Inhealth 10/05/2015 by The Inlander

Prescription Sticker Shock

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SPOKANE • EASTERN WASHINGTON • NORTH IDAHO also at inlander.com/inhealth 1227 W. Summit Parkway, Spokane, Wash. 99201 PHONE: 509-325-0634

EDITOR Anne McGregor

annem@inlander.com

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InHealth is published every other month and is available free at more than 500 locations throughout the Inland Northwest. One copy free per reader. Subscriptions are available and cost $2.50 per issue. Call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x215. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2015. InHealth is locally owned and has been published every other month since 2004.

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FROM THE EDITOR

collaboration innovation collaboration drives innovative health care

At INHS collaboration drives everything we do. Through innovative health care technology, health education and patient care, more than 1,000 INHS employees are creating tomorrow’s health care today.

St. Luke’s Rehabilitation Institute Engage Northwest MedStar Northwest TeleHealth Community Wellness COHE Community of Eastern Washington Health Training

We improve patient outcomes. We lead health care innovation. We create healthier communities.

Do you have a story idea? Share it with Editor Anne McGregor at annem@inlander.com.

High Price of Health

rescription pricing has been all over the news this fall. In particular, the story of the price increase from $13.50 to $750 per pill for a drug called Daraprim used mainly by AIDS patients struck a nerve. (At press time, the manufacturer was reconsidering the price hike.) Nobody knows what future American policy regarding pricing will be, but for people who need prescriptions filled now, there are ways to circumvent high prices. Linda Hagen Miller reports on getting medication via the Internet from pharmacies based in Canada. Here’s a sample: Daraprim was available for $1.77 per pill as of Sept. 23 on one reliable Canadian website. But there can be both risks and rewards to ordering drugs online, as you’ll read in “Medication Frustration.” From the medicine cabinet to the spice cabinet: Did you know research shows that if you indulge in a high-fat meal, making sure it includes cinnamon and turmeric can help cancel the negative effects? Spices, herbs and exotic blends have been an integral part of everyday cuisine in India and Asia for centuries. Yet here in the U.S., we’ve tended to rely mostly on salt and pepper, with some basil and oregano thrown in from time to time. It’s time to get adventurous, and “The Spicy Side of Life” includes information on the health benefits of aromatics, along with some recipes to get you started. To your health!

Inland Northwest Health Services (INHS) is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of the community and its member organization Providence Health Care.

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If you’re looking for relief from knee or hip pain, Deaconess and Valley Hospitals are here to help. We’ll help you learn about your treatment options including exercise, weight control, joint replacement and more. We’re the only Inland Northwest hospitals to earn The Joint Commission’s Gold Seal of Approval® for Hip & Knee Replacement*.

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CHECK-IN RESEARCH FILES

Sunny Disposition

ow happy are you? Compared to your friends in other states, would you say you’re way more happy than your Oregon bros, but maybe not as stoked on life as your Florida friends? Can you prove it?

You may not have time to conduct research on your comparative happiness, but thankfully, the people at WalletHub.com have taken it upon themselves to do it for you in a new report. First, they convened a panel of psychology and philosophy professors from across the country to determine just what constitutes happiness. The panel came up with 25 metrics, including having enough, but not too much, money (happiness levels off at about $75,000 a year), being physically healthy, having a satisfying job, being socially engaged and having a safe place to live, among other things. Using numbers from research previously conducted by such august groups as the U.S. Census Bureau, the Centers for Disease Control and the Henry J. Kaiser Foundation, states were scored in three categories: “Emotional and Physical Well-Being,” “Work Environment” and “Community, Environment and Recreational Activities.” Finally, states were ranked according to a weighted average of those three. So after all the number crunching, how did we do? You’ll no doubt be happy to learn that Washington ranks seventh in overall happiness; Idaho comes in at No. 12. Not too shabby on either score. In the subsets of “Work Environment” and “Community, Environment and Recreational Activities,” Washington ranked fourth and fifth, respectively.

ALISSIA BLACKWOOD MEAD PHOTO ILLUSTRATION

Washington’s barely in the top half, though, at 22nd, in “Emotional and Physical Well-Being.” Of particular concern is the finding that Washington and Oregon are the two states with the highest rates of depression.

On a happier note, Washington is tied for third (with Vermont) in the rate for sports participation; maybe all that exercise helped Washington rank 11th lowest in obesity rate. — ANNE McGREGOR

LIFE COACHING

A Kinder, Gentler Self

Carla Brannan is a certified professional life coach in Spokane. STAY CONNECTED Email InHealth Editor Anne McGregor at annem@inlander.com. The conversation continues on the Inlander Facebook page, and stay in touch with us at Inlander.com/InHealth.

alking smack about ourselves is so acceptable it’s nearly a pastime. What are your personal zingers — do they relate to your appearance, your intelligence, your ability to organize and plan? Over time, little by little, we can’t help but start to buy into these negative thoughts, regardless of their validity. This disparaging self-talk can have an impact on our attitudes and may ultimately affect our actions. For example, an exciting promotion is announced at work, and on paper you’re a perfect match. However, you may let the opportunity pass by because you’ve convinced yourself that you’re just not smart enough to handle the job. Since our self-talk impacts our attitudes

and actions, perhaps increasing positive thoughts will lead us in a healthier direction. Here’s how to get started: 1) Get curious about your thoughts. When you catch yourself in a negative moment, practice reframing that negative to a positive: “Oh, I could never do that” becomes “It’s not impossible, so I’m gonna give it a try.” 2) Surround yourself with words and images that make you feel good. Use magazines, quotes from the Internet or create your own. With consistent effort, being kinder to yourself will help you develop a more positive perspective that’s sure to benefit you and the people in your life. — CARLA BRANNAN OCTOBER-NOVEMBER, 2015

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CHECK-IN PILL BOX

Infection Protection I am considering skipping my flu shot this year. Last year I got one but still ended up with the flu. What do you recommend?

ast year was a bad year for the flu shot. Every year, scientists must evaluate an enormous amount of data, and based on that data, predict which strains of influenza are going to be problematic in the John R. White chairs coming year. The vaccine WSU-Spokane’s is then formulated to Department of include protection against Pharmacotherapy. those strains. Two things can go awry. First, even if the strains that are predicted to be problematic in the coming year are correctly predicted, they may still mutate or change, rendering the vaccine less than effective. This happened last year with an influenza A subtype called H3N2, and the vaccine was only about 13 percent effective against that strain. Second, we are not always accurate in predicting which strains will be problematic. In that case, the strains causing illness are not covered by the vaccine. While last year was not a stellar year in terms of the efficacy of the influenza vaccine, the vaccine is typically quite effective, and you’re more likely than not to realize a benefit from receiving the vaccine. Generally speaking, almost everyone over 6 months old should receive an annual influenza vaccination. There are some exceptions, such as life-threatening allergies to the vaccine or a having a history of Guillain-Barré syndrome, so you should check with your primary care provider or pharmacist first. Now is the time to act. The sooner you receive your vaccination, the better. — JOHN R. WHITE

INHS health coaches help people with diabetes to begin a workable care plan.

WORKSHOP

Dealing with Diabetes

n just two decades, the number of Americans living with diabetes has more than doubled. Tackling the disease can be daunting, often requiring medication and many lifestyle adjustments. As in most things, it helps to have a little support. That’s why Inland Northwest Health Services is offering a series of workshops called “Living Well with Diabetes.” The workshops will be taught by teams of trained leaders who will not only offer education on diet and exercise, but also discuss their firsthand experience with the disease and facilitate practical problem-solving by participants. “The peer-to-peer approach gives participants living with type 2 diabetes the social support needed to cope and thrive,” says Brittany Hadley from the INHS Community Wellness team. “The group settings are an important component of

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this program and what makes these workshops unique.” In addition to learning about diet and exercise from workshop leaders, participants will have a chance to share their own stories and collaborate on developing action plans for staying healthy. Importantly, the sessions will be held not in hospitals or clinics, but out in the community at libraries and community centers. The set of six workshops is free and the program will run for the next year. People with diabetes, as well as their caregivers and family members, are invited to attend. — ANNE McGREGOR

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ASK DR. MATT

Concussion Discussion

Matt Thompson is a pediatrician at Spokane’s Kids Clinic.

ver the past several years, there has been an increased focus on the perils of concussion, particularly to the stilldeveloping brain. Two of the clearest reasons to promote proper recovery are to reduce the risk of re-injury during a period of brain vulnerability that could result in second impact syndrome, which can be life-changing, if not fatal; and to reduce the likelihood of post-concussive syndrome, which involves prolonged symptoms affecting cognition, memory, exertional tolerance, headache, sleep, mood and more. Post-concussive syndrome can last from weeks to years, so proper recovery is crucial. But most guidance on the best way to do this is based on consensus opinion, not evidence. In 2012 in Zurich, the 4th International Conference on Concussion in Sport resulted in a consensus statement, which proposed an approach to diagnosing concussion, then an algorithm for the safe return to play which first involved cognitive and physical rest, then a staged return to full physical activity. Although it has been a good starting place, there are critics of this approach. They suggest the approach to diagnosis lacks specificity, allowing those who may truly be concussed to underreport symptoms and return too soon, while certain subjective symptoms seen in the general population can be mistaken for symptoms due to concussion. This can lead to prolonged restriction of activity, with the potential for associated consequences such as deconditioning, stress and depression. Since the Zurich statement, several studies have suggested there is a sweet spot between returning too soon or too late to reg-

