Minnesota Health care News January 2012 by Minnesota Physician Publishing

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January 2012 â&#x20AC;˘ Volume 10 Number 1

Health care cost anxiety Lee Beecher, MD

Seizures

Robert Gumnit, MD

Medication safety tips Julie Johnson, PharmD

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CONTENTS

4 7 8

JANUARY 2012 • Volume 10 Number 1

NEWS

PEOPLE

COMMUNICABLE DISEASE Meningitis By Marjorie Hogan, MD

PERSPECTIVE Robert Albee A Partnership Of Diabetics

NUTRITION Tips for healthy restaurant dining

PATIENT TO PATIENT The Chemo Zone

26 28

NEUROLOGY Seizures and epilepsy

10 QUESTIONS George Peltier, MD

By Julie K. Johnson, PharmD

DENTAL HEALTH Orthodontics for second-graders?

HEALTH INSURANCE Relieving health care cost anxiety By Lee H. Beecher, MD

Specialty pharmacy

Hennepin County Medical Center

PRESCRIPTION DRUGS Medication safety tips

SESSION

By Robert J. Gumnit, MD

By Jennifer Eisenhuth, DDS, MS

T H I R T Y- S E V E N T H

By Tracy Rubietta, MBA

By Heidi Greenwaldt, MS, RD, LD, CNSD

MINNESOTA HEALTH CARE ROUNDTABLE

CALENDAR Radon

www.mppub.com PUBLISHER Mike Starnes mstarnes@mppub.com EDITOR Donna Ahrens dahrens@mppub.com ASSOCIATE EDITOR Janet Cass jcass@mppub.com

Controlling the cost of care Thursday, April 19, 2012 1:00 – 4:00 PM • Duluth Room Downtown Mpls. Hilton and Towers

Background and focus: Medications treating chronic and/or life-threatening diseases are frequently new products, which are often more expensive than generic or older, branded products that treat similar conditions. The term specialty pharmacy has come to be associated with these medications. Exponents claim the new technology improves quality of life and lowers the cost of care by reducing hospitalizations. Opponents claim the higher per-dose cost spread over larger populations does not justify the expense.

The cost of research, both failed and successful, is reflected in product pricing. Current federal guidelines allow generic equivalents marketplace access based on the patent date, not the release date, of a product. This considerably narrows the window in which costs of advances may be recovered. A further complicating dynamic involves the payers. Physician reimbursement policies sometimes reward utilizing lower-cost “proven” products and cast those prescribing highercost products as “over-utilizers,” placing them in lower-tiered categories of reimbursement and patient access. Objectives: We will discuss the issues that guide the early adoption of new pharmaceutical therapies and how they relate to medical devices. We will examine the role of pharmacy benefit management in dealing with the costs of specialty pharmacy. We will explore whether it is penny-wise but pound-foolish to restrict access to new therapies and what level of communication within the industry is necessary to address these problems. With the baby boomers reaching retirement age, more people than ever will be taking prescription medications. As new products come down the development pipeline, costs and benefits will continue to escalate. We will provide specific examples of how specialty pharmacy is at the forefront of the battle to control the cost of care.

ASSISTANT EDITOR Scott Wooldridge swooldridge@mppub.com ART DIRECTOR Elaine Sarkela esarkela@mppub.com OFFICE ADMINISTRATOR Juline Birgersson jbirgersson@mppub.com ACCOUNT EXECUTIVE John Berg jberg@mppub.com

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Advisory Board: Minnesota Medical Association (MMA), Minnesota Hospital Association (MHA), Minnesota Medical Group Management Association (MMGMA), Buyers Health Care Action Group (BHCAG), Minnesota Business Partnership (MBP), Minnesota Healthcare Network (MHN), Advocates for Marketplace Options for Mainstreet (AMOM), Minnesota HomeCare Association (MHCA), Minnesota Physician-Patient Alliance (MPPA), Physicians Service Network (PSN), Minnesota Center for Rural Health, and Minnesota Council of Health Plans. Minnesota Health Care News is published once a month by Minnesota Physician Publishing, Inc. Our address is 2812 East 26th Street, Minneapolis, MN 55406; phone (612) 728-8600; fax (612) 728-8601; email mpp@mppub.com. We welcome the submission of manuscripts and letters for possible publication. All views and opinions expressed by authors of published articles are solely those of the authors and do not necessarily represent or express the views of Minnesota Physician Publishing, Inc., or this publication. The contents herein are believed accurate but are not intended to replace medical, legal, tax, business, or other professional advice and counsel. No part of this publication may be reprinted or reproduced without written permission of the publisher. Annual subscriptions (12 copies) are $36.00. Individual copies are $4.00.

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JANUARY 2012 MINNESOTA HEALTH CARE NEWS

NEWS

Task Force Unveils New Website

sion. The address for the new site is http://mn.gov/health-reform/.

The Health Care Reform Task Force recently appointed by Gov. Mark Dayton will promote its work on a new website, officials announced last week. The site will serve as a clearinghouse for information on health care reform efforts in Minnesota, and will detail how reform efforts will affect families, businesses, and individuals. It will update Minnesotans not only on state reforms but also on the federal Affordable Care Act as it continues to be implemented. The site is sponsored by the task force and the Minnesota Department of Commerce. The site features information on Health Care Reform Task Force meetings, answers questions about health insurance coverage in Minnesota, features a column by Department of Human Services Commissioner Lucinda Jesson, and explores a range of reform issues such as health insurance exchanges and Medicaid expan-

Allied Effort by Allina, HealthPartners Saves $6 Million

A collaborative effort between Allina Hospitals and Clinics and HealthPartners resulted in more than $6 million in reduced medical costs in its first year, according to the two organizations. The Northwest Metro Alliance attempted to make health care delivery more efficient by enhancing connections between health care providers, integrating the electronic medical records used by both organizations, and providing better data to providers about performance in comparison to their peers. Some specific strategies used by the two groups included increasing the use of generic drugs; reducing the rate of induced labor; expanding urgent care services to reduce emergency department use; providing

MINNESOTA HEALTH CARE NEWS JANUARY 2012

expanded support for high-risk and complex patients; and improving patient satisfaction. The alliance involved 27,000 patients who received care at Allina’s Mercy Hospital and eight Allina and HealthPartners clinics in the northwest metro area. Officials say that as a result of the collaboration, the medical cost growth rate for the facilities dropped from 8 percent to 3 percent. “These results show the value of collaboration between health care organizations to create innovative models that can serve as an accountable care organization, which are models of federal and state health care reform,” says Penny Wheeler, chief clinical officer for Allina Hospitals and Clinics.

Nursing Homes Join Forces to Reduce Rehospitalizations Nearly 50 Minnesota nursing homes are joining an effort to reduce rehospitalizations among

their residents. The facilities are working with the Minnesota Department of Human Services to implement a program called Interventions to Reduce Acute Care Transfers (INTERACT). The program, which has been adopted by 49 of the 384 nursing homes in Minnesota, is based a national model developed by geriatric care experts in Georgia and Florida. The INTERACT program provides a set of tools and practices that help nursing home staff make better observations about residents and changes in their health status. The program also helps nursing home staff communicate more clearly and accurately with physicians if necessary, and provides for better communication with hospital personnel if a hospital admission becomes necessary. “The overall goal is to reduce the inappropriate use of hospitals and also to create a work environment for staff in which they feel more empowered and more committed to doing a good job,” says Robert Kane, MD, who leads the

University of Minnesota’s Center on Aging and is the director of the Minnesota Area Geriatric Education Center (MAGEC).

Mayo Clinic Says Smoking Ban Cuts Heart Attacks, Deaths A new report by Mayo Clinic researchers shows that the incidence of heart attacks and sudden cardiac deaths was cut by as much as 50 percent in Olmsted County after a smoke-free ordinance took effect. The new report, presented at an American Heart Association conference in Orlando, shows that during the 18 months before Olmsted County's first smoke-free law for restaurants was passed in 2002, the regional incidence of heart attack was 212 cases per 100,000 residents. In the 18 months following a comprehensive smoke-free ordinance in 2007, the report says that rate dropped to 103 cases per 100,000 residents—a decrease of about 45 percent. Additionally, the report found a 50 percent decrease in sudden cardiac arrest cases during that period. “This study adds to the observation that smoke-free workplace laws help reduce the chances of having a heart attack, but for the first time we report these laws also reduce the chances of sudden cardiac death,” says Richard Hurt, MD, director of Mayo Clinic’s Nicotine Dependence Center. “The study shows that everyone, especially people with known coronary artery disease, should avoid contact with secondhand smoke.”

Supreme Court Rules on Newborn Screening A Minnesota Supreme Court ruling could limit the way state health officials use blood samples drawn from newborns. In a divided ruling, the court said that although the state can use blood samples to screen new-

borns for disease without specific consent from parents, the state cannot store the samples for other research purposes. Privacy advocates and a group of parents had challenged the state policy, and a lower court ruled that the Minnesota Department of Health (MDH) could store the blood samples indefinitely for further research. However, the Supreme Court overturned that finding. “The newborn screening statutes … expressly authorize the [MDH] Commissioner to use the blood samples without written informed consent only to the extent necessary to conduct tests for heritable and congenital disorders and conduct follow-up services,” the ruling says. Although some predict that MDH will be required to destroy close to 1 million samples as a result of the ruling, state officials reacted cautiously. “We are reviewing the court’s decision to determine the potential implications of the ruling on the ongoing operations of the state’s Newborn Screening Program,” says Commissioner Ed Ehlinger, MD. “This important public health program protects Minnesota babies from serious congenital and heritable disorders.” The case will now be sent back to the lower court to consider remedies for the plaintiffs.

Uninsured Rate Goes Up for Kids In Minnesota A new report finds that Minnesota is the only state in the nation to see an increase in the number of uninsured children in a twoyear period. The study, published jointly by the Georgetown University Health Policy Institute’s Center for Children and Families and the Children’s Defense Fund (CDF), looks at Census Bureau data from 2008 to 2010. It finds that even though the country has gone through a difficult economic period, most states have managed to

NOW hear this! D

o you know of family members, friends or neighbors who have difficulty using their telephone? Do they have trouble hearing, speaking or have a physical disability that prevents them from using a standard telephone? The Minnesota Telephone Equipment Distribution Program can provide special telephone equipment at NO CHARGE to Minnesota residents of all ages!! The equipment includes amplified (corded and cordless) phones, speakerphones, captioned telephones, telephone ring signalers, deafblind equipment and other special equipment. To learn more about this program visit our Web site at: www.tedprogram.org or contact us at (800) 657-3663, (888) 206-6555 TTY. Eligibility requirements do apply.

The Telephone Equipment Distribution Program is administered by the Department of Commerce Telecommunication Access Minnesota (TAM) and funded by a telephone surcharge.

Public Health Certificate in Clinical Research The University of Minnesota School of Public Health offers a program for people who work with research clinical applications on human beings but who do not have an advanced degree in clinical research. Coursework is conveniently offered online and the program can be completed in six terms.

www.sph.umn.edu/programs/certificate/cr

News to page 6 JANUARY 2012 MINNESOTA HEALTH CARE NEWS

News from page 5 reduce the number of children who lack health insurance. “During the recession, the number of children in poverty increased significantly, yet the number of uninsured children decreased nationally from 6.9 million in 2008 to 5.9 million in 2010,” the report’s authors write. The study credits government programs for improving the rate of coverage among children. “The progress for children can be attributed to the success of Medicaid and CHIP, which have continued to fill the void created by a decline in employer-based health insurance, a high unemployment rate, and the increasing cost of private health insurance,” the report says. Overall, the number of uninsured children in the U.S. decreased by 14 percent, from 6.9 million in 2008 to 5.9 million in 2010. Minnesota’s experience, however, has been different. The report finds that nearly 11,700 fewer children had health insur-

ance in 2010 than in 2008, which equals a change in the uninsurance rate for children from 5.8 percent to 6.6 percent. “It’s surprising to see a state like Minnesota losing ground in its efforts to protect children’s health care,” says Joan Alker, coexecutive director of the Georgetown University research institute. “Minnesotans are not used to seeing their state on the bottom of the list. But I’m sure they will be able to overcome this setback and get back up to the top, as state leaders have demonstrated a strong commitment to children’s health care coverage in the past.” Experts in Minnesota blame poor economic conditions for the rise in uninsured children. “Health insurance premiums have increased much faster than wages and now, on average, cost about 17 percent of median household income in our state,” says Amy Crawford, director of CDF–Minnesota. “Those costs are putting health insurance out of reach for more and more Minnesotans. We need to strengthen

our public health coverage programs like Medical Assistance and MinnesotaCare to make sure children are not falling through the cracks.”

HCMC Burn Center Opens in Minneapolis Hennepin County Medical Center (HCMC) has officially opened its new Burn Center, a 16,000-squarefoot facility that doubles the size of its former burn center. Officials say the facility is designed to serve patients from the entire Upper Midwest at a time when hard economic times for hospitals means that some have closed specialty units such as burn centers. The $12 million expansion and remodeling of the Burn Center and adjacent 12-room, 7,000-square-foot Surgery Trauma and Neurology team center are projects funded by bonds from Hennepin County. The center will treat patients with severe burn injuries and complex wounds such as frost-

bite, hypothermia, inhalation injuries, plastic reconstruction, complex wounds, and road rash. The center will also include a state-of-the-art hyperbaric chamber (the only one in Minnesota), which will be used to treat emergency cases of carbon monoxide poisoning and burn wounds. A multidisciplinary team approach will be used for all burn center patients, officials say. Inpatient care will include access to general and plastic surgeons; nurses in the burn intensive care unit; adult and pediatric specialists; rehabilitation services; and dietary and nutritional support to promote healing and recovery. “We have a burn-trained physician or physician’s assistant present every day, including most holidays,” says HCMC burn surgeon Anne Lambert, MD. “This intensive, coordinated, and consistent care is why HCMC’s Burn Center is so successful at its ultimate goal: restoring the lives of our patients.”

