Healthy Times Fall 2014

Stormont-Vail HealthCare

Dedicated to your health ... for a lifetime.

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FAMILY HEALTH Think it could be your heart? Call 911 . . . . . . 4 Pumpkin More Than Just for Show . . . . . . . 6 LIFESTYLES Making Sense of Healthy News . . . . . . . . . . . 8 MEDICAL NEWS Minimally Invasive Spine Surgery Gets Patients Back Quicker . . . . . . . . . . . . . . . 3 Stormont-Vail WoundCare Center® Celebrates 10 Years . . . . . . . . . . . . . . . . . . . . . . 10 Stormont-Vail Provides State-of-the-Art Prostate Cancer Treatments . . . . . . . . . . . . . . 11 CALENDAR Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Support Groups . . . . . . . . . . . . . . . . . . . . . . . 12 Family Education . . . . . . . . . . . . . . . . . . . . . . 13 Parenting

Programs . . . . . . . . . . . . . . . . . . . . 13 HealthWise 55 . . . . . . . . . . . . . . . . . . . . . . . . 14

Healthy Fall 2014

TIMES

Stormont-Vail HealthCare’s

New 3T High-Field Magnet is Drawing Attraction Magnetic resonance imaging, or MRI, is a non-invasive test that uses magnetic waves to take two- and three-dimensional pictures of the inside of the body. An MRI scanner can look at body parts, organs, and tissues, from head to toe.

Stormont-Vail HealthCare installed a new, high-field strength 3T MRI in March 2014. This advanced scanner allows for faster scans, clearer images and more accurate diagnoses.

The increased image clarity of the 3T scan provides more magnetic strength and has approximately 60 percent greater signal or “data” from the patient compared to lower field magnets, which provides physicians with a better diagnostic tool. It is particularly beneficial for pathological conditions involving the brain, spine and musculoskeletal systems.

“The 3T magnet has a cleaner, crisper image,” said Johannes Heyns, M.D., radiologist at StormontVail HealthCare. “This means a better acquisition and detail of pathology. You can detect abnormalities on a very small scale, which allows for a more specific and firmer diagnosis.”

Since the 3T magnet produces more detailed images, they have a greater resolution enabling the identification of smaller lesions and anatomical structures. The images have a lower distortion also – lessening the need for repeat scans.

“Patients can spend a shorter amount of time inside the magnet which helps with overall comfort and patient anxiety,” said Heyns.

Some patients may not be suitable for the stronger 3T magnet, such as those with certain metal in their bodies or those who have had extensive dental work.

The new 3T is the first in the Topeka community and it joins the two other highfield MRIs at Stormont-Vail to offer complete MRI services.

– Linda Ruiz (Continued on page 2)

MEDICAL NEWS

Understanding MRIs Stormont-Vail HealthCare has different MRI scanners to provide imaging for a variety of patients’ needs.

Learn more about each of the “magnets.”

high-field strength MRI a 3T • Beneficial for pathological conditions involving neurological, spinal and musculoskeletal systems. Helps physicians to diagnose and treat, with more clarity, conditions such as epilepsy, tumors, strokes, musculoskeletal and heart diseases.

a

1.2T high-field strength Open MRI at the Stormont-Vail MRI Center of Kansas •

a

• •

eneficial for large or broad frame patients B or those who experience claustrophobia.

Good for general MRI imaging.

Utilized for Breast MRI.

1.5T high-field strength MRI •

•

• •

2

eneficial for general knee, hip or spine B cases. Also beneficial for early onset of arthritis or conditions involving small nerves, cartilage or bones.

Most common field strength for general MRI exams in the country. Good for general MRI procedures/studies.

Utilized for Cardiac Imaging.

Utilized for Breast MRI and Breast Biopsies.

MEDICAL NEWS

Minimally Invasive Spine Surgery Gets Patients Back Quicker Everyone has heard someone complain, “Oh my aching back,” but back pain is a serious problem. Back pain is the second largest cause of disability in the United States. Affecting more than 80 to 90 percent of the population, back pain crosses all age, socio-economic and gender demographics.

While most back pain can be alleviated through non-surgical methods, there are patients who must undergo back surgery. For those patients, there is a bit of good news.

Dr. Tausif-Ur Rehman, a neurosurgeon at Stormont-Vail HealthCare, specializes in minimally invasive spine surgery. Surgeries like spinal fusion or microdiscectomy that used to leave a 12-inch scar, can now be performed with a one-inch incision and three or four smaller, quarter-inch incisions.

“Over the next 10 years, I’m hoping they get smaller,” Dr. Rehman said.

Minimally invasive spine surgery uses small ports or incisions, cameras, microscopes and surgical tools to align vertebrae, remove degenerated disks and various other procedures all while preventing disruption to the surrounding muscles.

While surgery always has some risks, minimally invasive spine surgery is reducing those risks. Patients typically have shorter hospital stays and depending on the surgery, patients could be released the same day.

Dr. Rehman says with minimally invasive surgery, most people are back to work faster, they lose less blood during surgery and infections are up to 10 times less likely.

Dr. Rehman strives to do 80 to 90 percent of his surgeries minimally invasively, but he reminds patients the term “minimally invasive” is subjective. The goal is to perform the most effective surgery with the smallest incision possible.

One of the greatest barriers Dr. Rehman faces when scheduling spine surgery is patient fear and uncertainty. If a primary care physician suggests

spine surgery, a patient should speak with the surgeon to see if minimally invasive surgery is an option.

“This field has changed,” Dr. Rehman said. “What patients know from the last 20 to 30 years may not be applicable.”

Dr. Rehman suggests that people with recurring pain that radiates from the back down through the legs see their primary care physician. Seek emergency care if one experiences motor weakness in the legs or a person has a loss of bladder or bowel control, as these may be signs of something more serious.

Dr. Rehman has served in Topeka for three years. Previously he studied medicine in Pakistan and practiced in New Mexico, New York and Rhode Island.

“I find the brain and spinal cord the most fascinating organs in the human body,” Dr. Rehman said.

– Niki Thiessen

Tausif-Ur Rehman, M.D., Neurosurgery

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FAMILY HEALTH

heart?

Call

Think it could be your

911

Pop Quiz: You’re sitting at home watching TV when it hits you. You begin to feel sudden chest pain and shortness of breath. You become clammy and nauseated. You think it could be your heart. Should you:

A)

Call 911.

