2020 MyNorth Medical Insider

2020

Medical Insider Professionals • Hospitals • Practices • Technology

William Rawlin, DO Physician of the Year Michigan Association of Osteopathic Family Physicians

New Leaders in Patient Care

Meet the next generation of medical experts who call Northern Michigan home

McLaren Northern Michigan’s Breast Cancer Nurse Navigators Give Support Every Step of the Way Munson Medical Center’s Transformed NICU Close-to-Home Care for our Area’s Tiniest Residents Breakthrough Outcomes: TCAR Procedure for Carotid Artery Disease Traverse Health Clinic’s Counselors Shed Light on Anxiety

Tips for Managing Your Blood Pressure Proven Methods to Maintain Weight Loss Make the Very Most of Your Dermatology Visit MI 1

MyNorth.com

A supplement to

Medical Insider A MyNorth Media Publication

PRESIDENT/EDITOR IN CHIEF

Deborah Wyatt Fellows

CHIEF OPERATIONS OFFICER

Michael Wnek

EDITOR MANAGING EDITOR DIGITAL AND CONTENT EDITOR PROOFREADERS REGULAR CONTRIBUTORS

Emily Tyra Elizabeth Edwards Carly Simpson Elizabeth Aseritis, Caroline Dahlquist Kim Schneider, Tim Tebeau, Andrew VanDrie

Table of Contents Dermatologists Focus on Patient Interaction........................... MI 3

ART DIRECTOR PRODUCTION DIRECTOR

Gail Snable Theresa Burau-Baehr

Tips for Managing Blood Pressure................................................ MI 5

Rachel Watson

Meet a Nurse Navigator....................................................................... MI 7

WEB DIRECTOR

Jen Berigan

Real Solutions for Anxiety................................................................. MI 9

DIRECTOR OF SALES

Julie Parker

ASSOCIATE ART DIRECTOR, SPECIAL SECTIONS

ACCOUNT EXECUTIVES

Darren Bergquist Ann Gatrell Jill Hayes Meg Lau Cyndi Ludka Lori Niemer

Seeing People Beyond Their Eyes................................................. MI 10 Her Passion in "Prevention'............................................................... MI 11 Go Back to Basics to Manage Weight.......................................... MI 13 A Doctor & A Teacher........................................................................... MI 16 Munson's NICU Continues to Expand......................................... MI 17

MARKETING DIRECTOR MARKETING COORDINATOR MYNORTH TICKETS CUSTOMER SUCCESS SPECIALIST OFFICE MANAGER BOOKKEEPER

Erin Lutke Kara Jarvis

Emily Oakes Libby Stallman Kim Stewart

Just Breathe!............................................................................................. MI 19 Tasty Medicine......................................................................................... MI 21 Mysteries of the Inner Ear.................................................................. MI 23 Breakthrough Artery Surgery.......................................................... MI 25 Healthy Smile at Any Age.................................................................. MI 26 Medical Listings...................................................................................... MI 28

A Supplement to

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MyNorth Medical Insider 2020

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Dermatologists Focus on Patient Interaction

by Kandace Chapple | photo by Paul Yezbak

The Associates in Dermatology of Traverse City recently expanded from 10 exam rooms to 21—and now uses scribes, a sort of “two heads are better than one” at every appointment. The two major changes have transformed how quickly and personally patients can be seen, according to founder and dermatologist Joan Griner, MD, and the scenario is a win-win for both patients and docs.

“By increasing our available exam space, we have improved the patient flow for each provider,” Griner says. Instead of the typical industry six-month wait to get in to see a dermatologist, AID can see patients within days instead.

In addition, there is now a scribe in the exam room with each patient, tapping away on an iPad, recording everything for the doctor.

“Our Medical Assistants (MAs) are fantastic,” Griner says.

“They are in the rooms with us, noting what we see on the patient’s skin and recording our recommendations. For example, they might begin setting up a procedure while I’m discussing it with the patient. Or they might step out and retrieve samples of a product I’m recommending. They remain a silent partner, quietly performing their job in the background.”

An additional benefit of the scribe system, Griner adds, is that the MAs get to connect with the patients personally.

“They now have a stronger sense of purpose and interest in the care of the individual patient, which reflects in the subsequent interactions with that patient, such as for phone calls or scheduling,” she says. “They have a greater ownership of patient care and a desire to be a part of the success of our practice.”

Griner sees a multitude of skin care issues, but because of the prevalent population of retirees in Northern Michigan, she most often treats skin cancer and UV damage.

“At least one third of my patients travel to warm, sunny climes in the winter, essentially exposing their skin to intense UV light 12 months of the year,” she says. “Most people choose to live here to enjoy the outdoors! And while the most effective way to protect your skin is to avoid sun exposure, I recognize my patients need more realistic options.”

