor Kreisers, Inc. is one of a trio of companies joining forces to form one large distribution company known as Concordance Healthcare Solutions.

16 VIRTUALLY IDEAL

july/august

Avera’s Expanding eCare Empire

A 42 year old Parkston, South Dakota area man is having dinner with friends when he suddenly develops the classic signs of a stroke. He becomes week, half of his face droops, and he loses the ability to talk. His wife rushes him to the nearest hospital, Avera St. Benedict Health Center in Parkston, where his friend, family physician Jason Wickersham, MD, is waiting. Dr. Wickersham, who has worked in Parkston for 12 years, is not unfamiliar with stroke and has had experience using clot-busting drugs in the treatment of elderly heart attack patients, but this is a different scenario. In a larger health center, he and his patient would likely be surrounded by colleagues who could weigh in on the situation. Here, he is on his own. Until, he presses a button on the wall of one of the two ER rooms. Within seconds, the high-definition screen on the wall fills with the image of an ER physician at Avera’s eCare hub in Sioux Falls and he and Dr. Wickersham are collaborating on the case, working in tandem as physicians are trained to do. Within a short time, the two are joined by a neurologist, who helps walk Dr. Wickersham through a series of tests with the patient to confirm the diagnosis they all suspect: acute ischemic stroke. Through eCare, even the most geographically remote or understaffed facilities can connect with an ER physician 24/7, for everything from a quick second opinion to assistance with a complex procedure. At 120 sites and counting, eEmergency is second only to eConsult as the most popular eCare service. “It is truly amazing,” says Sioux Falls emergency medicine specialist Brian Skow, MD, medical director of both eEmergency and eCare. Skow has logged more than 8,000 hours in front of a camera and a 50-inch high definition monitor, working alongside rural doctors like Wickersham from a distance. What began in the early 1990s as an outreach service heavily funded by the Helmsley Charitable Trust has evolved into a self-sustaining business with new sites coming on board every few months. More than two-thirds of these sites are non-Avera facilities. More than 100 types of Avera specialists in areas such as critical care, infectious disease, pulmonology, cardiology, neurology and others now provide care in ten percent of the nation’s critical access hospitals across ten states in the Midwest and the Northeast through Avera eCare.

■ Avera and the Avera Institute

for Human Genetics established the first and only twin register in South Dakota.

■ Six children’s hospitals sign an agreement to form the Sanford Children’s Genomic Medicine Consortium,

sept/oct

FAMILY BONDS, HEALTHCARE BENEFITS

Conversations About Growing Up in Medicine on the Northern Plains

From family farms to small-town hardware stores and diners, to banks, there is a long tradition across the Northern Plains of passing on passion for a special line of work from one generation to the next. It turns out that the passion for the medical profession is no exception. While national surveys find fewer than half of today’s doctors would recommend the same path to a young person, we found many notable exceptions–and their physician offspring–in our region. ELDON BECKER, MD, GENERAL SURGEON AND HIS SON, GENERAL SURGEON BRANDT BECKER, MD, Avera Medical Group Pierre Dr. Eldon: Brandt has worked at the hospital and the clinic nearly as long as I have. If he wasn’t outside, he was at my office or a partner’s office. He got to see what life was like as a surgeon. Dr. Brandt: I mowed the lawn at the clinic when I was 8 years old. So it made me comfortable with medicine and with the other docs. It’s always been there as part of my life. I think it’s really not that different from passing on the family farm or local hardware store. That whole gerations thing.

DERMATOLOGISTS ROGER KNUTSEN, MD, AND HIS DAUGHTER SIRI KNUTSEN-LARSON, MD West River Dermatology, Rapid City Dr. Roger: She is definitely going to have to deal with managed care more often than I have. But on the other hand she has been trained in different treatment modalities and with different drugs than I have. Dr. Siri: There are a lot more hoops to jump through now. It is no longer that the doctor just does what best. Now we have so many other things we have to take into consideration. RONALD ANDERSON, MD, OBGYN, AND HIS DAUGHTER BREANNE ANDERSON MUELLER, MD, OBGYN Sanford Health, Mitchell and Sanford Aberdeen Medical Center Dr. Anderson: She picked up the joy I had in my job. She also understood the lifestyle. You miss some christmases and birthdays, but it’s also a rewarding practice. I let her decision unfold naturally. Dr. Mueller: When I went college, I found that, of all the things I tried, I liked medicine the most. This was the only specialty that really made me happy. As my dad says, this was the specialty where people are usually happy to be coming to the hospital

News Flash the

YEAR in

REVIEW

■ Avera Health announces plans to build a new Avera Cancer Institute in Pierre.