B)

Drive yourself to your doctor’s office.

C)

Ask someone to drive you to the hospital.

D)

Give it 30 more minutes to see if the symptoms go away.

The Answer is always: A) Call 911.

A heart attack is a time-critical diagnosis. Eighty-five percent of damage occurs in the first two hours of symptom onset. This means the faster you get to treatment, the more heart muscle can be preserved.

“Damage from a heart attack is not reversible so every second counts,” explained Barb Columbus, RN, BSN, Acute Coronary Syndrome Program Manager at the Cotton-O’Neil Heart Center. “If you think for even one second that what you are experiencing could be your heart – you need to call 911 immediately.”

Unfortunately, many people think they can drive themselves or have someone else take them to the hospital faster than an ambulance can. What they don’t realize is, even if they get to the hospital faster, they may actually get to treatment slower.

When you arrive at the Stormont-Vail Emergency Department unannounced, you have to have an electrocardiogram (EKG) performed on you to confirm you are having a heart attack, and register to be admitted. A doctor must then review your EKG results before they can call the cath lab, where a team of experts will perform the procedure to unblock your artery. Once paged, the team has 30 minutes to arrive to the hospital, and must then prepare the room for you.

Barb Columbus, RN, BSN, Cotton-O'Neil Heart Center

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FAMILY HEALTH In contrast, when you call 911, as soon as EMS arrives at your location they are able to perform the EKG, administer pain medication and perform other procedures that may be necessary. They are also equipped to help you if your heart stops beating or something else goes wrong on the way to the hospital. Most importantly, they will call the hospital and alert them of your arrival, often times giving them advance notice before they even leave your location. This allows the hospital to prepare for you and assemble their team of experts while you are en route, so that when you arrive at the hospital, you can be taken to the cath lab much sooner. In some cases, if the team is already assembled and awaiting your arrival, the Emergency Department can be bypassed altogether, and you could be taken directly into the cath lab.

The amount of time from when you set foot in the hospital to the time the cath lab team has unblocked your artery is referred to as “doorto-balloon” time. A shorter door-to-balloon time has been shown to minimize the amount of cardiac damage.

“The median door-to-balloon time for patients who arrive to the Emergency Department by a private vehicle is 54 minutes. That time drops to 29 minutes if you call 911 and arrive by ambulance,” said Columbus.

Why aren’t people calling 911?

According to a national database, 60 percent of people in 2011 who were experiencing a heart attack called 911. In the past 12 months, only 35 percent of Stormont-Vail heart attack patients called 911. Aside from assumptions that an ambulance will take too long, other concerns include the cost of an ambulance and embarrassment.

“Patients have expressed embarrassment and worry associated with calling 911,” explained Columbus. “Some say they’d be embarrassed if their symptoms didn’t turn out to be something serious, and others said they’d be embarrassed to have neighbors see an ambulance outside their home.”

A potential heart attack is nothing to be embarrassed about.

Columbus strongly suggests putting your pride aside and calling 911.

“The only way to find out if it’s your heart is to have us check,” said Columbus. “With a heart attack, subtle symptoms can turn into something major in a very short amount of time.”

This is why driving during a heart attack is extremely dangerous. Not only are you at risk of something going wrong, but you also put the lives of everyone else on the road at risk as well.

“I’ve had some patients drive to their physician’s office. This is also a mistake because a physician’s office is not equipped to handle a heart attack,” said Columbus. “Your physician will call 911 and your visit just delayed your treatment.”

When you’re dealing with a potential heart attack, every second counts. By calling 911 you are most likely to receive treatment faster than any other options.

What are the risk factors of a heart attack?

The following are some risk factors that can increase your odds of having a heart attack; however, heart attacks do not discriminate. You could still have a heart attack even in the absence of these risk factors. They include: • Older age • Smoker • High blood pressure • High cholesterol • Obesity • Family history of heart disease and stroke • Diabetes • Physical inactivity

What are the symptoms of a heart attack?

Not all heart attacks begin with chest pain, and the severity of symptoms does not correlate with the severity of the heart attack.

It’s important not to ignore any of the symptoms. You may have vague or gradual early symptoms that could include: • Nausea • Pain down one or both arms (does not matter which arm) • Jaw pain • Fatigue • Anxiety – having that nagging feeling that something doesn’t feel right • Chest pressure – squeezing or discomfort • Back pain • Shortness of breath • Feeling of fullness in your chest Columbus suggests comparing your symptoms to a baseline. If you’ve never experienced these symptoms before, or if the symptoms worsen with activity or stop when you rest, call 911.

– Yvonne Etzel

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FAMILY HEALTH

Pumpkin More Than Just for Show

Nothing symbolizes fall like a bright orange pumpkin. But in addition to reminding us that fall is here, pumpkins can be a nutritious food item. Pumpkin is loaded with beta-carotene, an important antioxidant. Beta-carotene is one of the plant carotenoids converted to vitamin A in the body.

Research indicates that a diet rich in foods containing beta-carotene may reduce the risk of developing certain types of cancer and may offer protection against heart disease. One cup of cooked, boiled, drained pumpkin, without salt, has: • • • • •

49 calories 2 g protein 12 g carbohydrate 3 g fiber 37 mg calcium

• • • •

1.4 mg iron 22 mg magnesium 564 mg potassium 2650 IU vitamin A

Though we tend to think of pumpkins as a vegetable, they are technically a fruit because it is a part of the plant that develops from a flower.

Pumpkins are grown primarily for processing with a small percentage grown for ornamental sales through “you pick” farms, retail sales and farmers’ markets. Ninety to 95 percent of processed pumpkins are grown in Illinois. In colonial times, pumpkins were used as an ingredient for the crust of pies, not the filling. Pumpkin seeds can be roasted as a snack.

– Melissa Moore, RD, LD

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FAMILY HEALTH

Pumpkin Oatmeal

Baked Pumpkin Pasta

2 cups quick or old-fashioned oats 3 cups fat free milk 1/2 cup canned pumpkin 1/4 tsp pumpkin pie spice 1/8 tsp cinnamon 1 Tablespoon raisins Brown sugar to taste

12 ounces uncooked penne pasta 2 tsp olive oil 1 medium onion finely chopped 2 cloves garlic finely chopped 2 s mall zucchini, halved lengthwise, then sliced 1/2 tsp dried thyme

Place oatmeal in a microwave safe bowl and stir in milk.