Griner encourages her patients to limit their direct sun exposure time, particularly aiming to avoid midday sun from 10 a.m. to 4

p.m. in the summer, to always look for shade (umbrellas, trees, cabanas), to choose hats with a wide brim to cover ears and neck, and wear long-sleeve “sun shirts” and pants.

“I recommend sunscreen with SPF 30, containing titanium dioxide or zinc oxide. These have always been my favorites because they are a more effective ‘physical’ block. They screen all waves of UV light and typically don’t cause as much irritation. Several really good products are on the market, and they will not make you look like Casper the friendly ghost.”

Griner recommends patients who have had skin cancer or a family history of skin cancer, see their dermatologist every year.

She recommends every six months if they have had a melanoma within the last five years. Also, patients who have had “atypical” or “dysplastic” moles should be seen yearly, as these are thought to be a marker for higher risk of developing melanoma.

“Anyone who notices a spot that captures their attention, whether it be because it is new, itching, bleeding or darker, or the ‘ugly duckling’ that doesn’t look like the rest, should be seen by a dermatologist,” Griner says.

Griner recommends setting aside 15 minutes once a month for monitoring moles and using UMSkinCheck, a free app developed

by The University of Michigan to guide users through a skin check.

“Just like every other cancer, early detection is the key in skin cancer,” Griner says. “The difference is that skin is so readily accessible that you CAN exam it at home!”

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Tips For Managing Blood Pressure

by Courtney Jerome | photo courtesy of McLaren Northern Michigan

As an interventional cardiologist who practices a wide scope of cardiology, managing his patients’ blood pressure is something Dr. Thomas Earl, MD, of McLaren Northern Michigan in Petoskey knows well.

Often Dr. Earl sees his patients when they’re suffering a heart attack or another kind of medical catastrophe. “I really do my best to try to focus on prevention on the other end of that spectrum before something terrible happens,” he shares. And that includes educating them on taking ownership of their own health.

One recommendation Dr. Earl stresses is for patients to get their blood pressure checked regularly. “High blood pressure is super common. Close to two thirds of people over 60 in this country will have high blood pressure. And for the most part it’s asymptomatic.

What I mean by that is there aren’t a lot of symptoms associated

with it. So it’s important to have your blood pressure evaluated at least once a year.”

And what if a patient’s blood pressure is too high? What’s next?

Here are Dr. Earl’s tips on managing your blood pressure via lifestyle modifications, before resorting to medication.

• Follow a healthy diet—particularly a lower sodium diet with 2400 mg of sodium a day or less.

• Get regular exercise. “It has a role in keeping blood pressure low, and even helping to lower it.”

• Drink alcohol in moderation—one to two drinks per day at a maximum.

• Don’t smoke.

• Control other health issues like high cholesterol and diabetes.

• Maintain a healthy body weight. “This is also critically important, as losing or gaining as little as 10 pounds can impact your blood pressure in a good or a bad way.”

MyNorth Medical Insider 2020

MI 5

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Meet a Nurse Navigator

by Courtney Jerome photo courtesy of McLaren Northern Michigan

Melissa DeSimone, MSN, RN, OCN, CBCN

“They are numb,” says Melissa DeSimone, MSN, RN, OCN, CBCN, Breast Cancer Nurse Navigator. She’s describing a patient who has been recently diagnosed with breast cancer.

“They don’t remember much of what is said, and that is pretty normal. It’s overwhelming. It’s nice to be a second set of ears, support them, be there for them and help them through.”

And that's exactly what DeSimone does as a nurse navigator for McLaren Northern Michigan. From diagnosis through the establishment of a plan of care and medical oncology, DeSimone is there. She sits in on medical meetings between doctors and patients. Helps with discovering and solving their financial dilemmas. Coordinates genetic appointments for patients' families. Calls patients before surgery to answer questions. Visits them after surgery in the hospital. And even creates a customized care plan per patient that outlines every step of their journey to help understand their diagnosis and treatment plan.

“A big part of what I do is help with education,” explains DeSimone. “Making sure patients understand everything. If patients meet the criteria to see if they need chemo immediately, I am able to get that process started. So when they meet with medical oncology it’s ready, instead of needing to wait for approval.”

The Oncology Nurse Navigator Program in Petoskey has been in effect for over 10 years now for breast cancer and lung cancer patients at McLaren. Annually, more than 2,000 people receive individualized positive support thanks to it, from across 22 Northern Michigan counties.

Each nurse navigator receives specialized training that complements their well-established healthcare careers. Not only do they help with patients’ physical symptoms, but they support their emotional, psychosocial and financial needs as well.

The financial impact is huge, says DeSimone.

“If we identify a patient without insurance or with a large deductible, I help them enroll in assistance that helps patients get treatment who wouldn’t get treatment otherwise.”