Now accepting new patients

A unique perspective on cardiac care Preventive Cardiology Consultants is founded on the fundamental belief that much of heart disease can be avoided in the vast majority of patients, and significantly delayed in the rest, by prudent modification of risk factors and attainable lifestyle measures.

Elizabeth Klodas, M.D., F.A.S.C.C is a preventive cardiologist. She is the founding Editor in Chief of CardioSmart for the American College of Cardiology www.cardiosmart.org, a published author and medical editor for webMD. She is a member of several national committees on improving cardiac health and a frequent lecturer on the topic.

We are dedicated to creating a true partnership between doctor and patient working together to maximize heart health. We spend time getting to know each patient individually, learning about their lives and lifestyles before customizing treatment programs to maximize their health. Whether you have experienced any type of cardiac event, are at risk for one, or

are interested in learning how to prevent one, we can design a set of just-for-you solutions. Among the services we provide • One-on-one consultations with cardiologists • In-depth evaluation of nutrition and lifestyle factors • Advanced and routine blood analysis • Cardiac imaging including (as required) stress testing, stress echocardiography, stress nuclear imaging, coronary calcium screening, CT coronary angiography • Vascular screening • Dietary counseling/Exercise prescriptions

To schedule an appointment or to learn more about becoming a patient, please contact: Preventive Cardiology Consultants 6545 France Avenue, Suite 125, Edina, MN 55435 phone. 952.929.5600 fax. 952.929.5610 www.pccmn.com

MINNESOTA HEALTH CARE NEWS JANUARY 2012

PEOPLE David Perdue, MD, has been named medical director of the American Indian Cancer Foundation, a nonprofit organization established to

Health care …naturally

address the cancer inequities faced by

The clinics of Northwestern Health Sciences University offer natural health care solutions at three Twin Cities locations. We also partner to provide free services at community clinics.

American Indian and Alaska Native communities through education and improved access to prevention and treatment. Perdue, a member of the Chickasaw tribe, practices with Minnesota David Perdue, MD

Gastroenterology, PA, where he has focused on

decreasing colorectal and other gastrointestinal cancer disparities in American Indian and Alaska Native populations. In addition, he co-

• Acupuncture and Oriental medicine

chairs the Minnesota Intertribal Colorectal Cancer Council and the Minnesota Colon Cancer Task Force. He is also a member of both the

• Chiropractic

University of Minnesota Masonic Cancer Center and the Mayo

• Healing touch

Clinic’s Spirit of Eagles Cancer Research Network.

• Massage therapy

Christopher Wenner, MD, has been recognized by the Regional Extension Center for Health Information Technology (REACH) for his

• Naturopathic medicine

leadership in the nationwide transition to electronic health records

• Nursing practitioner services

(EHR). Wenner, a solo family physician in Cold Spring, is one of the first providers in Minnesota to attest to meaningful use for the Medicare EHR Incentive Program. Wenner will receive one of the first incentive payments in Minnesota made to professionals and hospitals when they adopt, implement, upgrade, or demonstrate meaningful use of a certified electronic health record.

Many services are covered by health insurance. Visit our website or call to find out more about locations, hours and services:

nwhealth.edu/patients • 952-885-5444

The Alzheimer’s Association Minnesota–North Dakota Chapter announced recent hires for the Northern Minnesota office in Duluth. Lisa Sanders was hired as program manager. Sanders previously was with Arrowhead Area Agency on Aging Senior LinkAge Line and holds a master’s degree in community health education. Wendy Ruhnke was hired as community engagement manager. She previously served as development director of the YWCA for five years. Mark Blegen, PhD, an associate professor of exercise and sport science at St. Catherine University, St. Paul, has been elected president of the Northland American College of Sports Medicine

A diagnosis of

(NACSM). NACSM is one of 10 regional affiliates of the American College of Sports Medicine (ACSM), a professional group for health and fitness-related professionals. Blegen, who is a fellow of the ACSM, teaches classes in exercise physiology, nutrition, biomechanics, fitness assessment, and strength and conditioning, and is a codirector of the university’s Women’s Health Integrative Research Lab. William Payne, MD, has been named medical director of LifeSource, a Minneapolis-based organ and tissue donation organization. Payne was instrumental in the formation of

Cancer is overwhelming news.

the organization in 1987 and has served on the

If you or a loved one is facing cancer, we are here to help.

LifeSource board of directors since the group began. Payne has stepped down from his role as surgical director of the adult liver transplant program at the University of Minnesota Medical Center, Fairview, but will continue to see patients at the U of M. The Minnesota Alliance for Patient Safety

It raises many questions few of us are prepared to answer, such as: • How can I take time off from work? • Can I get help paying bills? • What is the difference between a health care directive and a power of attorney? • Can I keep my health insurance even if I lose my job? • And many others.

William Payne, MD

We are a nonprofit organization funded entirely through grants and donations. Your tax-deductible donations are welcome.

We provide free cancer related legal information on a wide range of topics.

Please visit our web site to find out more: www.cancerlegalline.org

(MAPS) has hired Nancy Kielhofner, RN, as executive director. Kielhofner most recently was director of quality, safety, and accreditation at Allina Hospitals and Clinics. She served as MAPS culture workgroup co-chair during the past year. Kielhofner’s hiring is part of a MAPS reorganization that will expand its scope of patient-safety efforts to include not only hospitals but also nursing homes, long-

educate.inform.empower

term care, assisted living, ambulatory clinics, and hospice care. JANUARY 2012 MINNESOTA HEALTH CARE NEWS

PERSPECTIVE

Controlling our diabetes for life Support from those who know what it’s like

P Robert Albee A Partnership Of Diabetics

Robert Albee co-founded the American Indian Community Development Corporation in 1992 and worked there until his retirement in 2007. He has also worked in television and radio production at Twin Cities Public Television and KFAI-FM. Albee created Wisconsin’s Lac Courte Oreilles (LCO) tribal station WOJB-FM and edited the LCO Journal. As a grant writer, he has assisted start-up organizations by writing approximately $40 million in grants, and has been a Peace Corpsman in Afghanistan.

eople who have just gotten a diagnosis of diabetes for themselves or a loved one can feel overwhelmed by the flood of new information they need to process and the new tasks they must suddenly add to their daily routine. For those of us living with diabetes 24/7, it helps to know we are part of a community of other diabetics who understand what we are going through and who can provide advice and emotional support. This sense of community helps day-to-day, makes long-term management more successful, and is an important part of a carefully constructed network of family, social, and community-based resources that effectively complement assistance from one’s chosen health care providers.

ter, but at the end of the day, each of the participants who stays with the program experiences progress with his or her diabetes management. A-POD is not just for those who need help and support. It also allows those who have successfully managed their condition to mentor and share their hard-earned skills with the community. Tim, an insulin-dependent type 1 diabetic, is approaching 43 years of success in his management and spends countless hours mentoring others online via diabetes-specific websites. He benefits from this just as much as those he mentors.

No English needed A-POD was created in Minneapolis’ Phillips neighborhood, which has a broad range of age and ethCommunity-based support nicities. There, A-POD recently initiated a Somali In 2010, my wife, Sharon, and I created A Partner- Women's Diabetes Workshop for participants who ship Of Diabetics (A-POD) to provide sustainable, spoke little or no English. We recruited four Somali community-based support, strategies, planning, Americans, including two health care professionand tools to assist us in effective diabetes self- als, to translate and help with presentations and management. There is no magic involved: A-POD listening sessions. Each part of the program has presents a series of full-day a facilitator who provides workshops (“POD-Tensives”) demonstrations. This PODfor up to 25 people to When we share, support, Tensive workshop will be folacquaint them with A-POD lowed by another specificaland challenge each other and our 12 strategies for ly for Somali men, and optimized management. A we discover how similar, another for people of any person need attend only culture who speak and read and yet how unique, once. POD-Tensives are folEnglish. lowed by weekly Meetups to each of us is. Based on evidence reinforce the 12 strategies. Clinics and other medical Most importantly, Meetups facilities have been slow to refer patients to Aprovide an opportunity for one diabetic to talk POD despite the fact that it is based on evidencewith another at check-ins, where each of us shares based programs. These programs work for diahow we are personally progressing or struggling betes as successfully as for weight loss, chemical with our efforts to manage our condition. dependency, and chronic disease self-manageCompared with an average of one hour of annual ment. Allina Health Systems provided initial financontact with primary health care professionals, cial support through its Minneapolis-based A-POD participants who consistently attend Backyard Initiative and was recently joined in A-POD Meetups can clock 84 or more hours per funding by Novo Nordisk, a global manufacturer year in which to meet with other people with dia- of insulin and other diabetes-related products and betes and the health care professionals who join services. Novo provides scholarships for those us. One of the topics is a discussion of healthy eat- with incomes too low to participate in this inexing and physical activity, and our new location at pensive program of long-term support. the Phillips Community Center has a fitness center Experienced health care professionals are present and a kitchen/dining room. So we can demon- at each session. We are truly “Controlling Our strate healthier practices instead of just talking Diabetes for Life!” about them. Soon there will be a swimming pool To participate in an upcoming A-POD Meetup or in the building as well. POD-Tensive, contact Robert Albee at Everyone benefits ralbee4045@aol.com.These events are held at the When we share, support, and challenge each Phillips Community Center, 2323 11th Ave. So., other, we discover how similar, and yet how Minneapolis. Our schedule is published at unique, each of us is as a diabetic. Those who www.meetup.com. Just type in “Diabetes” and choose to be silent and listen are honored just as your Zip Code, and it will take you to A-POD. much as those who talk.There are tears and laugh-

MINNESOTA HEALTH CARE NEWS JANUARY 2012

FOR TYPE 2 DIABETES

Victoza® helped me take my blood sugar down…

and changed how I manage my type 2 diabetes. Victoza® helps lower blood sugar when it is high by targeting important cells in your pancreas—called beta cells. While not a weight-loss product, Victoza® may help you lose some weight. And Victoza® is used once a day anytime, with or without food, along with eating right and staying active.

Model is used for illustrative purposes only.

Indications and Usage: Victoza® is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes when used along with diet and exercise. Victoza® is not recommended as the first medication to treat diabetes. Victoza® is not insulin and has not been studied in combination with insulin. Victoza® is not for people with type 1 diabetes or people with diabetic ketoacidosis. It is not known if Victoza® is safe and effective in children. Victoza® is not recommended for use in children. Important Safety Information: In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice. It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early. Do not use Victoza® if you or any of your family members have a history of MTC or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). While taking Victoza®, tell your doctor if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. Inflammation of the pancreas (pancreatitis) may be severe and lead to death. Before taking Victoza®, tell your doctor if you have had pancreatitis, gallstones, a history of alcoholism,

If you’re ready for a change, talk to your doctor about Victoza® today.

or high blood triglyceride levels since these medical conditions make you more likely to get pancreatitis. Stop taking Victoza® and call your doctor right away if you have pain in your stomach area that is severe and will not go away, occurs with or without vomiting, or is felt going from your stomach area through to your back. These may be symptoms of pancreatitis. Before using Victoza ®, tell your doctor about all the medicines you take, especially sulfonylurea medicines or insulin, as taking them with Victoza® may affect how each medicine works. Also tell your doctor if you are allergic to any of the ingredients in Victoza®; have severe stomach problems such as slowed emptying of your stomach (gastroparesis) or problems with digesting food; have or have had kidney or liver problems; have any other medical conditions; are pregnant or plan to become pregnant. Tell your doctor if you are breastfeeding or plan to breastfeed. It is unknown if Victoza® will harm your unborn baby or if Victoza® passes into your breast milk. Your risk for getting hypoglycemia, or low blood sugar, is higher if you take Victoza® with another medicine that can cause low blood sugar, such as a sulfonylurea. The dose of your sulfonylurea medicine may need to be lowered while taking Victoza®.

Victoza® may cause nausea, vomiting, or diarrhea leading to dehydration, which may cause kidney failure. This can happen in people who have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration. The most common side effects with Victoza® include headache, nausea, and diarrhea. Nausea is most common when first starting Victoza®, but decreases over time in most people. Immune system-related reactions, including hives, were more common in people treated with Victoza® compared to people treated with other diabetes drugs in medical studies. Please see Brief Summary of Important Patient Information on next page. If you need assistance with prescription drug costs, help may be available. Visit pparx.org or call 1-888-4PPA-NOW. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call 1-800-FDA-1088. Victoza® is a registered trademark of Novo Nordisk A/S. © 2011 Novo Nordisk 0611-00003312-1 August 2011

To learn more, visit victoza.com or call 1-877-4-VICTOZA (1-877-484-2869).

Non-insulin • Once-daily

• Serious low blood sugar (hypoglycemia) may occur when Victoza® is used with other diabetes medications called sulfonylureas. This risk can be reduced by lowering the dose of the sulfonylurea.