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ular cognitive and physical activities, with either extreme leading to increased risk of post-concussive syndrome. Fortunately, studies are underway to evaluate different options for a balanced, staged program to return to school with reasonable accommodations, even though some symptoms may persist. After a student can return to learn, they can then follow a staged return-to-play protocol. It has been proposed that in 80 to 90 percent of individuals who sustain mild traumatic brain injuries (concussions), full symptom resolution occurs in seven to 10 days. The trick will be discovering the approach that allows sorting out the other 10 to 20 percent who take longer and are at risk for post-concussive syndrome. Though the Zurich criteria may be considered by some to be overly conservative, we are in a much better place these days than when I was a kid, and “getting your bell rung” tackling somebody was evidence that you had a great tackle. Once you regained consciousness, you were applauded by your coach and teammates and told to “get back in there!” — MATT THOMPSON

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CHECK-IN GRAND OPENING

Checkups in Cheney

ith major medical centers and physicians’ offices dotting the skyline and landscape in Spokane, it may be hard to believe that for people living in Cheney and the West Plains, access to health care can be a time-consuming challenge. “There are thousands of low-income residents in the area who must overcome major geographic barriers to access health care,” says Matt Grebe, communications specialist with CHAS Health. Currently, travel to a community health center requires either a 15-mile drive or an hour of travel time via public transit. That will change in December with the opening of a new CHAS Health clinic in Cheney. A staff of physicians, physician assistants and nurse practitioners will be joined by behavioral health providers and a pharmacy at the 16,000-square-foot facility at 1720 2nd Street. They will provide general primary care, including pediatrics and women’s health services, as well as immunizations and health education. CHAS Health research indicates there are 10,000 low-income people living near the new center. “We think it will be a very wellreceived clinic for the West Plains community, there is a strong need for it in the area, and we expect to see a lot of patients from the surrounding area as well,” says Grebe. The new center is one of 266 “Access Points” in 46 states that received a portion of $169 million in Affordable Care Act funds distributed by the U.S. Department of Health and Human Services in September. The Cheney site received just over $350,000; other sites in Washington include Chewelah, Yakima and Seattle. All told, Washington received a total of just under $5.8 million. The big winner? California, with more than $44 million. — ANNE McGREGOR

SUPERFOOD

Hidden Treasure ATTRIBUTES: Acorn, butternut, Hubbard, kabocha, spaghetti and of course pumpkin are just a few of the many varieties of winter squash. Unlike zucchini, a member of the same family, winter squash are hard-skinned and harvested in the fall. Also unlike zucchini, they will last for months in a decorative bowl on your kitchen counter. SUPERPOWERS: We know a lot of people say they don’t like squash. Get over your reticence. Squash is so good for you, so inexpensive, and, uncut, lasts so long that you can’t afford to miss the wallop of nutrition inside that hard shell. With all the doubt raised recently about trying to get your nutrients from supplements, you can’t afford to miss this naturally abundant source of Vitamin A, Vitamin C, potassium and manganese.

WEAKNESS: Subjectively, the word squash is somewhat icky-sounding. Objectively, many adults, and virtually all children past infancy, seem to find the mushy, sometimes stringy texture of the innards of the genus Cucurbita off-putting. HOW TO USE IT: Whole Foods Market offers a method for “rich, perfectly roasted winter squash without any prep work at all.” Preheat the oven to 400 degrees. Place whole squash on a baking sheet and roast about an hour, until the skin is papery and the squash is tender if you poke it with a fork in several spots. Cool and then peel away the skin and discard seeds. Now your squash is ready to be featured prominently, or cleverly disguised, in nutritious soups, salads, casseroles, and even baked goods. — ANNE McGREGOR

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BRAIN EXERCISE

Sudoku

9 6 8 5 7

2 2 1

RATINGS: Moderate (left), Diabolical (right) To complete Sudoku, fill the board by entering numbers 1 to 9 such that each row, column and 3x3 box contains every number uniquely.

Answers to all puzzles on page 41

6 3 1 7 2

PUZZLES BY JEFF WIDDERICH & ANDREW STUART www.syndicatedpuzzles.com

Codewords

1 8 2 2 3 8 5 9 2 6

2 9 8 6

Each letter has been replaced by with a number. Using the starter clues, work out the words that must go in each cell on the codeword grid. Some well-known phrases and names may also be found. For a three-letter clue, turn to page 25. 18

21 8

5 9

15 24

3 6

12 5

8 8

18 2

4 3

3 17

13 1

N D

4 2

4 1

2 2

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

1 4 2 3 7 4 7 1 9 6

Str8ts

RATING: Gentle Like Sudoku, no single number can repeat in any row or column. But rows and columns are divided by black squares into compartments. These need to be filled in with numbers that complete a ‘straight’ — a set of numbers with no gaps but can be in any order. Clues in black cells remove that number as an option in that row and column, and are not part of any straight. Glance at the solution above to see how ‘straights’ are formed.

3 9 4

3 2 3 5

1 3 1

6 6 2

7 4 8 9

3 2 1

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Partnerships can fund hope. This is our home. And our cause. That’s why we’re honored to stand with another home team in the local fight against cancer: InnerPacific Alliance for Cancer Care, the Official Medical Partner of Community Cancer Fund. Cancer Care Northwest, Kootenai Health and Providence Health Care have joined together to elevate the level of cancer care in our region. Even better, they’ve all joined together with Community Cancer Fund to provide the support local families need during their fight with cancer.

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NEWS

JIM CAMPBELL ILLUSTRATION

PRESCRIPTION DRUGS

Medication Frustration Prices for some pills have soared, leaving consumers searching for cheaper options. But do discounts come at a cost? BY LINDA HAGEN MILLER

cross the country, Americans are facing sticker shock at the local pharmacy. The New England Journal of Medicine recently documented numerous increases in the price of generic drugs, including a staggering 2,800 percent price

spike in the blood pressure drug Captopril between 2012 and 2013. Whatâ&#x20AC;&#x2122;s going on? The Peopleâ&#x20AC;&#x2122;s Pharmacy, a nationwide radio program and newspaper column written by the husband-and-wife team of pharmacologist

Joe Graedon and medical anthropologist Terry Graedon, blames consolidation of generic manufacturers that has resulted in decreased competition, and higher prices. ...continued on next page OCTOBER-NOVEMBER, 2015

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NEWS

“It is unacceptable that Americans pay, by far, the highest prices in the world for prescription drugs,” says 2016 presidential candidate Bernie Sanders.

“MEDICATION FRUSTRATION,” CONTINUED...

the burden on patients when drug prices increase. In addition to Sanders, two other presidential candidates, Hillary Rodham Clinton and Sen. Marco Rubio (R-Florida), have raised the issue of high drug prices. Insurance companies, hospitals and physicians are also clamoring for drug costs to decrease and are pushing for the issue to come to the forefront in the 2016 presidential election. Meanwhile, patients having trouble paying for their drugs right now have two money-saving options: they can apply through various channels for reduced-rate pharmaceuticals, or they can order medications from Canada. Low-income and uninsured patients may be able to get free or at least less-expensive drugs through the Partnership for Prescription Assistance. After submitting an online form, patients will be referred to a state or local agency or a pharmaceutical company for reduced-rate medications. For others, Canadian online pharmacies often offer prescription medication prices far lower than the same medication would cost in the United States. Because Canada and most other industrialized nations impose price restrictions and limit what pharmacies can charge for drugs, the cost of medication sold in Calgary can be half of what it would be in Spokane. But like all things Internet, trouble can be found at the end of a keystroke.

