Recent additions to CHI St. Alexius in Minot
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DR. KOYEJO OYERINDE is a pediatrician at Medical Plaza in Minot. He is a graduate of Obafemi Awolowo University in Nigeria. He completed his residency at BronxLebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University in Bronx, New York. As a pediatrician, Dr. Oyerinde has particular Oyerinde interest in the wholesome growth and development of children. He enjoys seeing a diverse population of children. He is board certified in pediatric medicine by the American Board of Pediatrics. He is a Fellow of the American Academy of Pediatrics and a member of it sections on the International Child Health and on Tobacco Control.
November 2016
emy of Nurse Practitioners and a member of the Association of Women’s Health, Obstetric and Neonatal Nurses.
DR. PROMILA TIMOTHY, a specialist in family medicine at Medical Plaza Minot, earned her medical degree from American University of the Caribbean School of Medicine in Sint Maarten. She completed her residency in family medicine at Providence Hospital and Medical Center in Southfield, Mich. She completed a fellowship in Addiction at Brighton Hospital in Brighton, Mich. As a family physician, Timothy provides patient centered care and focuses on healthy living and prevention of illnesses. She has particular interest in chronic illnesses including hypertension, diabetes and cardiovascular disorders. Timothy is a board certified diplomate LINDSEY SIEMENS, a physician assis- in family medicine by the American tant in family medicine at Medical Plaza Board of Family Medicine and in addicMinot, earned her bachelor of science in tion medicine by the American Board of nursing at Medcenter One Addiction Medicine. She is a member of College of Nursing in Bisthe Association of American Medical marck and a master of Colleges, American Society of Addiction physician assistant studies Medicine, American Academy of Family at the University of North Physicians and Substance Abuse and Dakota in Grand Forks. Mental Health Services Administration. As a physician assistant, she works with a vaSHARON WRIGHT, a nurse at Medriety of patients and has Siemens ical Plaza Minot, earned a bachelor of sciparticular interest in ence in nursing at the University of women’s health. Siemens is certified by the National Com- Wisconsin Oshkosh in mission on Certification of Physician Assis- Oshkosh, Wis. and a tants and a member of the American master of science at Marian University in Fond Academy of Physician Assistants. du Lac, Wis. KAYLA THOMAS, a family nurse practiAs an adult nurse tioner at Medical Plaza Minot, earned a practitioner, Wright bachelor of science in nursing at Minot State works with adult and eldUniversity and a master of erly patients evaluating, Wright science in nursing, family diagnosing and managnurse practitioner at the ing common, acute and chronic health University of North problems. She has a particular interest in Dakota in Grand Forks. stroke and heart disease prevention and As a family nurse praclipid management. titioner, Thomas works She is certified by the American with patients of all ages, Nurses Credentialing Center and is a from newborn to elderly. member of the American Nurses AssociThomas She has particular interest ation. in women’s and children’s health. She is certified by the American Acad-
Recent additions toSanford Health Northwest Clinic
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November 2016
VISHAL CHHIBBER, M.D., Family Medicine, recently joined Sanford Health Northwest Clinic in Minot. He received his medical degree from Saint James School of Medicine in Bonaire, Netherland Antilles, and completed his residency training at University of North Dakota in Minot. Dr. Chhibber is board certified in Family Medicine by the American Board of Family Medicine. MEGAN WARD, DNP, family medicine provider, recently joined Sanford Health Northwest Clinic in Minot. Ward graduated from Minot State University and received her master’s degree from University of Arizona in Tucson, Ariz. She also earned a doctorate of nursing practice from University of Arizona. JANIS NEUMANN, family nurse practitioner, recently joined Sanford Health Walkin Clinic in Minot. Neumann graduated from Minot State
Chhibber
Ward
Neumann
University and received her master’s degree from University of North Dakota in Grand Forks. The Sanford Health Walk-in Clinic is located within Sanford Health Highway 2 Clinic at 801 21st Ave. SE. SUZI NIGRO, family medicine nurse practitioner, recently began seeing family medicine patients at Sanford Health Highway 2 Clinic in Minot. She graduated from St. Francis College in Loretto, Pa., and also received her master’s Nigro degree from the college. KRISTY LEIER, family medicine nurse practitioner, recently began seeing family medicine patients at Sanford Health Highway 2 Clinic in Minot. She graduated with her master’s degree in nursing form the University of Mary in Bismarck. Leier Sanford Health has added three visiting specialists from Bismarck to its Minot clinics this year. ERIC BELANGER, MD, neurosurgery, offers specialty services at Sanford Health Northwest Clinic once a month. He graduated from and completed his residency in neurosurgery at
