Inhealth 6/5/2017 by The Inlander

Decoding Your Genes

| Animal Attraction

| Lessons in Adulting

Health

HEALTHY LIVING IN THE INLAND NORTHWEST â&#x20AC;¢ FREE

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WHO NEEDS MEAT? er

You do, But maybe not so much page 22

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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

MANAGING EDITOR Jacob H. Fries ART DIRECTOR Ali Blackwood Mead CALENDAR EDITOR Chey Scott COPY EDITOR Michael Mahoney CONTRIBUTORS Hector Azion, Dan Couillard, Wilson Criscione, E.J. Iannelli, Young Kwak, Robert Maurer, Taryn Phaneuf, Mitch Ryals, Carrie Scozzaro, Matt Thompson, Daniel Walters, John R. White, Samantha Wohlfeil PRODUCTION MANAGER Wayne Hunt ADVERTISING DIRECTOR Kristi Gotzian DIRECTOR OF MARKETING Kristina Elverum ADVERTISING SALES Autumn Adrian, Mary Bookey, Gail Golden, Jeanne Inman, Claire Price, Carolyn Padgham-Walker, Wanda Tashoff, Emily Walden SALES COORDINATION Kati Bronson, Camryn Barker DESIGN AND PRODUCTION Tom Stover, Derrick King, Alissia Blackwood Mead, Jessie Hynes DISTRIBUTION MANAGER Justin Hynes

Helping to slow disease progression.

BUSINESS MANAGER Dee Ann Cook CREDIT MANAGER Kristin Wagner

Making health care more accessible.

PUBLISHER Ted S. McGregor Jr.

Advancing solutions that reduce costs.

GENERAL MANAGER Jeremy McGregor

InHealth is published every other month and is available free at more than 500 locations across the Inland Northwest. One copy free per reader. Subscriptions are available at $2.50 per issue: call x213. Reaching Us: Editorial: x261; Circulation: x226; Advertising: x215. COPYRIGHT All contents copyrighted © Inland Publications, Inc. 2017. InHealth is locally owned and has been published since 2004.

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INSIDE

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ON THE COVER | ALI BLACKWOOD MEAD DESIGN

CHECK-IN SUPERFOOD

Just the Flax 10

Join us for a pregame

100% LOCAL 9 / ASK DR. MATT 9 / CHARITY CORNER 11

Pitch for the Cure

Breast Cancer Awareness Walk

Saturday, July 15 6:00 pm

NEWS

INDIANS

HIGH-TECH HEALTH

What’s In Your Genes? 15 MEDICAL RESIDENCIES IN SPOKANE 21

SALEM-KEIZER

Proceeds will support

Every Woman Can +

breast cancer awareness

FOCUS

COST: ADULTS $25 – KIDS $15 Includes ticket, T-shirt and a donation!

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Health 5

FROM THE EDITOR

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

Thank you.

Thanks to your support in our first three years, the Community Cancer Fund reached its goal to fully fund the CCF Camp

Endowment ($3 million). That means every kid in our region who struggles with the affects of cancer, on or off treatments, will

always be able to enjoy a free week of summer camp. It’s just

one of the many ways we’re battling cancer in our community. For details or to donate, visit communitycancerfund.org

If you know of a child in our region between the ages of 7-17 battling the affects of cancer and they could use a week away to just be a kid, visit CampReed.org or call (509) 777-9622.

6 Health JUNE - JULY, 2017

Companions in Health

here’s a pie-sized hole in my cedar fence, an opening surprisingly crafted by the tiny teeth of my little mixed-breed dog, Boomer. Looking at his work, which includes numerous other chewed-up items, it is hard to appreciate the health benefits of pet ownership. Still, even a quick look at Facebook will confirm there are few things people are more devoted to than their furry companions. The National Institutes of Health have compiled some of the more robust studies on the benefits of animal companionship. In one study, older people with pets walked faster and for longer periods than those without pets. Dog owners are more likely to be physically active and less likely to be obese — they are even more likely to be alive a year after a heart attack, no matter the severity, than those who don’t have a dog. And if you have a pet, doggone it, people like you! Passersby are more likely to strike up a conversation, with all the ensuing benefits of social connectedness. What are the secrets of the humananimal bond? In this issue, Carrie Scozzaro will introduce you to some of the region’s “working” pets — animals trained to provide companionship, soothe anxiety and boost spirits in all kinds of settings. To Your Health!

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Smooth Sailing

ori SiJohn is as resourceful as she is resilient. After serving in the Navy and law enforcement, SiJohn applied to both truck driving and beauty school. Although she never made it to beauty school, she’s built a rapidly growing health and beauty products company from her Plummer, Idaho home. Sailor Girl Soap and Supplies offers 15 allnatural, handmade products, ranging from soaps and cleansers to butters, balms and lotions. Most products were made in response to family requests, such as a deodorant for her grandson and a muscle relief bar for a cousin. Her late husband, Lori SiJohn in her Navy uniform Cliff SiJohn, inspired her first product: a bar of soap. A Vietnam War veteran, Cliff suffered from the effects of the highly toxic chemical herbicide

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.

and defoliant Agent Orange, says Lori, including early onset diabetes and severe skin issues. Cliff, who called Lori his “Sailor Girl,” died in 2012, leaving Lori bereft. Her eldest daughter, Shaina Nomee, encouraged Lori to transform her grief and talents into a business. “She’s always been my hero,” says Nomee, who at age 6 wrote a book about her mother and asked her to send it to the president. (SiJohn couldn’t bear to part with it.) The admiration between mother and daughter is mutual. “We wouldn’t even have [the business] if it weren’t for Shaina,” says SiJohn, who credits her daughter’s marketing, social media and website skills for helping catapult the business online and into three states. Besides their website (sailorgirlsoap.com), Sailor Girl is offered via HuesBox, an online subscription-based company started by a motherdaughter team to highlight minority-owned health and wellness businesses. Sailor Girls is also in Oregon at the Tamástslikt Cultural Institute in Pendleton, home to the museum of the Confederated Tribe of the Umatilla Indian Reservation-Cayuse, of which mother and daughter are members. In Idaho, find the products at Willow Market and Boutique in Coeur d’Alene and Brickwall Beauty Bar in St. Maries; in Spokane, at Modern Tipi in the Saranac Commons and Window Dressing’s Pop Up Shop. — CARRIE SCOZZARO

e clearly have some major problems in our culture when it comes to nutrition. Obesity is our fastest growing public health crisis. Recent research from Johns Hopkins predicts that at our current pace, 8 million children who are between ages 8 and 11 now will be obese by 2020. They estimate this will translate to a cost of $2.8 trillion dollars in lost wages and medical expenses over the course of their lives. The good news? They also estimate that if those 8 million children exercised just 25 minutes, three times a week, more than a million fewer children would be obese in 2020. While much is known about public health issues like smoking and cardiovascular disease, research into helping kids maintain a healthy weight is still in its early stages. So we need to Matt Thompson is a continue to stick with the pediatrician at basic recommendations: Try Spokane’s Kids Clinic. to get an hour of activity a day. Promote a diet rich in fiber from whole fruit, whole vegetables and whole grains — the fresher the better. The American Association of Pediatrics recently endorsed keeping juice out of the diet until children are at least a year old, unless they are being treated for constipation. Sugary drinks, including pop and most juices, deliver empty calories and promote tooth decay. In spite of the abundance of calories, kids’ diets can fall short when it comes to some key nutrients. Make sure kids get plenty of vitamin D, which is found in dairy products, fish and eggs. Perhaps the most common deficiency in the diets of U.S. kids is iron. The most abundant source of iron is meat. In particular, red meat provides hemebased iron, which is far more bio-available than plant-based iron (found in leafy greens, legumes, dried fruits and cereals). It’s best to combine iron-rich food sources with other foods containing ample vitamin C — think broccoli, oranges or tomatoes — to help the body absorb the iron better. In the words of Michael Pollan in his great book In Defense of Food: “Eat food. Not too much. Mostly plants.” — MATTHEW THOMPSON

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CHECK-IN

SUPERFOOD

Just the Flax ATTRIBUTES: Flax destined for use as a food or oil is grown primarily in North Dakota. Chickens fed flaxseed meal produce eggs that are higher in omega-3 fatty acids. SUPERPOWERS: Flax contains ALA, a type of omega-3 fatty acid, and lignans, chemical compounds that research shows may protect against some cancers, including those of the breast, colon and prostate. Flaxseed may protect the cardiovascular system by lowering inflammation, reducing blood pressure and normalizing the heartbeat. Flaxseed is also high in fiber.

WEAKNESS: It’s better to consume the whole flaxseed, rather than just flaxseed oil. The beneficial omega-3 fatty acids in flax are inside the seed, and unless you’re willing to spend a lot of effort chewing up your flax seeds, you’ll need to grind up them in a coffee grinder before eating them. Or just purchase pre-ground flax meal. To maintain its nutritional assets, store flax in the freezer. HOW TO USE IT: Add a tablespoon or two of flaxseed meal to yogurt, or use it to replace a portion of the regular flour in baked goods. Flaxseed meal can also replace eggs in most recipes (brownies are an exception). Bob’s Red Mill offers this recipe for flaxseed-meal egg replacer: Combine one tablespoon of flaxseed meal with 3 tablespoons of water. Allow it to sit for 5 minutes. Use in place of one egg. — ANNE McGREGOR

LIFE COACHING

Food for Thought

F Robert Maurer is a Spokane psychologist, consultant and author of “One Small Step Can Change Your Life.”.

ood is vital for life. It is a source of pleasure, and it sparks community, as meals are shared with family and friends. Special foods are linked with holidays and events. But food is also associated with some of our greatest health challenges. So what do we need to know to enhance food’s pleasures, while diminishing its dangers? Making good choices nutritionally is one obvious example. However, let me share two others that we may want to consider as we examine our relationships with food. Did you know that food is the fastest-acting tranquilizer?! The moment we put food on the tongue, the amygdala — the “fear center” of the brain — shuts down. We may have exercised and chosen foods all day that would make a nutritionist weak with joy, but as night falls we may find ourselves tired, dwelling on some irritation at home or at work. The potato chips or chocolate we reach for will immediately calm our amygdalas. However, the instant we swallow it, our fatigue and irritation

10 Health JUNE - JULY, 2017

returns, requiring… more food. This is one reason that people who lose weight often put it back on. A crisis occurs, and rather than reaching out to other people for help, they turn to food for comfort. Food can also impact sleep. A common pattern leading to insomnia is to eat little or no breakfast, a small lunch, and a full dinner. People who were tired all day may report that they have all this extra energy at bedtime, because the body has received the majority of its fuel supply a few hours after dinner, when digestion has turned food into blood sugar. Our relationship to food mirrors our relationship to life. Turning to people rather than food for comfort, and choosing healthy foods to eat in small quantities throughout the day, can provide our bodies and minds with the steady supply of the nourishment we need for a pleasurable life. — ROBERT MAURER