Last year, U.S. Sen. Bernie Sanders (I-Vermont) and Rep. Elijah Cummings (D-Maryland), requested that the Office of the Inspector General of the Department of Health & Human Services investigate skyrocketing generic drug costs. Research accompanying that request cited numerous examples; among them was the finding that the price of 100 albuterol sulfate pills was $11 in October 2013. That same bottle

checked in at $434 by April of 2014. “It is unacceptable that Americans pay, by far, the highest prices in the world for prescription drugs. Generic drugs were meant to help make medications affordable for millions of Americans who rely on prescriptions to manage their health needs,” said Sanders, who is running for president. The lawmakers have also introduced twin bills in the House and Senate to help ease

PRICE CHECK

Prices quoted here were posted on Costco.com (United States) and Canadianpharmacymeds.com (Canada) on Sept. 21, 2015. As noted, some quantities vary.

f you Google “Canadian online pharmacies,” you’ll be greeted with pages of professional-looking websites offering prescription brand-name and generic drugs at highly competitive prices. Some

ADVAIR (50/250 MCG; 180 DOSES)

ACTONEL (3 PILLS)

CELEBREX (200G)

United States: $1024.42, generic not available Canada: $203 brand, $147 generic

United States: $795.73 brand, $301.73 generic Canada: $233 brand, $54 generic

United States: $910.20 brand, $178 generic (100 pills) Canada: $146 brand, $68 generic (90 pills)

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Home Design is are legitimate companies selling legitimate drugs, but others are actually criminal organizations, selling fake drugs with little or no active ingredient. And once you release your credit card number to buy from an illegitimate pharmacy, you may not only receive subpar or dangerous drugs, you could also open the door to fraud. “We have found that approximately 96 percent of the sites advertising prescription medications on the Internet are illegal or rogue sites,” says Carmen Catizone, executive director of the National Association of Boards of Pharmacy (NABP), referring to worldwide Internet sites. “These sites do not offer medications approved for use by the FDA, or require a valid prescription from a licensed prescriber. The drugs they are selling are not approved for U.S. patients or Canadian patients. In fact, medications shipped from these sites have been counterfeit, sub- or super-potent, or poisonous.” These warnings cast a sinister pall over purchasing online drugs from Canada, but the fact that about 5 million Americans buy prescription medication internationally each year with little or no health problems would seem to belie those warnings. Adding to consumer confusion is that getting more affordable drugs from Canada is not a subject that local providers seem eager to discuss. Ten sources contacted by InHealth declined to talk about the issue, with one pharmacist calling it a “conflict of interest.” Obviously, American drug companies have a lot to lose if patients can easily and confidently shop for their medication out of the country, and the pharmaceutical lobby has pushed hard to prevent it. It should be noted that, sadly, people have died from buying drugs internationally without a ...continued on next page

PHONY GENERICS

a W� k of Art

ncidents of counterfeit drugs are by no means limited to Canadian online purchases. Former Federal Drug Administration Commissioner Margaret Hamburg, M.D., acknowledged that 80 percent of active pharmaceutical ingredients sold in the U.S. come from foreign sources; many are legit but some are not. Last year, a Bloomberg News exposé reported that a number of major generic drug manufactures in India systematically fudge their data, delete negative test results and simply package up the bogus drugs and mail them to unsuspecting distributors. The FDA is charged with testing and monitoring hundreds of generic drug manufacturers — there are more than 600 in India and 500 in China alone — but the organization is woefully understaffed, with only a handful of inspectors in each country. The most popular counterfeit drugs are Cialis and Viagra for erectile dysfunction, Zyprexa for schizophrenia, Effexor for depression, Plavix for heart conditions and Reductil for weight loss. Whether ordering prescription drugs from Canada or taking meds you picked up at your local pharmacy, it’s up to the consumer to be vigilant. Pay attention to your body’s reaction to your medication. Check packaging, labels and dosage. If anything seems amiss, contact your doctor and your pharmacist. — LINDA HAGEN MILLER

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NEWS “MEDICATION FRUSTRATION,” CONTINUED... prescription or from counterfeit websites. Mike Metcalf, a Spokane family practice doctor who recently retired after 40 years in practice, claims he has never heard of patients receiving counterfeit drugs from Canada, and is a staunch believer that Americans should have the option to purchase prescription drugs online. “I frequently invited my patients to use Canadian pharmacies,” he says. “My wife and I buy several medications for personal use, as do many of my friends. Our medications include Celebrex, an arthritis medication, and Vivelle-Dot generic, an estrogen patch, from NorthwestPharmacies. com in Canada,” he adds. “Celebrex would cost me at least $300 for 100 tablets if I bought them through my insurance company, Group Health, but they’re only $75 through the online pharmacy. The estrogen patch has a very significant savings by purchasing in Canada.”

Patients still need a prescription to order from websites like canadianpharmacymeds.com

here are several ways that consumers can try to verify the validity of a Canadian online pharmacy. The National Association of Boards of Phar-

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macy (napb.net) carries updates and news about online drug issues, and recommends that consumers search AWARxE (awarerx. org). NAPB endorses the Verified Internet Pharmacy Practice Sites (VIPPS) program, which accredits online pharmacies that dispense prescription drugs. VIPPS requires an Internet pharmacy to comply with state licensing, meet nationally endorsed standards of pharmacy practice and adhere to a quality assurance policy. The Canadian International Pharmacy Association (CIPA) offers its endorsement to licensed retail pharmacies and verifies that they are in good standing. CIPA reports that it has served more than 10 million U.S. patients since 2002 and claims a 100 percent safety record. Until recently, PharmacyChecker.com was also recommended as a source to verify online pharmaceutical companies, but as we go to press, PharmacyChecker is under investigation for certifying Winnipeg-based Canada Drugs as a legitimate online seller. Canada Drugs is accused of selling $78 million worth of counterfeit drugs to U.S. doctors over the past three years, and Dr. Ram Kamath, one of PharmacyChecker’s

directors, has been included in the indictment. On its website, PharmacyChecker.com states that “Dr. Kamath’s conduct had no connection to PharmacyChecker’s business and it was not part of his work for the company. While we have no greater insight into the present allegations, we can say this: years of verifications by PharmacyChecker, and peer-reviewed, empirical studies confirm the strength of our program. Safe online pharmacies have enabled millions of Americans to benefit from significantly lower cost medications from other countries, helping many Americans get prescribed medication they may otherwise have gone without.” “My patients have reported sharp increases in their drug costs … I certainly understand how enticing it is to order drugs from Canada and save money in the process,” says Janice Jordan-Bichler, a physician assistant with Optimal Healthcare in Spokane Valley. “I caution my patients to monitor their condition and come in to see me immediately if they feel something’s not right. We can certainly go to an alternative.” 

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NEWS

ABOVE: Inside the new UW Spokane Center in downtown Spokane. KRISTEN BLACK PHOTO LEFT: Some of the 40 UW Med students studying in Spokane. UW SCHOOL OF MEDICINE PHOTO

EDUCATION

Purple Presence With the debate about a new med school over, the University of Washington has only increased its pawprint in Spokane BY DANIEL WALTERS

hen the Washington state legislature looked at two diverging proposals this spring for medical education in Spokane — one from Washington State University and one from the University of Washington — it said, with the commanding voice of both houses and both parties, “Why not both?” It was the exact outcome that civic boosters had been rooting for. A win-win for the universities, but especially a win for Spokane.

Many of the local backers of WSU’s proposal for its own fully accredited medical school had pointed to what they saw as the University of Washington’s comparative lack of investment in Spokane. Most of the research dollars, ink and headlines went to Seattle. Some students sent to the UW medical school in Spokane even initially saw it as a kind of misfortune. Colloquially, it was nicknamed “getting WWAMIed,” after the med school’s WWAMI program. (WWAMI is an acronym standing for the

program’s five-state partnership: Washington, Wyoming, Alaska, Montana and Idaho.) But no one can accuse the University of Washington of ignoring Spokane now. Most dramatically, the UW moved into the old Visit Spokane building. Its mark — a bold white “W” — now hangs on brick building in the middle of Main Avenue. And at night? It glows purple. “They were seeing they needed to increase their presence,” says Catherine Brazil, a third-generation Husky who is the UW’s new director for Spokane and Eastern Washington. The creation of her position is yet another recent UW investment in the area. “We are a centerpiece for folks in the alumni association to have events to bring people together,” says Brazil about the UW Spokane Center. Local students can visit the center and learn about the university, or at times meet with admissions officers. Brazil hopes that community groups, like the board of Greater Spokane Inc., will hold meetings at the Center. “I’m hoping we get more students from

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Spokane and this region going to the University of Washington,” Brazil says. “I hope you’ll see more of the ‘purple presence’ in all facets.” That presence includes research and innovation. Brazil says that Vikram Jandhyala, director of UW’s CoMotion hub, has been chatting with Tom Simpson, one of Spokane’s most visible startup gurus. CoMotion focuses on connecting researchers with businesses to spark startup companies. “Vikram is already thinking of Spokane and what he wants to do in bringing innovation” to the city, Brazil says.

till, the UW School of Medicine, mostly through the WWAMI program, remains the central way that the University of Washington impacts Spokane. “I think it’s great that we increased funding for UW medical education in Spokane,” says state Rep. Marcus Riccelli. “We’re moving forward to really make Spokane a hub for medical education.” The UW is still working out the details of separating the WWAMI program from Washington State University, and still

talking with Gonzaga University about slipping into WSU’s former role as WWAMI partner. For now, a new crop of 40 UW medical school students has arrived on the campus. For the first time, all of them will stay in Spokane all four years — no transferring back to Seattle or leaving the area until they’re done. Thanks, in part, to a massive curriculum overhaul. “The new curriculum vastly improves the classroom experience, gets students into the clinical setting more quickly and allows us to offer all four years of medical school in Spokane,” interim UW president Ana Mari Cauce said in a statement in May. It’s the natural evolution of what’s called the “flipped classroom” model, where textbook learning, lectures and basic instruction often happens at home. Classroom time is spent on discussions, or — this is key — in medical clinics, from the very start. “Instead of being in a lecture six to eight hours a day, students will be in class no more than four hours a day,” says Suzanne Allen, the UW School of Medicine’s vice dean for academic, rural and regional

affairs. “We’re starting the new curriculum with two weeks of clinical immersion.” The organization of the curriculum has been streamlined as well, Allen says, focusing on a comprehensive understanding of treating specific parts of the body. Instead of learning about the kidney’s biology in one unit, pathology in another, and potential pharmaceutical treatments in another, she says, “now you’ll learn the anatomy and the physiology and the pathophysiology, the medication and physical exam” in one unit. The university has hired eight new faculty members from the local area to make it possible. “The exciting part of medical school is when you feel like you’re practicing medicine, when you’re in the clinics learning hands-on,” says Kim Blakeley, a UW Medicine spokeswoman. “They’re extremely excited about that.” And by keeping students in Spokane all four years, Allen says, the likelihood that they’ll remain in the region to practice medicine becomes that much higher. That, ultimately, is the UW investment that will pay off in the long run. n

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Miracles Are Collection:

Ready for Use:

every day InBC needs 200 donors to ensure a safe and dependable blood supply.

once the blood arrives at the hospital, it is immediately available for use. Blood products can be stored up to 42 days and platelets can be stored for 5 days.