Microwave on high 2-3 minutes. Remove from microwave and stir in pumpkin puree, spice and cinnamon. Heat for 40-60 seconds, or until heated through. Stir in raisins. Sweeten with brown sugar.

Preheat oven to 400 degrees. Cook pasta in a large pot of boiling water according to package directions, less 2 minutes and reserve 1/2 cup of cooking water when done. Heat oil in large skillet. SautĂŠ onions and garlic for 5-6 minutes, until softened. Stir in zucchini and herbs, and sautĂŠ for 3-4 minutes. Stir in pumpkin and ricotta cheese. Empty drained pasta plus 1/2 cup reserved cooking water into skillet and mix well. Spoon pasta into an 11 by 7 baking dish.

Sprinkle Parmesan cheese on top. Bake for 10-15 minutes.

Stove top method: Bring milk to a boil in a medium saucepan.

Stir in oats and cook on medium heat for 5 minutes. Add pumpkin and spices and stir until heated through. Stir in raisins just before serving. Sweeten with brown sugar.

Serves 4. Nutrition per serving: 242 calories, 2.9 g fat, 3 mg cholesterol, 99 mg sodium, 40 g carbohydrate, 5.3 g fiber, 13.2 g protein.

1 tsp dried sage 1 15 ounce can pure pumpkin 1 cup part skim ricotta cheese 1/2 cup water reserved from pasta pot 1/2 cup shredded Parmesan cheese

Six servings. Nutrition per serving: 349 calories, 7.7 g fat, 18 mg cholesterol, 168 mg sodium, 54 g carbohydrate, 5.2 g fiber, 15.9 g protein.

Frosty Pumpkin Pie

Roasted Pumpkin Seeds

2 cups low fat vanilla frozen yogurt, softened 1 reduced fat graham cracker crust (9 inches) 1 cup canned pumpkin 1/2 cup sugar 1 tsp pumpkin pie spice 1/2 tsp salt 1/2 tsp ground ginger 1 carton (8 ounces) frozen reduced fat whipped topping, thawed

1 quart water 1 Tablespoon salt 2 cups pumpkin seeds 1 Tablespoon oil

Spread yogurt into crust. Freeze for 30 minutes. Combine the pumpkin, sugar, pumpkin pie spice, salt and ginger in a bowl. Fold in whipped topping.

Spoon over frozen yogurt. Freeze for 6 hours or overnight. Remove from the freezer 20 minutes before cutting.

8 servings. Nutrition per serving: 282 calories, 7 g fat, 3 mg cholesterol, 273 mg sodium, 47 g carbohydrate, 1 g fiber, 4 g protein.

Preheat oven to 250 degrees. Pick through seeds and remove any cut seeds. Remove as much of the stringy fibers as possible. Bring the water and salt to a boil. Add the seeds and boil for 10 minutes.

Drain, spread on kitchen towel or paper towel and pat dry. Place the seeds in a bowl and toss with oil. Spread evenly on a large cookie sheet or roasting pan.

Place pan in a preheated oven and roast seeds for 30 to 40 minutes.

Stir about every 10 minutes, until crisp and golden brown.

Cool the seeds, then shell and eat or pack in air tight containers or zip closure bags and refrigerate until ready to eat.

Yield 2 cups

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MEDICAL LIFESTYLES NEWS

Making Sense of

Healthy

News

Some days news reports can make us worry that it is not safe to eat, drink milk, sleep, breathe, or exercise. The number of reports regarding healthrelated hazards, diseases, germs and treatment advances are coming at us from every source and at all hours. With around-the-clock news coverage, there is lots of time to fill and health-related stories are easy to report and easily accessible. We are used to breaking news and thankfully there are not too many disease outbreaks in the United States that merit breaking news coverage. Advances in medicine are almost never breaking news; they are based on science and years of research.

High-quality news reports inform us about medical advances. However many stories are based on a single study or a single presentation at a recent association meeting and some are chosen because they are contrary to current health recommendations. Reporters seldom take or have the time to do an in-depth study or have the breadth of knowledge to determine the accuracy of what they are reporting. They report on just a small piece of the entire subject and not on how the new study fits in with other evidence on the topic.

The public is left to assume that once again scientists are contradicting each other, leaving us totally confused; today it is good to drink red wine, yesterday the news story said to avoid drinking red wine.

Most medical advances come about slowly and before a study is proven safe and effective in humans, studies in animals and small trials in humans are required. These small, preliminary studies are critical because many drugs or treatments do not deliver on their early promises; the side effects are almost worse than the disease or perhaps the new drug will make the pain will go away but only 10 minutes faster than what is available already. For this reason, many reports of breakthroughs that are based on initial results do not deserve the publicity and excitement they generate.

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LIFESTYLES Whenever reading, listening to or watching a news story on health, consider the following questions to help you decide whether the report is important to you: • Where was the research done – at a medical school, university or large hospital?

• Was this a study in the laboratory, with animals, or with people?

Mice, rats, and monkeys are not people and to best understand how food, medications, devices, etc. affect human health, it helps to be studied in humans.

• Is the story simply reporting the results of a single study? How does the study fit into what you already know about the topic; the evidence that is already available? Only rarely would a single study be influential enough for people to change their behaviors based on the results. It is important to see how the study fits in with other studies on the topic. Some reports provide this background; other times you may need to do more digging on your own.

• How large is the study? Were enough people studied? Large studies often provide more reliable results than small studies.

When the number of people in a study is small, the results are not as strong.

• Was it a randomized controlled clinical trial involving thousands of people? Randomized controlled trials provide the most useful information about whether a treatment or a lifestyle change is effective. They are the most costly to do and scientists hope to find more efficient, less expensive ways to study in the future.

• Were the study participants similar to you in ways that may matter, such as age, race, or gender? Does the study include enough people like you? Were the participants in good health or dealing with diseases? Did they have the same health concerns and lifestyle?

• Did the study last long enough to show long-term benefits or risks? Some side effects may take months or years to show up.

Sometimes the side effects are almost as serious as the disease or a new drug might worsen or create a different health problem.

• What does it mean when the results of a study are described as statistically significant? It means the findings are not likely to be due to chance.

• Was the study funded by a group that would profit financially from the study findings?

If so, be a little wary of the results. Who

paid for the research? Sometimes the Federal government or a nonprofit foundation helps fund research costs. They look at the project and decide if it is worthy of support, but they will not make money as a result. If a drug is being tested, the study might be partly or fully paid for by the company that is developing the drug and they may make money based on the results.