Important Patient Information This is a BRIEF SUMMARY of important information about Victoza®. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about Victoza®, ask your doctor. Only your doctor can determine if Victoza® is right for you. WARNING During the drug testing process, the medicine in Victoza® caused rats and mice to develop tumors of the thyroid gland. Some of these tumors were cancers. It is not known if Victoza® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people. If MTC occurs, it may lead to death if not detected and treated early. Do not take Victoza® if you or any of your family members have MTC, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). This is a disease where people have tumors in more than one gland in the body. What is Victoza® used for? • Victoza® is a glucagon-like-peptide-1 (GLP-1) receptor agonist used to improve blood sugar (glucose) control in adults with type 2 diabetes mellitus, when used with a diet and exercise program. • Victoza® should not be used as the first choice of medicine for treating diabetes. • Victoza® has not been studied in enough people with a history of pancreatitis (inflammation of the pancreas). Therefore, it should be used with care in these patients. • Victoza is not for use in people with type 1 diabetes mellitus or people with diabetic ketoacidosis. ®

• It is not known if Victoza® is safe and effective when used with insulin. Who should not use Victoza®? • Victoza should not be used in people with a personal or family history of MTC or in patients with MEN 2. ®

• Victoza® may cause nausea, vomiting, or diarrhea leading to the loss of fluids (dehydration). Dehydration may cause kidney failure. This can happen in people who may have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration. • Like all other diabetes medications, Victoza® has not been shown to decrease the risk of large blood vessel disease (i.e. heart attacks and strokes). What are the side effects of Victoza®? • Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath while taking Victoza®. These may be symptoms of thyroid cancer. • The most common side effects, reported in at least 5% of people treated with Victoza® and occurring more commonly than people treated with a placebo (a non-active injection used to study drugs in clinical trials) are headache, nausea, and diarrhea. • Immune system related reactions, including hives, were more common in people treated with Victoza® (0.8%) compared to people treated with other diabetes drugs (0.4%) in clinical trials. • This listing of side effects is not complete. Your health care professional can discuss with you a more complete list of side effects that may occur when using Victoza®. What should I know about taking Victoza® with other medications? • Victoza® slows emptying of your stomach. This may impact how your body absorbs other drugs that are taken by mouth at the same time. Can Victoza® be used in children? • Victoza® has not been studied in people below 18 years of age. Can Victoza® be used in people with kidney or liver problems? • Victoza® should be used with caution in these types of people. Still have questions?

What is the most important information I should know about Victoza®? • In animal studies, Victoza® caused thyroid tumors. The effects in humans are unknown. People who use Victoza® should be counseled on the risk of MTC and symptoms of thyroid cancer. • In clinical trials, there were more cases of pancreatitis in people treated with Victoza® compared to people treated with other diabetes drugs. If pancreatitis is suspected, Victoza® and other potentially suspect drugs should be discontinued. Victoza® should not be restarted if pancreatitis is confirmed. Victoza® should be used with caution in people with a history of pancreatitis.

This is only a summary of important information. Ask your doctor for more complete product information, or • call 1-877-4VICTOZA (1-877-484-2869) • visit victoza.com Victoza® is a registered trademark of Novo Nordisk A/S. Date of Issue: May 2011 Version 3 ©2011 Novo Nordisk 140517-R3 June 2011

NUTRITION Understanding menu terms

TIPS for healthy

restaurant dining By Heidi Greenwaldt, MS, RD, LD, CNSD

Restaurants may have menu symbols that identify healthy items, but foods that restaurants call “healthy” may range from 500 to 750 calories. While the lower end of that range should fit most people’s needs for weight loss, 750 calories is high for a healthy meal. And while a 250-calorie difference may not seem big, 100 extra calories a day can produce a 10-pound weight gain in a year. If your weight loss plan is to consume 1500 calories daily and you eat one, 750-calorie “healthy” choice, you’ve just consumed half your daily calories at one meal. If you do not choose one of the restaurant’s healthy options, you could easily consume your entire daily allotment of calories at one meal. It is better to consume calories more evenly throughout the day.

Restaurants may not list sodium content on their menus, although 2010 Dietary Guidelines from the U.S. Department of Agriculture and U.S. Department of Health and Human Services recommend reducing sodium intake to fewer than 2300 milligrams of sodium per day. The typical daily American diet contains approximately 6000 to 8000 milligrams of sodium. These guidelines also recommend reducing intake to 1500 milligrams of sodium per day for persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1500-milligram per day recommendation applies to about half the U.S. population, including children and the majority of adults. Requesting that your meals be prepared without salt or monosodium glutamate (MSG), which is used at many Asian establishments, can significantly reduce the amount of sodium you consume. Plan before you go What else can you do to monitor calories, sodium, and other nutrients when dining out if limited nutrition information is available? First, read the menu online when you are not hungry—before going to the restaurant—to review healthy options. Tips to page 34

Living with gout? Keep enjoying life’s simple pleasures.

Gout is the most common form of inflammatory arthritis in men and affects millions of Americans. In people with gout, uric acid levels build up in the blood and can lead to an attack, which some have described as feeling like a severe burn. Once you have had one attack, you may be at risk for another. Learn more about managing this chronic illness at www.goutliving.org

JANUARY 2012 MINNESOTA HEALTH CARE NEWS

PRESCRIPTION DRUGS

Medication safety tips A trip to the pharmacy can be one of the most important health care visits you make. You may not be feeling well and may be in a hurry. But please allow enough time at the pharmacy to ensure that you Ask questions to receive the correct medication understand your and get all the information you prescription need. Take the time to speak with your pharmacist if you are By Julie K. Johnson, not completely clear on instrucPharmD tions, or forgot to mention another medicine you are taking or other medical conditions to the prescribing physician. The pharmacist will ask you for identifying information (home address, etc.) to make sure that it matches the information in your pharmacy record. This is to ensure that the pharmacy dispenses the right medication to the right person. Just as at the doctorâ&#x20AC;&#x2122;s office, your information is private and is not shared with anyone other than your doctor (whom the pharmacist would contact if he or she had questions or concerns) and your health insurance company (for payment information).

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Make sure to provide all of the current information about the patient, other medications, changes in health or doses since the last pharmacy visit, and of course, current insurance information. Many prescriptions are sent to the pharmacy electronically, which is usually more efficient and less prone to error. However, just because they are sent electronically does not mean that prescriptions are filled faster. Allow ample time for the pharmacy to check to make sure your prescription is compatible with other medications you may be taking and to fill it according to standard safety procedures. Advocate for yourselfâ&#x20AC;&#x201D;ask questions Ask the pharmacist for further instructions or an explanation if the label is unclear. Ask the pharmacist for any additional information for the medicine youâ&#x20AC;&#x2122;re taking. Mention any pertinent information, such as other medications youâ&#x20AC;&#x2122;re taking, any changes in health or dosage, etc. â&#x20AC;˘ Ask questions regarding a new medication; discuss the risks and benefits with your doctor or pharmacist. â&#x20AC;˘ Ask your physician or pharmacist about possible side effects. Is the medicine sedating? Should you take it with food? Not take with milk or calcium? â&#x20AC;˘ Tell your doctor or pharmacist about all of your allergies, especially medication-related allergies. â&#x20AC;˘ Tell your doctor or pharmacist about all nonprescription drugs, vitamins, herbal remedies, and other dietary supplements you take, because some may interfere with the effectiveness of your prescription drug. â&#x20AC;˘ Ask how long it might take to reach therapeutic level (i.e., when it might â&#x20AC;&#x153;kick inâ&#x20AC;?), and what you can expect by the time you stop taking the medicine. â&#x20AC;˘ Examine the label and contents when you pick up a new prescription. Ask the pharmacist about anything on the label you do not understand.

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MINNESOTA HEALTH CARE NEWS JANUARY 2012

â&#x20AC;˘ Examine the label and contents when you pick up a refill prescription, too. If the medication looks different than it has before, tell your pharmacist immediately. â&#x20AC;˘ Make sure that you know the name of the prescribing physician and the name of his or her clinic. If you cannot read the physicianâ&#x20AC;&#x2122;s name on the prescription, itâ&#x20AC;&#x2122;s likely that the pharmacist will not be able to read it, either. Therefore, ask your physician to print his or her name on the prescription. â&#x20AC;˘ If you have a common name, verify the full name on the prescription, not just first and last name.

Tell your doctor or pharmacist if you experience side effects from a new prescription. • Take the medication as directed by the doctor. If you are having difficulty with your medication schedule (i.e., taking the medicine at the time prescribed), talk to your doctor or pharmacist before adjusting

Poison Center emergency number is 1-800-222-1222. (TTY number is the same.) • Store your medication as instructed in a secure but accessible place—i.e., out of the reach of children—away from heat, moisture, and freezing temperatures. The bathroom cabinet is not the best place for medications; a better place might be the upper shelf in a linen closet or a kitchen cupboard. • Discard outdated medications.

the schedule yourself.

Bottom line

• If you miss a dose of your medication, or mistakenly take more medication than recommended, call your doctor or pharmacist.

Billions of prescription medications are dispensed every year in this country to treat disease, alleviate pain and discomfort, and control lifelong medical conditions. The safety of our drug distribution system is second to none, worldwide. The medication expert at your disposal is your pharmacist. Take advantage of the chance to speak with one to ensure that you get the most benefit from your medications. Medications are powerful tools that can be toxic if not taken, as directed, by the person for whom they were prescribed—or simply a waste of money if not taken correctly.

• Don’t increase or decrease the dose, or stop taking the medication altogether, without first calling your doctor. • Don’t crush or split tablets unless you have been instructed to do so by your doctor or pharmacist. Some dosage forms are not meant to be broken or crushed. If broken, crushed, or split unevenly, the drug may not be released properly or a coating on the tablet meant to ensure proper release or avoidance of irritation can be destroyed. In the occasional instance where your doctor or pharmacist okays splitting or crushing, care must be taken to do so accurately. However, asking the pharmacist or doctor if splitting or crushing is acceptable is the only way to do this appropriately.

Take the time to speak with your pharmacist.

• Tell your doctor or pharmacist if you experience side effects from a new prescription. Pay attention to how you feel; if you feel different after beginning a new medication, call your doctor or pharmacist immediately.

• If you believe that you or someone in your care is having a drug interaction, call your doctor or pharmacist immediately. Children are not small adults: Recent studies show that the potential for adverse drug events was three times higher for children. Your pediatrician or family physician may prescribe medication, but you—parent, guardian or day care provider—are the person(s) responsible for administering the medication to children in your care.

Julie K. Johnson, PharmD, is executive vice president and CEO of the Minnesota Pharmacists Association (MPhA) in St. Paul.

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• If you believe that you or someone in your care is having a drug interaction, call your doctor or pharmacist immediately. • Don’t share your prescription medication with anyone, and don’t take medicine prescribed for someone else. • If you mistakenly take medication not prescribed for you or have taken too much medication—prescription or nonprescription—call the Poison Control Center immediately. The Hennepin Regional

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HEALTH INSURANCE

Relieving health care cost anxiety

ore and more frequently, I’m seeing patients with a type of anxiety not described in psychiatric textbooks. I call this condition “health care cost anxiety.” This increasingly common condition has its roots in uncertainty and fear of the unknown, not the least of which are the unknown costs of recommended medical care and medications—what the patient (or the patient’s family) will need to pay out of pocket. Health care cost anxiety arises when your doctor tells you that you need an Getting the cost MRI—but you’re not sure if your health insurance plan will pay or if you’ll have and coverage to pay $3,000 out of your pocket. It information you need occurs when the pharmacy clerk tells you that instead of the $12 copayment By Lee H. Beecher, MD you expected, you need to pay $200 to pick up your medications. Simply being ill, or being afraid of becoming ill, causes plenty of anxiety. And when you’re already ill, getting the straight story from an insurance company about costs and coverage is all the more difficult. Other factors—financial stressors such as unemployment, worry about losing or loss of employment or health care benefits, escalating insurance premiums, and difficulty in getting appointments with providers who will accept your insurance plan or medical assistance—are driving anxiety about health care. Clearly, in our uncertain health care insurance environment, patients need to become much more involved in knowing and managing their own health care spending. This article looks at how health insurance coverage is changing, what this means for empowering patients, and some steps patients and their families can take to help manage their health care cost anxiety. Insurance coverage: Paying more out of pocket

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The days of first-dollar insurance coverage without copayments or deductibles are over for most of us. In addition, although 58 percent of U.S. workers are still covered by employer-sponsored insurance, that percentage is diminishing. Many small businesses are dropping coverage or not offering it to their new hires. A June 2011 McKinsey & Co. survey of 1,300 businesses found that 30 percent of employers plan to drop employee insurance altogether and that 60 percent will be looking for alternatives to traditional employer-funded insurance by 2014 if the federal health care law employer insurance mandate goes into effect. Employers are already dramatically increasing the employee share of health costs, often requiring their employees to come up with $1,000 to $6,000 in medical expenses before their health insurance takes effect. A shift toward high-deductible health plans

Many larger employers still offer several choices of health care insurance plans, but these choices are narrowing: • A health maintenance organization (HMO) plan offers first-dollar coverage. With Minnesota HMOs, there is no deductible to be met before insurance pays for health care services, and a very restricted network of providers is available.

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MINNESOTA HEALTH CARE NEWS JANUARY 2012

• A preferred provider organization (PPO) plan offers greater choice of providers, but patients pay more or cannot see physicians out of the PPO network.