MyNorth Medical Insider 2020

MI 7

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Real Solutions for Anxiety

by Kandace Chapple | photo by Michael Poehlman

Toni T. Hernalsteen, LMSW, SAP

Even a few years ago, anxiety wasn’t something often talked about. But today, there’s a language for anxiety disorders, along with an ever-growing professional field of treatment, according to Clinical Social Worker Toni T. Hernalsteen, LMSW, SAP. “Anxiety disorders are real,” she says. “Just as real as heart disease or disabilities. Anxiety does not discriminate. Its ability to affect all ages, race, gender and profession is profound.”

Hernalsteen believes that the rate of people seeking treatment has become more noticeable as mental health stigmas are challenged and seeking support becomes normalized.

“Anxiety disorders may be on the rise or perhaps they have always been present,” she says. “But they are now becoming a part of the conversation.”

In her work at Traverse Health Clinic in Traverse City, Hernalsteen offers insight on how to tell when everyday anxiety is something more.

“Everyone experiences anxiety before a job interview or when facing a challenging situation,” she says. “Anxiety can serve a healthy purpose. It helps us remain solution-focused and productive.

The concern lies with the inability to control worry, fears, irritation or difficulty concentrating, thus interfering with daily life.”

Physical symptoms may include increased heart rate, hot flashes, sweating, chronic fatigue or nausea.

“The first step to getting help is to create a pathway to assistance,” she says. “Start with a phone call to your primary care provider, counselor or a trusted friend.”

Hernalsteen says that treatment can be multifaceted and could include medication and lifestyle changes in conjunction, or separate from, psychotherapy.

“Psychotherapy such as Cognitive Behavioral Therapy (CBT) is widely used and works on replacing negative and unproductive thoughts with productive and realistic ones,” she says.

To get started at Traverse Health Clinic, clients can expect a 45-60 minute initial appointment, during which a counselor will discuss personal history, the current situation and symptoms.

“The joy of counseling is that the clients are in control about how much information they share and when they share it,” Hernalsteen says. “Be honest and ask questions. This is your treatment. The counselor is there to provide assistance while you do the work of bringing satisfaction to your life.”

MyNorth Medical Insider 2020

MI 9

Seeing People Beyond Their Eyes

by Courtney Jerome | photo by Michael Poehlman

Dr. Rebekah Noss Lynch

She might have moved away from Traverse City for her undergraduate and optometry education, but Dr. Rebekah Noss Lynch knew she was bound to come back home. Dr. Lynch has been back in Traverse City for more than 10 years now, and loves having the opportunity to practice and raise her children here and take advantage of all Northern Michigan has to offer.

That’s a message we hear a lot here in Northern Michigan. And when you can do WHAT you love in the PLACE you love, “fortunate” is the feeling that comes next, says Dr. Lynch. An added bonus for her: She gets to practice alongside her dad.

Why are you passionate about optometry?

It sounds cliché, but what is cooler than helping someone see? One of my favorite moments as an optometrist is prescribing a child their first pair of glasses, or a teenager their first pair of contact lenses.

Helping a patient with a second pair of glasses for their eight-hour workday at the computer or a pair for someone who loves to sew or read can be both enjoyable and very fulfilling.

What experiences have made you positive this field was your calling?

When I graduated and moved back to Traverse City, my dad had been in practice for almost 30 years.

Working and collaborating together at Full Spectrum Eye Care for the past 10 years has made me so grateful that I became an optometrist and had the opportunity to work with him and with patients in this capacity.

Aside from working with my dad, forming relationships with patients and building their trust in me as their optometrist is something I really value about my career and the way I operate my office.

What is the most prevalent health issue you see in patients?

I am seeing more Diabetic Retinopathy in my office than I have in the past. As we all know, our nation is becoming less healthy, more obese, and therefore we are seeing an increase in diagnosed cases of diabetes.

When a patient’s diabetes is uncontrolled, I can see that in their retina with bleeding and swelling, which can potentially cause permanent vision loss.

What are three things patients at any age can do to promote healthy eyes?

• Wear sunglasses. The sun can be extremely damaging to the eyes and can contribute to both cataracts and macular degeneration.

• Eat a healthy diet. Dark leafy greens and orange peppers are really good for the health of the eye.

• Check yearly, see clearly! Eye exams aren’t just if you need glasses or contacts. Many conditions like high blood pressure, high cholesterol, diabetes, brain tumors and many more can be detected during a routine eye exam.

MI 10

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Her Passion is “Prevention”

by Courtney Jerome | photo by Michael Poehlman

Initially Dr. Jennifer Emmons planned to practice family medicine. But something happened when she was in med school. She did something she had never done before and it absolutely affected her ambitions—she read an entire textbook. About the heart.

“I was just so fascinated about it all that it almost felt like fun reading, not just school work,” she says. “I think for me it involves a lot of physics (which was never my favorite in undergrad!) but when applied to how the heart works and blood flow in the body in general, it makes sense. And I see how affecting one part can change how the heart functions for the better or the worse.”