• Where did you see or hear the results? Are the results presented in an easy-to-understand way? Some media outlets have special science reporters and writers on staff. They are trained to interpret medical findings.

Reading, watching or listening to health news can help us learn about new medical findings, teach us about the importance of health issues and change how we think and what we should do about our health. However, there’s a lot of important information to consider before trying something featured in the news. You should talk to your health care provider to help you judge how accurate the reports are, and whether they are of value to you and your health. Keep in mind that many health news stories end with the familiar: More study is needed …

– Lenora Kinzie, MLS

Steven Crouch, M.D., Pediatric Hospitalist

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MEDICAL NEWS

Stormont-Vail WoundCare Center®

Celebrates 10 Years of Extraordinary Healing

Christopher Brodine, D.P.M., CWS

Jeffrey Conrow, M.D.

John Gilbert, M.D.

Bita Haji-Zadeh, M.D.

Robert Holmes, M.D., CWS

For 10 years, the Stormont-Vail WoundCare Center® has been providing care for people suffering from chronic, hard-to-heal wounds with the most advanced treatments in wound care.

The center was the first to offer Hyperbaric Oxygen (HBO) Therapy in the region and is currently the only WoundCare Center with two wound certified physicians and a wound certified nurse on staff.

The WoundCare Center staff develops care plans for people with wounds resulting from venous insufficiency, diabetes, pressure ulcers, circulatory problems and other circumstances. Dedicated, experienced professionals use the latest technologies to heal wounds, reducing the possibility of amputation, shortening hospital stays and preventing prolonged and/or permanent disabilities.

Over the past decade, the WoundCare Center has treated more than 5,000 wounds. The lives of those patients have forever been changed by the extraordinary healing provided by the staff at the Stormont-Vail WoundCare Center. The Stormont-Vail WoundCare Center is owned by Stormont-Vail HealthCare and managed by Healogics. For more information about WoundCare Center services, call (785) 368-0400.

– Yvonne Etzel

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MEDICAL NEWS

Stormont-Vail Provides

State-of-the-Art Prostate Cancer Treatments

Two state-of-the-art medications to treat advanced prostate cancer are now available at the Stormont-Vail Cancer Center, and both promise fewer side effects and increased survival rate. The treatments are a sign of the innovation taking place in the world of cancer care, as more targeted medications are developed.

Dr. Mehmood Hashmi, a hematologist/oncologist at the cancer center, said Stormont-Vail is the only medical facility in Topeka and its surrounding area to treat prostate cancer patients with the medications. The medications are: • Radium-223, a radioisotope for men whose cancer has spread only to their bones, and • Sipuleucel-T, a vaccine made using the patient’s own blood cells.

“These are state-of-the-art treatments, (and we’re at) the forefront of the field to be able to administer these medications in the area (to which) Stormont-Vail caters,” said Dr. Hashmi.

Dr. Hashmi said cancer was once a “monolithic untreatable disease” with limited therapeutic options that could cause serious side effects. Today, although conventional chemotherapy remains an important aspect of treatment, targeted and immune-based therapies are leading the way.

“This is an era of personalized medicine,” he said.

Radium-223, marketed under the name Xofigo, was approved by the Federal Drug Administration in May 2013, and Stormont-Vail first used the radioisotope to treat a patient with advanced prostate cancer earlier this year, Dr. Hashmi said.

Radium-223 is intended for men whose cancer has metastasized only to their bones and have already received treatment to lower testosterone, which can cause prostate cancer to grow. When the cancer spreads or comes back after testosterone-lowering treatment, it is called castration-resistant prostate cancer.

Hashmi said Radium-223 is a “bone-seeking element” that delivers high-energy radiation directly to bone tumors while minimizing damage to normal bone marrow.

One dose of Radium-223 is given intravenously every four weeks for a total of six cycles. Fewer side effects result but still might include bone marrow suppression, lowering of blood counts, nausea and vomiting.

Sipuleucel-T, which received FDA approval in April 2010 and is marketed under the name Provenge, is a vaccine that is prepared from the prostate cancer patient’s own blood cells. It is used to treat castration-resistant prostate cancer with minimal symptoms.

Dr. Hashmi said a patient goes to a blood bank for leukapheresis, a procedure during which a machine removes dendritic cells, a subtype of immune cells, from his blood.

Mehmood Hashmi, M.D. The harvested blood cells are transported to a pharmaceutical company, where they are exposed to recombinant proteins. The cells are then returned to Stormont-Vail, where they are infused back into the patient, about three days after they were originally harvested.

The patient receives three doses of the vaccine, given two weeks apart. Side effects, which include fever, chills, fatigue, nausea and headache, are typically resolved within one or two days.

Dr. Hashmi said clinical trials indicate both medications increase the survival rate of advanced prostate cancer patients by three to four months.

Both treatments, which take from one to two hours, are administered as outpatient procedures and covered by most insurance companies.

– Anita Fry

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Calendar SEPTEMBER, OCTOBER AND NOVEMBER 2014 SUPPORT & EDUCATION GROUPS The MADD Power of Parents Presentation A presentation by Safe Streets and Stormont-Vail HealthCare will give parents and caregivers simple, effective, practical tools to talk with youth about alcohol (and other drug) use. You may think it’s too early to talk to your kids about alcohol, but it’s not. In Shawnee County, over 15 percent of 6th graders report having drank more than a few sips of alcohol. By 8th grade, that number doubles. It’s never too early to start an ongoing conversation with your kids and we can help you do it.

MADD Power of Parents presentation will be 10 to 11 a.m.

Saturday, Oct. 18, or 7 to 8 p.m. Tuesday, Dec. 16, in the Pozez Education Center. Registration encouraged through Health Connections at (785) 354-5225. The class can be presented in Spanish. Please call for information.

Depression and Bi-Polar Support Alliance Sponsored in part by Behavioral Health Services at Stormont-Vail West, meets at 6:30 p.m. on the first and third Wednesdays of the month at Valeo, 330 S.W. Oakley and at 1:30 p.m. on the second and fourth Mondays of the month at the Topeka Public Library, 1515 S.W. 10th Ave. Alzheimer’s Support Groups The Alzheimer’s Association has three caregiver support groups available as well as other support services. Call Alzheimer’s Association at (785) 271-1844 for days and times.