■ Brookings Health System

opened the newly constructed Medical Plaza building, completing the first leg of the health system’s hospital expansion and renovation project.

■ Siouxland Physician Dr. Gerald McGowan is the recipient of Mercy Medical Center’s Dr. George G. Spellman Annual Service Award.

16 HEALING HEARTS IN THE HILLS

november

Regional Heart Doctors Achieve Important “Firsts” in Cardiac Care

As the Black Hills regions’ largest group of cardiovascular specialists, Regional Heart Doctors, a department of Regional Health’s Rapid City Regional Hospital, continues to push the envelope to advance comprehensive cardiac care for the communities they serve. In recent months, several RHD physicians have performed notable “firsts”, bringing world-class new techniques and technology to heart patients in Western South Dakota. When cardiologist Bhaskar Purushottam, MD, was completing his fellowship training in Endovascular & Structural Interventional Cardiology at Mount Sinai Medical Center in New York in 2015, he never imagined that, less than a year later, he would be the first physician in the Dakotas to implant the world’s smallest heart pump, Abiomed’s Impella RP, into the right ventricle of a Rapid City patient. Even the Mayo Clinic had not yet offered this procedure when Dr. Purushottam performed it at RCRH in May. “We were able to take him off the blood pressure medicine and he is doing phenomenally well,” says Dr. Purushottam. Just three months later, Dr. Purushottam's colleague, cardiologist/ electrophysiologist Kelly Airey, MD, who joined the practice in April of 2014, performed a first of her own. On August 23rd, Dr. Airey became the first in the Dakota’s to implant the world’s smallest minimally invasive pacemaker, the Micra Transcatheter Pacing System from Medtronic.Dr. Airey worked closely with Medtronic to help bring the procedure to RCRH. Cardiothoracic surgeon Zahir Rashid, MD, has been a part of Regional Heart Doctors for just seven months but, by October, he had already introduced several new approaches to the surgical treatment of heart patients at RCRH. Dr. Rashid was the first to perform a minimally invasive procedure to replace a patient’s diseased aortic valve through the right chest at RCRH. Another first for Dr. Rashid at RCRH was minimally invasive coronary artery bypass from the left side of the chest, a procedure that may be recommended when there are blockages in one or two coronary arteries, usually in the front of the heart. “The biggest benefit is for people at highest risk such as those with multiple comorbidities, people who have had a previous sternotomy, or elderly people with a condition like COPD or emphysema,” says Dr. Rashid. “With a minimally invasive approach, we don’t compromise lung function with a big incision.”

■ Prairie Lakes Healthcare System breaks ground on a new specialty clinic set to open in two years.

■ Regional Health announces a

multi-year, phased project to expand and renovate Rapid City Regional Hospital and construct an Advanced Orthopedic and Sports Medicine Institute in Rapid City.

Anesthesiologists Treating Chronic Pain Patients By Jeremy Wale

EARLY every hospital

in the United States provides anesthesia services to patients. Most offer surgical services with general anesthesia, providing for safe operative care of patients. Such services bring risk exposures, many of which you can proactively mitigate. An emerging area of risk for anesthesiologists involves treating chronic pain patients. Some anesthesiologists subspecialize in pain management, in addition or instead of traditional anesthesia services. Some patients prefer facilities that provide chronic pain management. Pain management presents unique risks requiring proactive assessment, direction, and mitigation. Allegations against physicians in this area can include, but are not limited to, failure to treat, accidental overdose, causing addiction, or death. CONSIDERATIONS WHEN MANAGING CHRONIC PAIN PATIENTS Start by assessing whether your facility has anesthesiologists and/or other physicians managing chronicpain patients. If yes, consider several important issues. Do you have a designated area or clinic for treating chronic pain patients?