CHARITY CORNER

Walking for Water

magine walking more than 4 miles a day to haul gallons of water just so you could cook, drink, bathe and wash your clothes. In countless locales across the world, this is the stark reality that millions face every day. For the past seven years, the locally organized Spokenya run and walk has raised funds to help ease this burden on residents of a region in western Kenya. Funds help install wells and rainwater catchment systems through its beneficiary nonprofit, Spring of Hope. “We have made a big difference in the region

where they started, but still, there are so many people in Kenya and the world who don’t have access to clean water,” says race director Rose Lawrence. The 7-kilometer (4.3 miles) Spokenya race might seem like an odd distance to some runners who are familiar with 5 or 10Ks. But that number is intentional; it’s the average distance that women and girls in Kenya must walk every day to get clean water, Lawrence says. Participants in the event can get a taste of what this daily chore is like by carrying a bucket of water on their heads for the final 100 meters. Last year, Spokenya’s 560 entries raised $18,000, enough to drill one well. All of the entry fees are donated directly to Spring of Hope, since the event is run entirely by donated services

and volunteers. This year’s proceeds have been earmarked to install a rainwater catchment system at a Kenyan elementary school. “Honestly, I’ve been there and seen the schools, and they have this green pond, and that is the water kids are supposed to drink while they’re at school,” Lawrence notes. “The kids are going to school and drinking dirty water, and they’re sick and can’t focus and can’t show up for school. People are dying there every day because of that simple thing.” — CHEY SCOTT Spokenya Run/Walk • Sat, July 15 at 9 am • $25/advance; $35/late registration • Starts at Life Center Church • 1202 N. Government Way • spokenyarun.org

MEMORABLE HAPPENS HERE.

spokanecenter.com

SPFD_060517_InHealth_QtrH_KS.pdf

JUNE - JULY, 2017

Health 11

CHECK-IN GOOD READ

Street Medicine

y turns painfully honest, achingly sad and wryly humorous, Patricia Kullberg’s memoir of her work as physician at a Portland clinic serving the city’s “dispossessed” is also unfailingly compelling. Fleeing the boredom of work in a suburban clinic where, “My patients were lovely. Few were particularly sick,” Kullberg lands at the Burnside Health Center. Her new patients are uniformly poor, with no shortage of serious health problems. “Most lived with mental illness, addictions or both. The majority had suffered abuse… Most were poorly educated, though among them was a doctor from Iran, a lawyer from Afghanistan, a nurse from Somalia. Also a musician, a journalist, a contractor and a professor of physics, all native born and fallen on hard times or bad choices, usually a combination of the two.” The book is a fascinating series of 15 sparsely eloquent case studies of patients Kullberg treated, some-

times for years. The sweet young man who lived under an overpass on U.S. Highway 26, tending his private garden of daffodils and roses. A woman who, through an interpreter, reports that her chief complaint, among many, is dizziness. “I hate dizziness… The underlying pathology can be anything from depression or stomach flu to incipient cessation of the heartbeat — in other words, the last symptom this patient will ever experience if the doctor doesn’t figure it out fast. Not that I’m feeling any kind of pressure.” Part diagnostic procedural, part medical mystery, On the Ragged Edge of Medicine also offers ample evidence of medicine’s shortcomings. Though Kullberg brings all of her medical training to bear on her patients’ difficult cases, with some degree of success, she feels that she comes up short. “I really did not, and could not, grasp what it was like for her,” she writes of a patient with bipolar disorder. ”It was like having a baby. You think you know what it will be like, until you actually have one and realize the profound limits of your own imagination.” — ANNE McGREGOR

PILL BOX

Medication Mishaps My father was recently admitted to the hospital for a problem that stemmed from his previous stay. Unbelievably, he was taking a double dose of one of his medications because he didn’t understand that the two bottles — one from before his hospital stay and one given to him at the hospital — were actually the same John R. White chairs medication. How can it be prevented?

WSU-Spokane’s Department of Pharmacotherapy.

ens of thousands of people end up in the hospital due to adverse drug reactions. In fact, it is estimated that 100,000 people die every year in the U.S. because of adverse drug reactions. Discharge from a hospital is always a high-risk time, but there’s an even greater risk seen in those with multiple medications. Too often, adverse drug events end up resulting in readmission. These adverse drug events have a number of causes. There can be a misunderstanding of a new medication regimen. Or confusion may arise if there have been adjustments to medications that were taken prior to hospitalization. Or, as in your father’s case, the problem might take the form of medication duplication or medica-

tion class duplication, in which the doctor has prescribed a different version of the same type of medicine. Other problems include drug interactions or intolerance to a new medication. Pharmacists can be very helpful during this transition. One recent study published in the American Journal of Managed Care reported an approximate 30 percent reduction in hospital readmissions in patients who received pharmacist assistance after being discharged. Unfortunately, the services provided in this study are not widely available, but hopefully they will be soon. On the other hand, a simple way to reduce your chances of suffering from a drug misadventure is to: 1) get all of your medications from one pharmacy; 2) ask to talk to the hospital pharmacist before you leave the hospital — many hospitals provide discharge counseling; and 3) make sure that you have a clear understanding of what you are taking. This may mean taking all of your medications to your pharmacy and having the pharmacist go through them with you to determine what you should and should not be taking. In short: If you are unsure, always ask your pharmacist. — JOHN R. WHITE

Reach over 90,000 readers advertise in the next INHealth* * 2016 Media Audit

Contact: advertising@inlander.com • 509.325.0634 ext. 215

12 Health JUNE - JULY, 2017

BRAIN EXERCISE

Sudoku

RATINGS: Gentle (left), Tough (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.

6 1

6 7

Answers to all puzzles on page 38

8 9

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

1 3

2 9 4

7 8

5 2 6 1

Codewords

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 19. 17

19 4

12 12

8 12

3 21

10 20

19 2

9 3

23 3

9 3

22 19

5 12

9 3

5 8

3 9 2 7 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

6 8 8 9 3 2

5 7 5 3 4

5 4 7 6 5 4 2 3 1 1 3 9 7 3 21 2

1 to 25

8 10 11

13 17 16 13 12 11 12

To solve 1 to 25, move the 15 18 15 14 9 10 numbers from the outer 20 19 20 21 8 7 ring onto the board in the directions of the arrows. The 24 2 1 22 6 24 number must appear on the 23 3 4 5 23 25 line â&#x20AC;&#x201D; up, down or diagonal 9 17 16 14 6 7 â&#x20AC;&#x201D; that the arrow indicates. As you place them, they must snake together vertically, horizontally or diagonally so they link in sequence from 1 to 25. We started you out with a number to work from. A solved puzzle will look like the one above. There is only one solution.

16 2

18 19 22 3 25

7 15 19

6 25 23 12 13 18 14

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NEWS

HIGH-TECH HEALTH

What’s In Your Genes?

Genetic testing is poised to radically alter the future of health care BY WILSON CRISCIONE

icture a time in the not-too-distant future when whole genome sequencing is routine. A time when, before babies even learn to talk, their parents will have the ability to learn what the future may have in store for their offspring: Is their little girl predisposed to getting breast cancer? Will their happy-go-lucky son one day develop Alzheimer’s? “There is no doubt in my mind that, in addition to going in and having blood chemistry done, you’re gonna have DNA sequencing done, too. It will be there at some point,” says Nicholas Schork, a quantitative geneticist at the J. Craig Venter Institute in La Jolla, California, who has

studied genomic medicine for more than three decades. “We can debate about the timeline, but it’ll become routine.” The hope is that genetic testing will make health care more effective by allowing doctors and patients to focus on areas that need attention — the patient’s genetic “vulnerabilities.” At the same time, patients may learn of areas where they won’t need to be quite as vigilant. And treatments could, in turn, be perfectly tailored to a patient’s specific needs. But as with any significant and broadly applicable medical advance, there are questions. For example, should patients learn that they carry markers for currently

incurable genetic diseases, or that they are at high risk for developing a condition like Alzheimer’s, which has no effective treatment? And just who owns all that genetic data? Who will have access to it? Even with important questions left unanswered, health educators are moving forward to take advantage of the promises genetic testing offers. Washington State University’s new Elson S. Floyd College of Medicine has announced it is partnering with Arivale, a Seattle-based company that conducts whole genome sequencing, to help complete a portrait of a person — a “portrait” that can be used to promote wellness over that individual’s entire lifespan. ...continued on next page

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Health 15

NEWS

Arivale’s Leroy Hood and Jennifer Lovejoy explain the company’s genetic testing program in Spokane.

“WHAT’S IN YOUR GENES?” CONTINUED... Every member of the school’s inaugural class will have the opportunity to undergo testing, which will also include blood tests and a lifestyle evaluation. Then, over the next year, Arivale’s team of nurses and dietitians will provide individually tailored follow-up, based on each individual’s risks and goals. It’s a unique partnership, made possible in large part because the medical school is new, with its first class of students starting in 2017. Allowing the medical students to experience genetic testing firsthand is just part of the goal. “We need physicians that under-

stand it well enough that they can make it better going forward,” says John Tomkowiak, founding dean of WSU’s College of Medicine. “That’s where our students are going to be uniquely positioned.”

WHAT GENES TELL US

Genetic testing already provides important information about a person’s health or their heritage. Hospitals screen newborn babies for certain genetic disorders, and in some cases, tests can detect disorders before birth. And diagnostic testing can confirm, or rule out, many disorders in adults. Testing doesn’t have to be ordered by a physician. For $200, you can provide a sa-

ALL ABOUT ARIVALE F

or about $3,500, clients can sign up for Arivale’s program. The fee includes whole genome sequencing, which is also available from other sources. So how do Arivale clients achieve “scientific wellness”? Here are the elements of their program:

WELCOME PACKAGE: Clients get a welcome package with a Fitbit to track sleep, activity and heart rate. The package asks for information to help understand a client’s bacteria in their gut, and asks for a sample of saliva to measure a person’s stress level. ONLINE TEST: Clients take a series of online assessments about their goals, health history, lifestyle, stress, personality and happiness.

16 Health JUNE - JULY, 2017

liva sample, mail it back to 23andMe.com and find out not only your ancestry, but also your risks for a number of diseases, including Alzheimer’s and Parkinson’s. Ancestry.com offers a glimpse into your heritage for $99. Color.com claims to reveal your risk for the most common hereditary cancers, and even offers “complimentary genetic counseling” for a $249 fee. But if genetic testing is to revolutionize the health care industry, as many have promised, there’s still a ways to go. “The technology is at the beginning stages,” says Thomas May, a faculty researcher for the HudsonAlpha Institute for Biotechnology. Companies like 23andMe offer genetic tests that may provide information about some genetic disorders from currently known genetic variants. But whole genome sequencing is different; it will reveal all your individual genetic variants. How valuable is that information? There are a relatively small number of conditions that researchers are confident result from a specific genetic variant, May says. For example, there is one variant that researchers have found is associated with an increased risk of developing breast or ovarian cancer. A genetic test that shows an increased risk for breast cancer is considered an “actionable” outcome, meaning there are things you can do to prevent the outcome, like beginning mammograms earlier. Though there are more than 50 actionable outcomes like that, it’s still a relatively small number. Adding to the confusion is the fact that not everyone who develops breast cancer actually has the genetic variant — in fact, May says only about 10 percent do. So even if testing shows that you don’t have the “breast cancer gene,” that doesn’t mean it’s OK to stop getting mammograms.