200 Separation: Donated blood is taken to our Components laboratory for testing and to prepare blood products.

nland northwest Blood Center (InBC) is so much more than our community “blood bank.” Yes, collecting blood to save lives through transfusions is the heart and soul of what we do it’s our mission. But unbeknownst to many, a portion of the life-saving work happening here at InBC is not derived from blood donations taken on our draw floor. It goes much deeper than that. have you ever known someone who is waiting desperately to hear their organ transplant match has been found? Chances are our HLA Laboratory found that match. Has someone close to you been diagnosed with cancer about to undergo chemotherapy? Most likely, our therapeutic nurses will remove and preserve their healthy blood cells to be re-infused when the patient needs them most. our laboratories and nurses play a vital role in saving lives every day. when you support Inland northwest Blood Center and the Blood Center Foundation of the Inland northwest, you’re supporting the life-saving work that is changing the lives of blood recipients, cancer patients, organ recipients and many more. InBC is where miracles are happening.

Transportation: INBC couriers transport blood products 7 days a week/ 365 days a year/ 24 hours a day to over 37 regional hospitals.

Testing: Our Transfusion Laboratory then performs extensive patient testing for all area hospitals in preparation for transfusion therapy.

“We make a living by what we get, but we make a life by what we give.” - Winston Churchill

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Happening Here Inland Northwest Blood Center is more than just a blood bank… Human Leukocyte Antigen (HLA) Laboratory: InBC provides specialized histocompatibility testing for patients awaiting organ transplantation, for patients requiring hla compatible platelet transfusions and for patients with conditions associated with certain hla antigens. the hla laboratory works closely with the sacred heart Kidney transplant Program and the Inland northwest thoracic organ transplant Program to provide hla typing, hla antibody screening and lymphocyte cross-matching for patients awaiting kidney or heart transplants. the hla laboratory also works with the organ procurement organization, life Center northwest, to help carry out the wishes of deceased donors in eastern washington, north Idaho and Montana.

Therapeutic Apheresis Program: our InBC therapeutic nurses perform therapeutic apheresis (ay-fur-ee-sis) procedures, meaning a portion of the blood is removed or treated, with the remaining components being returned to the patient. these procedures are most commonly used among cancer patients, transplant recipients and patients with other neurologic diseases.

the Blood Center Foundation of the Inland northwest raises funds and provides grants for health care education, technology and research given back to InBC and our regional community. a sample of our support, made possible through your charitable gifts: $9,000 for three Vein Viewers, to provide visualization of veins, valves and bifurcations in the arms of blood donors, for INBC.

$36,000 for Medical laboratory Science student scholarships and equipment in the Department of Laboratory Medicine at Providence sacred Heart Medical Center and Children’s Hospital.

$16,890 for ten automated external defibrillators (aed’s), placed at InBC locations in Spokane, Moses Lake, Pullman, Lewiston, Coeur d’alene and five mobile collection buses.

$3,500 for InBC to establish a Patient assistance Fund to HLA-type uninsured family members to determine if they are a match for a relative in need of a stem cell transplant.

Move healthcare forward and partner with us today! Visit www.bloodcenterfoundation.org

NEWS inhealth 10-5-2015.indd 23

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NEWS

ENVIRONMENT

“It’s always been hazardous,” says Randy Connolly, Superfund coordinator for the Spokane Tribe, at the entrance to the cleanup site. JAKE THOMAS PHOTO

Toxic Turf Uranium mining left a scar on the Spokane Tribe’s land and a legacy of health problems for its people; do current cleanup plans do enough? BY JAKE THOMAS

andy Connolly, the Spokane Tribe’s Superfund coordinator, wheels his Jeep onto a side road outside of Wellpinit. Underneath the layer of gravel and pavement, he says, is a layer of contaminated uranium mining material that was originally used to line the road. Farther up the road is a fence topped with barbed wire, designed to keep out animals and people who might wander in and unwittingly pick up and take home radioactive rocks. Beyond the fence is a 350-acre scar consisting of 33 million tons of waste rock and ore, along with pits as deep as 500 feet, filled with blue and green wastewater. “It’s always been hazardous,” says Connolly.

The atomic age came to the Spokane Tribe in the spring of 1954, when brothers John and James LeBret, using an ultraviolet light and a Geiger counter, discovered fluorescent uranium minerals in the mountains outside of Wellpinit. The discovery led to a partnership between the LaBrets and other members of the tribe, with the Dawn Mining Company acquiring control of the property. The mine opened up shortly afterward, providing uranium for the government and the energy industry. Lois Stratton, a former Spokane city councilwoman and state legislator who grew up on the reservation, remembers the mine being a source of jobs in the economically depressed area. She recalls people

fixing up their houses and buying cars, sometimes their first. Someone even bought a Cadillac. After the Three Mile Island nuclear reactor in Pennsylvania partially melted down in 1979, the nation’s appetite for uranium withered. The mine closed in 1981, but its effects lingered. “Every time you pick up the paper and see that someone has died on the reservation, it’s always cancer,” says Stratton.

he site drains into nearby Blue Creek. Tribal members are advised not to drink from it, eat fish caught from it or gather plants nearby. The creek runs into the Spokane River, a tributary of the Columbia River. “It may appear to be a remote issue in northeastern Washington, ” says Mary Verner, a former Spokane mayor who served as the tribe’s director of natural resources. “But it’s a regional issue.” Warren Seyler, a former tribal council member, worked at the mine to help pay for college. He remembers wearing a button that would change colors, indicating that its wearer had been exposed to too much radiation and needed to stop working. But he says most ignored the warning

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and kept working, hoping to take home a bigger check. Many also took dust-covered clothing home to their families. “[They thought] this is my job, and I’m putting food on the table,” he says. Verner says that it wasn’t until about a decade after its closing that the tribe realized how serious the environmental problems resulting from the mine were. After years of incremental regulations, mandates, negotiations and litigation, the federal government finally reached a settlement with Dawn Mining Company, LLC, and its corporate parent Newmont USA Ltd. (which didn’t respond to a request for comment) under which both companies agreed to pay up to $193 million for the cleanup. “The legacy of this mine has been an open, gaping wound on the landscape and a series of broken promises for the Spokane Tribe,” says Verner.

arol Evans, who in July became the first woman to be elected as chairperson of the Spokane Tribe, says her father didn’t talk much about his day in the mine when he came home from work. He went out to tend cattle, while she

played with her siblings. But he later fell open pits will be partially filled with topsoil ill, says Evans. She doesn’t remember the to prevent radon from escaping, which will name of the illness, but it was from the require clear-cutting surrounding trees and mine, and he qualified for compensation will make the footprint of the mine larger. under a federal program. “They’ve done enough damage,” she “I think back to the employees worksays. “It’s just a big, huge scar, and it’s geting,” says Evans. “They didn’t know ting bigger.” then what they know now, so you defiThe agreement also requires the companitely have fathers and grandfathers that nies to build a new water treatment facility had diseases that were most likely caused to clean any nearby water to the tribe’s by working in those places.” stringent water quality standards before it is While serving as vice-chair of the discharged into the Spokane River. Meeting council, Evans helped negotiate some the standards will be hard enough, but this of the final details of the cleanup plan, facility will need to operate in perpetuity, a which was submitted in July and awaits prospect that concerns Verner and others. final approval from the U.S. EnvironShe says that questions of who’s responsimental Protection Agency. The cleanup, ble for funding and maintaining the facility which could take a decade to inevitably will arise. complete, could begin next The cleanup could be year. further stalled, according from the puzzle on page 13 But the reservation will to Verner, who notes that 2 = I; 10 = Y; 18 = L never be the same. every major development Twa-le Abrahamson, a tribal memrequired a trip to Washington, D.C., to ber and activist with the Sovereignty, convince the federal government to move Health, Air, Water, and Land Society, a forward. n grassroots advocacy group long active on mine-related issues, is concerned A version of this story first appeared about the cleanup plan. She says the in the Inlander.