Page 3 Laval University in Quebec, Quebec. He is board certified by the American Board of Neurological Surgery. IAN FYFE, MD, orthopedics, offers specialty services at Sanford Health Northwest Clinic once a month. He graduated from the University of British Columbia in Vancouver and completed residencies in orthopedic surgery from Memorial University in St. Johns, Canada, and Dalhousie University in Halifax, Canada. He is board certified by the Royal College of Physicians and Surgeons of Canada. BURKLEY JENSEN, DPM, podiatry, also offers specialty services at Sanford Health Northwest Clinic at 1500 21st Ave. NW twice a month. He graduated from Midwestern University in Glendale, Ariz., and completed his residency in podiatric medicine and surgery at United Health Services Hospitals in Johnson City, N.Y.
Belanger
Fyfe
Jensen
Sanford Health studying impact of precision medicine cancer treatments
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Sequencing tools analyze unique genetic information
November 2016
Submitted Photo
Dr. Sam Milanovich, an oncologist at Sanford Health in Sioux Falls, S.D., right, speaks with a medical worker in a laboratory. Sanford patients with rare or difficult to treat cancer may have tumor samples collected in their local laboratories to be sent to analysis centers to determine genetic makeup. By JILL SCHRAMM Staff Writer jschramm@minotdailynews.com
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The genetic makeup of cancer cells often can be a factor in determining a patient’s best treatment options. Patients at Sanford Health with advanced or rare forms of cancer are being invited to enroll in a new study to further explore potential benefits of genomic profiling. “The idea we are trying to look at here comes from current, scientific technology in the field of genomics. We have had a lot of advances in the last decade or so in our knowledge of genetics,” said Dr. Sam Milanovich, an oncologist and cancer researcher at Sanford. He is leading the COMPASS trial with Dr. Steven Powell at Sanford. The COMPASS study will employ the latest genetic sequencing to personalize cancer treatments. The purpose of the study is to determine how many patients get a targeted treatment or end up in clinical trials, Milanovich said. The study group will be followed over several years to examine how technology is applied and how it is improving treatment options. COMPASS, which stands for Community Oncology use of Molecular Profiling to personalize the Approach to Specialized cancer treatment at Sanford, follows on the heels of
the GEMMA pilot study. GEMMA enrolled 120 Sanford cancer patients who had genetic testing done. The study demonstrated molecular profiling increases awareness of clinical trial and off label treatment options for patients with incurable cancer. “Most cancer is the result of genetic mutations or genetic problems that arise in a cell or tissue,” Milanovich said. In the GEMMA study, most patients had a particular DNA mutation or characteristic associated with their cancers that, at least in theory, could be targeted with specific medications, he said. Forty percent of GEMMA participants were able to get that type of treatment and 17 percent were admitted into clinical trials. Not all patients might be suited for a targeted treatment based on a variety of factors, including whether physicians find conventional treatment a better option. At Sanford, patients with rare cancers or whose cancers have persisted despite standard treatment are offered genetic testing. “We encourage all patients, if they are getting this testing done, to be enrolled in this trial,” Milanovich said. In participating, patients might have an additional laboratory test done but would not need to change their Sanford doctor and would continue to receive the same level of care. Data from the genomic profiling is viewed by the Sanford Genomic Tumor Board to See CANCER — Page 6
IMPROVING SYSTEMS
November 2016
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Developments to improve outcomes for stroke, cardiac patients
By ELOISE OGDEN Regional Editor eogden@minotdailynews.com Stroke and cardiac systems of care across the state are having successes and changing people’s lives. Since the creation of the North Dakota cardiac and stroke systems of care task forces, nurses, doctors, hospitals, EMTs, governments and other agencies in the state have been working to improve stroke and cardiac care outcomes. Dr. Jeffrey Sather was a presenter at The North Dakota Stroke and Cardiac Conference held in Fargo in early October. Sather is Trinity Health’s chief of medicine and medical director for the Emergency Trauma Center in Minot. He’s also medical director for the North Dakota Department of Health’s Division of Emergency Medical Systems. The conference brought together people across the state who are working to improve the systems of care, education and training, Sather said. He said the conference was started several years ago as part of a grant from the Harry B. and Leona M. Helmsley Trust. The conference has continued now under the N.D. Department of Health and is part of the Stroke and Cardiac Systems. Sather, in an Oct. 24 interview, said the two-day conference is designed for basically all levels of care – including ambulance personnel, hospital nursing staff and other hospital paraprofessionals to the physicians. It is designed around education specifically toward stroke and cardiac. The cardiac and stroke systems started around 2010 and 2011 when the grant was received and has been developing since. “We’ve seen a lot of work going into system development, not just focusing on what happens in the hospital, for example, focusing on what happens from point of contact from a patient all the way through their hospital stay. It involves public education, it involves ambulance pre-hospital personnel, emergency medical dispatch, the rural critical access hospitals and all the way to the larger tertiary hospitals,” said Sather.