CALL FROM COACH: You’ll talk to a coach who will get to know what you want to accomplish and give you a personalized action plan. LABS: You’ll take blood tests so your coach can understand your current health. While you’re there, they’ll take your vital signs. A PICTURE EMERGES: The various test create a picture of you, which an Arivale coach will use to provide a step-by-step plan to “optimize your wellness,” according to the company. FOLLOW-UP: You’re not done yet. You’ll be contacted by your coach regularly to review your action plan, and Arivale will provide reports on how you’re progressing. Every six months, you’ll complete another set of clinical labs. SOURCE: arivale.com/your-journey

“Most variants and correlations are of that type: We can’t say for certain if you’re gonna get a disease,” May says. Doctors are mixed about whether genetic testing is currently having a real impact on patients. In a May survey conducted by the Medscape Physician Oncology Report on Genomics Testing, 71 percent of oncologists surveyed felt that genetic testing was either “very” or “extremely” important to the oncology field. At the same time, 61 percent said that, currently, fewer than a quarter of their patients would actually benefit from genetic testing. The number of diseases with “actionable” outcomes will inevitably grow, as more people are tested and more data becomes available. But this leaves deeper questions, says Schork, the quantitative geneticist. A company or health care provider would likely give patients information about diseases that can be prevented or cured. If someone is predisposed to obesity, for instance, then he or she can elect to receive targeted care to reduce that risk. But what about diseases that, right now, are incurable? Take Huntington’s disease, a genetic disorder that breaks down nerve cells in the brain. It’s rare, but it’s a “hideous way to die,” Schork says. A person can be screened at the age of 25 and be found to carry the Huntington’s gene, but there’s debate about whether or not that information should be shared with a client or not. The same goes for genetic variants related to Alzheimer’s disease. “If there’s nothing they can do about it, then there’s a concern about whether or not that information should be imparted,” Schork says. When the Food and Drug Administration ordered 23andMe to stop telling customers their odds of contracting diseases in 2013, Harvard Medical School genetics professor Robert Green and Laura Beskow, a professor at Duke University’s Institute for Genome Sciences and Policy, argued against the FDA. They cited a number of studies showing that direct-toconsumer genetic testing does not cause a large percentage of customers despair. In an interview with the New York Times in April, Green said the potential for distress based on results of a genetic test for Alzheimer’s was “much smaller than anticipated.” Another question: Who really owns the DNA data that is being collected from willing users of genetic testing? Consider Myriad, a company that offers genetic testing both to help determine cancer risk and ...continued on next page

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Health 17

NEWS “WHAT’S IN YOUR GENES?” CONTINUED... design better treatment plans for patients who already have cancer. The company has something that “others do not,” Schork says: insight into which genetic variants predispose women to breast cancer. What Myriad is really selling, then, is not the genetic test itself, but access to insights it has gained through mining its database, insights that can be leveraged into

the monopoly that Myriad has,” Schork says. “There are many groups out there that would like to counteract the monopoly Myriad has, by building public domain data sets.”

JUST ONE TOOL

“Genetic testing is not a blueprint. It’s really not,” says Jennifer Lovejoy, chief translational science officer for Arivale. “Genes are really just one factor — the

“That is the grand vision: that everybody would have these dense, dynamic data clouds and understand the choices that will… optimize wellness.” whatever level of payment the company decides to charge. It’s potentially critical information that could help save a life, and some argue that the data should be in the public domain — not held by a private company. “There have been huge debates about whether the community should challenge

environment, diet, exercise, pollutants and even emotional state have a big impact on genes.” That’s why Arivale not only collects genetic information on each client, but also evaluates various blood tests and lifestyle factors to create a “dense data cloud” of information about a patient.

“That is the grand vision: that everybody would have these dense, dynamic data clouds, and understand the choices that will be optimal to optimize wellness and avoid disease,” says Lovejoy. Arivale touts the success stories among its nearly 2,000 clients. One client found out he had a gene associated with high sensitivity to saturated fat, giving him a better indication of an appropriate diet that helped him lose weight. Another client discovered that his genes may have an impact on his cholesterol. Another learned he was at risk of developing diabetes. Ideally, this type of preventive care will soon be covered by insurance, Lovejoy says. The thinking is that preventing disease will bring down the cost of health care overall, making insurers likely to cover more preventive care, “but we have to prove it,” Lovejoy says. Researchers are conducting studies and trials to do just that, and if they can prove it, then genetic testing could soon be routine in health care. “If you think about what health care should mean, it should mean, one, the ability to deal with disease — and that’s what everyone does today,” Arivale co-founder

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HOOPFEST FRIDAY COME SEE OUR SECOND ANNUAL ALUMNI GAME Leroy Hood said at a press conference in April announcing the company’s partnership with WSU. “But two, it should mean the ability to optimize wellness for each individual. That is, improving their health and/or letting them avoid disease.” That’s a concept Hood calls “scientific wellness, and he thinks it could lead to “a whole new health care industry in the future.” Tomkowiak, of WSU’s College of Medicine, agrees: from the puzzle on page 13 “The concept of 5 = N; 7 = L; 12 = I scientific wellness has the potential to disrupt the entire industry by shifting the cost curve, by keeping people healthier and reducing the cost of health care overall.” Regardless of whether or not Arivale becomes an industry leader, Tomkowiak believes that the practice of medicine will be fundamentally altered in the near future. “We absolutely believe that seven years from now, the practice of scientific medicine and scientific wellness will be common,” he says. “Instead of being behind the curve, we want… to be leading this effort.” n

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Health 19

NEWS To some doctors and residents, it’s a welcome change, recognition that one size doesn’t work for all students. To others, it’s a dangerous step that could lead to more patient mistakes.

LONG SHIFT

ALI BLACKWOOD MEAD ILLUSTRATION

EDUCATION

24-Hour Fitness Does requiring first-year residents to work some 24or 28-hour shifts make things safer for patients? BY DANIEL WALTERS

ast year, when she was a secondyear resident at Kootenai Health in Coeur d’Alene, Hollie Mills made it through her marathon 24-hour shifts without any coffee. “There are residents in my programs that do drink, like, 20 cups of a coffee a day,” Mills says. “That is not me.” There were some nights that she managed to total as many as six hours of sleep in the call room, broken up during slower periods. But other nights, busier nights, she didn’t get a wink of sleep. “It’s tiring,” Mills says. “Sometimes you don’t feel like you’re thinking clearly.” It’s an experience nearly every resident is familiar with: Fatigue sets in during shifts that can last 24 hours — or even longer. This issue is why, back in 2011, the Accreditation Council for Graduate Medi-

20 Health JUNE - JULY, 2017

cal Education set a hard-and-fast national rule: First-year residents could only work a maximum 16-hour shift. It was an attempt to avoid the sort of mistakes that relatively inexperienced, exhausted, bleary-eyed residents could make. But now the group has reversed itself, concluding the 16-hour cap “may not have had an incremental benefit in patient safety, and that there might be significant negative impacts to the quality of physician education and professional development.” Starting in July, patients nationwide may start being treated by first-year medical residents who’ve been awake for up to 24 hours. In some cases, the rule allows residents to work even longer, including a four-hour “transition” time depending on patient needs.

In April, Josephine Valenzuela, an emergency medicine resident in San Francisco, penned an article for the Center for Health Journalism describing how, exhausted by a series of marathon shifts, she sliced her finger on a bloody scalpel previously used on a patient with HIV, had an emotional breakdown, and then backed her car into a concrete pole. She pointed to a study that found that being awake for 24 straight hours was equivalent to having a blood-alcohol level of 0.1 percent. “Exhausted, backs aching, gulping down coffee, we continue to report for 28-hour shifts. And starting in June, we will be joined by the new intern class, who will have graduated medical school just weeks earlier,” Valenzuela warned. “It doesn’t take a doctor to understand that this isn’t safe for anyone.” Mills is more in the middle. She says she knows how the lack of sleep can affect her, but also knows how to adapt. When she’s feeling tired, she brings in other staff to make sure she isn’t making a mistake. “I would call my attending [physician], for something that I maybe typically wouldn’t have a question on. A dose on the medication. Or ordering a medicine,” Mills says. “I’d double-check it.” She sees the downsides to shorter shifts as well: “When there are too many handoffs, there are errors in patient care.” The crucial nuances of a patient’s issues can be hard to summarize in writing, or even in a face-to-face conversation. And even if only small things get missed or lost in translation? In medicine, small things can matter a great deal. But while she supports long shifts for second and third-year residents, she’s concerned about whether first-year residents will have the experience to cope with 24hour shifts while simultaneously learning the ropes of a new residency. “You don’t know how to run the computer system,” Mills says about the first-year experience. “You don’t even know where the bathroom is.”

BALANCING ACT

Asked about the benefits and drawbacks for long shifts for residents, John McCarthy, president of the Spokane County

Medical Society, says it depends on the context. “Is it a good decision to have your speed limit be 35, or should it be 70?” says McCarthy. “It depends on where you are.” For some specialities, like obstetrics and certain types of surgery, long shifts can be particularly crucial for education purposes. McCarthy also has concerns about the mistakes that happen with physician turnover. He also knows that, if doctors don’t get a chance to get a little bit of shut-eye, “nobody can be on their game the whole time for 24 hours. I don’t think that’s physically possible. There needs to be a down time.” He says the danger is that, traditionally, there’s been a culture at hospitals of pushing through fatigue, even when it’s not a good idea. It’s the kind of mentality most common among surgeons, he says. “We’re a bunch of macho guys, so everybody should have to put up with the crap we have to put up with,” McCarthy

says. “That’s a not a good approach to medicine.” Mills and Andrea May, a third-year resident at Family Medicine Spokane, say that their residency programs make accommodations to ensure that both residents and patients are protected. “Most frequently, you get to sleep for at least two hours,” says May. “You get tired. But not to a point of exhaustion.” Both residents say that if they’re so tired they’re struggling to function, they can request the night off. Sometimes, May says, their colleagues will notice a resident’s struggle and say, “You don’t look good and you should go home.” But mostly, the residents know they need to get used to handling fatigue. The long shifts and late nights don’t end when their residency does. “I would say, and most of my colleagues would say, that they work harder in practice than they worked as a resident,” McCarthy says. n

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Dr. John McCarthy: “We should probably have 300 to 350 residents [in Eastern Washington].”

pokane County Medical Society President John McCarthy has a single word to sum up how Spokane has done when it comes to meeting the need for residency slots to train doctors. “Poorly,” he says. With the addition of WSU’s Elson S. Floyd College of Medicine, and the flood of new Spokane medical students from the University of Washington, the city has taken the first steps to addressing the low numbers of doctors in

Eastern Washington. But the bigger bottleneck is the number of residency slots. Historical practices have meant that East Coast hospitals get significant amounts of federal resources for residency slots, while hospitals on the West Coast get very few. Slowly, Spokane is addressing the issue. Last fall, the Spokane Teaching Health Clinic opened; six new residents will graduate from there at the end of this year. “Now we have 18 additional residents in the pipeline,” says Nancy Vorhees, executive director of the Spokane Teaching Health Center, a consortium of Washington State University Health Sciences Spokane, Providence Health Care and the Empire Health Foundation. “If you go to a residency in a community, there’s a really good chance you’ll stay in the community. We really think it’s going to make a huge difference.” But it’s still just a drop in the bucket when it comes to the overall need, says McCarthy. “We’ve moved from about 70 to 90 [residents] because of this,” he says. “We did a study that says we should probably have 300 to 350 residents.” One of the best signs for the future, McCarthy says, is the fact that MultiCare Health System, a nonprofit based in Tacoma, bought Deaconess and the rest of the local Rockwood Health System from Community Health Systems. MultiCare, unlike CHS, has a strong track record of investing in residencies. — DANIEL WALTERS

August

12 2017

JUNE - JULY, 2017

Health 21

FOCUS: SUMMER FOOD

veggie tales Science says to eat more plants and less meat — here’s why BY E.J. IANNELLI

iets, like fashion, appear to be in a state of constant inconstancy. There’s Paleo, Atkins, South Beach, DASH, 5:2 and dozens more, their popularity rising and falling according to their novelty or the number of celebrity proponents they happen to have on a given day. And in news articles that report on the latest dietary studies, the scientific findings would seem to be constantly at odds with themselves: One week eggs are linked to heart disease, the next week they’re an integral part of healthy eating. Yet, amid the tumult of dietary crazes and conflicting dietary recommendations, one piece of advice is essentially eternal: We really should be eating far more fresh fruits and vegetables and, ideally, less meat. But why? One of the many reasons has to do with basic nutritional balance.