For more information • High-deductible health plans (HDHPs) offer much lower monthly insurance premiums than the other two plans.

• The Minnesota Department of Commerce website provides a list of licensed health care companies that market individual and family health care coverage in Minnesota: http://mn.gov/commerce/insurance/index.jsp (click on “Medical and Health” and “Find a Health Plan”) • U.S. Internal Revenue Service website provides information about health savings accounts and high-deductible health plans: http://www.irs.gov/publications/p969/ar02.html

HDHPs are becoming much more prevalent because of their much lower premiums. They operate on the principle that health care insurance should cover high-cost medical services and unpredictable costs while most low-cost forms of health care are financed outside of an insurance protection contract. There are basically two types of HDHPs: (1) Insurance policies in which high deductibles are completely managed by the insurance company (e.g., Medica Solo); and (2) Insurance that is paired with a health savings account (HSA) regulated by the federal Internal Revenue Service (IRS). Both kinds of HDHPs require that individuals have money from a source other than health care insurance—such as a health care reimbursement arrangement (employer-funded), a health savings account (HSA), or a direct government subsidy—to cover the costs of care until the insurance plan deductible is satisfied. Independent insurance agents can provide details. With the rise of HDHPs, both patients and doctors will need to deal with the permutations of payment, costs, and restricted options in health care services. The increasing variety and scope of health insurance plans mean that patients (and their doctors) will need to know actual costs of their care and assume a collaborative role in cost management. Doing so is often a daunting experience in the current environment. Below are some guidelines for getting the cost and coverage information you need from the clinic and the pharmacy. Learning the “rules of the road” from your insurance company

As of this writing, getting specific answers on benefits or allowed dollar coverage from your medical care insurance company requires persistence and patience. The process of calling the insurance company may take an hour or longer. In my office, we offer a “team call” with a clinic staffer (outside of the patient's appointment time with me) to help patients or family members get this information. The call helps clarify the insurance “rules of the road,” and this improves the doctor-patient alliance. When phoning the insurance company about enrollee benefits and the schedule of allowable payments, have the policy and group numbers from your insurance card in front of you. Callers typically encounter many programmed responses and holds. When you reach an actual person, even the most pleasant and consumer-oriented insurance company representative cannot tell you the allowable payments for a specific service or specific physician. They will tell you if the doctor or clinic is in or out of the health plan provider network, and you are likely to be referred to a website. Here are important questions to ask your insurance company: • Does your insurance plan have a restricted provider network of clinics or doctors? If so, when are these network clinics/physicians available to see you? What coverage is available if you decide to use physicians or clinics that are not in the provider network? It is very important that you contact the clinic directly to see if and exactly when they can see you.

• What is the insurance plan deductible, and how does one satisfy the documentation of medical services which apply to satisfying the insurance deductible amount? [Either the clinic or the patient submits the clinic charges using current procedural terminology (CPT) codes. The CPT codes are well known to doctors and clinics and are the agreed-on descriptors of medical procedures.] Following submission to the insurance company, these charges are first “denied for payment” by the insurance company, and then are accounted towards satisfying the enrollee’s insurance deductible. • Does your insurance plan cover this health service? For example, there are often strict limits on mental health and chemical dependency care, despite Minnesota and federal mental health parity legislation. Most Minnesota health plans require treatment at in-network mental health or substance abuse clinics or programs, even though none may be available when a patient contacts them. • Are there providers in the network who are appropriately trained and available to see you? The health plan will refer patients to their website for you to search out names and locations. Patients should Relieving health care cost anxiety to page 16

Leg Pain Study Do your legs hurt when you walk? Does it go away when you rest? Or, have you been diagnosed with PAD? You may have claudication, caused by lack of blood supply to the leg muscles The University of Minnesota is seeking volunteers to take part in an exercise-training program, funded by the National Institutes of Health

To see if you qualify, contact the EXERT Research Team at

612-624-7614 or email EXERT@umn.edu or visit EXERTstudy.org

EXERTstudy.org JANUARY 2012 MINNESOTA HEALTH CARE NEWS

Relieving health care cost anxiety from page 15

insist on getting personalized help from their health plan or insurance company in order to connect with an available provider suited to their particular medical needs, since availability is part of an insurance contract. • Do medication copayments qualify toward satisfying your insurance deductible? And how are they to be accounted? The insurance company should know this. Medications are handled by a pharmacy benefit manager (PBM) company, so you’ll need to go to your retail pharmacy (armed with your insurance By making card) to learn about your medical care costs medication copayments and restrictions, as your business, explained in the section you'll relieve a lot below.

of your health care cost anxiety.

Your insurance plan’s pharmacy benefits

When asked about prices, community pharmacists quote their “retail” prices for medications they have on hand or dispense. However, they can readily check on the out-of-pocket cost of a given medication for a specific patient if they have your insurance information. With a swipe of your insurance card, the pharmacist can instantly find out from your

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Winter can be a hard time. It’s tough to get out of the house. And sometimes, it can be lonely. Now is exactly the time to call Seniors Helping Seniors in-home services. We’re like a friend who helps with light housekeeping, small repairs, driving, shopping, cooking and more. Call for a free consultation and warm your body and your heart. • Companion Care • Transportation to appointments • Homemaker Services • Respite for caregivers Other help needed? Just ask

health plan pharmacy benefit manager (PBM) what you must pay at the pharmacy. Armed with your insurance card, check with your pharmacy about which drugs are on your insurance plan formulary that pertain to your care needs. The formulary is a list of prescription drugs, both generic and brand name, that are covered by your health plan. The health plan will pay for a portion of the pharmacy cost, but the amount of coverage varies greatly. You do need to get the specific details of your copayments directly from the pharmacy. I recommend that you do this before the doctor or prescriber writes or renews your prescription. Use your cell phone, even in the doctor’s office if necessary. Knowing the actual cost to a patient is a big deal to the doctor. Failing to consider affordability of medications for a patient means that an unfilled or insufficiently dosed prescription is likely to cause a poor treatment outcome. A recent Consumer Reports survey showed, unsurprisingly, that patients do not follow doctors’ recommendations when they believe they cannot afford them. Affordability is a major cause of treatment and medication “noncompliance” or “nonadherence” when patients don’t fill the doctor’s prescriptions, skip doses, or cut pills in half without the doctor knowing. Becoming prudent “health shoppers”

In today’s changing health care environment, patients do need to know the specific costs of their care so that they can be prudent “shoppers” when it comes to spending their health care dollars. Health care insurance coverage is much more complicated than it used to be—and it will not get less so. There is also general agreement that helping patients decide about the personal value of health care services by considering costs is an important role for physicians to play. At present, most traditional medicine clinics in Minnesota do not post their fees or prices. When patients ask for cost Most details, clinics may say that financial conMinnesota cerns are the business of the patient’s insurance company or the clinic administrator, medicine rather than doctors or patients. clinics do So, I advise patients to make it their business to patiently and persistently ask not post their doctors about what they must pay for their fees the care and medications that the doctor recor prices. ommends. It helps when the doctor knows they really care. Doctors and clinics are beginning to help patients glean insurance and pharmacy benefits information. Regarding shopping for health care insurance, patients and their families should consult a qualified independent insurance agent to discuss their health care insurance options. Everybody wins

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MINNESOTA HEALTH CARE NEWS JANUARY 2012

By making medical care costs your business, you'll relieve a lot of your health care cost anxiety. You will help your doctor and care team make better treatment recommendations for you and your family. And, from your personal experience, you can talk to your political representatives about how to better our health care system and make it more cost-effective. Lee H. Beecher, MD, is president of the Minnesota Physician-Patient Alliance (www.physician-patient.org) and a psychiatrist in private practice.

January Calendar National Radon Action Month: Radon in Minnesota homes MDH recommends that all Minnesota Radon is a colorless, odorless radioactive homeowners test their homes for radon. gas that seeps up from the earth. When inhaled, it gives off radioactive particles that Radon test kits are sold at some hardware can damage the cells that line the lung. or home supply stores. Your local health Long-term exposure to radon can lead to lung cancer. According to the Minnesota Department of Health (MDH), more than 21,000 lung cancer deaths in the U.S. each year are from radon, making it a serious health concern for all Minnesotans. Radon, because it is a gas, is able to move though spaces in the soil or fill material around a home's foundation. Minnesota homes tend to operate under a negative pressure pulling soil gases, including radon, into the lower level of the structure—especially during the heating season. Your home can have radon whether it be old or new, drafty or well sealed, and with or without a basement.

Kidney Early Evaluation Program (KEEP) Free Screening For adults 18 years or older who are at increased risk of developing kidney disease. Get a yearly screening if you have diabetes, high blood pressure, or have a parent, grandparent, brother or sister with diabetes, high blood pressure, or kidney disease. Space is limited; contact the National Kidney Foundation at 651-6367300 to schedule an appointment. Tuesday, Jan. 10, 3–7 p.m., First Community Church, 3001 Russell Ave. N., Minneapolis Lymphedema Seminar For people who have had lymph nodes surgically removed from under their arms. Learn about causes, signs, and symptoms of lymphedema (swelling), and lifestyle precautions that can decrease the risk of developing the condition. Free. Call 952-993-5700 for more details. Wednesday, Jan. 11, 12:30–1:30 p.m., Frauenshuh Cancer Ctr., 3931 Louisiana Ave. S., St. Louis Park Brain Injury Patient Education/Support If you have experienced a brain injury, this group is designed for both you and your family members. We meet on the third

Family-to-Family Connections This is a free support group for families with children who have intellectual or developmental disabilities. The group meets on the fourth Tuesday of each month. Call The Arc at 952-920-0855 to register. Tuesday, Jan. 24, 5:30–7:30 p.m., Coon Rapids Evangelical Free Church, 2650 128th Ave. N.W., Rm. 202, Coon Rapids

Miracle Voices of Central Minnesota People who have had a laryngectomy can find comfort belonging to a group that understands their needs. Your family, caregivers, and friends are welcome to attend. For more information, call Mandy at St. Cloud Ear, Nose, Throat, Head and Neck Clinic at 320-252-0233 or 800450-3223. Wednesday, Jan. 25, 6:30–8 p.m., St. Cloud Hospital’s Conference Ctr., 1406 6th Ave. N., Aspen Rm., St. Cloud

Disability Bowling Program Join fellow bowlers at Park Tavern on Friday afternoons. The bowling program is open to anyone with a physical disability. Games cost $1.50. Shoe rental and adaptive equipment are available. Call Park Nicollet’s INSPIRE program at 952993-6789 to register. Friday, Jan. 27, 1:30–5 p.m., Park Tavern Bowling, 3401 Louisiana Ave. S., St. Louis Park

department may also offer test kits at reduced prices, or order online at www.mn.radon.com. A radon test kit should cost between $5 and $25 and include laboratory analysis. If you choose to hire someone to test your home, it will be more expensive. A number of steps can be taken to lower the amount of radon in a home. Experienced radon mitigation professionals are available and can install appropriate control systems. Questions? Email health.indoorair@state.mn.us, or call MDH at 651-201-4601 or 800-798-9050.

Monday of the month and feature a guest speaker. Registration is not required. For further information, contact Tanya Rand at 651-232-2202. Monday, Jan. 16, 6–7:30 p.m., Bethesda Hospital, 559 Capitol Blvd., 7th Flr., Indihar Conference Ctr., St. Paul

The Lowdown on Insulin Pumps: An Informational Class Are you tired of multiple daily injections? Learn the advantages of insulin pump therapy and view the latest pumps. This free class is for patients with either type 1 or type 2 diabetes; presented by Lakeview Hospital certified diabetes educators. Advance registration required; call 651-430-8715 or 866-727-3907. Tuesday, Jan. 17, 5–6 p.m., Stillwater Medical Group Specialty Clinic, 1500 Curve Crest Blvd., Stillwater

Breathe Better Pulmonary Support Group This group is for people with chronic obstructive pulmonary disease (COPD) and their families. We meet the third Thursday of each month, January to October. For more information, call 651-982-7945. Thursday, Jan. 19, 1–3 p.m., Fairview Lakes Medical Ctr., 5200 Fairview Blvd., Conference Rm. B., Wyoming

Send us your news: We welcome your input. If you have an event you would like to submit for our calendar, please send your submission to MPP/Calendar, 2812 E. 26th St., Minneapolis, MN 55406. Fax submissions to 612-728-8601 or email them to jbirgersson@ mppub.com. Please note: We cannot guarantee that all submissions will be used. CME, CE, and symposium listings will not be published.