CODEWORDS: HINT

11 Locations | 444-8200 | chas.org OCTOBER-NOVEMBER, 2015 NEWS inhealth 10-5-2015.indd 25

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Robotic-assisted surgery. Less pain. Faster recovery.

At Deaconess Hospital, our surgeons have access to minimally invasive tools and techniques, including robotic-assisted technology, that allows them to perform delicate and complex procedures for the treatment of a variety of conditions with greater control, accuracy and precision. It may mean a smaller incision, less pain, less scarring, and a quicker recovery compared to traditional surgeries.* For more information, visit DeaconessSpokane.com/RoboticSurgery.

*Typical results depend on many factors. Consult your physician about the benefits and risks of robotic-assisted surgery for your condition.

26 Health OCTOBER-NOVEMBER, 2015 NEWS inhealth 10-5-2015.indd 26

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LIVING

the

Spicy Life

side of

Freshen up familiar foods with the healthy addition of aromatic spices and herbs BY JAKE THOMAS

rowing up in Malaysia, Christina Arokiasamy remembers both her family’s kitchen cooking cabinet and their medicine cabinet being full of spices. She recalls helping her mother haul turmeric, cinnamon and cloves for her family’s spice business. And she remembers her father, a naturopathic physician, giving her clove oil for toothaches and hot water with star anise for colds. Now based in Seattle, Arokiasamy is a chef, culinary instructor and the author of The Spice Merchant’s Daughter: Recipes and Simple Spice Blends for the American Kitchen, a cookbook that draws on her personal narrative. She’s also Malaysia’s official food ambassador to the U.S., introducing the foods of her homeland to American tables. At work on a second cookbook now that will be published in 2016 by Houghton Mifflin Harcourt, her central message to American audiences is that incorporating ...continued on page 29

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LIVING

spices to use now

Turmeric “One of the spices that I think everyone should use in the kitchen is turmeric,” says chef and author Christina Arokiasamy. Turmeric, with its deep golden color, has long been a staple in curries and other Indian foods, as well as in naturopathic medicine. Now Western research has shown it is a potent anti-inflammatory that may benefit the cardiovascular system, as well as having a protective effect against some types of cancer. Turmeric shouldn’t be limited to curries — it can easily be woven into Western foods like mac-andcheese and scrambled eggs.

spices to use now

Chiles and peppers Hot and spicy chiles and peppers are consumed all all over the world, and their health benefits are well established. Capsaicin, one of the key components of chiles and peppers. may assist with weight loss, managing diabetes and reducing inflammation. Spiceologist’s Pete Taylor notes that the heat in a dish can be balanced by adding a something sweet, like honey. Novices, he says, may want to start with a pepper blend.

Christina Arokiasamy’s first cookbook, The Spice Merchant’s Daughter, was hailed as one of 2008’s Top Ten by NPR. Her second, due in 2016, focuses on using spices for health.

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“THE SPICY SIDE OF LIFE,” CONTINUED... more herbs and spices into their cooking will not only make their food more flavorful, but also will result in health benefits. “I want to see changes in diets and food for children, college students, everyone,” she says. “We have a lot of health issues in

can reduce blood sugar and blood pressure, as well as potentially decreasing the risk of diabetes, heart disease and some forms of cancer. “I definitely believe that people should incorporate more spices or herbs in their cooking, no question,” says Craig Hunt, a Spokane registered dietitian.

“…it’s hard to pin it down. We know they have an effect, but how do you measure it, and what happens when you digest it?” the U.S., and more people need to understand that if they eat right, they’ll have a better quality of life.” Once relegated to naturopathic or traditional medicine, herbs and spices are increasingly becoming accepted as mainstream ways of improving health. Research has found that consuming herbs and spices

Hunt says in the 1960s, he would hang out in health food stores, which were some of the few places that touted the benefits of herbs and spices. The concept that these aromatic ingredients were actually good for you remained on the fringes throughout the 1970s and 1980s, he says, and it wasn’t ...continued on page 31

Exclusive food news & a calendar of culinary events Delivered to your inbox every Thursday Subscribe at: inlander.com/newsletter

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LIVING

spices to use now

Cumin Made from the seeds of a plant related to parsley that’s native to the Mediterranean region, cumin is an earthy, somewhat bitter but versatile spice that goes well in a range of food, including dishes based on grains, meat and legumes. Research has shown that it’s rich in antioxidants, and researchers are intrigued by its potential anti-cancer activity in the body.

Spiceologist CEO Pete Taylor recommends that newbies start with a spice blend.

YOUNG KWAK PHOTO

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VOLUNTEERS NEEDED

“THE SPICY SIDE OF LIFE,” CONTINUED... until the past 10 years or so that researchers in modern medicine began to consider whether there were health benefits to be exploited. But Hunt says researchers are still trying to nail down precisely what those health benefits are. For instance, he says that cinnamon has been the object of substantial research inquiry, with evidence showing it can play a role in modulating blood-sugar spikes, but overall much of the research on spices remains inconclusive. It could be, he says, that the health benefits of herbs and spices are different when they’re consumed with other spices, and it’s likely that they affect different people in different ways. “That’s why it’s hard to pin it down,” he says. “We know they have an effect, but how do you measure it, and what happens when you digest it?”

fter 15 years as a chef, Pete Taylor says he was drawn to working with spices because of the seemingly

The Spokane County Superior Court Guardianship Monitoring Program recruits and trains volunteers to assist in monitoring guardianship cases. Volunteers are needed as Financial Auditors and Court Visitors to serve as the eyes and ears of the court to help detect or prevent abuse, neglect, and exploitation of incapacitated persons. Volunteers must be 21 years of age or older. Training and supervision are provided. FINANCIAL AUDITORS The Financial Auditors review court-ordered accountings of the incapacitated person’s finances, submitted to the court by the guardian, to ensure that the incapacitated person’s finances are being handled properly and in their best interest. COURT VISITORS The Court Visitors visit the incapacitated persons, guardians, and any other caregivers to ensure that the incapacitated person’s needs are being met and adequate care is being provided. This monitoring function enables the court to have first-hand information about persons under guardianship. JEWELS or ANA Phone: 509-477-2622 Fax: 509-477-5195 Email: gmp@spokanecounty.org

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...continued on page 33

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LIVING-MAIN inhealth 10-5-2015.indd 31

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spices to use now

Cinnamon If you’re not ready for anything too spicy, familiar old cinnamon offers benefits in managing blood sugar and may assist in the battle against fungal infections. “I cook a lot with cinnamon,” says chef Christina Arokiasamy. “For me, it’s maybe ironic that it’s a sweet for Americans, used in sugary confectionaries. In Malaysia, we don’t look at it as a spice for dessert,” she says, noting that cinnamon also goes with meat, curries and stir-fries.

RECIPES

Cinnamon-Seared Pork Tenderloin w/Mango Chutney This recipe offers great way to use cinnamon in a savory setting. 3 tablespoons canola oil ¾ cup all-purpose flour ¼ cup ground cinnamon 2 tablespoons brown sugar 1 tablespoon salt 1 tablespoon cayenne pepper 2 pork tenderloins 1 jar Major Grey’s Chutney (or make your own) Preheat oven to 375. Combine flour, salt, sugar and spices in bowl and hand mix. Dredge tenderloins in flour/spice mix. Heat a cast-iron skillet (or heavy-gauge sauté pan), add oil and sear all sides of tenderloins. Once all sides are seared (be careful not to over-caramelize), finish the pork in the oven until its internal temperature reaches 145 degrees. Remove from oven and let pork rest for five minutes before serving. Serve pork with warmed chutney. Rice or sweet potatoes are a good accompaniment.

A Spiceologist block

YOUNG KWAK PHOTO

Turmeric Smoothie You don’t have to reserve spices for cooking. This smoothie unleashes the power of turmeric. 1 cup almond milk 1 scoop vanilla protein powder 1 banana ½ cup frozen pineapple chunks 2 teaspoons turmeric powder Place all ingredients in a blender jar and blend until smooth. Serve immediately. — Recipes by Pete Taylor, Spiceologist

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LIVING “THE SPICY SIDE OF LIFE,” CONTINUED... infinite combinations of flavors. Now, as CEO of Spokane-based Spiceologist, a rapidly expanding company, spices are his full-time job. He enjoys helping customers discover spices for both their culinary and health benefits. For example, he says, chiles may actually help people lose weight. That’s because people generally eat spicier and more flavorful foods more slowly, and consequently eat less because they start to feel full. But chiles also contain capsaicin, a substance that studies have shown can increase metabolism while decreasing appetite. He’s also a fan of a lesser-known spice called sumac, which has a citrusy note, and has been shown by research to help keep arteries clear. He suggests that saffron, which lends a rich yellow color to dishes, may reduce the risk of some types of cancer. For spice novices, Taylor suggests trying a blend to start. Za’atar, an antioxidant-rich Middle Eastern blend of spices that includes sumac, thyme and oregano, is one of his favorites.