Topeka Celiac Support Group The Topeka Celiac Support Group provides information, support and knowledge of how to eat safely to avoid gluten from grain-based proteins in wheat, rye, barley and possibly oats. Meeting is 10:30 a.m. to 12:30 p.m.

Saturday, Sept. 13 and Nov. 1 at Pozez Education Center. For more information, contact Sharon Larson, president, (785) 379-0479.

MOMS: Moms of Multiples Support Support group for parents expecting or parenting multiples. For information about meetings, call Angela at (785) 267-2955.

Grief and Loss Support Groups Midland Care offers weekly grief and loss support groups available to the public. For more information, call Tim Keogh at (785) 232-2044.

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Pregnancy and Infant Loss Group First and third Thursdays of the month from 6 to 8 p.m.

Pozez Education Center. For information, call (785) 354-5225.

The Pregnancy and Infant Loss Group, which has regular meetings to share information and experiences, also has a blog for members, which offers communication, resources and support. If you are interested in learning more about the blog, please e-mail lrosen@stormontvail.org

BS, RN, CDE, CPT. The next class will be 10 to 11 a.m., Monday, Sept. 8, in the Diabetes Learning Center, located on the lower level of the Cotton-O’Neil Diabetes and Endocrinology Center, 3520 S.W. 6th Ave. Insurance will be billed for the cost of attending. For reservations, call the Diabetes Learning Center at (785) 368-0416.

Cancer Support Group Meets Mondays at 11 a.m. to noon in the library of the Stormont-Vail Cancer Center, 1414 S.W. 8th Ave. For more information, call 1-800-354-0091.

Loved Ones Partnering for Support (Caregivers Group) Meets Tuesdays at 2 p.m. in the library of the Stormont-Vail Center, 1414 S.W. 8th Ave. For more information, call 1-800-354-0091.

Cancer Center Pet Meet and Greet Wednesdays at 10 to 11 a.m. in the lobby of the StormontVail Cancer Center, 1414 S.W. 8th Ave. For more information, call 1-800-354-0091.

Topeka “HEALS” Support Group A confidential peer support group that is also known as Survivors of Suicide, “HEALS” stands for “Healing After Loss by Suicide.” It is for those who have lost a loved one by suicide. First and third Tuesdays of the month in Pozez Education Center at 7 p.m. For more information, call (785) 220-1368.

Head and Neck Cancer Support Group Affiliated with SPOHNC (Support for People with Head and Neck Cancer). Meets the second Wednesday of the month, 3:30 to 4:30 p.m. in the Stormont-Vail Cancer Center library, 1414 S.W. 8th Ave. For more information, call 1-800-354-0091.

Topeka Chapter, The Compassionate Friends Peer-facilitated group offering friendship, hope and support to families who have experienced the death of a child, at any age and from any cause. Fourth Monday of each month from 7 to 8:30 p.m. in the Formation Room of Most Pure Heart of Mary Parish Center, 3601 S.W. 17th. Bi-monthly newsletter and three memorial events a year. For more information, call Susan Chan, (785) 554-4895.

Prostate Cancer Support Group Meets the first Thursday of the month at St. Francis Comprehensive Cancer Center, second floor conference room, 7 to 8:30 p.m. Men who have been recently diagnosed with prostate cancer or been cancer-free for years are invited to attend. Family members welcome. The group is lead by a cancer survivor volunteer. For more information, call (785) 230-4422.

“On the Road to Better Managing Your Diabetes” Class This 90-minute refresher class is designed for those who have had diabetes education in the past and would like an update.

The next class meets from 9 to 10:30 a.m. Thursday, Oct. 9, in the Diabetes Learning Center classroom, lower level of the Cotton-O’Neil Endocrinology Center, 3520 S.W. 6th Ave. Call (785) 368-0416 to reserve a seat. Your insurance will be billed for the cost of attendance.

Parents Partnering for Support Support group for parents with children with a diagnosis of cancer. Fourth Thursday of the month at 6 p.m. For location and information, call Leigh Ann at (785) 270-4905.

Living with Diabetes Adult Support Group Meets from 10 to 11 a.m. each Tuesday, except holidays, at the Cotton-O’Neil Diabetes and Endocrinology Center, lower level, 3520 S.W. 6th Ave. A Diabetes Learning Center staff educator facilitates each meeting. There is no fee to attend and no need to pre-register. Call (785) 368-0416 with questions.

The Latest in Insulin Pumps and Glucose Sensors A class designed for current pump users and those considering an insulin pump for the first time. It provides an overview of pump therapy and CGM (Continuous Glucose Monitoring) as well as current options available.

Following the 60-minute class, all major insulin pump and CGM device manufacturers are available to offer a ‘hands on’ look at the products. Class presenter is Julie Johnson,

Tai Chi for Patients and Families of the Stormont-Vail Cancer Center Tai Chi Easy offers physical and mental benefits no matter what your age or physical limitations. Tuesdays at the Stormont-Vail Cancer Center (3:30 p.m. hard, and 4:30 p.m. easy). For more information, call 1-800-354-0091.

Look Good Feel Better Educational Program Program is offered at the Cotton-O’Neil Cancer Center on a regular basis. For more information, call 1-800-354-0091 or the American Cancer Society at (785) 273-4462.

Stroke Support Group at KRH A stroke support group is now meeting the first Friday of each month at the Kansas Rehabilitation Hospital. Meetings are 4 to 5 p.m. in the West Dining Hall, first floor. The support group is for patients and families of those who have suffered a stroke. For more information or to RSVP, call Randy Williams at (785) 235-6600, Ext. 553.

CALENDAR FAMILY EDUCATION PROGRAMS To register for Family Education classes, call Health Connections at (785) 354-5225.

And Baby Makes Four or More (for children 5 and older) 6:30 to 8 p.m. • Wednesdays, Sept. 17, Oct. 15, Nov. 12 and Dec. 10 • Pozez Education Center • $10 per family • Lori Hamilton, occupational therapist This class for potential siblings and their parents includes a tour of The Birthplace, a video presentation and a discussion of what to expect after the baby comes. The special roles of big brother and big sister are explored. Parents are able to address how they can help their older child adjust to the new baby.

And Baby Makes Four or More (for children ages 2 to 4) 6:30 to 8 p.m. • Wednesdays, Sept. 10, Oct. 8, Nov. 5 and Dec. 3 • Pozez Education Center • $10 per family Lori Hamilton, occupational therapist This sibling preparation class includes a tour of The Birthplace and provides structured activities to help young children verbalize their concerns and expectations about when “the new baby comes.” This class is for young children who will soon be big brothers and big sisters and their parents.