A centralized location for treating these patients helps your facility: 1 Track patients and providers 2 E stablish facility-wide policies and procedures for handling this unique medical population. Another consideration when providing care for chronic pain patients is the physician’s qualifications for treating these patients. Pain management is a growing healthcare subspecialty, due in part to a reported 100 million Americans suffering from chronic pain. According to the American Board of Medical Specialties, pain medicine is a subspecialty of anesthesiology, emergency medicine, and family medicine. Consider employing boardcertified pain medicine specialists in your clinic to treat chronic pain patients. These specialists’ additional education and training will help ensure your chronic pain patients are being treated by qualified physicians. Your facility can implement policies and procedures to help lessen potential risks of treating patients who require pain management. A strong risk-reduction strategy may require each patient to enter into a pain management contract with the treating physician. This contract clearly and concisely outlines the physician’s expectations of the patient and may include:

● The patient agrees not to accept narcotics prescriptions from other providers.

● The patient will not give or sell narcotics to others.

● The patient agrees to refrain from using drugs not specifically authorized by the physician.

● The patient is responsible for managing his or her medication to ensure he or she doesn’t run out before scheduled visits/ refills.

● The patient agrees to random drug testing. This is not a comprehensive list for a pain management contract. Consult with your physicians and legal counsel to create a document that best fits your institution’s needs. Consider having a policy for ending your pain-management program’s relationship with its patients. While best handled on a case-by-case basis, a policy aids consistency. Situations such as illicit narcotics use, persistent missed appointments, or suspected drug diversion are more common instances that typically require action. Also consider what to do when a chronic pain patient enters your facility’s ED. When these patients become addicted to opioid medications, they often run out of prescriptions early, and then try to secure narcotics by visiting the ED. An integrated EHR may help notify ED physicians these

Midwest Medical Edition

patients are being treated by a pain specialist; it may further aid understanding that the patient may not receive narcotic pain medications without consulting the pain-management physician. Lastly, depending on your state, physicians may be able to monitor chronicpain patients’ prescription history via an electronic prescription monitoring program. Several states implemented such programs to help fight prescription drug abuse and diversion. Depending on the state, physicians may review a patient’s prescription history. Be sure to review your state’s rules to understand what you may access. ■ Jeremy Wale, JD, is a Risk Resource Advisor with ProAssurance.

For additional key considerations to help mitigate risks associated with anesthesia services, see the extended version of this article on our website.

December 2016

Corey Howard, RKC, SFG, CK-FMS, PM 605.310.6591 www.resultsptonline.com•rkc.corey@gmail.com 5020 S. Tennis Lane, Suite 8•Sioux Falls, SD 57108

In Studio Private & Semi-Private Personal Training

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Avera Opens New Sioux Falls Health Center and Freestanding ED

IHS to Fund Extended Telemedicine for Native Americans

AVERA MEDICAL GROUP has opened a new Family Health Center in Sioux Falls that includes South Dakota’s first freestanding Emergency Department and a variety of other medical services. The 84,000-square-foot building on Marion Road includes family medicine, urgent care, optometry, occupational medicine, therapy, case/social workers, obstetrics and gynecology, pediatrics, and an Avera Breast Center with mammography services. Onsite lab and imaging services, including X-ray and CT, are also in the building. The main floor, including the ED, urgent care, radiology/ imaging, lab, occupational medicine, therapy and eye care, opened October 12th. The second floor, housing family practice, pediatrics and behavioral health counseling, will open in December, and third floor, home to ob/gyn and the

AVERA HEALTH could receive up to $100 million dollars over five years from Indian Health Service to offer provider education and extend its Avera eCare telemedicine to serve 130,000 Native Americans in South Dakota, North Dakota, Nebraska and Iowa. Under the proposal, Avera would have an exclusive contract with the Indian Health Service and would receive approximately $6.8 million in the first year with the opportunity to extend the contract for five years. Avera eCARE connects specialists in more populous areas to patients and providers in rural locations. The program includes eEmergency which gives rural centers immediate access to emergency medicine specialists at the touch of a button. eConsult gives patients the opportunity to see specialty

the Avera Breast Center opens in January. The emergency department is staffed 24/7 with residencytrained ER physicians and is connected to Avera eCARE eEmergency for additional support when necessary. The clinics will be staffed by more than a dozen Avera Medical Group physicians and advanced practice providers. “Almost one-third of the city lives west of I-29 and this will provide more services closer to their homes,” said Mark Vortherms, Vice President of Primary Care at Avera McKennan Hospital & University Health Center. About 50 employees will move into the building from the Avera McKennan campus and the Avera Medical Group McGreevy West 41st Street location. No decision has been made yet about which services will move into the 41st street building. ■

physicians in areas such as behavioral health; cardiology; nephrology; pain management; pediatric behavioral health; rheumatology; wound care; ear, nose and throat care; and dermatology. “It is challenging to provide specialty healthcare in rural areas, and this is especially true in Indian Country,” says Mary L. Smith, IHS principal deputy director. “IHS experience shows that telemedicine is an effective way to increase access to quality healthcare services in remote, hard to reach areas,” “Avera eCARE has more than 250 sites across 13 states. We have the experience and background and we’re confident we’ll be able to impact patient care and outcomes,” said Deanna Larson, CEO of Avera eCARE. “Avera looks forward to this opportunity.” ■