For both taste and health reasons, fresh spices are best. Taylor recommends not buying seasonings in bulk, because both flavor and health benefits fade as they sit on the shelf. To test for freshness, Arokiasamy suggests giving a spice container three taps on the side and sniffing before purchasing. If you can’t smell the aromas, she says the spices are probably no good. For the freshest spices, Taylor says you should consider grinding them yourself, adding that toasting whole seeds or powders before adding to food will help unlock their flavor. While an appropriate amount of salt can be part of a healthy diet, if you’re under doctor’s orders to have little or no salt, spices can prevent a lifetime of dull, flavorless foods. In particular, Taylor recommends chiles, paprika and cumin to replace salt’s ability to enhance flavors. In fact, while teaching classes in the U.S., Arokiasamy says that her students have been amazed at how flavorful food can be without adding salt. “Americans rely so much on salt and sugar for their flavor … instead what Americans should do is impart spices.” n

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Rosemary Recent cleverly devised research in England demonstrated that the aroma of rosemary in a room enhanced recall in subjects given memory tests. (Conversely, the scent of lavender reduced memory.) Blood samples taken after the unwitting subjects spent time in the aromatic rooms revealed the presence of a rosemary compound that researchers believe may act similarly to current medications used to treat dementia.

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LIVING

Picabu Bistro owner Jane Edwards says homemade soup is, “a good way to use up ingredients you don’t have anything else to do with.” YOUNG KWAK PHOTOS COOKING

Bowls of Goodness Picabu Bistro serves homemade soup year-round BY CARRIE SCOZZARO

ith the onset of cooler weather, our attention turns toward warm foods like stews and soups, which provide more than just physical sustenance. They’re economical, versatile, usually easy to prepare and serve, and can accommodate a range of dietary requirements, including gluten-free, vegan and those wanting to minimize their fat, salt or sugar intake without sacrificing flavor. “Soups are also a good way to use up ingredients that you don’t have anything

else to do with,” says Picabu Bistro’s Jane Edwards. Her Harvest Chicken Soup is a onepot meal designed to deliver two different menu items. By cooking the chicken herself, Edwards not only gains a flavorful, nutritious broth for her soup, she can allocate the remainder of the meat to another entrée, such as Picabu’s Garlic Chicken Melt. Chicken soup — or some variation of it — is ubiquitous, almost worldwide. Switch

the chicken broth with coconut milk and Thai spices for the beginnings of thom kha kai. The Greeks add lemon and eggs to create avgolemono, while Latin American and South American versions of sopa de pollo might include rice, tomatoes, corn and such spices as cumin and cilantro. The history of soup is the history of cuisine and of culture: borscht (Russia), minestrone (Italy), ramen (Japan), bouillabaisse (France), pho (Vietnam). And soup need not be warm to be a soup; gazpacho (Spain) and khyar bi laban or cucumber yogurt soup (Lebanon) are both served cold. At Picabu Bistro, soup is a year-round offering, says Edwards. In addition to black bean chili, Picabu makes a vegan soup — cream of broccoli with coconut milk, for example — and a soup du jour. Their soups sell amazingly well in the summer, says Edwards, especially when paired with salad; perhaps people don’t want to heat up their own kitchens with a pot on the stove for several hours. “It is a comfort food,” says Edwards,

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Chicken Harvest Soup Rich in healthful ingredients and so simple to make, this chicken soup is also versatile, says Picabu Bistro’s Jane Edwards. Add more chicken for a heartier meal, and feel free to substitute similar vegetables you have on hand, such as chard for spinach. 1 medium chicken 4 quarts water 1 tablespoon oil 1 large onion, chopped 3 cloves garlic, minced 1 cup carrots, sliced into rounds 1 cup celery, chopped 1 each, medium red and green bell pepper, chopped 1 cup corn 1 medium zucchini, quartered and chopped 2 cups fresh spinach, chopped 1 tablespoon thyme ¼ cup concentrated chicken base (Picabu prefers liquid to bouillon) salt and pepper to taste

To get the best flavor and nutrients, bake the chicken, let cool and remove largest portions of meat for use in another meal, such as chicken salad or chicken enchiladas. Boil bones in 4 quarts of water covered loosely for about an hour or two. While the chicken is boiling, prepare vegetables. When the chicken is done, pour the bones and liquid through a strainer. Let the bones cool and pick off remaining meat to add to your soup, chopping into smaller pieces as needed. Set aside. In the pot you boiled the chicken in, sauté onion and garlic in oil until the onion is translucent. Add all the vegetables except the zucchini and spinach. Season with thyme and add the chicken stock and chicken base. Stir and bring to a boil, then simmer on low for 30 to 45 minutes until the vegetables are tender. Finally, add zucchini, spinach, and chicken, season as needed and simmer another 5 to 10 minutes until fully warmed through. Makes 5 quarts.

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“sort of a luxury to have cooking all day.” In the colder months ahead, a large pot of soup might be just what the doctor ordered. Although medical studies have not yet revealed exactly why soup (chicken soup, in particular) seems to help combat cold and flu-like symptoms, there is some agreement on its health benefits. It’s easy to digest, often contains an abundance of vegetables, and its warmth helps unblock stuffy noses and lungs. Not all soups are created equally, says Edwards, who notes that some are probably healthier than others in terms of fat, for example. “But I do believe that when you make things from scratch, you can control

what goes in it.” For Edwards, that means flavor from spices like basil, tarragon, thyme and curry, and using the freshest ingredients possible. “We cut every vegetable that goes in [our soup],” she says. “We boil our own chickens to make our own base.” Edwards, who started Picabu with brother John 10 years ago (she’s run it herself for seven years), says that servers not only have access to recipes, they’ve been involved in meal prep. That enables them to quickly respond to customer concerns about such things as food allergies: “You know what you’re going to get when you come here.” n

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PARENTING

Searching for Rest Symptoms of disordered sleep may not be recognized in kids BY CHELSEA BANNACH

ommy seemed unusually withdrawn and reluctant to try new things. His mood was fragile, swinging from teary to explosive, and he didn’t joke and laugh with his family anymore, says his mom, Liana Groza, a dentist and coordinator of the Spokane Regional Sleep Apnea Network, in an email interview. “There were several years worth of photos where he is always looking somewhat absent, tired or sad,” Groza writes. “This was particularly heartbreaking for me, because I remembered a child who had a remarkable sense of irony and sparkling humor only a couple of years earlier — and now that child was gone.” It would be several years before the cause was discovered. Tommy, now 9, had sleep-disordered breathing. Although most research focuses on adults, insufficient sleep in the formative years has been associated with metabolic, cognitive and emotional effects, and pediatric sleep-disordered breathing is a growing area of interest among experts. It’s

a relatively new field, and many providers don’t receive in-depth training on the topic. With a lack of clear, universal screening and treatment protocols at the primary care level, kids can fall through the diagnostic cracks.

GETTING A BREATH

Causes of sleep-disordered breathing can be obstructive (think large adenoids or tonsils, or a tongue displaced back into an airway), environmental (allergies or chronic sinusitis), genetic (mismatched, narrow jaws), and anatomic/structural (misaligned jaws or airway dysplasia). The symptoms can be obvious — mouth breathing, loud snoring, tossing and turning, and gasping and choking during sleep. But in some cases, symptoms (attention difficulties, aggressive behavior at school, even depression) may be only indirectly related to sleep. “That’s the tricky thing,” says Sean Park, a pediatrician at Lakeside Pediatric & Adolescent Medicine in Coeur d’Alene. “It can be hard to find sometimes.”

Twenty to 25 percent of kids diagnosed with Attention Deficit Hyperactivity Disorder have sleep apnea, Park says. That doesn’t mean they don’t have ADHD. Some might be misdiagnosed, or “they might have both and the sleep apnea is making things worse.” One study concluded that a history of sleep-disordered breathing in the first five years of life is associated with a 40 to 60 percent greater chance of special educational needs by age 8. Park says he may refer patients for a sleep study, or to an otolaryngologist if large tonsils or adenoids need to be removed, or simply prescribe allergy meds. Weight management, oral appliances, or positive airway pressure therapy are other treatments. Managing the condition is complicated by the fact that there are currently no universally accepted guidelines as to when children’s obstructive sleep apnea is sufficiently severe as to warrant treatment. Park says that sleep apnea could be more common than previously thought. It’s also getting more attention with the rise

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in childhood obesity, because “childhood obesity actually plays a role in sleep apnea,” he says. Several studies show a strong association between between pediatric sleep disorders and childhood obesity. One study of adolescent patients found that obstructive sleep apnea increased the odds of metabolic syndrome — a cluster of conditions that increase the risk of heart disease, stroke and diabetes — sixfold. Bed-wetting, sleep-walking, diminished growth and other hormonal, metabolic problems and dental problems can result.