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Albuterol 2mg tab ...............................................................90 ......270 Albuterol 4mg tab ...............................................................60 ......180 Albuterol 2mg/5ml syrup...........................................120ml 360ml Albuterol 0.5% nebulizer soln* (20ml bottle)† ............1 ...........3 Albuterol 0.083% nebulizer soln* (25x3ml vials)† .......1 ...........3 Ipratropium 0.02% nebulizer soln* (25x2.5ml vials)† .1 ...........3

Atropine Sulfate 1% op. soln* (5ml bottle)† ....................1 .........3 Erythromycin op. ointment (3.5gm tube)†* ....................1 ..........3 Gentamicin 0.3% op. soln (5ml bottle)† ............................1 .........3 Levobunolol 0.5% op soln (5ml bottle)† ...........................1 .........3 Neomycin/Polymyxin/Dexamethasone 0.1% op. ointment (3.5gm tube)† ........................................1 ........3 Neomycin/Polymyxin/Dexamethasone 0.1% op. susp (5ml bottle)†....................................................1 ........3 Pilocarpine 1% op. soln (15ml bottle)† ..............................1 ........3 Pilocarpine 2% op. soln (15ml bottle)† ..............................1 ........3 Polymyxin Sulfate/TMP op. soln* (10ml bottle)† ............1 ........ 3 Sulfacet Sodium 10% op. soln* (15ml bottle)† ............... 1 .........3 Timolol Maleate 0.25% op. soln (5ml bottle)† .................1 ........ 3 Timolol Maleate 0.5% op soln (5ml bottle)† ....................1 ........3 Tobramycin 0.3% op. soln (5ml bottle)† ............................1 ........3

Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle)† .................1 Amoxicillin 125mg/5ml susp (100ml bottle)†................1 Amoxicillin 125mg/5ml susp (150ml bottle)†................1 Amoxicillin 200mg/5ml susp (50ml bottle)†...................1 Amoxicillin 200mg/5ml susp* (75ml bottle)† ................1 Amoxicillin 200mg/5ml susp* (100ml bottle)†..............1 Amoxicillin 250mg/5ml susp (80ml bottle)† ..................1 Amoxicillin 250mg/5ml susp (100ml bottle)†................1 Amoxicillin 250mg/5ml susp (150ml bottle)†................1 Amoxicillin 400mg/5ml susp (50ml bottle)†...................1 Amoxicillin 400mg/5ml susp* (75ml bottle)† ................1 Amoxicillin 400mg/5ml susp* (100ml bottle)†..............1 Amoxicillin 250mg cap ......................................................30 Amoxicillin 500mg cap .......................................................30

.........3 ..........3 ..........3 ..........3 ..........3 .......30 .......30 .......30 .......30 .......30 .......30 .......30 .......90 .......90 Cephalexin 250mg cap ......................................................28 .......84 Cephalexin 500mg cap ......................................................30 .....90 Ciprofloxacin 250mg tab ...................................................14 .......42 Ciprofloxacin 500mg tab ...................................................20 .......60 Doxycycline Hyclate 50mg cap ....................................... 30 .......90 Doxycycline Hyclate 100mg cap .....................................20 .......60 Doxycycline Hyclate 100mg tab .....................................20 ........60 Penicillin VK 250mg tab .....................................................28 ........84 Penicillin VK 125mg/5ml susp (100ml bottle)† .............1 ...........3 Penicillin VK 125mg/5ml susp (200ml bottle)†..............1 ...........3 Penicillin VK 250mg/5ml susp (100ml bottle)†...............1 ...........3 SMZ-TMP 200mg-40mg/5ml susp* .......................120ml SMZ-TMP 400mg-80mg tab .............................................28 SMZ-TMP DS 800mg-160mg tab ....................................20 Tetracycline 250mg cap .....................................................60 Tetracycline 500mg cap .....................................................60

360ml .......84 .......60 .....180 .....180

Arthritis & Pain Allopurinol 100mg tab .......................................................30 ........90 Allopurinol 300mg tab .......................................................30 ........90 Baclofen 10mg tab ...............................................................30 ........90 Cyclobenzaprine 5mg tab .................................................30 ........90 Cyclobenzaprine 10mg tab ..............................................30 ........90 Dexamethasone 0.5mg tab ..............................................30 ........90 Dexamethasone 0.75mg tab ............................................12 ........36 Dexamethasone 4mg tab ....................................................6 ........18 Diclofenac DR 75mg tab ....................................................60 ......180 Ibuprofen 100mg/5ml susp*....................................120 ml 360ml Ibuprofen 400mg tab ..........................................................90 .....270 Ibuprofen 600mg tab ..........................................................60 .....180 Ibuprofen 800mg tab .........................................................30 ........90 Indomethacin 25mg cap*...................................................60 .....180 Meloxicam 7.5mg tab .........................................................30 .......90 Meloxicam 15mg tab ..........................................................30 .......90 Naproxen 375mg tab*.........................................................60 .....180 Naproxen 500mg tab*.........................................................60 .....180

Cholesterol Lovastatin 10mg tab ...........................................................30 Lovastatin 20mg tab*...........................................................30 Pravastatin 10mg tab ..........................................................30 Pravastatin 20mg tab ..........................................................30 Pravastatin 40mg tab* ........................................................30

........90 ........90 ........90 ........90 ........90

Diabetes Chlorpropamide 100mg tab* ...........................................30 ........90 Glimepiride 1mg tab ..........................................................30 ........90 Glimepiride 2mg tab ...........................................................30 ........90 Glimepiride 4mg tab ..........................................................30 ........90 Glipizide 5mg tab .................................................................30 ........90 Glipizide 10mg tab* .............................................................60 ......180 Glyburide 2.5mg tab ...........................................................30 ........90 Glyburide 5mg tab (blue) ..................................................30 ........90 Glyburide 5mg tab (green)................................................30 ........90 Glyburide, micronized 3mg tab ......................................30 ........90 Glyburide, micronized 6mg tab ......................................30 ........90 Metformin 500mg tab ........................................................60 ......180 Metformin 850mg tab ........................................................60 ......180 Metformin 1000mg tab* ....................................................60 ......180 Metformin 500mg ER tab*.................................................60 ......180

Ear Health Antipyrine/Benzocaine otic (15ml bottle)†.....................1 ...........3

Fungal Infections Fluconazole 150mg tab ........................................................1 Nystatin/Triamcin cream* (15gm tube)† .........................1 Nystatin/Triamcin cream* (30gm tube)† .........................1 Nystatin/Triamcin ointment* (15gm tube)†...................1 Nystatin cream* (15gm tube)† ...........................................1 Nystatin cream* (30gm tube)†.............................................1 Terbinafine 250mg tab*.......................................................30

..........3 ..........3 ..........3 ..........3 ..........3 ..........3 .......90

Gastrointestinal Health Belladonna Alkaloid/PB tab ..............................................60 .....180 Cimetidine 800mg tab* ......................................................30 ........90 Cytra2 solution ...............................................................180ml 540ml Dicyclomine 10mg cap .......................................................90 .....270 Dicyclomine 20mg tab .......................................................60 .....180 Famotidine 20mg tab ..........................................................60 .....180 Lactulose syrup ..............................................................237ml 711ml Metoclopramide 10mg tab ...............................................60 .....180 Metoclopramide syrup ..................................................60ml 180ml Promethazine 25mg tab*...................................................12 ........36 Promethazine plain syrup*.........................................180ml 540ml Ranitidine 150mg tab .........................................................60 ......180 Ranitidine 300mg tab .........................................................30 ........90

Revised 10/19/11

Heart Health & Blood Pressure Amiloride-HCTZ 5mg-50mg tab .....................................30 ........90 Atenolol-Chlorthalidone 100mg-25mg tab ................30 ........90 Atenolol-Chlorthalidone 50mg-25mg tab ..................30 ........90 Atenolol 25mg tab ...............................................................30 ........90 Atenolol 50mg tab ...............................................................30 ........90 Atenolol 100mg tab ............................................................30 ........90 Benazepril 5mg tab ..............................................................30 ........90 Benazepril 10mg tab ...........................................................30 ........90 Benazepril 20mg tab ...........................................................30 ........90 Benazepril 40mg tab ...........................................................30 ........90 Bisoprolol-HCTZ 2.5mg-6.25mg tab ..............................30 ........90 Bisoprolol-HCTZ 5mg-6.25mg tab .................................30 ........90 Bisoprolol-HCTZ 10mg-6.25mg tab ...............................30 ........90 Bumetanide 0.5mg tab ......................................................30 ........90 Bumetanide 1mg tab ..........................................................30 ........90 Captopril 12.5mg tab ..........................................................60 ......180 Captopril 25mg tab ..............................................................60 ......180 Captopril 50mg tab ..............................................................60 ......180 Captopril 100mg tab ...........................................................60 ......180 Carvedilol 3.125mg tab ......................................................60 ......180 Carvedilol 6.25mg tab .........................................................60 ......180 Carvedilol 12.5mg tab ........................................................60 ......180 Carvedilol 25mg tab* ..........................................................60 ......180 Clonidine 0.1mg tab ............................................................30 ........90 Clonidine 0.2mg tab ............................................................30 ........90 Digoxin 0.125mg tab ..........................................................30 ........90 Digoxin 0.25mg tab .............................................................30 ........90 Diltiazem 30mg tab .............................................................60 .....180 Diltiazem 60mg tab .............................................................60 .....180 Diltiazem 90mg tab*............................................................60 .....180 Diltiazem 120mg tab ..........................................................30 ........90 Doxazosin 1mg tab ..............................................................30 ........90 Doxazosin 2mg tab ..............................................................30 ........90 Doxazosin 4mg tab ..............................................................30 ........90 Doxazosin 8mg tab ..............................................................30 ........90 Enalapril-HCTZ 5mg-12.5mg tab ....................................30 ........90 Enalapril 2.5mg tab ..............................................................30 ........90 Enalapril 5mg tab .................................................................30 ........90

Need to change your Pharmacy? Many large employers have recently dropped Walgreens and other Pharmacies from their Prescription Drug Benefit Plan, impacting where you can pick up your prescriptions. If this has happened to you please contact your local Walmart for assistance on our easy prescription transfer. $4, 30-day $10, 90-day

Enalapril 20mg tab ..............................................................30 Furosemide 20mg tab ........................................................30 Furosemide 40mg tab ........................................................30 Furosemide 80mg tab ........................................................30 Guanfacine 1mg tab ............................................................30 Hydralazine 10mg tab ........................................................30 Hydralazine 25mg tab ........................................................30 Hydrochlorothiazide(HCTZ)12.5mg cap*.....................30 Hydrochlorothiazide (HCTZ) 25mg tab ........................30 Hydrochlorothiazide (HCTZ) 50mg tab ........................30 Indapamide 1.25mg tab ....................................................30 Indapamide 2.5mg tab .......................................................30 Isosorbide Mononitrate 30mg ER tab ...........................30 Isosorbide Mononitrate 60mg ER tab ...........................30 Lisinopril-HCTZ 10mg-12.5mg tab ................................30 Lisinopril-HCTZ 20mg-12.5mg tab*................................30 Lisinopril-HCTZ 20mg-25mg tab* ..................................30 Lisinopril 2.5mg tab .............................................................30 Lisinopril 5mg tab ................................................................30 Lisinopril 10mg tab ..............................................................30 Lisinopril 20mg tab ..............................................................30 Methyldopa 250mg tab*....................................................60 Methyldopa 500mg tab*....................................................30 Metoprolol Tartrate 25mg tab..........................................60 Metoprolol Tartrate 50mg tab..........................................60 Metoprolol Tartrate 100mg tab* .....................................60 Nadolol 20mg tab ................................................................30 Nadolol 40mg tab ................................................................30 Prazosin HCL 1mg cap ........................................................30

........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 .....180 .......90 .....180 .....180 .....180 ........90 ........90 ........90 ........90 ........90

Prazosin HCL 2mg cap ........................................................30 Prazosin HCL 5mg cap ........................................................30 Propranolol 10mg tab .........................................................60 ......180 Propranolol 20mg tab ........................................................60 ......180 Propranolol 40mg tab .........................................................60 ......180 Propranolol 80mg tab .........................................................60 ......180 Sotalol HCL 80mg tab*........................................................30 ........90 Spironolactone 25mg tab*................................................30 ........90 Terazosin 1mg cap ...............................................................30 ........90 Terazosin 2mg cap ...............................................................30 ........90 Terazosin 5mg cap ..............................................................30 ........90 Terazosin 10mg cap .............................................................30 ........90 Triamterene-HCTZ 37.5mg-25mg cap ..........................30 ........90 Triamterene-HCTZ 37.5mg-25mg tab ..........................30 ........90 Triamterene-HCTZ 75mg-50mg tab ..............................30 ........90 Verapamil 80mg tab ............................................................30 ........90 Verapamil 120mg tab .........................................................30 ........90 Warfarin 1mg tab .................................................................30 ........90 Warfarin 2mg tab .................................................................30 ........90 Warfarin 2.5mg tab ..............................................................30 ........90 Warfarin 3mg tab .................................................................30 ........90 Warfarin 4mg tab .................................................................30 ........90 Warfarin 5mg tab*.................................................................30 ........90 Warfarin 6mg tab ..................................................................30 ........90 Warfarin 7.5mg tab ..............................................................30 ........90 Warfarin 10mg tab ...............................................................30 ........90

$4, 30-day $10, 90-day

Men’s Health

$9/30-day

Finasteride 5mg ...................................................................................30 $9/tablet