For more on Avera’s telemedicine services, see “Virtually Ideal: Avera’s Expanding eCare Empire” on our website.

Midwest Medical Edition

Expanding Surgical carE.

We take it personally. When it comes to surgery, we know you have a choice. That’s why Sioux Falls Specialty Hospital has expanded our personalized care with a second location to serve patients – Prairie States Surgical Center. Located at 2910 E. 26th Street in Sioux Falls, our newest facility offers: • More convenience • Continued innovative and personalized care • An expanded team of expert physicians and surgeons With a continued commitment to providing five-star rated* patient-centered care, we will offer more choices to patients now and in the future.

*HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey

Proud to be Physician Owned and Operated

2 910 E 2 6 t h S t r E E t | S i o u x Fa l l S , S D | ( 6 0 5 ) 97 7 - 0 8 6 7

December 2016

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sfsh.com 23

Local Doctor’s Invention Gives Rise to Sanford Vascular Innovations By Alex Strauss

Dr. Patrick Kelly and his research team

N 2011, Patrick Kelly, MD, was just

another vascular surgeon with a problem–how to repair a thoracoabdominal aneurysm and reduce the 25% mortality risk associated with the open procedure. Because of the marked differences in patient anatomy, there was no one-size-fits-all stent graft available for this kind of repair. By 2012, Dr. Kelly, who started his career as a structural engineer, had invented a solution. That solution has now become the Medtronic Valiant TAAA Stent Graft System which allows for minimally invasive repair of these aneurysms, independent of anatomy. It has been FDA approved for a single-center clinical trial.

“As that project evolved and with the success of that, I realized that I’ve got solutions for other problems,” says Dr. Kelly. “So I started working on some other ideas and we filed patents for those and, before I knew it, we had a small group of solutions.” It was not long before Dr. Kelly realized that he needed help to manage this growing portfolio of vascular solutions and Sanford Vascular Innovations was formed. “We hired a biomechanical engineer to help with prototyping and computer modeling. Then we needed help with the regulatory arm of this, so we hired someone to begin putting that in place,” says Dr. Kelly, who now has a portfolio of a dozen patent

applications and more ideas brewing. “That becomes quite a handful of patents to manage and maintain and before long you realize you had better have a budget.” SVI now includes engineers, chemists and other professionals and draws expertise from area universities. Johns Hopkins and Vanderbilt have already joined Sanford as test locations for the TAAA device trial. In the meantime, Dr. Kelly is developing and testing other new devices such as a Unitary Manifold Stent Graft System, a graft system designed to address pararenal and paravisceral aortic aneurysms, and Type IV thoracoabdominal aneurysms. “If we can keep people ambulatory and independent, we can significantly reduce the cost of medicine,” says Dr. Kelly. Kelly estimates that he still spends as much as 90 percent of his time practicing medicine, a situation made possible by the behind-thescenes work of the SVI team. “SVI is essentially an incubator for early innovation in vascular care that requires a huge amount of effort from lots of different people at centers both locally and nationally to become reality,” says Dr. Kelly. “Pat Kelly couldn’t possibly run this steam engine. I’m just the guy who lit the first match.” ■

The Medtronic Valiant TAAA Stent Graft System developed by Dr. Kelly

Midwest Medical Edition

Sanford Immunotherapy Trial

New immunotherapy study centers on colorectal cancer

SANFORD HEALTH has opened another

Oncologist Jonathan Bleeker, MD, is run-

melanoma, head and neck cancer and

clinical trial exploring the power of the

ning the colon cancer trial, which is called

certain types of lung cancer. Sanford also

body’s immune system to fight cancer. The

KEYNOTE-177. His team will compare the

has clinical trials open studying pembroli-

immunotherapy

effectiveness of treating participants with

zumab for patients with squamous cell

colorectal cancer and involves the inves-

pembrolizumab or one of six standard treat-

carcinoma of the head and neck, esophageal

tigational checkpoint inhibitor pembroli-

ment methods that include chemotherapy.