22 Health JUNE - JULY, 2017

“Some of the advantages of reducing meat [consumption] are to focus on the other food categories on our plate,” says Korrin Fotheringham, a registered dietitian nutritionist. Her company, Northwood Nutrition, serves individual and institutional clients in the Spokane area. “In my experience working with clients and patients who eat meat and don’t eat meat, the meat-eaters tend to not eat a lot of legumes or pulses. Legumes are any kind of bean out there — pinto beans, black beans — and pulses are foods like lentils. These foods have a lot of nutrient-dense vitamins and minerals in them, and they’re chock-full of fiber as well. If we’re thinking about reducing meat or going to a meat-free diet, it allows more room for those other food groups.” As researchers are discovering, though, vegetables’ vitamins and fiber might be

only one part of a more complex physiological interaction. “Gut bacteria have been just exploding in the research field recently, leading to a lot of new discoveries in regard to potential causes of obesity and irritable bowel syndrome. The latest one I saw was for Parkinson’s disease,” says Fotheringham. There’s even mounting evidence to suggest that a healthy microbiome in our intestinal tract, rich in diverse bacteria and other microbes, can improve sleep and mitigate mental health issues such as depression and anxiety. Eating prebiotic soluble fiber like inulin (found in garlic, onions, leeks, asparagus), pectin (plums, apples, quinces, citrus fruits) and raffinose (cabbage, broccoli, Brussels sprouts) helps to promote this diversity by “feeding” these gut species. Probiotics found in fermented foods—including kimchi, miso, certain forms of

sauerkraut and pickles, and yes, even dairy like kefir and yogurt — introduce new types of bacteria into our microbiome. It’s this combination of beneficial factors such as nutrition and gut flora that could explain why reduced-meat, plantheavy diets are consistently associated with longer, healthier lives. One study of 450,000 adults who maintained a 70:30 (plant to meat/dairy) diet saw their risk of dying from heart disease or stroke drop by 20 percent. Another study published in JAMA Internal Medicine followed 120,000 health professionals over three decades. Among its extensive findings was that those who ate red meat tended to die earlier than their counterparts.

atrick Crosswhite, an assistant professor in the Department of Human Physiology at Gonzaga University with a particular interest in metabolism and food nutrition, says that common levels of meat consumption in America still tend toward excess. Generally speaking, a portion of meat “the size of your palm” is a recommended serving amount. Fotheringham notes that as few as “one, maybe two dinners” per week with meat portions of that size should suffice for most of us — as long as its absence is compensated for with proper complementary food. That’s why, for all the benefits of a plant-based diet, both Fotheringham and Crosswhite caution against eliminating meat “cold turkey.” Vitamin B-12, which is vital for the synthesis of DNA, is only available in its natural form in meat. Supplemental Vitamin B-12 exists, but it can’t just be taken indiscriminately. Crosswhite adds that iron is “one of the biggest risks for nutrient deficiencies” in a “traditional vegan” diet. “We need iron for a lot of different things,” he says. “We need it for proper heme production, and we need heme in our red blood cells so we can carry oxygen. But iron is not created equally. With a plantbased diet, you’re getting mostly non-heme iron, and it’s more difficult for our bodies to absorb non-heme iron than heme iron, which is basically present in mammalian muscle tissue.” A lack of heme iron also puts menstruating and pregnant women at particular risk of anemia. But what about the contradictions of dietary information? That, says Crosswhite, is the scientific process at work.

Dietitian Korrin Fotheringham says reducing meat allows us to “focus on other food categories.”

HECTOR AZION PHOTO

SIDE EFFECTS OF MEAT

utritive benefits aside, there are ethical, ecological and economic reasons for a plant-based diet. Not only does meat on our plate necessitate the loss of sentient life, the cultivation of meat for consumption is far more resource-intensive than the cultivation of vegetables. It takes about 4 million gallons of water to produce a ton of beef, whereas vegetables require only a fraction (2.13 percent) of that: 85,000 gallons on average. Simply halving your meat intake in favor of plants like legumes and tubers can reduce your individual water footprint by 30 percent. That sustenance and labor also equate to a pricier product. “I teach a class about eating healthy on a budget,” says Korrin Fotheringham, RDN, “and the meat group is so, so hard to touch on. It takes a lot of money to feed a family of four these days, and if meat is part of every meal, that’s a huge chunk of change. I always suggest making two dinners a week vegetarian. That can really help trim the food budget.” — E.J. IANNELLI “As individuals, we want that smoking gun that effectively proves or links something,” he says, but the aim of scientific research is about coming to repeatable conclusions with different cohorts and at different times under similar conditions. That generates a lot of information, some of it at apparent odds with itself. “It’s confusing to the public. And the field of nutrition has not been around very long compared to physics or chemistry. Those disciplines have been around for 500 or 2,000 years. Nutritional science is maybe

100 years old, and modern nutritional science has only been around since the mid1950s. But I look at information in totality. If there’s, say, 1,000 studies saying that eating meat will cause colon cancer versus five studies saying [the opposite], I tend to put the most weight with the most data.” And that majority of data clearly points to the benefits of a plant-based diet and the advice that Crosswhite and Fotheringham, like other nutrition experts, offer unreservedly: The more fresh fruits and vegetables we consume, the better. n JUNE - JULY, 2017

Health 23

FOCUS: SUMMER FOOD

Chef Jamie Aquino’s cooking classes are “all about celebrating plants.”

No Meat? No Problem Fresh and hot off the grill, plant-based recipes can be just as flavorful as their meaty counterparts BY CHEY SCOTT

amie Aquino transitioned to the vegetarian lifestyle in early childhood, and has been teaching other people how to make healthy, flavorful and creative plantbased recipes for more than two decades. As a culinary instructor at The Kitchen Engine in downtown Spokane for the past five years, Aquino teaches a variety of classes that regularly fill up on veggie burgers, cooking with tofu, homemade soups,

24 Health JUNE - JULY, 2017

and farm-to-table cooking. “I don’t gear my classes specifically toward vegetarians, and a crazy amount of people who eat meat come to my classes,” Aquino says. Raised in the kitchen under the wings of her mother and grandmothers, Aquino’s family began experimenting with vegetarian recipes back in the 1980s, when she says reliable information on the plant-based

YOUNG KWAK PHOTO

diet wasn’t even remotely as accessible as it is now. “We had to forge ahead, and my mom taught me the unique techniques that I teach now,” the self-taught chef reminisces. “I taught my first class when I was 15, and something clicked. I love sharing with people, and my classes now are all about celebrating plants, from the most basic to the most extravagant. Flavor and nutrition are always number one.” When it comes to cooking meatless recipes on the grill this summer, Aquino is bursting with ideas and tips. The trick to successful veggie grilling, she says, is oil. “If they’re not well oiled, they need to be soaked in a wet marinade, since they have so little fat and want to adhere to the grill,” she explains, adding that “grilling baskets are going to be an absolute life-saver when you’re doing veggies that may be too thin or might roll around, like tomatoes and asparagus.” ...continued on page 26

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Health 25

FOCUS: SUMMER FOOD “NO MEAT, NO PROBLEM,” CONTINUED... When it comes to making your own meatless burgers to grill at home, Aquino says another key is making sure there is a balance of dry and wet ingredients, with a good binder, like eggs or a starch. Tapioca, potato or corn starch all work well. “It sounds strange, but oats are a tremendous glue to keep things together, and they add a nice texture to bite into,” she says. “Old-fashioned rolled oats combined with veggies and other moisture helps activate the starch to create that glue — it’s important not to make a mushy patty.” Aquino also advises not to fear adding extra spices and seasonings to boost the patties’ flavor. “If you made them before and it didn’t turn out well, double the garlic, onion or basil. Don’t be afraid to double the spice,” she says. To keep the patties from sticking to the grill, since they’re so light on fat, Aquino says it’s important to brush them with oil before tossing them on and when flipping. Cook over medium heat to ensure the patties are heated all the way through, and consider using the top rack of the grill if you’re also cooking meat-based items, which may require higher heat. Beyond these tips, however, Aquino’s most crucial tip for making veggie patties at home, including the Southwest-inspired recipe she shares here, is to pre-bake the patties in the oven to prevent them from falling apart on the grill. This can also be done ahead of time, and you can refrigerate or freeze the partially cooked patties before grilling, she says. When it comes to flavorful, veggiebased sides, Aquino recommends her recipe for cauliflower medallions — the smokiness of the grill complements the cruciferous vegetable’s natural flavors. She also likes grilling all types of onions, which are easy to slice up and toss on. Grilled onions make for tasty sides to go along with other plant-based dishes, as well as with meats. “Mango and pineapple, too, are my favorites to grill,” she says. “Those are just so enhanced from the grill and the smoke; it sweetens and caramelizes the sugars, as with any stone fruit — peaches, nectarines, plums, and pears.” She suggests adding any of these fruits to a balsamic-based dressing and some grilled onions for a smoky, sweet and salty flavor combination. n Find Jamie Aquino’s class schedule at thekitchenengine.com/events.

26 Health JUNE - JULY, 2017

MEAT-FREE BBQ RECIPES

YOUNG KWAK PHOTOS

SW Veggie Burgers with Roasted Garlic & Poblano Chutney The texture of these burgers may surprise you, chef Jamie Aquino says. A combination of chewy rolled oats, tender onions and brown rice, meaty mushrooms, and a bit of crunch from the pecans provides ample texture. Paired with the spices and chutney, this burger is a flavor- and texture-filled experience. Sauté the following until tender: 1 teaspoon extra virgin olive oil 1 large yellow onion, diced small 3 cloves garlic, minced Set aside onions and garlic, add 1 teaspoon extra virgin oil to the pan and sauté over medium high heat until golden brown. 5 oz. clean, finely diced cremini mushrooms While mushrooms are cooking, thoroughly mix together in a large mixing bowl: 1 cup old-fashioned rolled oats 1 cup quick oats 1 cup cooked brown rice ⅔ cup pecans, chopped fine ⅓ cup large flake nutritional yeast 2 tablespoons potato starch or cornstarch 1 tablespoon mild chili powder 1 teaspoon oregano 1 teaspoon cumin powder 1 teaspoon garlic, granulated ½ teaspoon onion, granulated ½ teaspoon black pepper ¼ teaspoon natural sea salt

Once mushrooms are sautéed, add to dry ingredients along with onions and garlic, and add: 3 tablespoons tamari (or soy sauce) 1⅔ cups boiling water 2 tablespoons extra virgin olive oil Stir all ingredients until well combined. Preheat oven to 400° and grease a baking sheet. Place a burger press* on a flat surface, add ½ cup of mixture into press, form into burgers. Transfer burgers to baking sheet, leaving at least 1 inch between each burger. Bake 20 minutes, or until bottoms are golden brown. Lightly oil the top of burger, flip and cook 12 to 15 minutes more. *Most veggie burger recipes do best with greasing the burger press in between additions, as the mix can be quite sticky compared to ground beef. ON THE GRILL: Before grilling, parbake using the directions above, but shorten bake time to 18 minutes on the first side, 8 minutes on the second. Refrigerate up to four days before grilling, and store in airtight container. Brush burger with olive oil and place on a hot grill, softer side down, (the side that was baked for 8 minutes) grill for approximately 4 to 5 minutes, turn and cook 3 to 4 minutes, or until center reaches 165 degrees.