Eloise Ogden/MDN
Dr. Jeffrey Sather, Trinity Health’s chief of medicine and medical director for the Emergency Trauma Center in Minot, also is medical director for the North Dakota Department of Health’s Division of Emergency Medical Systems. He said both stroke and cardiac are time-sensitive diagnosis. This, he said, means it makes a big difference from the onset of symptoms to how quickly a person gets the proper treatment.
He said North Dakota has six larger hospitals in the state – Trinity in Minot, two Bismarck hospitals, two in Fargo and one in Grand Forks –designated as primary stroke centers with more advanced capa-
bilities in dealing with strokes. He said those six hospitals also are primary cardiac centers with cardiologists and cath labs. This, he said, leaves a big gap in the rural areas in the state. “You take away the six and the majority of our hospitals are critical access level hospitals,” Sather said. “We have through system development worked with all of those hospitals in getting protocols around dealing with heart patients – how to properly treat people having an acute MI or heat attack,” Sather said. He said the state-recommended protocols have been developed using national guidelines. “We have a task force and have had consensus amongst the cardiologists to develop a set of state recommended treatment protocols,” he added. “The patients should feel better that there’s really a set system coming into play within the state that your treatment should be. Obviously, it’s going to be a little bit different based on where you’re at, but you’re coming into a statewide system that’s going to give you the best available care for the area that you’re in,” Sather said. Part of what has been developed in this system is the recommended treatment for people having what is called an ST Elevation MI – the kind of heart attack where there’s sudden complete blockage of an artery, Sather said. “The recommended treatment if it’s available is to go right to a cath lab to get your artery open as soon as possible,” Sather said. “The current guidelines say if that can be done within 120 minutes, it’s the best treatment.” “What we’ve been able to do through system development is actually look at what areas of the state where that’s possible,” he said. For example, someone in Rugby right now who calls 911, the ambulance’s protocol (is) the ambulance can do the EKG, he said. “Actually we’re one of the only states in the country where every ambulance has the ability to do that and that was through the Helmsley Trust that was made possible.” “If they identify that type of heart attack See SATHER — Page 7
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Cancer Continued from Page 4
help guide the decision process for the treating cancer team, patient and family. The committee is a panel of cancer and genetic experts from across Sanford. In some cases, targeted treatment leads to a greater success rate in eliminating cancer or sending it into remission. Along with better outcomes, though, targeted treatment can result in a better quality of life, Milanovich said. Identifying medicines that can target certain mutations can lead to treatment that avoids toxicity to normal tissue and carries fewer side
effects. Physicians already are using DNA information to guide the choice of treatment for some mutation types. However, there are more mutations that need to be studied. Genetic testing and targeted therapies are newer in the field of pediatric cancer treatment, Milanovich said. “There’s not as much out there, so it’s too early to say how many patients are going to find targets using this kind of approach in pediatrics. That’s part of why we want to include children with cancer in this trial. We can learn how to apply this kind of technology to kids with cancer. Pediatric cancers are
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often different than adult cancers,” he said. “I think this will be significant at helping us learn about some of our difficult to treat pediatric cancer patients,” he added. “We have come a long way over the years by enrolling a lot of children and their families in
clinical trials. We have many patients now who have a very high likelihood of getting a long-term remission of their cancer with conventional treatment, but we still have many that don’t. This trial will really help us learn more about what is the genetic makeup of some of
November 2016 these tumors and see how using this technology can help improve their outcomes.” Adding to the medical mystery is the ability of cancer cells to evolve and find ways around targeted treatments. “That’s the challenge in
applying this targeted therapy to get better long-term responses,” said Milanovich, who noted the most effective treatments will continue to be a combination of therapies. For more information or to enroll in the COMPASS trial, call 877-652-1838.