From Girl to Woman Saturdays, Sept. 13, Oct. 11 and Nov. 8 • 9 a.m. to noon Pozez Education Center • $25 mother/daughter couple Course pre-registration required.

The time in a girl’s life between ages 8 and 12 is one of dramatic physical and emotional changes. This program for girls and their mothers, will address menstruation and other physical changes of puberty, the emotional upheaval of adolescence, and communication techniques for mothers and daughters.

From Boy to Man Saturday, Oct. 11 and Nov. 8 • 9 to 11:30 a.m.

Pozez Education Center • $25/family • Course pre-registration required.

When we think of puberty and its changes, we usually think of girls and the transition they make, but boys experience puberty, too. While usually starting later than girls, the time in a boy’s life between the ages of 10 and 13 is filled with many physical and emotional changes. These changes are exciting, but often puzzling, sometimes embarrassing, and usually challenging to a young adolescent. Join us for a discussion that will focus on the physiological changes of puberty, the developmental tasks of early adolescence and ways to improve communication between boys and their parents. This class features time for boys and parents together but also time for separate facilitated discussion.

PARENTING PROGRAMS To register for Parenting classes, call Health Connections at (785) 354-5225.

Welcome Baby Sunday, Sept. 14 and Nov. 9 • 2 to 5 p.m. • Pozez Education Center • $15 per family

This three-hour class will consist of updated information for the whole family. Such topics include an overview of pregnancy with strategies to deal with common discomforts, intro to labor and birth, what to expect, choices and options during labor and delivery.

In addition, baby care, including car seat information, a gift bag and community resources will be provided. Finally, adjustment to parenthood and grandparenthood will also be covered in this class.

Mothers are welcome to bring their support person, family or a friend who provides support during their pregnancy and beyond.

Childbirth Preparation I: For New Parents Please visit us online at www.stormontvail.org for class dates and times • Pozez Education Center • Weekday evening and weekend classes available • $60 (payable at the first class) Learn breathing and relaxation skills plus information is provided on other pain control measures. Included is information on late pregnancy, labor and birth, early parenting experience and a tour of The Birthplace. Classes are taught by experienced instructors and are tailored to the adult learner with plenty of opportunity for individuals and couples to explore their own personal needs. Dress comfortably and bring two pillows. eLearning Online Childbirth Education Program eLearning Online Childbirth Education Program is an alternative for those parents who cannot attend conventional prenatal classes due to bed rest, scheduling conflicts or time constraints. It is an interactive web-based program that includes animated illustrations, videos and voice-overs. It can be viewed on a PC or Mac. High speed Internet is advised, but dial-up will work; it will take longer to download.

Upon registration, we will send you a code to access the class. Once you log in with the code issued, you have six weeks to complete the information at your own pace. The fee also includes a tour of the Birthplace. Visit us at www.stormontvail.org to register.

Childbirth Preparation I: For Parents Having Cesarean Sections Please visit us online at www.stormontvail.org for class dates and times • $30 (payable at the first class) Whether this is your first cesarean section or you are having a repeat cesarean section, your delivery is an event we would like to help you prepare for. You will find out what to expect from admission to dismissal. We will watch films, show slides, have open discussion, practice breathing and relaxation techniques, and tour The Birthplace.

Childbirth Preparation I: For Teens or Young Adults Please visit us online at www.stormontvail.org for class dates and times • Free • (certain restrictions apply) Classes are designed for teens, young adults and their support people.

Included are discussions about pregnancy, labor and parenting, as well as explore ways to cope and deal with labor. Information to assist new parents to care for and enrich their baby’s early years is provided. A tour of The Birthplace is included. The class series lasts five weeks. Dress comfortably.

Birthing with Confidence Please visit us online at www.stormontvail.org for class dates and times • Pozez Education Center • Weekday evening and weekend classes available • $60 (payable at the first class) This class is designed for a woman and their support person who would like an in depth exploration of alternative ways to deal with the pain of labor besides epidurals and IV pain medications. The instructors, who have many years of experience with laboring women,

will help the participants to be aware of their strengths and abilities to cope with the process of labor and the strategies that are effective for pain control. There will be opportunities to examine potential barriers to reaching individual goals and methods to overcome those barriers in order to achieve their unique goals. This class series is interactive and uses videos, games and more to prepare you and help you understand that birth is a normal, natural, and healthy process.

Breastfeeding Basics First Tuesday of each month (except for holidays) 6:30 to 8:30 p.m. • Sept. 2, Oct. 7, Nov. 4 and Dec. 2 Pozez Education Center • $10 This informal introduction to breastfeeding provides pregnant women and their families an opportunity to learn all they need to know about breastfeeding before their babies are born. Classes are designed to help families prepare for their breastfeeding experience by providing information on how breastfeeding works, how to get started, problems that may arise and how to incorporate breastfeeding and working.

Pumping for your Baby First and third Tuesdays • 1 p.m. • Breastfeeding Clinic, Stormont-Vail Regional Health Center • Free Designed for women planning to work outside of the home or for those who are breastfeeding but want the flexibility to be away from their baby. This class is designed for mothers who have delivered.

Mothers who are at least 2-3 weeks postpartum would benefit most from this class. We will provide information and options for expressing milk from the breast. We’ll address breast pumps and how to choose one, pumping techniques, milk storage and maintaining adequate milk production. For the mom working outside of the home, we also will explore issues of time management, negotiating with employers and relationships with co-workers. We’ll also discuss the very important role childcare providers play in breastfeeding success and methods of feeding breast milk to infants. Babies welcome, preregistration not required.

Join Us: Welcome Baby Jubilee Stormont-Vail invites pregnant and soon-to-be pregnant couples to an open house that showcases the services and amenities that the Birthplace and the Neonatal IntensiveCare (NIC) provide women and their families during the labor and delivery process.

Refreshments, tours, door prizes and information on Birthplace services and classes are provided. Physicians and other staff will be on hand to answer your questions about pregnancy and infant care. Vendors and other community resource representatives will be present.

Pregnant and soon-to-be pregnant couples are welcome to drop by anytime during the open house. Enter for a chance to win a $250 gift card to Babies R Us or a Medela Breast Pump. Visit stormontvail.org for details.