Roasted Garlic & Poblano Chutney

This chutney is full of flavor and has a bit of heat. You can reduce the spice by adding more sugar. Aquino recommends using fresh poblanos during their peak season (late July to September) for the best flavor. Grill in a foil packet over indirect heat until tender: 2 medium sweet onions, cut into large chunks 50 garlic cloves, peeled Roast on the grill over direct flame: 4 whole poblano peppers, washed Blacken peppers on all sides. Scrape off skins with the back of a knife, remove stems, cut in

half and remove seeds. Place peppers, onions and garlic cloves in a food processor with: ½ teaspoon natural sea salt (more to taste as needed) 1½ teaspoons raw cane sugar 1 tablespoon apple cider vinegar

FRESH INGRE DIENTS

Pulse until mixture resembles a chunky jam or salsa. Serve over Southwest Burgers with melted Oaxaca cheese and crispy onion straws on a large hamburger bun. Serves 8.

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Grilled Cauliflower Medallions

Cauliflower Street Tacos

Mix in a small bowl: 2 teaspoons mild chili powder ½ teaspoon granulated onion ½ teaspoon granulated garlic ⅜ teaspoon natural sea salt ¼ teaspoon black pepper ¼ teaspoon Chinese five-spice powder Set aside.

Shred finely, and place in a bowl: 12 oz. red or green cabbage 2 medium carrots Dice/mince small: ½ medium red onion ½ cup cilantro 3 tablespoons of fresh lime juice 3 pinches of natural sea salt Optional: hot pepper*, minced Stir to combine. Keeps up to 6 hours.

“You may not think of cauliflower as grill food, but a bit of smoky grill flavor is just what this cruciferous vegetable needs,” Aquino says.

Wash, remove leaves and base of stem from: 2½ lbs. cauliflower Cut large florets from the main stem, trim down opposing sides so florets will lay flat on the grill. Medallions should be ½ to ¾ inch thick. Using a silicone basting brush, brush both sides of medallions with olive oil. Sprinkle spice blend evenly, coating both sides well. ON THE GRILL: Preheat grill to high, place medallions directly on the grill. Cook 8 minutes on first side; turn and cook an additional 8 minutes. Keep warm by placing on foil over indirect heat. Serve with garlic or spicy aioli. This side dish can also be turned into a main dish, as follows.

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*The more seeds and veins you remove from your pepper, the less spice you will get. Warm: 18 street-sized corn tortillas. Cut grilled cauliflower into bite-sized pieces, fill tortillas with ¼ cup of cauliflower and top with slaw. Garnish with Greek yogurt and lime wedges. Serves 6.

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LIVING

Reuben volunteers with his owner Rita Burnett at Kootenai Health. DAN COUILLARD PHOTO PETS

Creature Comforts Mysterious and powerful, the bond between animals and humans provides elements of healing and understanding BY CARRIE SCOZZARO

inda Irish had been breeding Old English Mastiffs for several decades when she hit upon a novel way to connect with her Sheridan Elementary students. With her principal’s permission, she brought a 6-month-old brindled mastiff pup named Macie into the classroom, tapping into the mysteries and magic of the humananimal bond. One story was particularly memorable, says Irish, recalling a student on the autism spectrum who didn’t engage with anyone or anything. When Irish brought Macie into the classroom, the dog made a beeline

for the child, nuzzling and cuddling him, yet the boy remained shuttered. One day Irish noticed him petting Macie. Over time he engaged with the growing puppy, then his classmates, teachers and the school; the dog found a special way in. Dogs seem to sense who needs help most, says Irish, who has retired from teaching yet still volunteers with students, albeit now with dogs in tow. In addition to Shriners Hospital and the Ronald McDonald House, Irish visits Gonzaga University’s Foley Library during finals week with her teams of Reading Rovers, as they are

known. Consisting of trained volunteers and dogs, Reading Rovers are a hit with students who might be missing the family dog or just welcome the stress break from studying, says Theresa Kappus, Gonzaga’s Distance Services Librarian. “It’s really hard to determine whether dog intervention is helping empirically, in data,” says Irish, “but you can see the behavior and attitude change.” Cyndi Caniglia, a lecturer in special education at Gonzaga, knows firsthand the benefits of being around animals. Grow...continued on next page JUNE - JULY, 2017

Health 29

LIVING

Free Rein volunteer Cyndi Caniglia and a young rider wait for their horse.

Ellee is ready for a belly rub during a Reading Rover session with Kayden at Windsor Elementary in Cheney.

“CREATURE COMFORTS,” CONTINUED... ing up, she didn’t see her involvement with horses as therapy. “But now, looking back, I can tell you the emotional bond and the daily emotional outlet I had spending time with my horse helped me deal with challenges of teenage life in healthy ways. Horses brought great joy and fulfillment to my life, and a healthy way of coping with stress and familial dysfunction.” At Free Rein Therapeutic Riding, Caniglia is a riding instructor registered with PATH (Professional Association of Therapeutic Horsemanship International), a credentialing and advocacy organization that promotes equine-assisted therapies for people with special needs. Free Rein works with children and adults with disabilities — cerebral palsy, autism spectrum disorder, post-traumatic stress disorder — allowing them to experience a newfound mobility and freedom, gain confidence, and discover new avenues of engagement with their world. “I have witnessed volunteers and families shed tears of joy as they witness

30 Health JUNE - JULY, 2017

their child squeal with glee, as their horse trots and their team of a horse leader and side walkers cheer them on and laugh and giggle with them – a joy they may not experience anywhere else in their life,” says Caniglia.

quine therapy is one of several programs in Washington State University’s studies of human-animal interactions (HAI), a program that dates back more than 50 years. The late Dr. Leo Bustad, former Dean Emeritus of the College of Veterinary Medicine, is recognized for his pioneering 1986 humane animalcare curriculum called “Learning and Living Together: Building the Human-Animal Bond.” Bustad also helped form the Delta Society, which would eventually become Pet Partners, a 15,000-member national program focused on “improving human health through positive interactions with therapy animals,” namely through advocacy and training. According to Natalie Pond, Pet Partners’ Marketing & Strategic Partnerships Coordinator, there are roughly 100 human-

Debbie and Chuck Wing’s Irish Wolfhound, Keeva, responded to the Marysville school shooting in 2014. animal partnerships registered in Eastern Washington and North Idaho alone. Pet Partners is the only organization to register multiple species: cats, equines, rabbits, guinea pigs, llamas and alpacas, birds, pigs, rats and dogs; the latter account for 90 percent of their interactions. Sophie, for example, is Marie Brumfield’s irresistible 2-year-old English Springer Spaniel and registered Pet Partners dog. She illuminates the room when she visits Lakeland Village and Sacred Heart Medical Center, says Brumfield. “She totally ‘works the room’ from person to person,” says Brumfield. “I just watch while my heart explodes.”

ophie’s impact on humans has a lot to do with chemistry. The Human Animal Bond Research Institute, a nonprofit partnership of several pet products corporations, has compiled reports showing that human-animal interactions (mostly focusing on dogs) can “influence levels of blood pressure, heart rate [and] hormones correlated with well-being, including cortisol, oxytocin, b-endorphin, prolactin,

phenylacetic acid and dopamine.” In other words, being around animals can make us feel better. In educational settings, that can mean decreased anxiety, improved academic performance, even enhanced social skills. At Pawsitive Works, the goal is to help at-risk youth learn “lifelong values of empathy, patience, self-concept, mindfulness, and communication while also improving the dog’s adoptability.” The program, which began in Bonners Ferry, Idaho and at Eagle Peak School at the Pratt Building in Spokane, builds on the importance of social, emotional learning, according to founding director Karen Schumacher. Health care providers have also embraced animals as partners in wellness, ranging from visiting patients at hospitals and assisted living facilities to working with first responders in crises. HOPE Animal-Assisted Crisis Response (AACR) is a five-region network of teams across 34 states that provide “comfort in the time of crisis,” such as fire or flood, or in the aftermath of the unthinkable horror of a school shooting. Debbie Wing and her husband Chuck, members of HOPE AACR’s Pacific Northwest chapter, responded to the October 2014 school shooting in Marysville, Washington. The couple also run LynnDee’s Grooming & Dog Training Center in Spokane, which serves as a registration and testing center for Pet Partners. Wing, who has five dogs, two horses and a cat registered with Pet Partners, often brings her dogs to Spokane’s drug and mental health courts, providing a welcome calming and humanizing effect for people on all sides of the judiciary system. For Vickie Sienknecht and her golden retriever Desi, offering help means trips to Hospice House. After a lengthy process for the dog — puppy kindergarten, good canine citizen training, successful trips to public places — and handler, the duo completed their Pet Partners registration at LynnDee’s. With her gentle temperament and boundless energy, Desi is always a hit, says Sienknecht, who lost both parents in recent years. She’s thankful to have shared Desi with so many, including health care providers, she says. “I feel like we’re bringing it full circle. The people who have helped me, we get to bring it back to them.”

he desire to help others is a common thread among the 11 volunteer teams in Kootenai Health’s pet therapy services program, as they cover daily shifts from 9 am to 11 am. “Our pet

therapy program offers patients and guests the opportunity to relax during a time that may be difficult or stressful,” says volunteer services coordinator Shannie Davis. “Pet therapy is proven to help lower stress and anxiety, and having a caring, loving canine companion stop by for a visit offers a joyful distraction.” Many of the volunteers have a personal connection to the North Idaho health care facility. Bob Reynolds, who works in security, brings his dog, Huck, to Kootenai Behavioral Health for visits. Brandy Jowdy, a former nurse, turns heads with Barrister, one of three massive yet gentle Newfoundlands. She recruited friend and Newfie owne Kolleen Delaney, who described a recent encounter with her dog, Sadie: “Sadie and I were visiting an extended care facility here in town when we were approached by a woman asking if I could bring her to visit her sister who had suffered a stroke,” recounted Delaney. The woman hadn’t communicated since the stroke, yet when Sadie laid her massive head on the bed near the woman’s hand, to everyone’s surprise and delight, the woman not only began stroking the dog, she looked purposefully at her sister and smiled. In addition to volunteering with her Newfoundland, Moose, staff pharmacist Kathy Widmyer is an evaluator for Bright and Beautiful, which vets all Kootenai Health dogs (some also belong to Pet Partners). What does Widmyer look for in a dog? “Disposition, and if they naturally like people,” says Widmyer, who often brings Moose to the brain injury unit. Dogs have to be able to follow basic commands — sit, stay, down — as well as specialty ones, says Widmyer, such as avoidance when medication drops on the floor. She tests dogs around typical hospital equipment like wheelchairs and walkers. Crutches are a challenge, says Widmyer; to dogs, they look like weapons. Although they’re less frequently employed in therapeutic settings, cats undergo the same rigorous vetting process, says Diana Roberts, who has registered three dogs and two cats with Pet Partners since 1996. Nyuchi, which means “honeybee” in Zimbabwe’s Shona language, does hospice work, arriving in a crate and content to sit in patients’ laps. Roberts also volunteers at Deaconess Hospital with her dogs and finds working the pediatrics unit emotionally difficult, yet rewarding. “I do this work because the animals do the work,” says Roberts. “I consider myself to be the chauffeur.” n