AWAKENING AWARENESS

Sleep-disordered breathing is underdiagnosed, says Spokane-based orthodontist Duane Grummons, and sometimes even if a problem is suspected, clinicians will take a wait-and-see approach with the hope that a child will outgrow it. The child can suffer in the meantime, and invasive interventions may be needed to correct the problem later. “Clinicians can do harm by doing nothing,” he notes. “The key factor is recognizing and preventing worsening problems by intercepting sleep-disordered breathing conditions when the patient is younger.” In his office, Grummons uses a patient

questionnaire and cone beam-computed tomography — CBCT for short — to create 3-D images of a person’s head and identify airway restrictions. He can then use facial orthopedics to open the airway, or refer a patient to another specialist for treatment. He says he would like to see pediatric providers use consistent referral flow charts and collaborative protocols for diagnosing and treating children: “We know a lot, but we need to integrate that.” For Groza, the first indication that something unusual was going on was Tommy’s bruxism, causing his front teeth to become significantly worn down by the time he was 5. He also had frequent and severe ear infections starting at age 2, a lisp requiring speech therapy that may have been caused by inadequate tongue space, chronic dark circles under the eyes, difficulty getting up in the morning, irritability, mouth breathing and recurrent episodes of nasal congestion. When Groza was in dental school, students were taught not to worry about teeth grinding, and it wasn’t until she started attending courses on sleep apnea a couple of years ago that the connection between bruxism and sleep-disordered breathing

became apparent, she says. “All these other puzzle pieces fell instantly into place,” she says. “Suddenly I became acutely aware of every little sleeping noise and movement pattern possibly indicating that Tommy had some trouble breathing, and the daily struggles to get him out of bed in time for school were overshadowed by a guilty suspicion that he might simply be sleep-deprived and coping with unarticulated morning headaches.” Tommy underwent an imaging study in Grummons’ office and the radiologist’s report clearly showed a significant narrowing of the airway. He had his tonsils and adenoids removed and underwent rapid orthodontic expansion to correct his narrow maxilla. Within a few weeks, the dark circles under his eyes disappeared and he started waking up early all by himself. Other results of getting a good night’s sleep? “I am delighted to become reacquainted with my child’s wonderful sense of humor, the calm and sunny disposition that almost nothing seems able to disturb anymore,” she writes, “and the zest with which he now approaches whatever adventure life throws his way.” 

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LIVING OCTOBER - NOVEMBER HEALTH EVENTS WALK TO END ALZHEIMER’S | The annual 3-mile walk is the world’s largest event to raise awareness and funds to fight the disease, the sixth leading cause of death in the U.S. Sat, Oct. 3, from 8:30 am-1 pm. Entry by donation. Riverfront Park. (473-0456) HOEDOWN FOR HOPE | The fourth annual benefit event for Spokane HOPE School includes a catered dinner, live music and dancing, live/silent auctions, a raffle and more. The nonprofit provides specialized services to children with hearing loss, regardless of families’ ability to pay. Sat, Oct. 3, at 5 pm. $55/person. Spokane Convention Center, 334 W. Spokane Falls Blvd. spokanehopeschool. org (280-3108) BIG BROTHERS BIG SISTERS 50TH ANNIVERSARY GALA The local nonprofit celebrates its 50th year at an event offering dinner, drinks, silent and live auctions and more. Sat, Oct. 3, at 6 pm. Northern Quest Resort & Casino. nwbigs.org (328-8310) RUN FOR THE ANGELS | The annual 5K walk/run benefits the Inland Northwest SIDS Foundation, and also includes a silent auction, kids’ activities and remembrance ceremony for SIDS victims. Sun, Oct. 4, from noon-5 pm. McEuen Park, 420 E. Front Ave., CdA. inwsids.org CIRCLE OF HOPE | The 10th annual benefit breakfast shares and supports the mission and programs of the Spokane Guilds’ School. Tue, Oct. 6, at 7:30 am. Davenport Grand Hotel, 333 W. Spokane Falls Blvd. guildschool. org WSU SPOKANE HEALTH FAIR The annual Spokane Health Fair, hosted by the WSU Health Sciences department and Nutrition and Exercise Physiology student body, offers free cholesterol, body fat, blood pressure and fitness testing. Also includes local vendors, door prizes and food samples. Wed, Oct. 7, from 10 am-2 pm. Free. WSU Spokane, building at 412 E. Spokane Falls Blvd (South Campus Facility Room 260). BEYOND PINK | The annual fundraiser event includes a silent auction, complimentary wine and hors d’oeuvres, with a fashion show featuring local artists and designers’ work. Event proceeds support local women who cannot afford thermography. Fri, Oct. 9, at 5 pm. $50. Spokane Convention Center, 334 W. Spokane Falls Blvd. beyondpink.net HOLISTIC FESTIVAL | The annual event features 50-plus booths on healthy living practices, with free presentations throughout the day, organic/natural products and body care and pain relief remedies. Also on site are practitioners of naturopathic medicine, healers, readers, astrology, massage and more. Sat, Oct. 10, from 10 am-6 pm. $6 admission. CenterPlace, 2426 N. Discovery Pl. holisticfestivals.com (468-9001) WORLD RELIEF ANNUAL GALA | The event features a global food menu, and guests will experience the culture of local refugee communities, with entertainment from around the world. Sat, Oct. 10, from 6-10 pm. $50/person. DoubleTree Hotel, 322 N. Spokane Falls Ct. worldreliefspokane.org (484-9829) TEAM HOPE WALK | The first annual event is intended to raise awareness about Huntington’s Disease, and funds to support education, research, advocacy and services for families affected by the disease. Sat, Oct. 10, from 10 am-noon. $25. Riverfront Park. hdsa.org/thwspokane (208-596-1368)

INTO AFRICA | Partnering for Progress’ annual dinner and auction offers an African-themed menu, along with informational booths demonstrating the nonprofit’s work in Kenya helping provide access to health care, education and clean water. Sat, Oct. 10 at 5:30 pm. $65/person; $500-$650/table of eight. Mirabeau Park Hotel, 1100 N. Sullivan Rd. intoafricaauction.org (720-8408) BISHOP’S BRUNCH | Catholic Charities of Spokane hosts its annual fundraiser breakfast (formerly known as the Poor Man’s Meal) to support and share the mission of the House of Charity. Proceeds benefit the facility’s Sleeping Program. Sun, Oct. 11; time and price TBA. House of Charity, 32 W. Pacific Ave. catholiccharitiesspokane.org/events

THE PUMPKIN BALL | The 12th annual gala benefits Sacred Heart Children’s Hospital and the Vanessa Behan Crisis Nursery. Reception includes dancing to live music by the Cronkites, live and silent auctions, a three-course dinner, pumpkin carving competition and more. Sat, Oct. 24, at 5:30 pm. $150/person. Spokane Convention Center, 334 W. Spokane Falls Blvd. thepumpkinball.org SHARING OUR WORLD | Refugee Connections Spokane’s annual benefit offers food, wine, and a silent and live auction. The nonprofit advocates for refugees’ and immigrants’ self-empowerment, fosters community bonds, and celebrates talents and traditions across cultures. Sat, Oct. 24, from 5-9 pm. $25/person. refugeeconnectionsspokane.org (209-2384)

THE WOUND AND THE GIFT | A screening of the documentary (a 2015 SpIFF selection) about the deeply emotional human-animal connection, with proceeds from ticket sales benefiting 10 local animal rescue groups. Sun, Oct. 11, at 5:30 pm. Garland Theater, 924 W. Garland. on.fb.me/1NsshYW

LIVE WELL, DIE WELL | A conversation on improving healthcare through the end of life with Dr. Ira Byock, a leading palliative care physician and author of The Best Care Possible, sponsored by Providence Health Care and Eastern Washington University. Thu, Oct. 29 from 6-8 pm, Free, Spokane Convention Center, 334 W. Spokane Falls Blvd. providence.ca/instituteforhumancaring

PEOPLE WHO CARE | Transitions for Women’s 13th annual benefit breakfast and luncheon event, supporting the organization’s programs to aid local women and children and celebrating its 20th anniversary. Tue, Oct. 13. Doors open at 11:30 am, program/lunch from noon-1 pm. Red Lion at the Park, 303 W. North River Dr. help4women.org (328-6702)

SKATING FOR THE STARS | Spokane’s Cherry Bomb Brawlers host a fundraiser roller derby bout to benefit the Wishing Star Foundation, with each skater representing a child who is unable to play due to health complications, or whose parents would like them to be represented in memoriam. Thu, Oct. 29, at 6 pm. $10-$15. Pattison’s North, 11309 N. Mayfair. on.fb.me/1KTVXPY

BETTER ME, BETTER MOMS CONFERENCE | A one-day conference for moms in the Spokane community to provide knowledge, support and connection through speakers, workshops, and resources. Tue, Oct. 13, from 8:30 am-3 pm. Free; lunch and childcare provided, registration requested. Family of Faith Community Church, 1504 W. Grace. (838-6092 x322)