November 2016
Sather Continued from Page 5
in Rugby, they don’t take you to the Rugby hospital. They’ll come right here to Minot because it’s been proven through literature and research that the best treatment is to go right to the cath lab,” Sather said. “Further, if you come right here to Minot with enough notification, you don’t even stop in our emergency room. You go right from the ambulance to the cardiac cath lab and see the cardiologist and get your artery opened up because that’s the best treatment for the best outcomes.” Sather said they are looking closely at the data. “We’ve looked at not only local data but statewide data and multistate data where these type of systems are being put into place,” he said. “In using North
Dakota, South Dakota and Minnesota, we’re seeing a speed from identification of a problem to having that artery open. We’ve decreased that time by about 15 minutes in total time for patients that enter the system that way through ambulances. So by using that ambulance education we’ve been able to speed that time the patients get into the cath lab and get the artery open.” “Further, we’re seeing a decrease in the amount of time it takes for a patient to be transferred from a rural hospital into one of the cardiac centers for that same type of heart attack. Patients that present to outside hospitals are getting sent in quicker and treated quicker as well, and we’re starting to see that actually will improve outcome for patients meaning their survivability, their chances of death are less and their chances of
PULSE being discharged without any significant problems with their heart is becoming less. “We’re actually starting to see a movement in the outcomes of patients as well– (of) that speeding them through to the proper treatment,” he said. “Stroke is also time sensitive,” said Sather. He said a couple of treatments are available for stroke, with TPA, a clotbusting drug, the main one that most everybody knows about nowadays. He said TPA has some specific guidelines to use it, including it needs to be within three hours of the onset of their symptoms. “There’s a big education piece that we’ve been trying to push across the state teaching people if you’re having a stroke, you need to seek treatment right away because if you come in a day
later, the ability for us to do a lot in the way of treatment is not there. It’s really, really a time-sensitive treatment,” Sather said. He said some people realize right away they are having symptoms but many times people do not realize they are having a stroke. “That’s real time sensitive in that if it’s over a certain amount of time, you can’t give the drug for it,” he said. “Hospitals really have to have three things in place to do that. They have to have a CAT scan available that they can quickly get a CAT scan done and have it read because that’s one of the tests that has to be done before this can be given. They also have to have the drug (TPA) available and have the ability to give it, and they have to have protocols in place for giving it,” he said. Some other treatments can be done that can extend
Page 7 that time slightly. “But most of those timeframes are really within a small window so this is really a time-sensitive condition,” he said. As a state, Sather said a task force has worked on a statewide recommended protocol. Through the N.D. Department of Health, they have started designating hospitals as being stroke-capable facilities. “We’re just in that process of that first round of designation. This is going to be a big change for a few areas because there are some hospitals that won’t be able to be designated. There’s a handful of hospitals in the state that don’t have CAT scanners so because of that they can’t be designated as stroke centers,” he said. He said they anticipate a minimum of about six hospitals won’t be stroke centers.