Levitra 20mg (limit 10 per customer per month) ......................1

Mental Health

$4, 30-day $10, 90-day

Amitriptyline 10mg tab .....................................................30 .......90 Amitriptyline 25mg tab ......................................................30 ........90 Amitriptyline 50mg tab .....................................................30 ........90 Amitriptyline 75mg tab ......................................................30 ........90 Amitriptyline 100mg tab ...................................................30 ........90 Benztropine 2mg tab ..........................................................30 ........90 Buspirone 5mg tab ..............................................................60 ......180 Buspirone 10mg tab*...........................................................60 ......180 Carbamazepine 200mg tab*.............................................60 ......180 Citalopram 20mg tab ..........................................................30 ........90 Citalopram 40mg tab .........................................................30 ........90 Fluoxetine 10mg tab*..........................................................30 ........90 Fluoxetine 10mg cap ..........................................................30 ........90 Fluoxetine 20mg cap ..........................................................30 ........90 Fluoxetine 40mg cap ..........................................................30 ........90 Fluphenazine 1mg tab .......................................................30 ........90 Haloperidol 0.5mg tab ......................................................30 ........90 Haloperidol 1mg tab ...........................................................30 ........90 Haloperidol 2mg tab ...........................................................30 ........90 Haloperidol 5mg tab ...........................................................30 ........90 Lithium Carbonate 300mg cap* ......................................90 ......270 Nortriptyline 10mg cap .....................................................30 ........90 Nortriptyline 25mg cap ......................................................30 ........90 Paroxetine 10mg tab* .........................................................30 ........90 Paroxetine 20mg tab*..........................................................30 ........90 Prochlorperazine 10mg tab .............................................30 ........90 Thioridazine 25mg tab .......................................................30 ........90 Thioridazine 50mg tab .......................................................30 ........90 Thiothixene 2mg cap ..........................................................30 ........90 Trazodone 50mg tab ...........................................................30 ........90 Trazodone 100mg tab .........................................................30 ........90 Trazodone 150mg tab ........................................................30 ........90 Trihexyphenidyl 2mg tab ..................................................60 ......180

Thyroid Conditions Levothyroxine 25mcg tab .................................................30 Levothyroxine 50mcg tab .................................................30 Levothyroxine 75mcg tab .................................................30 Levothyroxine 88mcg tab .................................................30 Levothyroxine 100mcg tab ...............................................30 Levothyroxine 112mcg tab ...............................................30 Levothyroxine 125mcg tab ...............................................30 Levothyroxine 137mcg tab ...............................................30 Levothyroxine 150mcg tab ...............................................30 Levothyroxine 175mcg tab*..............................................30 Levothyroxine 200mcg tab*..............................................30

........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90 ........90

Viruses Acyclovir 200mg cap ...........................................................30 .......90

Vitamins & Nutritional Health Folic Acid 1mg tab ...............................................................30 Mag 64 64mg tab* ................................................................60 Magnesium Oxide 400mg tab0 ......................................30 Prenatal Plus qty 30*.............................................................30 Potassium Chloride 10% liquid ................................470ml Sodium Fluoride .25mg chewable (120ct bottle) †* ....1

........90 ........90 ........90 ........90 1419ml .....N/A

Women’s Health Estradiol 0.5mg tab .............................................................30 Estradiol 1mg tab .................................................................30 Estradiol 2mg tab .................................................................30 MedroxyprogesteroneAcetate 2.5mg tab ...................30 Medroxyprogesterone Acetate 5mg tab .....................30 Medroxyprogesterone Acetate 10mg tab ...................10

........90 ........90 ........90 ........90 ........90 ........30

$9, 30-day $24, 90-day

Alendronate SOD 35mg tab . ..............................................4 ........12 Alendronate SOD 70mg tab ...............................................4 ........12 Clomiphene 50mg tab ..........................................................5 ........15 Sprintec 28-day tab ..............................................................28 .....N/A Tamoxifen 10mg tab ............................................................60 ......180 Tamoxifen 20mg tab ...........................................................30 ........90 Tri-Sprintec 28-day tab .......................................................28 ....N/A

Other Medical Conditions

Skin Conditions †

Fluocinonide 0.05% cream* (15gm tube) ......................1 ...........3 Fluocinonide 0.05% cream* (30gm tube)† .....................1 ...........3 Gentamicin 0.1% cream (15gm tube)†.............................1 ...........3 Gentamicin 0.1% ointment (15gm tube)† ......................1 ...........3 Hydrocortisone 1% cream (28.35-30g tube)†................1 ...........3 Hydrocortisone 2.5% cream (30gm tube)†.....................1 ...........3 Silver Sulfadiazine 1% cream* (50gm tube)† .................1 ...........3 Triamcinolone 0.025% cream (15gm tube)† ..................1 ...........3 Triamcinolone 0.025% cream (80gm tube)† ..................1 ...........3 Triamcinolone 0.1% cream (15gm tube)† .....................1 ...........3 Triamcinolone 0.1% cream (80gm tube)† .......................1 ...........3 Triamcinolone 0.1% ointment (15gm tube)† ................1 ...........3 Triamcinolone 0.1% ointment (80gm tube)†.................1 ...........3 Triamcinolone 0.5% cream (15gm tube)† .......................1 ...........3

Chlorhexidine Gluconate 0.12% soln (473ml bottle)† ...1 ...........3 Hydrocortisone AC 25mg suppositories* ....................12 ........36 Isoniazid 300mg tab ............................................................30 ........90 Lidocaine 2% viscous solution (100ml bottle)† .............1 ..........3 Megestrol 20mg tab*...........................................................30 ........90 Oxybutynin 5mg tab ...........................................................60 ........90 Phenazopyridine 100mg tab.............................................60 .....180 Phenazopyridine 200mg tab ............................................30 ........90 Prednisone 2.5mg tab .........................................................30 ........90 Prednisone 5mg tab ............................................................30 ........90 Prednisone 10mg tab .........................................................30 ........90 Prednisone 20mg tab .........................................................30 ........90

Revised 10/19/11

*Prices may be higher due to State restrictions. † Prepackaged drugs are covered only in unit sizes specified on Drug list. See Program Details or your Walmart Pharmacist for details. Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more and some restrictions may apply. PHARMACIES ARE CONVENIENTLY LOCATED IN EVERY MINNESOTA WALMART LOCATION

FOR MORE INFORMATION AND THE MOST CURRENT LIST OF DISCOUNTED DRUGS VISIT

WALMART.COM/pharmacy

COMMUNICABLE DISEASE

eningitis is an inflammation of the membranes covering the brain and spinal cord. It is most commonly caused by an infection, either from a virus or bacteria. Meningitis is a scary illness, both for parents and doctors, and for good reason. In the past, a person with meningitis—sometimes called spinal meningitis—was at risk of serious complications, including death. Although there are other causes of inflammation of the membranes covering the brain and spinal cord (certain drugs and rare infectious agents such as tuberculosis and fungi, for example), viral and bacterial infections are the most common. The most common form, viral meningitis, is usually less severe and will go away without treatment. Meningitis can also be caused by several different bacteria: • Hemophilus influenza type B (HiB) • Streptococcus pneumonia • Neisseria meningitidis

Knowing the specific bacteria is very important for treatment, because the correct antibiotic must be selected. Bacterial and viral infections are often contagious, and meningitis is no exception. Some forms of meningitis are spread person-to-person through respiratory or throat secretions spread by coughing, sneezing, or kissing. For both the Neisseria meningitidis and Hemophilus influenza type B forms of meningitis, close contact may be a risk factor, for example, in day care centers and households, or within romantic couples. In these cases, prophylactic (or preventive) antibiotics can be offered to exposed people.

Meningitis Early diagnosis is critical By Marjorie Hogan, MD

Symptoms of meningitis Although the incidence of meningitis has decreased significantly, parents should be aware of symptoms and signs of this serious disease. Early on, a child or teen may seem to have caught a common cold or flu, maybe with fever, aches, and respiratory

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symptoms. But persistent or new symptoms such as the following indicate the need for immediate evaluation: • high fever • vomiting • confusion or difficulty concentrating • sleepiness or difficulty waking up • stiff neck • numbness, tingling, or weakness in extremities • sensitivity to light

huge reduction in the number of infections caused by Streptococcus pneumonia. Adolescents and young adults from 15 to 24 years old have been at special risk for meningitis caused by a third family of bacteria, Neisseria meningitidis, because they often gather in groups: in dorm rooms, army barracks, or other confined areas. In 2005, a vaccine protecting against many subtypes of Neisseria meningitidis became available. Teens now receive this Menactra vaccine at clinic visits, and a booster is recommended four years later. In 2011, thanks to safe and effective vaccines, meningitis is increasingly uncommon. Some of my young medical students today may never see a case of bacterial meningitis in their careers!

• spreading rash • seizures Infants with meningitis are much more difficult to evaluate, but if the infant or child has any of the above symptoms, or is not interested in usual pleasures such as playing and eating, or is “out of it” and does not recognize the parent, these could indicate a possible serious illness and the need for immediate medical attention. Diagnosing meningitis Early diagnosis of meningitis is critically important. The doctors will draw blood and obtain a sample of spinal fluid from the patient’s back; this is called a “spinal tap” or lumbar puncture and is the best way to identify the bacteria (or virus) causing the meningitis. Other tests, including CT or MRI scans of the brain, are often useful. The doctors will choose the best antibiotics for bacterial meningitis. Patients with meningitis, whether bacterial or viral, need supportive and intensive care with close monitoring. Development of vaccines Before the 1990s, bacterial meningitis was fairly common. According to the U.S. Centers for Disease Control (CDC), Hemophilus influenza type B (HiB) was the most common cause of meningitis before the vaccine was available, and led to the death of about 600 children yearly. HiB also caused pneumonia, bone infections, and throat infections. In 1985, a vaccine was developed to protect young children against Hemophilus influenza type B. Since introduction of the vaccine, the incidence of invasive HiB illness has decreased by 98 percent to just a handful of cases yearly. Now, all infants and toddlers receive four doses of HiB vaccine at their well-child visits. Both pneumococcal vaccine and HiB vaccine are given at 2, 4, and 6 months of age, and once anytime between 12 to 15 months—so four doses total for each vaccine. The next dramatic step in the fight against meningitis was the development of PCV (pneumococcal conjugate vaccine), a vaccine first licensed in 2000 that protects children from many types of Streptococcus pneumonia, another common bacteria that can cause meningitis, pneumonia, and other severe infections in children and others with weak immune systems. Studies are showing a

Before vaccines were available I often recall my early years of pediatric practice and the scourge of frequent cases of meningitis, when, despite our best efforts, children and adolescents either didn’t survive, or survived with tremendous, life-changing disabilities. When I was a medical student and resident in pediatrics, children and adolescents with symptoms of meningitis—fever, headache, irritability, stiff neck—often came to the clinic or emergency department and were admitted to the hospital for tests and intensive care. Many of these patients had long hospital stays, receiving antibiotics and other treatments. The complicated course of the illness and the frequently poor outcomes left a major impression on me. I will never forget one little boy, Dominic, then about 2 months old. I see him in my clinic to this day, some 20 years later. He develMeningitis to page 22

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and teens require many painful injections throughout their young lives, but isn’t this a small cost to pay for the prevention of meningitis (and other avoidable diseases)? If a child does happen to contract meningitis today, it can still—even with excellent medical care—cause serious complications such as hearing loss, blindness, brain injury, learning and developmental problems, loss of limbs, or even death. That a vaccine is available to prevent the tragic loss of a healthy youngster should provide peace of mind for parents and health care providers. For the few parents who refuse vaccines, I can only continue to educate and persuade ... and maybe invoke the stories of Dominic, Marquis, and Jennifer.

Meningitis from page 21

oped Hemophilus influenza meningitis before the immunization was widely available, and is now a young adult with complicated special needs including profound hearing loss, developmental delay, and the inability to walk. He is wheelchair-bound. Three-year-old Marquis came to the clinic with a fever of 104 degrees, was sleepy and vomiting. He had Streptococcus pneumonia meningitis. Within hours, despite the best antibiotic treatment, the infection damaged the blood supply to his extremities and he had to have his limbs amputated. Jennifer, a bright freshman at a local college, lived in a dormitory and hung out with friends as all teens do. One weekend during fall semester, she developed a fever, stiff neck, and confusion. Despite antibiotics and intensive care in the emergency department, she was unresponsive and died within 48 hours of Neisseria meningitidis meningitis and sepsis. Vaccination—the best prevention Obviously, prevention of meningitis through vaccination is our best option. Most parents embrace the availability of safe, effective vaccines—a powerful tribute to public health in this country. But a surprising number of parents do not. Yes, children

Adolescents and young adults [are] at special risk for meningitis because they often gather in groups.

Marjorie Hogan, MD, is board-certified in both pediatrics and adolescent medicine, and practices at Hennepin County Medical Center. In 2009, she received the Gold-Headed Cane Award from the University of Minnesota Department of Pediatrics. This award represents life-long dedication to children and the practice of medicine and is the highest honor the department can grant an individual.

Supporting Our Patients. Supporting Our Partners. SupportingYou. A 2011 trip to the remote mountainous region of Central Honduras, Central America, provided hope and healing for many children and a rewarding experience for Dr. William and Lauren Schneider and their daughters, Nikolett and Hannah. The Holy Family Surgery Center opened in 2009 to serve orphaned and abandoned children who have no other way of affording medical care. Dr. Schneider and a volunteer team had the opportunity to examine 200 and perform surgeries on 58 children, involving ACL reconstruction and the repair of many neglected fractures.

Pictured (l-r) are Lauren and Dr. William Schneider and their daughters Nikolett and Hannah. The family spent time caring for orphans and patients in Central Honduras.

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PAT I E N T T O PAT I E N T Something was still not right, however; Mom was losing more weight and her stomach was becoming distended.

clearly recall the crisp fall morning in 2007 when I arrived at my parents’ home and learned the news. My mother was upset because she did not feel well and was sure she had cancer. I tried to reassure her that she would be fine—after all, she was only 55 years old and had no other health conditions. I reasoned that she should see her physician immediately, and my dad was already on the phone trying to get an appointment. The diagnosis came quickly—celiac disease, not cancer. Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. So over the next couple of months, my mom switched to a gluten-free diet. (People with celiac disease cannot tolerate gluten, a protein found in wheat, barley, and rye.) We visited a dietician, bought cookbooks, and tried new recipes.