Fast-forward to the present and you’ll find Dr. Emmons with Munson Medical Center’s Traverse Heart & Vascular team in Traverse City and Grayling, focusing on cardiology and echocardiography. After growing up Grayling, she is ecstatic to be back in Northern Michigan.

Dr. Jennifer Emmons

What’s one thing about cardiology you’re most passionate about?

“Cardiovascular disease is the number-one cause of death for both men and women. I feel like it’s not talked about enough that it’s the number-one cause of death in women, specifically. There’s a big movement for breast cancer, etc., but more women actually die of heart disease or stroke.”

What is something you wish your patients would speak up about more?

“Often people who have chest discomfort say, ‘Oh I just assumed it was this.’ I think it’s human nature to assume it’s something less serious than your heart.

But it’s better to make sure it’s NOT your heart, and to not assume it’s heartburn—which presents differently in everyone, particularly in women. Women who get chest pain may have atypical symptoms: it could be shoulder pain, jaw pain or shortness of breath or nausea. If they’re getting any of those symptoms with exertion, and only with exertion, it’s much more concerning for heart disease.”

Tell us about the testing available to help prevent heart disease?

“I am more into non-invasive testing, so I love being able to get answers for patients noninvasively if possible. I think for women in general, there’s more research going into the risk factors that lead to heart disease. If we can help make them aware that their risk is higher, and start more preventative measures earlier in life (between their childbearing years and when cardiovascular disease usually presents), there’s good potential to help.”

MyNorth Medical Insider 2020

MI 11

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Go Back to Basics to Manage Weight

by Kandace Chapple | photo by Michael Poehlman

We talked with Ben Watson, MS, ACE-CMES, Weight Management Coordinator at Munson Medical Center's Healthy Weight Center. He and his teammates take a comprehensive, evidence-based approach to help clients reach and maintain their goals.

What is your best exercise advice?

Simplicity and consistency. Start simple with a plan and be consistent. You can always expand, add extra days or work out harder later.

But first build confidence, build a habit and learn what works for you.

Ben Watson, MS, ACE-CMES

What’s a great starter plan?

When I build programs, I aim for: upper body push, upper body pull, hip dominate exercise, knee dominate exercise, core strength and cardio. This typically creates a well-balanced routine for most people.

How hard is hard enough?

I encourage people to be uncomfortable with exercise. Breathe harder than normal and work to feel a slight burning of the muscles. Focus on frequency to start with: one to three times a week consistently, starting with 5-10 minutes a day and progress slowly.

People feel they need to exercise for 60 minutes or it’s not worth it, when in reality anything is better than nothing.

Is walking enough?

Walking is underrated! When all else fails, try to get more steps than normal. Find your baseline step count using a pedometer or your phone’s built-in step counter.

Work on adding 500-1000 more steps each month.

What is the best way to lose weight?

Plain and simple: hard work, plus time. Individuals who succeed are able to do so because they change behaviors, change the environment around them and make healthy decisions 80% of the time. Using food tracking apps, trying new group classes and health coaches all add a layer of accountability.

What is the latest in the exercise industry?

Instead of focusing on the scale, professionally we are now more interested in the individual parts: muscle, bone, fat tissue and hydration status. To answer these questions, we acquired an InBody Body Composition machine. Now we can measure body fat percentage, estimate metabolic rate and provide realistic end-goal weights for each person.

This information drives the exercise program and nutrition strategies because it can be very specific for each person, which brings better results.

MyNorth Medical Insider 2020

MI 13

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2 FOR 1:

a doctor & a teacher

by Kandace Chapple photo by Michael Poehlman

Dr. William Rawlin

J. William Rawlin, DO, holds a unique position in the Traverse City medical community: As the director of the Munson Family Practice Center, he spends his days doing what he’s always done—caring for his patients. But he also spends his days bringing up the next generation of doctors, as he works side by side with Michigan State University residents at the center.

And his work is being recognized: He was just named the Michigan Association of Osteopathic Family Medicine Physician of the year.

We caught Dr. Rawlin for a few moments recently to ask a little more about his style of teaching—and care: Why family medicine?

Family medicine, at its heart, is about relationships. At first, I thought I wanted to be an orthopedic surgeon. But my first family medicine rotation changed everything. I saw the long-term relationships with patients, and that’s why I wanted to be a doctor. Not to just fix things, but to be a part of people’s lives: sharing in the joy of a new baby, being present during the heartache of losing a loved one and all the points in between.

Why teaching?

I might be biased, but I think there is a significant benefit to getting care at a residency clinic. I have always jokingly said you get two for the price of one! You have a seasoned, experienced attending physician, paired with a less-experienced physician that is driven to learn how to practice the best medicine possible. That results in high-quality care. Patients get to be a part of that and contribute to teaching our next generation of physicians. To me, that’s pretty special.

What are three things that all people can do to live a healthier life?

• Life is motion. We all need to move more.

• Almost everything in moderation, except for tobacco and other illicit drugs.