EPICUREAN DELIGHT | The 34th annual gala benefits the Inland Northwest Blood Center and the Blood Center Foundation. The formal event features 30 local wineries and breweries, and 30-plus local restaurants showcasing and sampling their gourmet menus. Fri, Nov. 6, from 6-11 pm. $175/person. Ages 21+. Spokane Convention Center, 334 W. Spokane Falls Blvd. bloodcenterfoundation.com/ epicurean-delight (232-4442)

LAUGH FOR THE CURE | The fourth annual night of laughter (comedians TBA) with proceeds benefiting the Susan G. Komen Eastern Washington Affiliate. Also includes a raffle, appetizers, wine-pull and auction. Thu, Oct. 15, at 6 pm. The Lincoln Center, 1316 N. Lincoln. komeneasternwashington.org U-DISTRICT FOUNDATION OKTOBERFEST An outdoor benefit with drinks, sausages, music, and games celebrating October, beer, and the U-District Foundation’s programs. Tickets includes dinner, two drink tickets and a glass mug. Ages 21+. Sat, Oct. 17, from 5-10 pm. U-District PT, 730 N. Hamilton. udistrictpt.com (458-7686) CANCER KILLERS A seminar covering the primary causes of cancer, what cancer really is and how to prevent it and give your body the best ability to heal from it. Sat, Oct. 17, from 10 am-1 pm. $15-$25. CenterPlace Event Center, 2426 N. Discovery Place. spokancancerkiller.com (499-3245) MASQUERADE BENEFIT | The eighth annual gala and auction benefits Communities in Schools of Spokane County, which provides mentoring, resources and services to at-risk students at 20 regional schools. Sat, Oct. 17, from 6-9:30 pm. $50/person; $75/pair. Red Lion at the Park, 303 W. North River Dr. spokane.ciswa.org (413-1436) FEED YOUR BRAIN WELL | Is your brain starved for better nutrition? Do you find it hard to concentrate or focus? Do you feel irritable or moody for no discernible reason? Are you absent-minded or suffering from periodic brain fog? Learn the secrets of a better brain at any age. Thu, Oct. 22, from 10 am-noon. Free. Kroc Center, 1756 W. Golf Course Rd., CdA. kroccda.org (208-667-1865)

SUGAR RUSH SPOKANE | The third annual 5K or 10K fun run/walk benefits Inland Northwest Baby. Participants enjoy a cup of hot cocoa, treats and activities at the finish line. Sat, Nov. 7, at 8:30 am. Starts/ends near the McCarthey Athletic Center on Gonzaga’s campus. on.fb. me/1QkI63j NATIONAL HUNGER & HOMELESSNESS AWARENESS WEEK | Held annually the week before Thanksgiving, the weeklong movement includes local events to help end hunger and homelessness in the community, and to help understand the plight of those without a home or living in poverty. Nov. 14-22; details TBA. More information at voaspokane.org (624-2378) NATIONAL VETERANS DAY RUN | The third annual race offers a 11K, 5K and a 1-mile family and supporter walk/ run. Includes a pre-race ceremony honoring veterans. Sat, Nov. 14, at 8:11 am. $5-$30. Riverfront Park, Clock Tower Meadow. veteransdayrun.com/register/spokane SPOKANE HUMANE SOCIETY FURRBALL | The 16th annual fundraiser gala includes a reception, dinner, a live auction of decorated Christmas trees, a silent auction, parade of adoptable pets, a live band and dancing. Sat, Nov. 21, from 6-11:30 pm. $125/person. Davenport Grand Hotel, 333 W. Spokane Falls Blvd. spokanehumanesociety. org (467-5235 x211) n The calendar is a free service, on a space-available basis. Mark submissions “InHealth Calendar” and include the time, date, address, cost and a contact phone number. Mail: 1227 W. Summit Pkwy, Spokane, WA 99201; or Email: calendar@inlander.com.

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CHARITY CORNER

Embracing Diversity

hough our demographics don’t tend to show it, Spokane is a safe escape for dozens of refugees from countries around the world facing turmoil most Americans will never experience. Refugee Connections Spokane is a major resource for people who’ve fled Nepal, Iraq, Somalia, Burundi, Afghanistan, the Congo and other nations, helping connect them to community resources and services. Beyond serving as a liaison to refugees trying to navigate an unfamiliar place and culture, Refugee Connections also runs programs that allow refugees to give back to the community that has welcomed them. In the summer, the nonprofit’s harvest program invites local refugees to harvest donated produce, which is then distributed to those in need through the East Central Community Center, says outreach coordinator Anna Bondarenko. Refugee Connections’ annual fall fundraiser, called Sharing Our World, helps

Harvesting donated produce and supplying it to the needy is one way Refugee Connections gives back. keep programs like the harvest project going, Bondarenko says. Hosted at the Community Building, the event includes live and silent auctions, appetizers and a gallery of professional portraits of refugees served by the nonprofit. Some clients attending the fundraiser will also share their experiences

and talk about what life was like in their home countries. — CHEY SCOTT Sharing Our World • Sat, Oct. 24, 5-9 pm • $25 • Community Building • 25 W. Main • refugeeconnectionsspokane.org

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“There’s no reason they can’t do anything they want,” says Parasport Executive Director Teresa Skinner, with some of her athletes. YOUNG KWAK PHOTOS PEOPLE

Athletes With Abilities Helping physically disabled competitors achieve more than they imagined possible is the goal of ParaSport Spokane BY CHEY SCOTT

ive years ago, everything changed for Rachael Morrison. Her body betrayed her and began attacking itself. At just 23 years old, Morrison found herself battling ankylosing spondylitis, an inflammatory autoimmune disorder that left her unable to use the muscles in her trunk and legs and also affected her arms and hands. For the next few years, she relied on her family for assistance with even the smallest daily activities. Nine months ago, everything changed for Morrison again. In January, the 28-year-old packed up her bags and headed hundreds of miles west from her hometown in Michigan to Spokane. She came to train with ParaSport Spokane, as a para-athlete in track-and-field throwing events. There

wasn’t a program back home that could offer her the same level of specialized, competitive training she could get in Spokane. Today, Morrison is not only training as an athlete with coach Teresa Skinner, co-founder of ParaSport Spokane, she’s also living independently for the first time since her illness began. “I have learned so much,” she reflects a day after she and two other ParaSport athletes were named to the para-athletic division of the USA Track and Field Team for the 2015 World Championships being held in Doha, Qatar, this October. Morrison will compete in the discus and the club throw; the latter is a para-athletic throwing event that consists of lobbing a wooden implement across the field.

“It’s been a really great experience. It sounds cheesy, but it’s true. I’ve had to learn things, but Teresa and the program have been hugely instrumental,” Morrison says. “Now I say, ‘Hey, I want to do that!’ and Teresa is a very, very good teacher.”

nside a small office near the Sacred Heart Medical Center campus, Skinner is surrounded by shiny, colorful equipment: green- and pink-framed road racing wheelchairs, a tiny, child-sized basketball wheelchair and other specialized equipment used by the local athletes she trains. Skinner, an occupational therapist, and her husband, David Greig, founded the nonprofit two years ago. Already, demand for their services is nearly outpacing capacity.

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That’s a good problem to have, the couple says. Currently, they’re training more than 80 athletes — about two-thirds are under age 18 — from around the Inland Northwest. Two years ago, there were just 23 athletes. They have reason to believe that at least 100 more people in the region could be benefiting from ParaSport’s training. Run by an all-volunteer coaching staff of five, plus Skinner, ParaSport Spokane assists athletes who have many different physical challenges. “It can be anyone with any type of physical disability that doesn’t allow them to play stand-up or contact sports,” Skinner elaborates. “Some could potentially do some able-bodied sports, but they aren’t going to be as successful as they would be within the para-athletic system.” Coaching para-athletes isn’t new for Skinner. As an occupational therapist at St. Luke’s Rehabilitation Institute, she started Spokane’s first wheelchair rugby program back in 1995, and began coaching two-time Bloomsday women’s wheelchair division champion Susannah Scaroni, now 23, when the racer was just 9 years old. Over her 20-year coaching career, Skinner says she’s witnessed dozens of remarkable transformations. “There are a lot of athletes who never saw themselves going to college, and that’s something we really push with our athletes,” Skinner says. “We have some adults who are coming back into being active in sports and never saw themselves as being contributing members of society. They thought they’d live off disability and would never be able to do anything.”

ack in 2012 when she traveled to London as a track-and-field coach with the U.S. Paralympic Team, Skinner was stunned to see the Olympic Stadium sold out for 12 straight days. To be clear, the spectators’ cacophonous roar over those 12 days took place two weeks after the 2012 Summer Olympic Games’ closing ceremonies. The tens of thousands of people filling the stadium were there solely to cheer on the paralympic athletes, something Skinner had never witnessed in the United States. “I wish the rest of the U.S. knew about these athletes,” she says, noting it is nearly impossible to find a TV broadcast of a paralympic event. ”We don’t do a good job in the U.S. of showing that this is possible. We do a lot of feel-good, one-off stories, but there is not a lot of consistent messaging ... There is no reason they can’t do anything they want to do.” 

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