zumab which Sanford is already studying

Participants must have been recently diag-

as a potential therapy for other cancers.

nosed with stage IV colon cancer, with

trial

focusing

Pembrolizumab inhibits a key protein allowing the immune system to recognize and attack cancer.

particular gene mutations and not have previously received chemotherapy. Pembrolizumab is FDA-approved for

cancer, lung cancer and prostate cancer. ■ See our website for a complete list of ongoing immunotherapy clinical trials at Sanford.

DIAGNOSIS AND MANAGEMENT OF PEDIATRIC THYROID DISEASES PRIMARY CONGENITAL hypothyroidism (CH) in newborns occurs in approximately one in every 3,000 births. If left untreated it will result in mental impairment and growth retardation, which is why all states require that newborns be screened for it. It is also the most common thyroid disease in children up to three years old in the Endocrine Clinic at Children’s Medical Center in Omaha, according to pediatric endocrinologist Kevin P. Corley, MD. “All abnormal screenings merit follow-up,” he says. “If not treated early on in life, you could wind up with a child with severe mental retardation that was very preventable,” Either thyroid stimulating hormone (TSH) or free T4 (thyroxine) tests or both can be used for CH screening but a study in the Journal of Clinical Research in Pediatric

Endocrinology suggests that TSH screening is more specific for CH.. Free T4 screening is more sensitive in detecting newborns with rare hypothalamic pituitary-hypothyroidism. It is less specific, however, with a high frequency of false positives mainly in low birth weight and premature infants. Complicating the process further is the fact that normal ranges for free T4 and TSH are different in infants, children and adults. “We look at factors including age and gestation to see what is normal for that particular newborn. The goal of newborn screening is to identify CH and have the child on therapy by 2 weeks of age,” says Children’s pediatric endocrinologist Marisa Fisher, MD. Acquired hypothyroidism is the most common condition seen in the Endocrinology

Clinic in children over three. This is most often caused by direct attack of the thyroid gland from the immune system, known as autoimmune or Hashimoto’s thyroiditis. Children with congenital syndromes, especially Down syndrome, children with type 1 diabetes, and children who have received radiation treatments for cancer are at greater risk for hypothyroidism. Dr. Corley says management of hypothyroidism requires regular blood tests and treatment using the synthetic thyroid hormone Levothyroxine. “It’s a pill a day,” he says. “If the TSH elevation is major, then it is likely the child will be on medication for life.” Pediatric hyperthyroidism or Graves’ disease, is much less common, and Dr. Corley says it should automatically prompt a referral to an endocrinologist. ■

Welcome to the

Each year, thousands choose to give the gifts of Sight and Health This season, register to be an Organ, Eye, and Tissue donor at www.dakotasight.org/register

December 2016

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Holm Inducted into South Dakota Hall of Fame LONG TIME BROOKINGS internal medi-

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cine specialist Richard Holm, MD, has been inducted into the South Dakota Hall of Fame as part of its Class of 2016. Holm was honored as “South Dakota’s Voice of Healthcare” and was among 10 honorees in the current class. They were recognized during the Hall of Fame’s 39th annual ceremony held in Chamberlain in September. In addition to his work in healthcare, Holm was also recognized for his devotion to public health education. He has served as an on-air host of the local AM “Prairie Doc Radio” for 25 years, South Dakota Public Broadcasting’s “On Call with the Prairie Doc” for 15 years and is the author of the widely-read newspaper column, “Prairie Doc Perspective”, Holm said he was taken aback by the news of his honor, and that he’s grateful to be included in such an august group of South Dakotans. “It means so much to have received this recognition, and it’s quite humbling to have so many individuals around the state feel I am worthy of it,” said Holm. “When we started the radio and then television shows, we hoped it’d provide honest science-based health information to the people of our rural state. I had not conceived that it would last as long, provide the help that it has or lead me to a situation like this. I truly appreciate what it means, and I thank all those who helped me make it possible.” Holm earned his MD at Emory University in Atlanta, and has practiced in South Dakota since 1981. He is a past president of the South Dakota State Medical Association and former governor of the South Dakota Chapter of the American College of Physicians. Dr. Holm works at Avera Medical Group Brookings. ■