Just say no to those!

• We need to attend to all aspects of our overall health: physical, mental and spiritual. I wish there was less stigma regarding mental health issues. They have such an enormous impact on one’s overall health.

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Munson's NICU Continues to Expand

by Kandace Chapple | photo by Michael Poehlman

Imagine a little guy, weighing just one pound, born too early, needing help with everything he does. Enter neonatologists Lisa S. Allred, MD, and Matthew Arnold, MD. The pair has transformed the care available at Munson Medical Center’s Neonatal Intensive Care Unit (NICU) in Traverse City in the last few years, bringing help closer to home for hundreds of parents. Here, we chat with Dr. Allred, who shares how her team cares for our area’s tiniest residents: What is the biggest change you’ve made?

Before this year, Munson could only care for premature infants born at 28 weeks' gestation and greater. Now, we offer care for all infants born early, regardless of gestational age. Munson's NICU is the only Lower Peninsula facility north of Grand Rapids equipped to handle babies with medical needs. (Marquette also has a NICU.) Last year, we cared for 330 infants, including more than 100 babies brought to Munson via jet, helicopter or ambulance, from as far away as Sault Ste. Marie and Alpena.

Who are your tiniest patients?

Our smallest babies weigh about a pound and may only be 12 inches long. They are perfectly formed, and look like miniature, thin versions of a newborn baby. Our most premature infants cannot yet open their eyes, but can move, cry, take breaths and even hold on to their mother's finger.

Tell us about Munson's ongoing care for premature infants.

Education is key. Neonatal simulators are being used to model resuscitation, stabilization and interventions that will optimize brain development. A Critical Care Residency program is training our newest nurses in hands-on, acute management of critically ill newborns.

Additionally, we are moving toward a family-integrated model of care, where parents have an integral role within the care team.

Lisa Allred, MD

How can parents provide care?

Skin bonding with parents is one of the most important contributors to growth and development. We encourage parents to hold their little one against their warm, bare chests every day. This "kangaroo care" promotes bonding, stimulates maternal milk production and decreases infant stress. It’s amazing to watch babies heart rates and breathing rates slow down within minutes of snuggling into their parents’ chest, a clear indicator that they're at ease.

What’s next for NICU? Plans for a new NICU are a part of the Family Birth and Children’s Center expansion that is a few years down the road. There will be 12 private rooms, 12 semi-private transitional beds and an expanded facility of 15,500 square feet. Right now, we have 20 beds in a communal room and our current space is just 2,700 square feet.

MyNorth Medical Insider 2020

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Advertorial

The Butterfly Effect Life Skills Center 3291 Racquet Club Drive, Unit C • Traverse City, MI • 231-421-8000 Empowering patients to take charge of their own health is one of the most satisfying experiences of our professional work. We want our patients to have a meaningful experience when they walk through the door. Our mission and goal is to provide patient-centered education and assistance with Medication assisted addiction therapy. We are the only center in the region that takes the time to comprehensively evaluate each patient, looking at all aspects of care, including life coaching, living skills, mind, body, spirit and emotional needs. Your concerns, goals and needs are important to us, and your privacy is guaranteed. Our doctors and staff maintain

their position at the forefront of the ever expanding Medication assisted addiction therapy by actively studying the latest developments in this highly specialized field. The Butterfly Effect Center is now accepting new addiction patients and would like to invite you for a personalized assessment with our staff.

Please call for an appointment or information, or find us on our Facebook page at www.Facebook.com/TheButterflyEffectCenter

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1400 Brigadoon Court,City Traverse City, MI 49686 1400 Brigadoon Ct, Traverse | BoardmanLakeGlens.com

Daryl Busch

Just Breathe!

by Patty LaNoue Stearns | photo by Michael Poehlman

For an hour every Tuesday at Kalkaska Memorial Health Center, a group of formerly un-limber, achy people are stretching, chilling, taking deep breaths and reaping the healing powers of the ancient Indian practice of yoga. And thanks to former Munson Healthcare CEO Jim Austin, it’s free.

Austin had experienced the benefits of yoga firsthand in Traverse City when he decided to initiate the Kalkaska program a decade ago.

“He wanted to encourage the community to take care of themselves,” says Daryl Busch, the certified yoga instructor and former kindergarten teacher who has been teaching the class since 2012. Yoga combines physical, mental and spiritual pursuits to relieve anxiety, depression, enhance fitness, body image, improve the cardiovascular system and mindfulness pertaining to eating, according to the Harvard Medical School.

“We have a lot of regulars,” says Busch. Her students range from a sixth-grader to a woman in her 80s. “Their doctors recommend them. I give them the tools to help relieve their symptoms. The more you move, the better you feel—you lubricate your joints. Many of my students say they have improved.”