Carol Cook and her golden retriever, Molly, volunteer at Kootenai Health. DAN COUILLARD PHOTO

ANIMAL TERMS

et Partners, and organizations like it, have added a new dimension to our notion of animals in service, which is already rife with confusing and conflicting terminology. To be clear, “Under the ADA, a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability. The task(s) performed by the dog must be directly related to the person’s disability.” Therapy animals, in contrast, are not protected under ADA regulations. Also known as assistant animals, this group may include those providing comfort to a target audience, such as at a hospital, as well as those that are part of a recognized therapeutic treatment plan. The confusion concerns many involved in volunteering their animals to benefit others. Carol Cook figures she spends about 24 hours a month taking her golden retriever, Molly, to numerous assisted living homes and Kootenai Health. She worries that confusion over terminology may end up doing a disservice to legitimate dogs employed for specific tasks. — CARRIE SCOZZARO JUNE - JULY, 2017

Health 31

LIVING

PARENTING

Failure to Launch “Adulting” is a thing now: Are kids acquiring the skills to navigate real life? BY TARYN PHANEUF

t age 30, Ashley Grow is personally familiar with the struggle of millennials to cope with the responsibilities of adulthood. As a family consumer science teacher, she’s in a prime position to do something about it — if only schools and families will take advantage while they have the chance.

32 Health JUNE - JULY, 2017

“I can’t tell you enough how much I think schools need to wake up and realize we may be getting these kids a collegeready transcript, but they’re not prepared to function on their own,” says Grow, who teaches career and technical education classes at Rogers High School in Spokane. “I believe our entire nation is in the

midst of a collective coming-of-age crisis,” writes Nebraska Sen. Ben Sasse, a father of three, in his new book, The Vanishing American Adult. “Our kids simply don’t know what an adult is anymore — or how to become one … The older generations have forgotten that we need to plan to teach them. It’s our fault more than it is theirs.”

Sasse recounts a group of college students given the fun task of decorating a 20-foot Christmas tree in the lobby of their school’s basketball arena. They only completed the bottom half of the tree — the part they could reach — and left. Nobody thought to ask a custodian for a ladder, or to try to find one. “The day’s failure wasn’t at all about lacking brains; it was about will. It was about ownership. It was about not having much experience or interest in seeing tasks through to completion,” he writes. While decorating a tree isn’t essential for a successful life, it’s a window into the situation in which “adulting” tasks that used to be common sense may now seem to overwhelm or elude many 20- and 30-year-olds: Things like sticking to a budget, landing a job, choosing insurance, maintaining a car, or eating well prove simply prove out of reach.

haven’t planned correctly, or sometimes not at all.” She says her own kids, ages 21 and 22, have noticed personal shortcomings. “They’ve both stressed that school doesn’t prepare you for life,” Harvie says. “I think it should. I think if the kids are expecting it, that right there is a red flag.”

THE STRUGGLE IS REAL

Truthfully, it’s not just millennials who struggle with adulting. Really, who wants to pay bills or research insurance options? But part of adulthood is working through tough scenarios, because they’re inevitable. “We’re just not pushing kids enough,” Grow says. “None of our classes are pushing kids hard enough, because once it gets hard, we give them an out. “I think it’s just an epidemic. As a parent myself, it’s really hard. I always want to

solve my kids’ problems. They’re just 2 and 3 years old, and I already struggle to not just take over and do it for them. But it’s becoming a huge problem, because these kids can’t solve problems.” Sasse offers some ideas for parents of young kids. He writes of the value of building resolve through physically demanding work, exploring the world through avid reading, and learning self-reliance through traveling alone. Harvie has talked to own her kids about insurance and credit, but admits that not every parent has those things in place for themselves, let alone the knowledge to teach their child. “As a parent, you struggle, because you’re busy being a parent until something comes up for them,” she says. “You’re teaching on the fly.” n

A SCHOOL CALLED LIFE

Grow, whose classes include food & nutrition and culinary hospitality, believes middle and high schools should do more to prepare students in areas like finances, nutrition and cooking, and even relationships. But with the pressure to produce college-ready teens, she sees students pushed toward classes that look good on a college application. “There’s no room,” she says. In Spokane middle schools, most family consumer science classes have been cut entirely, she says. Those in high schools remain because they can be justified as preparatory courses for students interested in certain career paths. It’s a point of regret for parents and friends, who send her articles and tag her in Facebook posts lamenting all that school didn’t do to prepare them to be an adult. “‘It’s great that I know how to solve an algebraic equation, but now I can’t sew on a button,’” Grow recalls them saying. “I teach this stuff!” she says. “It is in schools. It’s just less known, because everyone is telling parents to get their kids in AP courses and to make sure they take a foreign language. There’s nothing wrong with that. But there should be a way … If we require a science lab, why can’t we also require an independent living class?” In her work as an local insurance agent, Kristi Harvie says that “It’s become very apparent that financial and insurance planning is a big gap in teaching kids how to adult, leading to adults who

Rachel Weinstein and Katie Brunelle, founders of the Adulting School in Maine.

WHAT TO DO?

he Adulting School, founded by two women in Portland, Maine, calls itself a collective dedicated to teaching skills in six essential areas, including health, money, relationships and work — from folding a fitted sheet to networking. It provides an accountability group to members, who sometimes meet in restaurants or co-working spaces, in addition to creating online content for one another, says co-founder Rachel Weinstein. A practicing psychotherapist, Weinstein wanted to create the Adulting School after hearing her clients talk about crushing debt, broken relationships, and work stress. But for kids without an adulting school nearby, “There’s just not a good tool out there in society to teach this kind of thing,” says Spokane insurance agent Kristi Harvie. “Who’s going to teach you?” Trying to do her part to pass on financial savvy, Harvie has started offering employee seminars at various local businesses as a way to improve financial literacy. Financial institutions are also stepping up. Spokane Teachers Credit Union has developed a series of user-friendly courses on its My Money, My Life website (stcumoney.org), which is divided into budgeting, borrowing and safekeeping sections. Topics include “What to do when you can’t pay your bills” and “‘Free Trials’ can be costly.” Spokane Federal Credit Union offers education targeted at various developmental stages, from games teaching money basics to 3-to-5-year-olds — “Peter Pig’s $$ Counter” — to “I Rule Money” for teens. — TARYN PHANEUF

JUNE - JULY, 2017

Health 33

LIVING faster than its previous testing equipment. The old equipment was installed 16 years ago, Michaelsen says. With the new technology, tests formerly done by human hands that would take eight hours are now automated, freeing up medical technicians’ time. But despite the shift toward more automation, Michaelsen says, the new technology did not replace any employees. “It’s an employee-neutral move.”

HOW IT WORKS

PAML’s new automated testing line. INNOVATION

Treatment and Testing Spokane-based PAML streamlines its laboratory testing; also, a local neurologist offers a new Parkinson’s treatment BY MITCH RYALS

n a sterile white room with a view overlooking the Park Inn Bar & Grill, shiny, new washing-machine-like devices whir and hum. Tubes of human samples from across the country automatically zip between the appliances via tunnels covered in blue-tinted plastic, reminiscent of a labrat run. This network of appliances — nicknamed Donald, Daisy, Huey, Dewey and Louie — are the behind-the-scenes cogs cranking out test results that tell physicians what’s ailing their patients. Accuracy and timeliness are imperative, which is why Spokane-based Pathology Associates Medi-

34 Health JUNE - JULY, 2017

cal Laboratories (PAML) recently installed this new multimillion-dollar automated testing line. “When you’re dealing with thousands of samples, and tens of thousands of tests on those samples, then it can be kind of tough looking through all that data,” says David Michaelsen, laboratory technical director at PAML. “This line, and the futuristic software that it is built with, allow some of those functions to happen automatically.” No other lab in the United States is using all of this technology together, which PAML estimates operates 250 percent

A medical technician will literally dump a load of tubes containing a variety of human samples into a silver basin to be sorted. A machine stands the tube upright, scans the barcode and shoots it into another machine for testing. Consider this example: three separate tubes containing one patient’s blood get dumped into the hopper. A doctor has ordered tests on the patient’s blood plasma, blood serum and the whole blood. Where a technician would previously have sorted the three tubes by hand, the new equipment now does that automatically. The technician then reads the results at the end of the line to ensure accuracy. Some test results necessitate that the sample be tested a second time. The system will recognize that and alert a technician, who then authorizes the extra test. “Not everybody has great solutions for that in the laboratory testing realm,” Michaelsen says. The line also recognizes “high-priority” tests and can shuffle those ahead of other, less time-sensitive samples. Overall, the new testing line carries about 50 percent of the diagnostic testing workload for PAML, Michaelsen says. The rest is done by other machines, and for some of the more complicated tests, by human employees. “The key thing for laboratories moving forward is how well you can automate it, how well you can put in that ‘smart logic,’ and how well you can minimize hiring tons of people,” Michaelsen says. “You’re never going to eliminate jobs totally, but the key thing is how to balance that out, and part of that is an instrumentation like this.” In early May, the global life sciences company LabCorp finalized its purchase of PAML, previously owned by Providence Health & Services and Catholic Health Initiatives. Michaelsen says the medical reference laboratory’s new automated line is not related to the sale. n

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Spokane-based neurology clinic — Northwest Neurological — is seeing success with a recently FDA-approved treatment for Parkinson’s disease known as Duopa. Parkinson’s is a chronic and progressive disease, meaning it slowly gets worse over time. Tremors, stiffness and slow movements are common symptoms caused by lack of dopamine in the brain. One of the most common treatments is a drug, known as levodopa, that replaces dopamine. However, as the disease progresses, and the body produces less and less dopamine, the drug becomes less effective. So for patients with moderate to advanced stages of Parkinson’s, Duopa can be an effective solution. The difference between the gel-like Duopa and an oral medication is the manner in which they’re administered. Rather than taking a pill, Duopa is sent straight into a patient’s small intestine via a flexible plastic tube. The advantage is that patients get a more continuous dose, and can control dosage levels more precisely, says Dr. Jason Aldred, co-owner of Northwest Neurological. Whereas patients can only take pills in 50- or 100-milligram increments, for example, the tube offers more a fine-tuned administration of the medication. “It’s like making a better wheel,” Aldred says. “We had a great treatment already, but this is really good. It’s the best way to deliver dopamine replacement.” Aldred, who has treated about 20 people throughout the Pacific Northwest with Duopa since 2015 when it was approved, says the new treatment offers insight into the disease moving forward. “There’s something about the continuous delivery that contributes to the motor state of that person,” Aldred says. “Patients end up on the same amount of drugs, but their motor state is radically different. That continuous delivery contributes to that. A burst [of medicine] is not a natural way for the brain to receive dopamine.” — MITCH RYALS