Midwest Medical Edition

Thoracic Surgeon Brings New Procedures to Black Hills By Alex Strauss

Y THE TIME A

patient with esophageal cancer is symptomatic, the malignancy is typically in an advanced stage. Which is why three esophageal cancer success stories at Regional Health’s Rapid City Regional Hospital in recent months are particularly notable. “Two patients received radiation and chemotherapy prior to surgery along with percutaneous endoscopic gastrostomy (PEG) for nutritional support and the third was not a candidate for neoadjuvant chemoradiation because of his comorbidities so we took him directly to surgery,” explains Dr. Zahir Rashid, the Black Hills region’s first fellowship-trained thoracic surgeon. A graduate of the Thoracic & Cardiovascular Surgery Fellowship program at the Medical College of Wisconsin, Dr. Rashid joined Regional Health in May 2016. In all three recent cases of esophageal cancer, Dr. Rashid performed the region’s first transhiatal esophagectomies. With the aid of video scope (to free the esophagus from the neck), the new approach allows the surgeon to remove portions of the

December 2016

diseased esophagus through the left side of the neck after mobilizing the stomach through an abdominal incision. “With this procedure, we pull up the freed stomach to the left side of the neck. We leave about a quarter of the length of the esophagus

“

With this procedure, we pull up the freed stomach to the left side of the neck.

”

behind and we then connect it to the stomach,” says Dr. Rashid. Although the risk of anastomotic leakage is slightly higher with this approach of doing the anastomosis in the neck, Dr. Rashid says this approach dramatically lowers the risk of complications and even death compared to doing a right thoracotomy and doing the anastomosis in the right chest. “If there is leakage in the right chest, the risk of death

is much higher,” says Dr. Rashid. ”If it leaks in the left side of the neck, the mortality rate is very low — not even 5 percent. You can easily drain it and people don’t tend to develop sepsis and other problems.” “The most compelling argument against an intrathoracic anastomosis is that while the rate of anastomotic leak is lower in the transthoracic approach (3-12 percent versus 10-25 percent in cervical anastomoses), the leakassociated mortality rate from intrathoracic leaks has historically been much higher (up to 50-70 percent versus less than 5 percent in cervical anastomoses),” explains Dr. Rashid. “Of course, with improved techniques and knowledge, results are getting better with both approaches.” Dr. Rashid’s expertise in the surgical treatment of lung diseases, including VATS segmentectomy, lobectomy, biopsy, wedge resection, decortication and other procedures — has also brought an influx of these patients to Regional Health. “We have done more than 60 lung cases since I have been here. Last year, this facility did only a few cases,” says Dr. Rashid. ■

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Interior and exterior views of Regional Health's new Sturgis clinic

Regional Health breaks ground on new projects in Sturgis and Custer ANOTHER CHAPTER in the history of

Sturgis Regional Hospital began in late October with an official groundbreaking for a new $10.2 million clinic to be constructed on the hospital’s campus. The project will add over 20,000 squarefeet to the existing hospital and replace some 8,000 square-feet of existing specialty clinic space. It will also provide a new front entrance to the hospital and the Emergency Department and increase parking spaces. Construction is expected to begin this spring and be completed in early 2018. Regional Health continues to see growth in patient demand in Sturgis, and cared for more than 27,300 patients last year at Sturgis Regional Hospital and Massa Berry

Regional Health Clinic. Local officials and city leaders, including Sturgis Mayor Mark Carstensen and Sturgis City Manager Daniel Ainslie, were among those who attended the groundbreaking with Regional Health executives, physicians, and caregivers all of whom celebrated at a social event following the ceremony. Just one day later, Regional Health’s $18 million hospital replacement building project officially kicked off at the site of the future Custer Regional Hospital and Clinic, just east of the current hospital. The 42,000 square-foot, one-story hospital and clinic will be built through a privatepublic funding partnership. The hospital and clinic design plan

includes larger public spaces and added privacy in patient rooms. The design will allow the hospital and clinic to more easily accommodate the increased number of patient visits usually experienced during peak tourism times. The project is the result of collaboration between Regional Health, the City of Custer, and Custer Community Health Services, Inc. Regional Health will own the new hospital and clinic, and is committing $14.425 million to the $18.425 million project. The City of Custer will contribute up to $4 million through the continuation of capital funds. The general contractor for the project is Scull Construction of Rapid City. The original hospital and clinic, first opened in 1962, will continue to operate throughout the construction process. Upon completion of the new hospital, Regional Health will deed the site back to the City of Custer. ■

The entryway of the New Custer Regional Hospital and Clinic

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Sarah Frost, Whitney Kreutzfeldt, Lisa Marek, Chelsea Dagen, Kayla Wiese and MRHS CEO, Tammy Miller, celebrated the first anniversary of the new facility with #1 cookies.