“What that means is the ambulance in that area within a relatively short time, probably by sometime next year, will be required to bypass those hospitals for stroke patients because it really just puts a delay in the care of those patients. They’ll have to take them to a stroke-ready hospital which could be one of the other smaller hospitals or to one of the primary stroke center hospitals which is one of the six larger hospitals in the four cities. Trinity Hospital in Minot is a primary stroke center. “The designation of primary stroke center which Trinity has as well as the other five larger hospitals in the state is a Joint Commission on accreditation of hospitals designation,” he said. He said it is very exciting for all this to be happening “because we’re seeing outcomes improve for patients.”
Genetic testing now available at St. Alexius
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November 2016 Jason Nichols, Web Developer and Web Content Strategist for Trinity Health, holds up his cell phone displaying the Trinity Mobile App that launched last year.
By ANDREA JOHNSON clude having a history of initely trigger us to look Staff Writer ajohnson @minotdailynews.com Patients at St. Alexius Medical Plaza who are at high risk to develop cancer now have the option of seeking genetic testing, said physician assistant Lindsey Siemens. Siemens said new patients are asked to fill out a risk assessment form along with their health history. Certain red flags in-
certain rare cancers, three or more first degree relatives on the same side of the family who have been diagnosed with cancer or having cancers Siemens diagnosed at an early age. Male breast cancer or ovarian cancer in the family, for instance, will “def-
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into genetic testing.” Siemens said insurance companies will generally cover genetic testing if it is indicated because of a family or personal history of cancers. Under special circumstances, a clinic may advocate for testing for a particular person. For instance, an adoptee who doesn’t have a medical history of his or her biological family members may have a compelling reason for needing genetic testing, even if they don’t meet the company’s criteria. The company used by St. Alexius Medical Plaza is Myriad and the genetic test given is called MyRisk. “It can be a life-saving tool for high risk families,” said Siemens. Once a patient has the comprehensive report based on their genetic makeup and knows whether they carry certain high risk gene mutations, they can make decisions about their future health care. Some people may need to undergo more frequent screenings for cancer. Siemens said the technology has evolved and will continue to evolve, so more information will be available for people who undergo testing. The company will also update results as more testing becomes available.
Easier access
Submitted Photo
Mobile app, online patient portal provide information to Trinity patients
By ELOISE OGDEN
Regional Editor eogden@minotdailynews.com Trinity Health patients have more access to their health information and medical providers through digital technology – a mobile app and the online patient portal. Mary Muhlbradt, a spokeswoman for Trinity Health in Minot, said the patient portal was activated in mid-2014 and the app about a year later. The Trinity Mobile App is adapted for iPhone and Android devices. It gives mobiledevice users a tool to connect with Trinity services and providers with just a tap of the finger, according to Trinity information. Trinity officials said the mobile platform makes it easy for people to access their healthcare information and other resources wherever they are. The app was produced by the Trinity IT Department in partnership with Network Center, Inc. With the app people can: – Search for a provider or office location. – Gain access to contact numbers for specialists and pharmacies. – Access the MyTrinity Health eConnect
Patient Portal, where patients can review information contained in their medical record, request prescription refills, communicate with members of their care team in secure messaging, etc. – View Trinity’s online nursery Baby Bytes. For information on how to download, visit: trinityhealth.org/mobile. The online patient portal gives patients secure internet access to their health information. People can access the portal through Trinity’s main website trinityhealth.org, according to Trinity information. Launch of the portal begins with a registration process inviting patients to register for an account in person and establish a secure username and password. The “in person” registration process is necessary so the ID can be verified. Once registered, people can view their health information including lab results, medications, immunizations and allergies. Patients also can communicate with their caregivers as well as request appointments and prescription renewals. Trinity Health adopted its electronic record in 2006.