Seeking an explanation

The

Chemo Zone A patient’s compassion for others lives on in her book By Tracy Rubietta, MBA

After more doctor visits and a trip to the ER, tests confirmed what my mom already knew—she had stage IV ovarian cancer. She was given only a few months to live, a year at best. My mom was strangely calm about her prognosis because she had somehow always known that she would take the same journey her mother had. (Her mother had died of bone cancer when Mom was eleven years old.) Mom wasn’t calm because she had given up. On the contrary, she wanted to fight, because she had a husband who adored her, a daughter who was her best friend, and two grandchildren who worshipped her—not to mention family and friends too numerous to count.

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A week after Mom’s diagnosis, she underwent nine hours of surgery to remove the cancer that had spread throughout her body. Several months of physical therapy and chemotherapy ensued, followed by remission. Unfortunately, the cancer returned three months later.

The sobering reality was that Mom’s cancer was still spreading.

Fighting back My mom fought back with more chemotherapy. Those around her watched in awe as she not only bravely faced her cancer, but also comforted others about her uncertain future; she was everyone’s rock. It was then that Mom decided she wanted to do more, to help others battling cancer. She could have just made hats to donate to cancer patients who’d lost hair from chemotherapy, or encouraged and counseled newly diagnosed cancer patients, or volunteered her time, all of which she did. But she felt it wasn’t enough. In the midst of chemotherapy, Mom felt she could best help others by writing a book about her chemotherapy journey. She wanted to inspire others to fight, and to answer questions for the layperson. She wanted her book to be medically accurate, so she assembled a group of physicians, nurses, and other health care professionals to serve as her book’s medical advisory board. We would sit during chemotherapy and discuss the contents of the book. Each time my mom experienced something new resulting from chemotherapy, she’d say, “This must be happening for a reason! I’d better add this to the book.”

Book takes shape She began typing immediately, but it was hard because chemotherapy had caused neuropathy (i.e., made her hands and feet numb). I kept offering to type for her, but she always refused, saying that it was something she had to do. I remember the early-morning and late-night phone calls like it was yesterday. “Tracy, how does this sound? Am I forgetting anything? You know I have ‘chemo brain’!” We collaborated and she typed. Previously a simple task, typing had She wanted become onerous. In 2009, my mom to inspire others self-published her book, to fight. The Chemo Survival Guide, through an online publishing website. She printed 50 copies and shared them with others undergoing chemotherapy. The response from patients, caregivers, and medical professionals was overwhelming.

the publisher, whose editor asked me to expand sections of the book. At first, I was reluctant. (It was my mom’s book! It was her legacy.) But after talking with my dad and my husband, I decided to do as requested. The Chemo Zone is a 270-page book in which patients can track appointments, medications, imaging tests, lab results, side effects, weight, and body temperature. It also provides advice about living with chemotherapy on a daily basis, e.g., how to manage side effects, exercise, diet, intimacy, and pet care. The Chemo Zone offers answers, advice, and hope to patients and those around them—just as my mom intended. The Chemo Zone is her legacy; Mom’s compassion for others will live on through her book. Linda Rubietta, MFA, co-author of The Chemo Zone, was an artist and award-winning graphic designer, art director, and creative director in the advertising industry. Tracy Rubietta, MBA, is a clinical oncology specialist for a pharmaceutical company and an advocate for cancer awareness, research, and prevention.

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Book’s message spreads In the summer of 2010, my mom asked a local publisher to publish the book nationally because she wanted to make it available to more patients undergoing chemo. The publisher immediately saw the book’s potential and agreed to publish it. Despite this positive development, however, the sobering reality was that Mom’s cancer was still spreading. She had more chemo, but by fall, the cancer had metastasized to her brain. More chemotherapy, radiation, and surgery followed. Mom lost her battle in November 2010.

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A patient’s legacy I had promised her that I’d publish her book so she could continue to help others posthumously. Four days after she passed, I contacted

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JANUARY 2012 MINNESOTA HEALTH CARE NEWS

NEUROLOGY What is a seizure? A seizure is a disturbance of brain function that starts and ends abruptly. Many things can cause seizures: head trauma, a brain tumor, malformation of blood vessels, or some other problem caused when the brain was forming in the womb. Some seizures are caused by a disturbance in brain chemicals, particularly sugar and oxygen. Actually, anyone can have a seizure if deprived of oxygen. Each person has an individual threshold, so if an airplane were to suddenly depressurize, for example, a few passengers might have seizures after three minutes of oxygen deprivation. Others might not seize until after

Seizures and epilepsy

How common is epilepsy?

What everyone should understand about this fairly common neurological disorder

Approximately one of every 10 Americans will have a seizure at some point in their life. In poorer countries, this number is much higher due to inadequate medical care and public health measures. Only about 2 percent to 3 percent of Americans will have more than one seizure on more than one occasion, and most people can control seizures with changes in lifestyle, by using antiepileptic medications, or by treating any underlying disease. Today, the best estimate is that approximately 3 million people currently experience seizures or are taking

By Robert J. Gumnit, MD eight or nine minutes, while most would seize somewhere between four and six minutes. If you see someone who you think might be having a seizure, call 911.

Two types of seizures There are two basic types of seizure: epileptic and nonepileptic. An epileptic seizure is caused by a problem

within the brain, like a tumor. A nonepileptic seizure is caused by a problem outside the brain, like a cardiac arrest, that affects the brain. If someone has epilepsy, it means he or she has had a seizure on more than one occasion or have a condition, such as a brain tumor or stroke, that has led to one seizure and puts the person at risk for more. Classifying seizures helps determine the right treatment, but classification alone is insufficient. Other information, such as EEG (electroencephalogram, which is a type of medical test), family history, age of onset, previous head injuries, etc., is equally important.

MINNESOTA HEALTH CARE NEWS JANUARY 2012

medicine to prevent them. With that many people suffering from seizures, why doesn’t everyone know someone with epilepsy? Actually, everyone probably does. Most people with epilepsy don’t disclose their condition, either because of the stigma still attached or because they hope they won’t have another seizure. Anyone who has had two seizures, even if they occurred many years apart, probably has epilepsy.

Common triggers Whether or not seizures begin in one part of the brain (known as focal localization or partial epilepsy), or whether they start all over the brain at once (known as generalized epilepsy), they all share common triggers. Each individual may have something that causes the seizure to occur, and each person’s seizure may be slightly different depending upon what part of the brain is involved. Some seizures are very difficult to recognize. There are certain factors, however, that make it likely for anyone to experience a seizure, even someone who has never had one before. These are: • Sleep deprivation: Lack of sleep is one of the most potent triggers for seizures. Unfortunately, in America today, sleep deprivation is common. • Stimulants, especially caffeine: Mixing caffeine with sleep deprivation is a recipe for trouble. • Street drugs: crack, “synthetic” marijuana, methamphetamine • Stress and anxiety: Anxiety and stress lower the seizure threshold; that’s why coaches are more likely to have a seizure on game day and students, just before final exams. • Hormonal changes and water retention: Some women are particularly sensitive to hormonal fluctuation and are thus more vulnerable to seizures at a certain point in the menstrual cycle. When I worked as a neurologist at a university student health service, I could predict every spring that I would see a substantial number of students experiencing a first seizure and that there would be more women than men because of hormone fluctuation.

Approximately one of every 10 Americans will have a seizure at some point in their life.

Most could be helped by epileptologists (neurologists with two or more years of specialized training in epilepsy), but it takes 15 years on average for patients to get to an epilepsy center for accurate diagnosis and treatment. The American Academy of Neurology recommends that a patient see a neurologist if he or she has had uncontrollable seizures for three months or more. If the seizures are not under control within one year, patients should see an epilepsy specialist. We are fortunate to have not one but four epilepsy centers in Minnesota. For a list of epilepsy centers in the U.S., go to www.naecepilepsy.org. Referrals from a medical doctor are usually not needed to make an appointment at most epilepsy centers. When a person calls, however, depending on his or her insurance, a referral can be arranged if it is needed. Robert J. Gumnit, MD, is the president of MINCEP Epilepsy Care, Minneapolis, and past president of the American Epilepsy Society.

In the next issue..

When to see a specialist Seizures are not good for the brain; the more you have, the harder they are to stop and the greater the risk for brain damage. Seizures are not good for the soul, either, since they can limit social activity, which can cause depression and anxiety. A seizure Unfortunately, many is a nonfatal people with seizures go disturbance through life without getof brain ting their seizures completely under control. function. Seizures can be scary because they can occur out of the blue, but most patients will do fine with the first medicine prescribed after they have been accurately diagnosed. Some patients will not respond to the first or second medicine prescribed, or will have an underlying disease that requires special treatment.

• Acupuncture • CO2 poisoning • Cholesterol JANUARY 2012 MINNESOTA HEALTH CARE NEWS

10 QUESTIONS

& George Peltier, MD Dr. George Peltier is chief of plastic surgery at Hennepin County Medical Center. He is board-certified in plastic surgery and is a fellow of the American College of Surgeons. Dr. Peltier is a member of the American Society of Plastic Surgeons, the Minnesota Academy of Plastic Surgeons, the Midwestern Association of Plastic Surgeons, and the Lipoplasty Society of North America. His special interests include reconstructive surgery, burn surgery, body contouring, and skin cancer. Please tell us about the different kinds of burn injuries. We see patients with burn injuries caused by many different mechanisms. Certainly there is the usual thermal injury caused by flame, burning grease, hot liquids, etc. We also see patients with frostbite from cold injuries. We see chemical burns that are caused by a variety of things such as anhydrous ammonia, sulfuric acid, nitric acid, etc. The most common type of burn injury is a scald injury, which tends to occur in children approximately 2 to 7 years old. These burns occur mainly in the kitchen, but occasionally in the bathroom as well. We see traumatic injuries to the skin such as degloving (skin abrasion) caused by motorcycle injuries, automobile injuries, etc. What are the most common burn injuries that you see? These are superficial, second-degree burns that occur from scalding liquids or steam. They most often occur in children, but can occur at any age. They can extend all the way from 100 percent of the body surface area to a fraction of a percentage. Is there a specific age group most prone to burn injuries? Small children, i.e., those approximately 2 to 7 years old, are indeed the most frequent victims of burn injury. Their injuries occur in the bathroom and the kitchen, and are usually scald injuries. Please give us a rough estimate of the number of burn injuries requiring medical treatment each year in Minnesota. Do they occur more often in a specific season? I donâ&#x20AC;&#x2122;t have any information to answer the first part of the question, but the second part can be answered easily enough: Most burn injuries occur during the summer months. What are basic things a person can do to minimize the chances of burns? Use common sense and be safeâ&#x20AC;&#x201D;which includes staying aware of risks. Parents should teach children about burn safety and make sure children are supervised at all times. Every year we care for toddlers who are burned when they fall into campfires, or are scalded from boiling liquids or hot bath water. Alcohol intoxication unfortunately plays a huge role in burn injuries because good judgment is compromised. Avoid using accelerants on fires, and turn pot handles away from the front of the stove. These are just a few ways to avoid injury. There are many more safety tips listed on our website, www.hcmc.org/burncenter. Photo credit: Bruce Silcox

How are burn injuries categorized by severity? There are first-, second-, and third-degree burns that are common in our community. Very occasionally, we get a fourthdegree burn. The severity of the burn injury is influenced by the age of the patient and the extent of the burn.

MINNESOTA HEALTH CARE NEWS JANUARY 2012

“

Small children are the most frequent victims of burn injury.

”

First-degree burns are very much along the lines of a sunburn and do not result in the loss of epithelium. Second-degree burns result in the superficial loss of skin. The areas that are burned may blister, and will take seven to 14 days to heal. Third-degree burns encompass the entire depth of the skin and will take a very long time to heal on their own, because even the hair follicles and sweat glands are destroyed. Fourth-degree burns extend into the fascia overlying the muscle and into the muscle or bone. In our community, these are usually electrical conduction burns.

At what point do you advise a person to seek immediate medical attention for a burn? This is an excellent question. The answer may depend on the ability of the patient to take care of a burn. A small burn in the kitchen that involves the fingertips should be run under cold water for five to 10 minutes, and can then be treated with Bacitracin. I don’t think these injuries need to be presented to a medical facility. Anything more than these kinds of small minor burns, however, such as that from a soldering iron, should be evaluated by a physician.

What is the healing process like in a burn injury? Generally, first-degree burns need nothing more than lotion. Seconddegree burns need to have a somewhat moist environment to allow them to heal in the seven to 14 days that is required. Third-degree burns are going to heal by contraction, one wound edge to the other, or with a graft. They will take much longer if not grafted.

What are things that someone should and should not do in first responding to a burn situation? The very first thing to do is to stop the burning process—whether that means putting out a fire or removing hot clothing. Knowing where to go or what to do in a burn situation is a matter of common sense. “Stop, drop, and roll” should be taught to all children; it’s important that they understand that if their clothing catches fire, they must stop, drop, and roll to put out the fire. Cool tap water is excellent immediate treatment for the burn; scientifically, we know that this can actually reverse some of the depth of the burn injury. For a serious burn, however, call 911 for immediate medical care.