Madison Regional Health marks first year in new facility MADISON REGIONAL HEALTH System

Health. “The MRHS staff has been resilient through it all and maintained the quality service that we have always provided. We are grateful to the community for their support of MRHS and this new building.” Madison Regional Health has served the community for over 130 years and was housed in many different locations during that time. In 1884, Dr. Alonzo Clough established the first hospital in Madison, on the corner of First Street and West Avenue. Since then, the hospital has moved

Christie Finnegan Executive Director of Estate Planning

to South Josephine, North Washington and now to its current location on Southwest Tenth Street. Over 200 medical providers, employees and volunteers work at the facility which includes two new family medicine physicians that joined MRHS early this fall. The size of the staff at Madison Regional Health has double since 2013, due to the merger of the hospital and clinic, along with a growing need for medical services in the community. ■

Jeana Goosmann CEO & Managing Partner Licensed in SD, IA, & NE

Breandan Donahue Attorney Licensed in SD, NE, & IA

recently celebrated their first full year in the new facility. MRHS began services in their new building on October 13, 2015 after completion of the 110,000 square foot facility on the south end of Madison. “The past year has been an adventure: new facility, new logo and branding, new processes, and higher volumes,” said Tamara Miller, CEO of Madison Regional

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Too Busy for the Gym? Try Calisthenics By Corey Howard

HIS IS A CRAZY time of year for doctors and surgeons. I train a lot of these professionals and the end of the year is typically when they disappear from my facility and simply can’t make their appointments. I get it. Everyone’s deductible has been met and now they want the procedure done they’ve been putting off for the past few months. I see it every year. Then in January my doctors and surgeons come staggering back in, worn out, out of shape, and ready to spend the next 4 weeks getting back to where they were in October. What if I could give you some quick, time-effective workouts that help you fend off fatigue, sluggishness and those extra end-of-the-year pounds? Maybe something that can be done almost anywhere and will keep your fitness from regressing? The simple solution is calisthenics. Bodyweight strength training gives you the freedom you need to get workouts in anywhere. It is also variable enough to provide easy high rep movements for conditioning and very difficult low rep strength movements for raw total body strength. Let’s look at a couple different examples… I like to take 3 or 4 different submaximal movements, put them together and do as many as possible for a certain time limit. You’ll need to pair a push, pull, squat and ab

movement, choose the desired number of reps, and fly from one movement to the next without a break for your chosen time limit. Remember, for something like this you’ll need to choose submaximal movements. In other words, if you can perform a one arm push-up, you may choose 10 reps of a feet elevated push-up. An example of this format might be 10 push-ups, 10 horizontal pullups, 10 bodyweight squats, and 10 lying leg raises for 20 minutes. You could see how many complete rounds you can do, or how many reps of each exercise you can do in the allotted time. Record your numbers and try and beat it next week! Calisthenics also provide a phenomenal way to maintain or even improve your strength when you can’t make it to the gym. If you don’t have a 15 or 30 minute block of time available, you can simply “practice” some of your more challenging movements throughout the day. For example: If you finally knocked out your first one arm pushup, try sporadically dropping down and ripping out 1 rep. With this technique, you do not want to go to failure; that is too taxing on the nervous system. Instead, you simply want to practice your new strength skill and accumulate reps as the day passes. Instead of a couple reps in the gym, now you’ll hit 20-30 reps a day. Trust me, you’ll be shocked at how well this works!

I know the end of the year is the busiest time for people in the medical field and taking the time to get to the gym can become impossible. Unfortunately, spending January trying to get back into shape can also be really aggravating. While you’re busy at the hospital and running on fumes, try to squeeze the timed workout in once or twice a week, and the strength reps in a couple of times a week. I guarantee that, by January, you’ll be shocked at the progress you’ve made. ■ Corey Howard is the owner of Results Personal Training in Sioux Falls.

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