For information on how to download, visit trinityhealth.org/mobile
November 2016
Trinity prepares to break ground on new hospital
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By JILL SCHRAMM Staff Writer jschramm@minotdailynews.com Trinity Health continues to move closer to an official ground-breaking on a new medical park in southwest Minot. Architects recently were conducting follow-up visits with Trinity officials and staff to work out the final details before construction begins next spring. Site work is expected to get underway before winter. The $275 million construction project covers more than a million square feet, with 850,000 square feet enclosed. It calls for a connected six-story hospital and clinic building, along with a three-story facility for behavioral health services. Plans call for 208 beds throughout the center, including 157 nursing beds, a 20-bed
intensive care unit and an emergency/trauma center with 27 treatment bays. The entire site covers 76 acres and will include more than 1,900 parking spaces. The project includes underground parking and a helipad. TEG Architects of Jeffersonville, Ind., and general contractor Mortenson Construction, Minneapolis, are handling the construction. Mortenson is a leading builder of healthcare, sports and cultural facilities in the United States, with projects that include the new Minnesota Vikings stadium in the Twin Cities, the Alerus Center in Grand Forks and the newly constructed Sanford Medical Center in Fargo. The medical park construction is expected to take just over 2.5 years, finishing late in 2019. Trinity will be seeking bonding to pay for the project.
Submitted Photos
TOP: A schematic from TEG Architects shows the proposed Trinity Health medical park to come under construction in the spring. The clinic is at right, hospital in center and mental health facility at left. MIDDLE: An architect’s rendering shows what the new Trinity Hospital atrium will look like. BOTTOM: A TEG Architects schematic shows the proposed new Trinity hospital, with the mental health facility in the background.
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Vitamin D deficiency is widely overestimated, doctors warn PULSE
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Doctors are warning about vitamin D again, and it's not the "we need more" news you might expect. Instead, they say there's too much needless testing and too many people taking too many pills for a problem that few people truly have. The nutrient is crucial for strong bones and may play a role in other health conditions, though that is far less certain. Misunderstandings about the recommended amount of vitamin D have led to misinterpretation of blood tests and many people thinking they need more than they really do, some experts who helped set the levels write in Thursday's New England Journal of Medicine . Correctly interpreted, less than 6 percent of Americans ages 1 to 70 are deficient and only 13 percent are in danger of not getting enough. That's concerning, "but these levels of deficiency do not constitute a pandemic," the authors write.
Yet people may think there is one. Blood tests for vitamin D levels — not advised unless a problem like bone loss is suspected — are soaring. Under Medicare, there was an 83-fold increase from 2000 to 2010, to 8.7 million tests last year, at $40 apiece. It's Medicare's fifth most common test, just after cholesterol levels and ahead of blood sugar, urinary tract infections and prostate cancer screening. "I'm not sure when it got popular to check everybody for vitamin D deficiency," but patients often ask for it, especially baby AP Photo boomers, said Dr. Kenny Lin, a Georgetown University family Doctors are warning about vitamin D again, and it physician and preventive medicine expert. Vitamin D pill use also grew, from 5 percent of Americans isn't the "we need more" news you might expect. in 1999 to 19 percent in 2012. Instead, they say there's an epidemic of needless See VITAMIN — Page 11
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testing and too many people taking too many pills for a deficiency that very few people truly have.