Busch starts with easy postures. “I take it in stages and push to higher levels.” The meditative component of yoga helps her students let go of anger, stress and pain, and the deep-breathing element is great for the heart, lungs and chest, “opening up areas of the body that have just been stuck,” says Busch, adding that practicing yoga provides a nice relief from the day.

“It’s the greatest gift—a chance to have one hour a day and let go and give themselves the attention they need to relieve stress and pain.”

Free classes are open to the public and employees in the Cardiac Rehab Gym. Contact Marianne Ewald, 231.258.7525. munsonhealthcare.org

MyNorth Medical Insider 2020

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Advertorial

105 Hall Street, Suite D Traverse City, MI 49684 1-800-640-7478 www.northernhealthcare.org Northern Health Care Management is proud to be part of Michigan’s statewide effort to provide comprehensive services for people who are nursing home eligible and those who choose to receive care at home. Our mission is to walk with you on your journey to living the most independent life possible while ensuring choice, dignity, and quality of life.

If you, or a loved one, are currently living in a nursing facility but prefer community living, we can help transition you into a home where your health and safety needs will be met. If you reside in the community in your own home but need help with medical and safety needs, we can also get you the assistance you need to remain healthy and safe at home.

Community-Based services we provide meet medical needs and support those who need care with activities of daily living. You will be assessed for service need and develop a person-centered plan with options tailored to meet your needs, ongoing support, and in-home follow-up. In addition to supports coordination, specific service choices include in-home care and assistance, home-delivered meals, private duty nursing, environmental modifications, snow plowing, medical equipment and supplies, housing assistance, access to a Medicaid eligibility specialist, and transportation.

Northern Health Care Management also provides Nursing Facility Transition services that are designed to help assist you in moving from a nursing facility back into the community to live in a home of your choosing.

We can provide services for residents within our 10-county region, including Antrim, Benzie, Charlevoix, Emmet Grand Traverse, Leelanau, Kalkaska, Manistee, Missaukee, and Wexford.

If you are seeking services for yourself, or a loved one, we would be happy to speak with you and share how we can help.

Please call us at 1-800-640-7478 to learn more.

Northern Health Care Management is a division of Northern Lakes Community Mental Health Authority and a MI Choice Waiver agent.

Advertorial

Traverse Dental Associates

555 S Garfield Ave • Traverse City, MI 49686 231-947-0210 • traversedental.com

Dr. Van Horn, Dr. Lumbrezer, Dr. Swan, Dr. Mazzola, Dr. Mazzola

Relationship Based Dental Care We value the relational component of dentistry. We take time to get to know our patients and together, we customize a plan to meet the goals you have for your oral health and your smile.

Drs. David Swan, Macare Lumbrezer, Christopher Mazzola, Josh Van Horn, and Christina Mazzola are all graduates of the University of Michigan School of Dentistry and continue to devote hundreds of hours to continuing education annually. Our dentists are leaders in their field; facilitating study groups and teaching other dentists at the distinguished Pankey Institute for

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Advanced Dental Education.

Our dentists, hygienists, assistants, and business team have a shared commitment of providing exceptional dental care, not the usual and customary. We understand that is it not in the best interest of our patients to allow insurance benefits to be the final determinant of care. Our goal is to provide you with the best options for care, the skills to give you excellent results, and the understanding that how you move forward with treatment is your decision.

Tasty Medicine

by Patty LaNoue Stearns | photo by Kelly Rewa

Fred Laughlin is unstoppable. Even though he retired last December after 27 years as director of Northwestern Michigan College’s Great Lakes Culinary Institute (GLCI), leading it to its designation as one of the country’s top cooking schools, Laughlin is onto his next quest: teaching doctors how to cook nutritious, delicious meals so they can spread the word to their patients.

Nutrition is a major key to good health, yet ironically, physicians-to-be receive little diet and nutrition education. Less than 1 percent of U.S. medical students' lecture time includes the role that diet plays in preventing and combating disease—and they’re hungering for more.

With that in mind, Laughlin has been the backbone of several nutrition-oriented gatherings, the latest and greatest of which was the Farms, Food and Health Conference held at GLCI at the end of September. That sold-out event, put on by Groundwork Center for Resilient Communities along with Munson Healthcare, GLCI, and Traverse Bay Area Intermediate School District, featured state-accredited hands-on Culinary Medicine training for healthcare professionals, with an emphasis on local and plant-forward diets.

Laughlin started thinking about this type of program a decade ago, when he and Munson Medical Center clinical dietitian Laura McCain started doing healthy cooking demos together. “This has always been a passion of mine,” he says. They got together with Munson cardiologist Jim Fox, who had attended the Harvardsponsored Healthy Kitchen, Healthy Lives conference in Napa Valley, then met with other interested physicians and formed a committee to create a similar conference in Traverse City.

“It has been a big collaborative effort,” says Paula Martin, a policy specialist for the Groundwork Center and a registered dietitian with a focus on public health, who wrote the lesson plans and modules and got a grant for the first confab in 2017. Laughlin got GLCI onboard with the space, paired dietitians with cooking instructors, and devised many easy, healthful recipes that anyone can cook on a weeknight.