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Health 35

LIVING

ALI BLACKWOOD MEAD ILLUSTRATION

ALT MEDICINE

A Human Problem Anxiety and depression are the most common mental health issues, and there are things you can do to help BY SAMANTHA WOHLFEIL

f you have depression or anxiety, it doesn’t mean you are flawed or broken: It’s a human problem, explains Dr. Sean Smitham, a clinical psychologist in Spokane. First, he says, no one ever taught you how to deal with your incredibly powerful brain, about feelings and how to cope with them. Second, when two parts of your brain are in conflict, the more ancient part is going to win, Smitham explains at a recent Healing Spokane forum at WSU Spokane. The newer, chatty, mammal part of the brain — the part behind what we think of as the voice in our head — can get overpowered by the more ancient reptilian brain, where our fight-or-flight responses are located, he says. Call it a design flaw. “Every time (fight-or-flight) gets acti-

36 Health JUNE - JULY, 2017

vated, the reptile brain gets in the driver’s seat,” Smitham says. “That top part keeps chattering away, but it’s no longer driving the bus. This is why you can’t talk yourself out of a panic attack. You can’t talk yourself out of anxiety very well, either.” In the U.S., more than 40 million adults experience anxiety disorders, which are the most common mental health concern, according to the National Institute of Mental Health. Those disorders are expensive: they cost the U.S. more than $42 billion a year, according to a 1999 study commissioned by the Anxiety and Depression Association of America, with about half of that cost due to frequent medical visits by people experiencing symptoms that mimic physical illnesses. The good news: There are ways to treat

both anxiety and depression, and there are plenty of things people can do to complement treatment they get from their doctors and physicians. “I think what people need to know is, there’s different ways of looking at medical issues,” says Renu Sinha, a thyroid surgeon at Inland Surgical Associates who also has a clinical education in Ayurveda, a system of medicine that has been used for thousands of years in India. “And I think what we want people to do is use allopathic [traditional or mainstream medicine] and complementary approaches to see what works best for them.” For anxiety and depression, working with a team of doctors and caregivers is important to create a plan tailored to you. Whether you work with a dietitian, a physical trainer, a therapist or someone who practices traditional Chinese or Ayurvedic medicine, there are a variety of approaches that can help balance body and mind aside from, or in concert with, medication. It’s important to note that all of the examples provided below are mostly intended to help with mild to moderate anxiety, and in all cases — but especially with severe anxiety and depression — it is essential to work with your primary care team and not just rely on any one technique, Sinha says.

WHAT YOU CAN DO

It turns out that even MODERATE EXERCISE — think a brisk walk — can

help relieve the symptoms of anxiety, says Richard Young, who is researching correlations between exercise and anxiety at WSU Spokane. While high-intensity cardiovascular exercise may come with other benefits, if someone is just looking to ease anxiety, it looks like moderate exercise, when people get their heart rate to between 50 percent and 85 percent of their maximum, is beneficial, Young says. For some, MINDFULNESS meditation can help through breathing and guided-thought exercises to focus on the here and now and have an open attitude, says Tracy Skaer, a tenured professor in the WSU College of Pharmacy. “We say the time is now. Forget later, forget before,” Skaer says. She shares a poem called “The Guest House,” by Rumi, that starts, “This being human is a guest house. Every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all!” Traditional Chinese Medicine (also called TCM) is holistic, meaning it takes

into account the connection between mind and body, and body and environment, and how physical health problems might be related to emotions, and vice versa, says Sherry Wu, a rheumatologist and licensed acupuncturist at the VA Medical Center in Spokane. With anxiety, as with other ailments, TCM tends to focus on making sure that different body systems are in balance, through DIET, HERBAL REMEDIES, ACUPUNCTURE, TAI CHI, QI GONG and other techniques. Organs are each associated with different emotions, colors, seasons and tastes, which a TCM practitioner would work with a patient to get in balance, to make sure they are all working together, Wu says. Similar to TCM, Ayurveda focuses a lot on self-care, and a holistic balance between body and mind. Each person’s baseline or blueprint is different, Sinha says, so advice for what to eat and do is highly individualized; what works for one person won’t necessarily work for another. However, in general, Ayurvedic teaching might recommend warm, soft foods for people who have anxi-

ety, and DISCOURAGE DRINKING ALCOHOL AND CAFFEINE. Similar to TCM, Ayurveda also uses herbs, and encourages mindful meditation, YOGA, and moderate exercise, such as swimming or walking, Sinha says. Across practices, there are a variety of SUPPLEMENTS that are thought to be helpful for different symptoms of anxiety and depression, including ashwagandha, SAM-e, kava and St. John’s wort, but each has its own risks and potential side effects, and some can interfere with medications, so it is essential to work with a pharmacist and your doctor if you decide to take them. Skaer says St. John’s wort, in particular, can cause a lot of drug interactions. “I have been very surprised that our allopathic partners in the community have been very open-minded to learning about these things that they can utilize with their own patients to help them feel better,” says Sinha, who helped found Healing Spokane to educate people about complementary health care. “I think it allows the patient to be engaged more and have options. We all want options for everything, right? That’s the beauty of all of this.” n

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Health 37

INDISPENSABLE INLANDERS know that no story is one-sided — no issue is cut and dried. That’s why we believe great journalism makes a great community. But we also believe that no weekend should go unfilled. So we get the word out about where good times can be had, all over the region.

With nearly 200,000 of the most loyal readers in the country counting on us every week, we know this is a big job. But we’re up for it, because we’re Inlanders, too. And it’s our mission to keep pumping out a must-read newspaper that helps cultivate the informed, creative community we call home.

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LIVING JUNE-JULY EVENTS 2017 FREE STATE PARK DAYS | Washington State Parks and Recreation allows visitors access to all state parks without needing a Discover Pass on specified days throughout the year. Includes access locally to Riverside State Park, Palouse Falls and Mt. Spokane state parks. Upcoming “free” days on June 10, Aug. 25 and Sept. 30. More details at discoverpass.wa.gov. MIRYAM’S HOUSE WARMING PARTY | Help get Transitions’ transitional living house for women on the path to recovery back to “normal” after a remodel. Bring a small gift of housewares and take a tour of the facility. Sat, June 10 from 10:3011:30 am. RSVP to Mary Tracey at 3286702 or mtracey@help4women.org. DONATE BLOOD | Give blood at the Inland Northwest Blood Center, which requires up to 200 donors each day to ensure that the blood bank is adequately stocked. Donors can schedule an appointment online or donate during walk-in hours at the Spokane, North Spokane, Spokane Valley, Coeur d’Alene, Lewiston, Moscow, Pullman and Moses Lake collection centers. Consider donating for World Blood Donor day, this year on June 14. Hours and collection center addresses at inbcsaves.org. SUMMER SOLSTICE FUN RUN | Fleet Feet and Spokane’s Flying Irish running team host a 10K fundraiser run along the Centennial Trail, with all registration proceeds benefiting the Children’s Tumor Foundation. Also includes a quarter-mile kids’ run (6 pm). Fri, June 16 at 6:30 pm. $15/ kids, $35/10K. Riverfront Park, starting line at the North Shelter. bit.ly/2qohagq PARADE OF PAWS | The Spokane Humane Society’s 14th annual dog-walk fundraiser is open to groups and individuals, offering 2- or 4-mile walks, local vendors and info booths and a barbecue. Walkers who collect $100 or more receive an event T-shirt. Sat, June 17 at 10 am; day-of registration starts at 8 am. Entry by donation and/or pledges. Spokane Humane Society, 6607 N. Havana. spokanehumanesociety.org (467-5235 x 212)

CHARITY CORNER

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hether you’ve been debating about making the switch to a meatless or entirely plant-based diet, or you’re simply looking for inspiration and resources to make some health-conscious lifestyle changes, the fourth annual Spokane VegFest welcomes all, from the “veg-curious” to already faithful vegans and vegetarians. For its fourth year, the one-day convention held on the Spokane Community College grounds continues to grow, hosting demonstrations, speakers, an outdoor vendor market, live music and other activities throughout the day. “Everyone comes for so many different reasons,” says event founder and organizer Josh Meckel. “There is not just one reason to get more plant power in your life. The health thing is where a lot of people come from — they’re scared about their health, and they want to learn how to

HUTTON SETTLEMENT OBSTACLE RUN | A 5-mile challenge: run up/down hills, complete boot-camp-style activities and overcome obstacles. Proceeds benefit the Hutton Settlement, Ghana Make A Difference and Better Me Better Moms. Sat, June 17 at 9 am. $40-$50. The Hutton Settlement, 9907 E. Wellesley. befittoserve.configio.com (315-5023)

TRAILBLAZER TRIATHLON | The 34th annual sprint-distance triathlon, consisting of a 350-meter swim, followed by a 12.2mile bike ride on paved roads and a 2.92 mile run around Medical Lake as part of the city’s Founders Day events. Open to individuals and teams of three. Sat, June 17 at 1 pm. $55/person; $75/team. medicallake.org/triathlon

THE POUR | The gourmet winemaker’s dinner and auction benefits the Providence Health Care Foundation, which designates this year’s funds to the Providence Adult Day Health and the B.E.S.T. child psychiatry program at Sacred Heart Children’s Hospital. Sat, June 17 at 5:30 pm. $175/person. Arbor Crest Wine Cellars, 4705 N. Fruit Hill Rd. thepour.info (474-2819)

TRANSITIONS’ GOLF OUTING | Sign up to play in this event and help raise $40,000 for the nonprofit which supports women and children transitioning from abuse, homelessness and other hardships. In addition to a day of golfing, guests enjoy live and silent auctions, dinner, dessert and a wine raffle. Tue, June 20. Details at help4women.org. SUMMER PARKWAYS | Spokane’s biggest

get healthy.” Meckel says this year’s VegFest will add to the number of live cooking demos held throughout the day, a feature that has been one of the most popular in past years. Six guest speakers, including a vegan dietitian, an Olympic medalist, and bestselling cookbook author Lindsay Nixon, also known as the Happy Herbivore, will present on various plant-based health topics throughout the day. Check the Spokane VegFest website, listed below, closer to the event for more event details and a complete schedule. — CHEY SCOTT Spokane VegFest 2017 • Sat, July 22 from 10 am-6 pm • Free admission and parking • Spokane Community College • 1810 N. Greene • inveg.org

summer block party: 4 miles of residential streets are closed to motorized vehicles and opened up to bikes, pedestrians, skaters, and other human-powered transportation. Activities, including a bikedecorating contest, and booths are set up in Manito and Comstock parks and along the designated route through the neighborhood. Wed, June 21 from 6-9 pm. Free. Manito and Comstock parks, on the South Hill. summerparkways.com BABYSITTING BASICS | This course is designed for youth ages 10 to 15, preparing them to become successful babysitters, and includes instruction in infant care, CPR, discipline issues, safety and more. Offered June 22, July 13, July 21 and Aug. 4 from 9 am-2 pm. $40; online registration available. St. Luke’s Institute, 711 S. Cowley. wellness.inhs.org (232-8138)