Page 11 PULSE Prepare now for winter safety Recent additions
November 2016
to Trinity Health
Trinity Health in Minot has a number of new providers. They are as follows:
Hospital Medicine Mohamad K. Baaj, MD
Adult-Gerontology Primary Care Alison Lynch, AGNP-C
Inpatient Behavioral Health Jessica Delorme, FNP-C Becky Schneider, FNP-C
Cardiology Amanda Weidler, FNP-C
Urology Diane C. Bigham, DO
Cardiothoracic Surgery C. Etta Tabe, MD
Neonatology Breanna Wheeler, NNP-BC
Emergency Medicine Virginia R. Keaveny, MD Karina Walker, MD Thomas L. Walsh, MD
Neurosurgery Charles O. Wood, MD
Family Medicine Rachel Gruenberg, FNP-C Purwa Joshi, MD Kimberly Krohn, MD Keri Weick, PA-C General Surgery AyJy P. Bhardwaj, DO
Vitamin Continued from Page 10
That may be due to many reports suggesting harm from too little of "the sunshine vitamin," called that because our skin makes vitamin D from sun exposure. It's tough to get enough in winter or from dietary sources like milk and oily fish, though many foods and drinks are fortified with vitamin D and labels soon will have to carry that information. Too much vitamin D can lead to high levels of calcium in the blood, which can cause nausea, constipation, kidney stones, an abnormal heart rhythm and other problems. "We're not saying that moderate-dose supplements are risky, but more is not necessarily better," said Dr. JoAnn Manson of Brigham and Women's Hospital in Boston. She and several other advisers
Obstetrics/Gynecology Jessie Fauntleroy, MD Physical Medicine and Rehabilitation Shelley A. Killen, MD
By ANDREA JOHNSON
Staff Writer ajohnson@minotdailynews.com
With winter coming, it’s important to be prepared for any possible problems, said Dr. Koye Oyerinde, a pediatrician at Minot Medical Plza. Oyerinde said children tend to suffer from the cold even more than adults. He said they should be dressed in proper winter attire, including boots, mittens, zipped up coats and hats. People lose most of their body heat through the head. Oyerinde said that advice holds true for adults as well. He said the clinic sometimes ends up treating people who were caught outside during poor weather conditions and suffer from exposure because they were not prepared. “If you go on a trip, make sure the car is winterized,” said Oyerinde. “Make sure the battery is checked out.” Oyerinde said every car should include a winter survival kit with things like a flashlight with fully charged batteries, a survival blanket, snacks to munch on and a fully charged cell phone.”
Psychiatry Kenneth Osiezagha, MD
“Make sure your gas (tank) is almost full at the time,” he said. If they get stuck, Oyerinde said people should stay with their vehicle and wait for help. They should not set out on foot looking for assistance. Oyerinde also advises that people be cautious when they are warming up a car during the winter. They need to make sure that the car’s exhaust pipe is not covered in snow and should never start a car in a closed garage. Doing either can result in carbon monoxide poisoning. Oyerinde said people should make sure they are in condition to do physical activities outside, such as shoveling snow. People should warm up first and be well dressed. People who are in poor physical condition should ask friends or family to help rather than try to do it themselves. If a child or adult is caught outside and gets too cold, Oyerinde said people should remove wet clothing and wrap the affected person in a blanket. Skin to skin contact can sometimes help warm them up while waiting for help to arrive. People should warm up slowly so they don’t injure the skin. In an emergency situation, a family should always seek medical attention, he said.
Radiation Oncology Ebony Peterson, FNP-C to the Institute of Medicine, which set the RDA, or recommended dietary allowance, wrote the journal article. People vary, biologically, in how much of any vitamin they need. The institute estimated this by comparing various intake and blood levels with measures of bone health. They estimated that, on average, people need about 400 international units of vitamin D per day, and 600 for people over 70. To be safe and ensure that everyone gets enough, they set the RDA at the high end of the spectrum of the population's needs — 600 to 800 units, depending on age. So by definition, nearly everyone's true requirement is below that. Many people and their doctors regard the RDA and its corresponding blood levels as a threshold that everyone needs to be above, the authors write. As a result, people often
are told they are inadequate or deficient in D when, in fact, they're not. "If you're chasing a lab number, that will lead to many people getting higher amounts of vitamin D than they need," and labs vary a lot in the quality of testing, Manson said. The bottom line: Get 600 to 800 units a day from food or supplements and skip the blood test unless you have special risk factors, Manson said. A big study she is helping lead is testing whether higher levels lower the risk of cancer, heart disease, stroke, memory loss, depression, diabetes, bone loss or other problems. Nearly 26,000 people have been taking 2,000 units of D-3 (the most active form of vitamin D, also known as cholecalciferol) or dummy pills every day for five years. Results are expected in early 2018.
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Your Heart is in Good Hands When it comes to your heart’s health, having a team of medical experts working together for your care can make all the difference. That’s why Trinity Health is adding more awesome talent to the region’s heart surgery team. C. Etta Tabe, MD joins Martin Rothberg, MD, to offer even more innovative solutions and heart surgery expertise for cardiac patients across the whole region.
C. Etta Tabe, MD Cardiothoracic Surgery
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