“This was the goal of the conference, the discovery that you don’t have to spend hours in the kitchen to prepare a healthy diet,” Laughlin says. Watch for another conference in the coming year.

MyNorth Medical Insider 2020

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Mysteries of the Inner Ear

by Elizabeth Edwards

In 2008 Dr. Kathleen Sawhill and Dr. Sandy Leahy combined their many years of experience to form Hearing Solutions of Northwest Michigan—a partnership that works to tailor hearing solutions to each client in a thoughtful, caring manner. New research is showing a link between a number of chronic diseases and hearing loss—which highlights the importance of getting your hearing checked.

There is some pretty fascinating research going on now in the world of hearing loss. Fill us in, please.

Yes. A big area of research in our profession right now is comorbidities—the presence of two or more chronic diseases in a patient and how they are related or linked. There are a number of chronic diseases that have been found to be associated with an increased risk of hearing loss.

What are some of them and what is the connection between the disease and hearing loss?

There is research going on in many areas, but a few associated health conditions include cardiovascular disease, diabetes and dementia.

In examining the relationship between cardiovascular disease and hearing loss, we sometimes observe a change in low frequency hearing sensitivity as a possible early indicator for cardiovascular disease. Our inner ear is very sensitive to blood flow changes.

If there is a disruption to normal blood flow in the inner ear, damage to the structures may occur and can result in a decrease in hearing sensitivity.

In diabetes, research suggests that high glucose levels may damage the nerves and blood vessels in the inner ear that may increase the likelihood of hearing loss. These changes to the inner ear, sometimes combined with peripheral neuropathy, may also cause problems with dizziness or balance function.

There is a lot of discussion about the relationship between dementia and hearing loss. It’s important to know that hearing loss is not causing dementia but there is a relationship—an association.

When hearing loss develops and is left untreated, there can be a

tendency to withdraw from conversations and activities. This lack of stimulation affects brain function and may increase memory problems. Having hearing loss also increases listening effort and cognitive load. Straining to hear can take up mental energy and can influence the energy that is left for other tasks.

This topic is so important. How is it influencing your work at Hearing Solutions of Northwest Michigan?

We are more aware of looking at our patients from a holistic point of view. It’s important to discuss and to be aware of our patient’s other chronic health conditions. Having knowledge of the symptoms and side effects that they may be dealing with helps to guide us through our treatment plan. When the specific needs of the patient are considered and addressed, we have better hearing outcomes.

It used to be that all hearing aids looked and performed about the same—but you are saying that you have an ability to personalize them?

Both the selection process and the fitting process are very specific to the needs of each individual. Everyone has different hearing needs. Technology is now allowing us the options to customize the fitting to the exact needs of the patient. Sometimes this may mean making specific changes to the automatic programming of the hearing aid or providing an additional device that allows for improved hearing in a noisy restaurant. Direct streaming from cell phones to the hearing aids has become very common. Our patients are also enjoying the added benefits of streaming music, podcasts, and audiobooks to the hearing aids too!

MyNorth Medical Insider 2020

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LOCAL TICKETS ONE PLACE

800.836.0717 // MYNORTHTICKETS.COM // TRAVERSE CITY

Breakthrough Artery Surgery

by Courtney Jerome photo courtesy of McLaren Northern Michigan

Dr. Richard Sheppek

What are the Carotid Arteries?

The major blood vessels in our neck that supply blood to the brain, face and neck are called carotid arteries. Untreated buildup of plaque in these arteries, or carotid artery disease, leads to stroke.

In fact, it’s estimated that up to one third of strokes are caused by blockage in carotid arteries, with 400,000 new diagnoses of the disease made every year in the U.S. alone.

“One of the most common procedures that bring patients to our office are those who have developed severe blockages in the carotid arteries,” says Dr. Richard Sheppek, Vascular Surgeon at McLaren Northern Michigan in Petoskey.

“When this plaque builds up and gets to be quite severe, the more severe it becomes, the higher the risk for stroke for a patient. And stroke is a leading cause of death in the United States—and not only death but significantly life-altering changes in your ability to care for yourself as time goes on.”

For decades, procedures have been in place to combat plaque build up, but recently a new procedure has presented much safer outcomes.

Instead of the traditional treatments, which include scraping off the plaque, or coming up from the groin to place a stent in the artery— both including risks of plaque breaking off and traveling to the brain, causing stroke—the TCAR Procedure is different. And for the first time, it’s being offered in Northern Michigan.

“TCAR stands for TransCarotid Artery Revascularization,” explains Dr. Sheppek. “You set up a system where you actually reverse the blood flow of the carotid artery. So if by chance in your attempt to get your stent in, or get a wire across the blockage (where you might knock something off)—rather than that piece traveling up to the brain, it instead gets washed out into the external flow circuit that has a filter in it, and after the blood is filtered, it gets returned to a vein down in the groin.”