To attend the Jubilee, please click “I’m Attending” on the Stormont-Vail HealthCare Facebook event page or e-mail us at marketing@stormontvail.org.

Mark Your Calendar for Welcome Baby Jubilee: Please join us from 2 to 4 p.m. Sunday, Oct 12, at Pozez Education Center – 1505 S.W. 8th Ave. (Stormont-Vail’s main campus).

Please park in the parking garage.

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CALENDAR

HealthWise 55 Programs

September, October and November 2014 HealthWise 55 is an organization sponsored by StormontVail HealthCare for those 55 years of age and older who want to stay current on health information and health resources. Membership is free. For information about joining HealthWise 55, a packet of exercise information and reservations for Senior Suppers, Lunch Bunch and coffees, call Health Connections at Stormont-Vail at (785) 354-5225. For clinic information and appointments, call (785) 354-6787.

Heart Failure – The Basics Dessert and Coffee • Drury Place • Wednesday, Sept. 10 2 – 3 p.m. • Allison Proctor, APRN, Cotton-O’Neil Heart Center • Free • Reservations: (785) 354-5225.

Heart Failure – The Basics Dessert and Coffee • Atria Hearthstone • Wednesday, Sept. 24 • 2 – 3 p.m. • Christine Curtis, APRN, CottonO’Neil Heart Center • Free • Reservations: (785) 354-5225.

Heart Failure – The Basics Lunch Bunch • Presbyterian Manor • Thursday, Sept. 11 11:30 a.m. – 12:30 p.m. • Christine Curtis, APRN, CottonO’Neil Heart Center • $5 • Reservations: (785) 354-5225.

Heart Failure – The Basics Koffee Klatch • Aldersgate Village • Thursday, Oct. 2 9:30 – 10:30 a.m. • Christine Curtis, APRN • Free Reservations: (785) 354-5225.

Senior Supper Information: Reservations – Call (785) 354-5225. Name, number of persons attending and a telephone number will be needed when making your reservation. To help us have a more accurate count for meals, please call for reservations as well as cancellations by the Thursday before each program. We understand this is not always possible.

Thank you for your consideration.

Parking – There is an alternative to parking in the StormontVail parking garage for those attending Senior Suppers.

Aldersgate Village and Brewster Place offer transportation from the parking lot of Grace Episcopal Cathedral (west side of parking area) to Pozez Education Center and back again.

The bus will be at the parking lot at 4:45 p.m. and leave at 5 p.m. Let Health Connections know you will need a ride when you make a reservation for Senior Suppers.

Wellness – Understanding the Benefits of the Annual Medicare Wellness Visit Dessert and Coffee • Lexington Park Independent Living Monday, Sept. 15 • 2 – 3 p.m. • Cotton-O’Neil Wellness Nurses • Free • Reservations: (785) 354-5225.

Heart Failure – The Basics Lunch Bunch • Thornton Place • Monday, Oct. 6 11:45 a.m. • Christine Curtis, APRN, Cotton-O’Neil Heart Center • Free • Reservations: (785) 354-5225.

No Lunch Bunch at Thornton Place on Sept. 1 due to the Labor Day Holiday

Wellness – Understanding the Benefits of the Annual Medicare Wellness Visit Koffee Klatch • First Apartments • Monday, Sept. 22 9:30 – 10:30 a.m. • Cotton-O’Neil Wellness Nurses • Free Reservations: (785) 354-5225.

My Chart – A Secure Online Connection to Your Health Information Koffee Klatch • Aldersgate Village • Thursday, Sept. 4 9:30 – 10:30 a.m. • Speaker TBD • Free • Reservations: (785) 354-5225.

Fall 2014 Vol. 11, No.4 Healthy Times is a local, community newsletter providing information on health care concerns, issues and interests for you and those you love. Published quarterly by Stormont-Vail HealthCare, 1500 S.W. 10th Ave., Topeka, KS 66604-1353, www.stormontvail.org

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Heart Failure – The Basics Lunch Bunch • Brewster Place • Tuesday, Sept. 16 11:30 a.m. – 12:30 p.m. • Allison Proctor, APRN, Cotton-O’Neil Heart Center • $5 • Reservations: (785) 354-5225.

Understanding Medicare & Medicare Advantage Senior Supper • Pozez Education Center • Tuesday, Sept. 16 • 5:15 – 6:30 p.m. • Bob Evenson, Century Health Solutions • $5 • Reservations: (785) 354-5225.

Wellness – Understanding the Benefits of the Annual Medicare Wellness Visit Dessert and Coffee • Drury Place • Wednesday, Oct. 8 2 – 3 p.m. • Cotton-O’Neil Wellness Nurses • Free Reservations: (785) 354-5225.

Heart Failure – The Basics Lunch Bunch • Presbyterian Manor • Thursday, Oct. 9 11:30 a.m. – 12:30 p.m. • Allison Proctor, APRN, CottonO’Neil Heart Center • $5 • Reservations: (785) 354-5225.

Heart Failure – The Basics Dessert and Coffee • Lexington Park Independent Living Monday, Oct. 13 • 2 – 3 p.m. • Christine Curtis, APRN, Cotton-O’Neil Heart Center • Free • Reservations: (785) 354-5225.

My Chart – A Secure Online Connection to Your Health Information Dessert and Coffee • McCrites Independent Living Tuesday, Sept. 23 • 2 – 3 p.m. • Speaker TBD • Free Reservations: (785) 354-5225.

Design: jones huyett Partners

Editor: Anita Miller Fry Advisers/Contributors: Melissa Moore, R.D., L.D. Nancy Burkhardt Tami Motley Carol L. Wheeler, RN, BSN, FACHE

Stormont-Vail and the Mayo Clinic Care Network Senior Supper • Pozez Education Center • Tuesday, • Oct. 14 5:15 – 6:30 p.m. • Lambert Wu, MD, Stormont-Vail HealthCare • $5 Reservations: (785) 354-5225.

Niki Thiessen Yvonne Etzel Linda Ruiz Lenora Kinzie, MLS

To receive your free subscription to Healthy Times, call (785) 354-5225.

CALENDAR

My Chart – A Secure Online Connection to Your Health Information Lunch Bunch • Brewster Place, main building • Tuesday, Oct. 21 • 11:30 a.m. – 12:30 p.m. • Speaker TBD $5 • Reservations: (785) 354-5225.