What are some of the recent advances in burn care? I think that we have many more choices for burn care than we did 30 years ago. Instead of a very simple choice of topical ointments, we now have many kinds of wound treatments that can last more than a day or two. They are more comfortable for the patient and allow us to have a better fit for the area on the body that was burned and the age of the patient and the depth of the injury.

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D E N TA L H E A LT H

Orthodontics for second-graders? An 8-year-old in braces? Many adults wonder why kids seem to be getting braces at such a young age these days. It’s because parents are realizing that proactive orthodontic evaluation can be thought of as well-child care. Evaluating a child’s teeth early may help detect and fix problems faster and easier than waiting for problems to surface. That’s why, even if your dentist doesn't suggest that your child have an orthodontic evaluation, you might want to consider scheduling one anyway. Earlier detection, easier remedy In the past, parents were advised to wait until their children lost all of their baby teeth before starting orthodontic screening or treatment. Now, orthodontists are working hard to change that mindset for many compelling reasons. Orthodontic treatment methods, materials, and technologies have changed dramatically over the past 25 years or so, and research has determined that many orthodontic problems can be corrected easily if identified and addressed early. In fact, the American Association of Orthodontists recommends that children receive their first evaluation by an orthodontic specialist by age 7. While the family dentist may be able to detect some obvious problems, an orthodontist has

Experts recommend initial screening by age 7, while teeth and facial bones are forming By Jennifer Eisenhuth, DDS, MS

WHO’S GOT BETTER MOVES ON THE DANCE FLOOR, YOU OR ME? Every day is a reason for a person with Down syndrome to smile. And find joy in things the rest of us often overlook. To learn more about the richness of knowing or raising someone with such an enthusiasm for life, call your local Down syndrome organization. Or visit ndsccenter.org today. It is the mission of the Down Syndrome Association of Minnesota to provide information, resources and support to individuals with Down syndrome, their families and their communities. We offer a wide range of services, programs and materials at no charge. If you are interested in receiving one of our information packets for new or expectant parents, please email Kathleen@dsamn.org or For more information please call:

(651) 603-0720 • (800) 511-3696 30

MINNESOTA HEALTH CARE NEWS JANUARY 2012

child’s facial growth is nearing completion, correcting some bite and/or profile issues can be difficult without extractions or surgery. Examples of early “interceptive” treatments that are best done while a child’s mouth and face are still developing include:

10 signs that your child should be seen by an orthodontist 1. Early or late loss of baby teeth 2. Difficulty chewing or biting 3. Mouth breathing 4. Finger sucking or other oral habits 5. Crowding, misplaced, or blockedout teeth 6. Speech difficulty 7. Protruding teeth 8. Teeth that meet in an abnormal way or don’t meet at all

• Expanders to correct crossbites, create room for crowded erupting teeth, and reduce the need for future tooth removal (a much more common practice years ago before expanders). An expander is an appliance that widens the upper jaw by putting gentle pressure on the upper molars each time an adjustment is made. The orthodontist decides how often an adjustment is needed based on how far the jaw needs to be widened. • Spacers to preserve room for unerupted teeth. • Partial braces that reduce the risk of trauma to protruding front teeth and create symmetry by influencing jaw growth.

2. Avoid decay or injuries: Genetic problems such as underbite, overbite, overjet, crossbite, jaw size, 9. Facial imbalance or asymmetry tooth size, crowding, extra or missing teeth, and 10. Grinding or clenching of teeth facial asymmetry issues are just some of the conditions that can be treated more effectively when detected early. Timely treatment for some of these problems can reduce susceptibility to tooth decay or gum disease by facilitating better access to teeth for proper brushing and flossing, decrease risk of chipping due Orthodontics for second-graders? to page 32

additional years of training beyond dental school and is specially trained to assess, detect, and address not only issues with teeth, but also the overall growth and formation of the jaw and facial bones that can affect the mouth’s form and function. What’s more, many orthodontists provide an initial exam free of charge, so there’s really no reason to delay asking your dentist to refer you to an orthodontist. But if you’re still skeptical or overwhelmed by the prospect of yet another family appointment, here are five good reasons to have your child assessed by an orthodontic specialist by age 7. 1. Reduce or avoid future treatment: Advancements in orthodontics have made it possible to correct many problems early and sometimes reduce future orthodontic treatment time. In some cases, early treatment can prevent the need for invasive surgeries that may be required to address problems that could have been more easily addressed while the child’s bones were still forming and malleable. Why begin orthodontic screening at age 7? Most children have a mixture of baby and adult teeth and their first adult molars may be beginning to erupt around this time, which establishes the back bite and makes it possible for an orthodontist to evaluate front-toback and side-to-side tooth relationships. For example, the presence of erupting incisors can indicate whether a child has an open bite, an overbite, crowding, or a gummy smile. Frequently, it is easier to correct problems when they are detected and treated early because the child still is growing. When parents wait until all of their child’s permanent teeth are in and the

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5. Kick bad habits early: Sometimes, the position of a child’s teeth is affected by oral habits that should be eliminated or corrected early to prevent problems from developing or progressing. For instance, speech therapy may be prescribed to correct tongue thrust, a swallowing pattern that can push the teeth forward and apart. Oral devices can help habitual thumb or finger suckers to

Orthodontics for second-graders? from page 31

to protruding teeth, and correct speech impediments caused by bite issues. 3. Prevent extractions: Today’s orthodontists generally try to avoid extractions, which were a more common practice in the past to address crowding and spacing issues. A Carrière Distalizer is an example of an early intervention appliance that can be used to prevent permanent tooth extraction in patients when they’re older. The device starts to correct overjet, a condition in which the patient’s bite is a full tooth ahead, before braces are applied. This is about a four-month process that also can decrease the time the patient is in braces. Previously, extraction was the common treatment for this problem. It’s important to note that in some cases, when a patient has more teeth than the individual’s jaws can support, an extraction actually is beneficial to long-term orthodontic results. However, the general priority is to preserve and maintain all of the permanent teeth because extractions can have long-term effects that are not apparent until well into adulthood.

Orthodontic treatment goes beyond aligning teeth.

kick their habit, which can cause front teeth to protrude. Addressing these habits can help to reduce treatment time and ensure the orthodontic treatment is not undone once braces are removed. It’s important to note that the majority of elementary schoolaged children do not need early treatment. However, for those who do, early screening and intervention can help prevent dental problems, reduce future treatment time, and correct issues that are much more difficult or impossible to address later, once facial bones are fully formed.

4. Maintain a positive profile: Orthodontic treatment goes beyond aligning teeth; it can affect overall facial appearance. A skilled orthodontist analyzes not only the jaws and teeth, but also facial form, shape, and symmetry, in order to develop a treatment plan that addresses form, function, and profile. In fact, proper early intervention often can prevent the need for oral or plastic surgery “extreme makeovers” later in life.

Jennifer Eisenhuth, DDS, MS, an orthodontist certified by the American Board of Orthodontics, has been practicing orthodontics since 1996. Dr. Eisenhuth and the staff members of her Cosmopolitan Orthodontics maintain offices in Eagan, Lakeville, and Savage.

Minnesota

Health Care Consumer

December survey results...

Association

1. In discussing my health status with my physician, I withhold information due to concerns it may increase my insurance premiums/status.

Each month members of the Minnesota Health Care Consumer Association are invited to participate in a survey that measures opinions about topics that affect our health care delivery system. There is no charge to join the association, and everyone is invited. For more information, please visit www.mnhcca.org. We are pleased to present the results of the December survey.

3. I limit my utilization of health care services because of potential impact on my insurance premiums/status. 40

Percentage of total responses

9.1%

5 0

Strongly agree

30.9%

Agree

No opinion

Disagree

16.4%

20.0%

18.2%

15 10

7.3%

12.7% 7.3%

5 Strongly agree

Agree

No opinion

Disagree

Strongly disagree

MINNESOTA HEALTH CARE NEWS JANUARY 2012

23.6%

12.7%

10.9%

10 5 Strongly agree

Agree

No opinion

Disagree

18.2%

23.6%

30 25 20

20.0% 16.4%

14.5% 10.9%

10 5

Strongly agree

Agree

No opinion

Disagree

Strongly disagree

5. When physicians are mandated to collect data about domestic violence, gun ownership, smoking, drinking, drug use, etc., it limits the productiveness of the physician-patient relationship. 40 38.2%

30.9%

25 20

Strongly disagree

Percentage of total responses

25 20

38.2%

29.1%

36.4% 36.4%

4. I do not feel my medical records are adequately private.

2. I feel there is inaccurate information in my medical record.

Strongly agree

Agree

No opinion

Disagree

Strongly disagree

Minnesota

Health Care Consumer Association

Welcome to your opportunity to be heard in debates and discussions that shape the future of health care policy. There is no cost to join and all you need to become a member is access to the Internet.

Members receive a free monthly electronic newsletter and the opportunity to participate in consumer opinion surveys.

www.mnhcca.org

Join now.

â&#x20AC;&#x153;A way for you to make a differenceâ&#x20AC;? JANUARY 2012 MINNESOTA HEALTH CARE NEWS

Tips from page 11

If losing weight is on your list of resolutions for 2012, consider using these recommendations for healthy eating in restaurants.

If you wait to pick out your food until you are at the restaurant, you may be persuaded by what people around you are ordering, smells, or the server’s recommendations. When you are overly hungry, your body releases hormones that make you want fat and sugar. Remember: 100 extra calories per day for a year equals a 10-pound weight gain! Deciding what to order before you reach the restaurant will help you stick to your meal plan. Potential pitfalls

Extras such as appetizers, soup, and bread typically just add more calories and sodium to your daily intake because it is easy to forget to adjust entrée choices or portion sizes to account for the added calories and sodium. Having the breadbasket sit in front of you when you are hungry may cause you to snack on the bread (and butter) instead of filling up on your more nutritious, balanced meal. People watching their calories should consume five to six ounces or servings of grains daily (depending on their weight, height, activity, and goals). One slice of bread is equal to one ounce of grain, so breadbasket snacking can easily put you over the recommended intake of grains if you also order pasta or rice. If a restaurant’s standard side dish is starchy, such as potatoes or rice, ask to substitute vegetables. That’s because vegetables are rich in vitamins and minerals, low in calories, and have fiber and a high water content that help to fill you up. Even a healthy option may be larger than you need. Ask the server for a to-go box and put half of the meal into the box immediately. People tend to nibble their food once they are full if it sits in

Catering by Seward Co-op

front of them. Another way to control portion size is to order an appetizer as your meal. On the side When ordering your meal, ask the server to put dressing and sauce on the side. Just be sure to monitor your use of dressing and sauces; typically, you receive more on the side than if it is served directly on food. Avoid the temptation to pour dressing or sauce onto the food yourself, as you will end up with excessive calories. Instead, dip your fork into the sauce or dressing and then pick up pieces of the salad or entrée. Be aware of high-calorie beverages. Don’t assume iced tea is unsweetened. Alcoholic beverages and dessert coffees can add 100 to 500 calories to your meal, and some specialty beers have as many calories in one glass as a six-pack of light beer. Some margaritas are equivalent in calories to consuming seven candy bars. Stick with water! Avoid problem ingredients If you have certain food allergies or intolerances, you need to be knowledgeable about your requirements. If you are intolerant to gluten, for example, it is best to look online or call the restaurant to see if it can accommodate your needs. Some restaurants are starting to label menu items as wheat-free or gluten-free. However, other establishments may have no idea what “gluten-free” means. Steve Kroeker, a chef by trade, recently started following a gluten-free diet and visited a restaurant where he was offered whole-wheat pasta as a glutenfree alternative, even though whole-wheat contains gluten. “Even though there are many more gluten-free options now available, it is still very misunderstood and 100 extra unless you, as a gluten-free eater, have a clear understanding of what you can and calories a day cannot have, you put yourself at risk,” can produce says Kroeker. Many sauces contain gluten and items that are sautéed may be dipped a 10-pound in flour, which contains gluten. Menus weight gain may not contain this information, so you need to request it. If your server is unsure in a year. whether or not an item contains gluten, ask to speak to the chef or manager. Check, please Plan your choices before you reach the restaurant, and ask the server questions about how the food is prepared or if you can substitute items. Make your plate as colorful as possible, since the more colors on your plate, the more vitamins, minerals, and antioxidants (inflammation- and cancer-fighting compounds found in food) you will consume. By following these suggestions, you can maintain proper nutrition when dining out. Heidi Greenwaldt, MS, RD, LD, CNSD, is a registered and licensed dietitian and is the spokesperson for the Minnesota Dietetic Association.

MINNESOTA HEALTH CARE NEWS JANUARY 2012

A philosophy of caring is good. A history of it is better. Caring. It would be nice if you could see it, like an amenity. Or tour it, like an apartment. But you can’t. All we can do is give you our definition: Caring is believing that everyone is someone who deserves to feel loved and valued, and be treated with dignity. That’s not just something we say. As the nation’s largest not-forprofit provider of senior care and services, it’s what we’ve been doing for almost 90 years.

www.good-sam.com

To learn more about our communities in Minnesota, call 1-888-GSS-CARE.

The Evangelical Lutheran Good Samaritan Society provides housing and services to qualified individuals without regard to race, color, religion, sex, disability, familial status, national origin or other protected statuses according to federal, state and local laws. All faiths or beliefs are welcome. Copyright © 2010 The Evangelical Lutheran Good Samaritan Society. All rights reserved. 10-G2016