“Doing it in this fashion with what's called flow reversal, the risk of stroke in trying to reverse the blockage has been dropped to the lowest that’s ever reported in any of these procedures and that’s around 1.4 percent,” Dr. Sheppek shares. “And that’s significant improvement; I don’t think you can get it any better than that.

Having done all three procedures, I completely understand why this procedure is as safe as it is.”

Currently, the procedure is limited to highrisk patients who qualify. However Dr. Sheppek feels that as soon as 2020 they “might be able to open it up to standard-risk patients because it really has proven that at each step of the way it’s a very safe and reproducible advance.”

“I believe TCAR is the future of carotid repair,” Dr. Sheppek says.

MyNorth Medical Insider 2020

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Healthy Smile at Any Age

by Elizabeth Edwards

Disclaimer: Dr. Lints is my orthodontist.

Yes, at 61 I am regularly in his office, right in there with the tweeners. When I was 59 my dentist suggested braces—actually not braces, the new, clear aligners that are way less noticeable than a mouthful of metal.

After my dentist brought it up I took a good look in my mouth and admitted to myself there were problems. My right canine had begun to bulge forward—more wolflike than grandmotherly! A bottom incisor appeared dark because it was pushed back and, horror of horrors, all those incisors were beginning to look, as they say about horses and old people: long in the tooth.

My aligner journey (the product name I have is Invisalign) has been enlightening—right down to the fact that the 3-D imagery done on my entire skull for the process revealed that I had narrow air passages making me a candidate for sleep apnea. At my last appointment, six months into my projected two years of wearing alignables (and yes, my teeth are straightening, yahoo!), I asked Dr. Lints more about the new world of seniors in braces.

So, am I the only grandmother wearing these, or has this become a senior phenom?

We have patients who are 70 and 80 years old getting aligners because they want the nice smile back they had when they were 16—but they didn’t want to have to wear braces. Aligners are a non-invasive way to move your teeth. They can also solve real orthodontic problems like occlusion. And as you age, your teeth push up, and with aligners we can push them back down. So the reasons for seniors wearing them are both aesthetic and functional.

On my first appointment you took a fascinating 3-D image of my skull and it revealed that I was a candidate for sleep apnea, something I have now talked to my doctor about. Are there other health issues this procedure can reveal?

Yes, with 3-D imaging we can see what you can’t see with traditional X-rays.

Among other things, 3-D imaging can reveal pathology in the mouth—so we can prevent and identify infections. This is especially important with older people and people going through radiation and immunotherapy treatment.

Any thoughts on the online alignable products that you can get in the mail— without ever seeing an orthodontist?

The online products do not even compare to what we can do with Invisalign and its patented SmartTrack material.

SmartTrack applies gentle force and fits really tightly on your teeth. We also apply attachments on your teeth that hold the retainer in the mouth securely. Online products don’t have the attachments, aren’t made from the SmartTrack material and they don’t use the 3D imaging—and they don’t have a doctor supervising the entire process. With Invisalign you are seeing a doctor every 8 to 12 weeks to check that the teeth are moving correctly. If a tooth is not moving correctly, we take another digital scan and take corrective action.

We also work closely with a patient’s dentist and periodontist to make sure the teeth and the gum tissue around the teeth are healthy before we start. We really cross our t’s and dot our i’s.

MyNorth Medical Insider 2020

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Medical Insider M E D I C A L L I ST I N G S

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ANDRIS KAZMERS, MD, MSPH, FACS, RPVI Board Certified in Vascular Surgery, Endovascular Medicine, Surgical Critical Care and Integrative Medicine

KELLI BROWER, PA-C LISA MACLELLAN, FNP-C At Integrative Cardiovascular Health and Wellness we provide traditional vascular surgery care, including medical management, and when appropriate endovascular and open surgical intervention. Our goal is to prevent or arrest progression of cardiovascular disease for those at all levels of health or illness. Our intent is to provide comprehensive, respectful care which takes into account the uniqueness and needs of each individual. Vascular lab onsite.

3290 Woods Way, Suite 5 & 6, Petoskey MI 49770 P: 231-881-9700 | F: 231-881-9388

Our Audiologists • Offer complete diagnostic hearing services and a wide range of hearing aids • Provide the most accurate hearing aid fittings and adjustments using Real Ear verification measures Dr. Sandy Leahy

Dr. Kathleen Sawhill

• Participate with most insurances • Conveniently Located in Logan Place West in Traverse City

Schedule a complimentary initial consultation by calling 231-922-1500 or online booking available at

www.hearingsolutionstc.com

Many who find Bay Ridge, no longer leave the area in the Winter!

Independant Living 231-995-9385 Assisted Living 231-932-9757 3850 Scenic Ridge - Traverse City MI 49684 - TRS Dial 711