Heart Failure – The Basics Koffee Klatch • First Apartments • Monday, Oct. 27 9:30 – 10:30 a.m. • Christine Curtis, APRN, Cotton-O’Neil Heart Center • Free • Reservations: (785) 354-5225.

Wellness – Understanding the Benefits of the Annual Medicare Wellness Visit Dessert and Coffee • McCrites Independent Living Tuesday, Oct. 28 • 2 – 3 p.m. • Cotton-O’Neil Wellness Nurses • Free • Reservations: (785) 354-5225.

My Chart – A Secure Online Connection to Your Health Information Dessert and Coffee • Atria Hearthstone • Wednesday, Oct. 29 • 2 – 3 p.m. • Speaker TBD • Free • Reservations: (785) 354-5225.

Quality Cancer Care Today Right Here at Home Senior Supper • Pozez Education Center • Tuesday, Nov. 11 • 5:15 – 6:30 p.m. • Vicky McGrath, RN, MBA, BSN, OCN, Director, Cotton-O’Neil Cancer Center • $5 • Reservations: (785) 354-5225.

NO OUTREACH PROGRAMS IN NOVEMBER OR DECEMBER The Annual Holiday Brunch will be Tuesday, Dec. 16.

Invitations with times and reservation information will be mailed in November.

HEALTHWISE 55 CLINICS The Health Wise 55 Resource Center hours are 8 a.m. – 4:30 p.m., Monday through Thursday. The office is located at 2252 S.W. 10th Ave. #B, Topeka, Kan. For appointments and information on clinical services, please call (785) 354-6787.

• Second Thursday • 9:30 to 11:00 a.m. • Southwest YMCA, 3635 S.W. Chelsea • Third Thursday • 8:30 to 9:30 a.m. • Oakland Community Center, 801 N.E. Poplar • Third Thursday • 9 to 10 a.m. • Rose Hill Place, 37th and Gage • Fourth Thursday • 9 to 10:30 a.m. • Kuehne Branch (North) YMCA, 1936 N. Tyler St. SHICK (Senior Health Insurance Counseling for Kansans) Counseling • For questions and assistance with Medicare, Supplemental, Long Term Care Insurance or the Medicare Prescription Drug Program • HealthWise 55 Resource Center • Free • Call (785) 354-6787 for times and appointment.

Medication Clinics • Every Wednesday • Bring questions to our trained pharmacy staff regarding your medications (prescriptions or over-the-counter) • 12:30 to 4:30 p.m. • HealthWise 55 Resource Center • Free • Call (785) 354-6787 for an appointment.

Zostavax Clinics • Every Tuesday and Thursday • Ask your primary care doctor if you are a candidate for the shingles vaccine. (Prescription Required) • 8 a.m. to noon HealthWise 55 Resource Center • Call (785) 354-6787 for an appointment.

Information and Referral • Assistance to help connect you with resources in the community • FREE • HeathWise 55 Resource Center • Call (785) 354-5225 for assistance.

AARP DRIVING PROGRAM AARP Smart Driver Course • Tuesday and Wednesday, Sept. 9 and 10 or Monday and Tuesday, Nov. 3 and 4 10 a.m. to 3 p.m. • Pozez Education Center • (NEW PRICES) $15 per person for AARP members, $20 per person for nonmembers of AARP • (Must bring your AARP membership card at time of registration. Bring your HealthWise 55 membership card for a discount in the Food Connection if you plan to eat lunch at Stormont-Vail) • Registration: (785) 354-5225.

HEALTHWISE 55 EXERCISE Exercise Programs Available to HealthWise 55 Members Call Health Connections at (785) 354-5225 to have a packet of information mailed to you regarding these exercise programs.

•H ealthWise 55 exercise group meets in the Pozez Education Center every Tuesday and Thursday, 9:30 to 10:45 a.m. Included in the schedule: chair aerobics, strength training, balance and flexibility.

Cost is $25 for 20 times.

•Y MCA Exercise Programs with special rates for HealthWise 55 members.

•G reat Life Golf and Fitness with special rates for HealthWise 55 members. The YWCA and many other locations are managed by Great Life. A list of locations is included in the packet.

•K ansas Rehabilitation Hospital offers aquatic exercises classes, Wavemakers and Tai Chi. •H ealthy Steps: A walking program sponsored by Stormont-Vail HealthCare and West Ridge Mall.

HEALTHWISE 55 LINE-UP ON TV The following HealthWise 55 television programs are available on WIBW-TV, Channel 13.

HealthWise After 55 “HealthWise After 55” airs from 9 to 9:30 a.m. the first and third Fridays of each month. It offers interviews on health topics of interest to seniors as well as the 20-minute exercise segment. Sponsors are AAA Travel and Insurance, and Aldersgate Village. for Family Caregivers “for Family Caregivers” airs the second and fourth Fridays of each month from 9 to 9:30 a.m. The show highlights information for people who are providing caregiving services to loved ones and a 20-minute exercise segment for caregivers and their loved one. Sponsors are Brewster Place, Caregivers Home Health Care and Jayhawk Patient Supply.

The Exercise Programs are sponsored by Topeka Ear, Nose and Throat.

Blood Pressure Clinics • Free • No appointment necessary •C all (785) 354-6787 for more information. Walk-ins are welcome at the following locations: •E very Tuesday • 10 a.m. to noon • HealthWise 55 Resource Center, 2252 S.W. 10th Ave. #B • F irst Tuesday • 9 to 10:30 a.m. • West Ridge Mall (Food Court, Restroom Entrance), 1801 S.W. Wanamaker Rd.

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1500 S.W. 10th Ave. • Topeka, KS 66604 stormontvail.org

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MEDICAL NEWS

Fall is For Flu Immunizations Fall is the traditional time to get immunized for the seasonal flu. Cotton-O’Neil Clinic physicians, including pediatricians, recommend everyone 6 months and older get an annual flu shot.

The seasonal flu vaccine is especially important for pregnant women, people 65 years of age and older, and others with chronic illnesses like asthma, diabetes, heart disease or lung disease. People with chronic illnesses may have an increased chance of developing pneumonia as a result of getting the flu. Those who may have close contact with high-risk individuals including infants, should also be vaccinated. That might include: adults or children living with or caring for people at high-risk of developing complications.

To find out about seasonal flu clinics at Cotton-O’Neil facilities, check stormontvail.org.

NONPROFIT ORG. U.S. POSTAGE PAID TOPEKA, KS PERMIT NO. 85