HOOPFEST | Participate in or be a spectator at Spokane’s annual three-on-three basketball tournament, the largest of its kind in the world. June 24-25. Free to watch. Downtown Spokane. spokanehoopfest.net (624-2414) IRONMAN 70.3 | Athletes can train for the full Ironman in August with this half course, which includes a 1.2-mile swim, a 56-mile bike ride and a 13.1 mile run. Sun, June 25. Starts at City Beach; ends along Sherman in downtown CdA. ironman.com THE DIRTY DASH | The annual mud-run obstacle course returns to Spokane. Kids ages 12 and under can also sign up for the “Piglet Plunge” ($20). Sat, July 8 at 9 am. $20-$44. Riverside State Park ORV Park, Nine Mile Falls. thedirtydash.com …continues on next page JUNE - JULY, 2017

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LIVING JUNE-JULY EVENTS

BASKETS FOR BABIES DISC GOLF TOURNEY | The annual tournament supports the nonprofit’s mission to provide basic baby supplies to new parents in need. Sat, July 29 at 9 am. $20/youth, $30/adults. High Bridge Park, 2800 W. Riverside. basketsforbabies.org

VALLEY GIRL TRIATHLON | The annual women’s sprint distance triathlon includes a ⅓-mile swim, 12-mile bike ride and 3-mile run. Proceeds support Transitions women’s shelter and programs. Sun, July 9 starting at 7:45 am. $75/person, $120/ team. Race starts and ends at Liberty Lake Village Beachfront; Molter and Inlet Rd. valleygirltri.com

Summer Parkways is back on June 21 on Spokane’s South Hill

JACEY’S RACE | A timed 5K race/walk and 1K kids fun run benefiting local families with children who are currently being treated for cancer or other life-threatening illness. Sun, July 9 at 8:30 am. $15-$25. Sandpoint High School, 410 S. Division Ave. jaceys-race.com (208-610-8023) LILAC BLIND CHARITY GOLF SCRAMBLE The 20th annual event raises money for client-centered training, support and optical aids to people in the Inland Northwest who are seeking ways to remain selfsufficient and active while living with vision loss. Fri, July 21 at 1 pm. $125/person, $500/team. Downriver Golf Course, 3225 N. Columbia Circle. lilacblind.org RELAY FOR LIFE CDA | Gather up your friends and family to create a team to participate in the biggest national fundraiser event benefiting the programs and services of the American Cancer Society. Sat,

July 22 from noon to midnight. McEuen Park, 420 E. Front St. relayforlife.org/ coeurdaleneid

tournament on July 24 at the Kalispel Golf & Country Club. Register at rypienfoundation.org.

RYPIEN FOUNDATION HOPE CLASSIC | Formerly the Zak!Charity Open, the annual dinner, auction and golf tournament was passed in 2016 to its beneficiary, the Rypien Foundation, which supports local children with cancer. Attend the Hope Lights the Way dinner and auction on July 23 at Northern Quest, followed by a golf

RACE THE RIVER | The 10th annual sprintdistance triathlon includes a half-mile swim with the current of the Spokane River, a 15-mile bike ride and a 3-mile run. Also includes a kids’ race ($20). Sun, July 23. $65/individual, $140/relay teams. Starts at Riverstone Park, Coeur d’Alene. racetheriver.com

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SPOKANE VALLEY CYCLE CELEBRATION Spend the day exploring the scenic beauty in and around Spokane Valley on your choice of a 10-, 25-, or 50-mile bike ride. Also includes the second annual Kids’ Bike Rodeo in the park (free; ages 10 and under). Sun, July 30 at 8 am. $20/person; $8/ages 12 and under. Mirabeau Park Meadows, 13500 Mirabeau Pkwy. cyclecelebration.com

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TRI & DU IT | New this year (replacing the West Plains WunderWoman Triathlon), the co-ed short-distance triathlon or duathlon race raises funds and awareness for osteoporosis research and education. Sun, July 30. $55/person, $100/team. Waterfront Park, Medical Lake. wunderwomantriathlon.com (953-9924)

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STRIDES FOR STRONG BONES | The annual osteoporosis awareness 5K walk/ run also features a raffle, bone screenings and educational information and presentations. Sat, July 29 at 9 am. $15-$25. Waterfront Park, Medical Lake. signmeup. com/118035 (953-9924)

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BARE BUNS FUN RUN | The nudist ranch hosts its 33rd annual clothingoptional 5K fun run/walk. Sun, July 30 at 9:30 am. $24-$30. Kaniksu Ranch Family Nudist Park, 4295 N. Deer Lake Rd., Loon Lake, Wash. kaniksufamily. com (327-6833) 8 LAKES LEG ACHES | The 19th annual bike ride heads through West Spokane, Cheney and Medical Lake, offering 30-, 45-, or 75-mile routes, with the longest route passing eight area lakes. Proceeds benefit the Sexual Assault Family Trauma Response Center of Lutheran Community Services. Sat, Aug. 5. $50-$60 (pledge rider options also available, $100-$355). Starts at Kaiser Permanente, 5615 Sunset Hwy. lcsnw.org/8lakesride (343-5020) LONG BRIDGE SWIM | Swim 1.76 miles across Lake Pend Oreille in Sandpoint in the 22nd annual open-water event, which helps fund swimming lessons for local children and adults. Sat, Aug. 5 at 9 am. $25-$30. Downtown Sandpoint, Idaho. Longbridgeswim.org IRONMAN COEUR D’ALENE | Athletes in the triathlon swim 2.4 miles, bike 112 miles and run 26.2 miles. Sun, Aug. 27. Starts at City Beach on the lake; ends along Sherman Avenue in downtown CdA. ironman.com

MIDNIGHT CENTURY | An annual, informal and unsupported 100-mile nighttime bicycle ride on dirt roads through rural areas around Spokane. Sat, Aug. 5 at 11:59 pm. Free; no registration required. Starts at the Elk Public House, 1931 W. Pacific. midnightcentury.com KIDICAL MASSIVE | Spokane joins thousands worldwide for the annual community bike ride. The familyfriendly ride of about 3 miles heads out through Kendall Yards and back on the Centennial Trail. Sat, Sept. 16, at from 1-2:30 pm. Free. Starts at The Nest at Kendall Yards, at West Summit Parkway and Cedar. summerparkways.com HAPPY GIRLS RUN | The popular women’s race series returns to Spokane, offering a course of varied terrain, pre- and post-race yoga, music and race swag bags. Includes 5K, 10K and half-marathon distance routes. Sat, Sept. 23. $30-$90. Riverside State Park. happygirlsrunspokane.com n The calendar is a free service, on a space-available basis. Mark as “InHealth Calendar” and include the time, date, address, cost and a contact number. Mail: 1227 W. Summit Pkwy, Spokane, WA 99201; or Email: calendar@inlander.com.

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LIVING

Mystery Poem Genealogy can be an engrossing hobby — especially when you stumble upon somebody else’s story BY DANIEL WALTERS

he poem took thousands of miles, three generations and 78 years to get to me. It took a flood — an inch and a half of water soaking the carpet in my grandma and grandpa’s basement on Five Mile Prairie — to expose it. She finds it in the room with the old National Geographic issues: An antique edition of Ralph Waldo Emerson’s Essays and Representative Men. Grandma knows I like literature, so she gifts me the copy. The book has a soft blue cover, thin yellowed pages, and no copyright date. But it’s what’s on the first page that grabs me. It’s a handwritten love poem, dated March 18, 1939. And as the poem progresses, it becomes less about attraction and more about the ability of love to transcend time and age. Here’s how it ends: And deeper than all that is seen or heard Time has not power to injure what you are. Weep not for youth when it has ceased to be, But now that all the years can never mar The loveliness that you reveal to me It’s signed “Elof Theodore Olson,” and dedicated to “My Pet — Dawn in the ‘Blue.’” It’s a thrilling find, a sort of time capsule of emotion. It’s like eavesdropping on a romantic confession from nearly eight decades ago. But I want to know more. I want to know who Elof Theodore Olson is. I Google his name, call librarians

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and look up obituaries. I bike over to the Spokane Public Library, log onto Ancestry. com and begin poring through troves of documents — marriage records, death records, property records, military enlistment records, probate filings, state and federal censuses. In 1939, there are at least two Elof Theodore Olsons alive in America. One is born in Sweden, moves to America, gets married, and spends 60 years living in Geneva, Illinois. He’s 85 in 1960, when he’s hit by a drunk driver and dies. But there’s one more Elof Theodore Olson; he was born in New York. Normally, it would be impossible to tell which Elof Theodore Olson had written the poem. But with the Emerson book, I have his signature.

t’s June 5, 1918. The Elof from New York is 21 and thin, with light brown hair and blue eyes. He’s a clerk at A.E. Outerbridge Co., the shipping agency that Mark Twain once used to charter a ship to Bermuda. When he has to sign up for the draft, Elof does so with a flourish, continuing

the line from the final “n” to underline his name. He does the same thing with the “y” in “you” in “The loveliness that you reveal to me” in the poem written 21 years later. The “O” in Olson and the “E” in Elof are nearly identical. It’s got to be the same guy. Gradually, I’m able to piece together snapshots of Elof’s life. It’s 1899. Elof is 2 when his mother, a 25-year-old Swedish immigrant named Ida, marries Charles Zakesio Petersen at a Lutheran church in Brooklyn. Petersen is a machinist, and he’s an immigrant too, from Norway. His first wife has just died in childbirth a few months earlier. It’s 1910. Elof is 12. He’s living in a newly constructed house on 12th Avenue in Brooklyn with nine other people, and his stepdad has been unemployed for nine months. It’s 1915. Elof is 18. His stepdad has found work as a pipefitter, but Elof goes in a different direction. He has a job at the public library. The sort of place, perhaps, where you develop a love for literature, for poetry, for the classics. It’s 1930. Elof is 33, and he’s still unmarried. He’s working as a bookkeeper at an auto supply company. It’s March 18, 1939. Elof is 41. “Chamberlain Denounces Hitler,” the New York Times reports that day.

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“Hitler is cheered by Vienna as hero.” It’s the day he writes his love poem. Here, the trail goes cold. From all indications on Ancestry.com, Elof’s branch of the family tree ends with his death in October 1965. There are no marriage records, no records of any children. Who his “Dawn in the ‘Blue’” was, or what happened to her, remains unanswered. We do know this: In red and blue ink, a few other phrases are underlined in the Emerson essays themselves. They look to be more recent. One underlined phrase in particular stands out. “The only thing grief has taught me, is to know how shallow it is.” The annotations carry their own arc: A profession of undying love; then, flip through the pages and find a bitter expression of loss. But the story doesn’t quite end there.

t’s 2017. Alison Apple is a 58-year-old pharmacist living in Memphis, Tennessee. She’s spent quite a bit of time on Ancestry.com, too. “Once I start going on it, it’s an allconsuming thing,” Apple says. “I just like the investigative piece of it.” She’s dug into the life of her grandfather, a World War I veteran named Charles Augustus Petersen. At one time, he was an accountant for an advertising firm. She has a framed print of a 1935 Camel cigarette ad featuring a testimonial of her grinning grandpa holding a cigarette between his fingers, enthusing that “Camels do not frazzle my nerves or upset my condition.” Apple’s grandpa was Elof’s half-brother. They lived together in the house on 12th Avenue in Brooklyn. Somehow, the Emerson book ends up in the library of a farmhouse in Warrensburg, Missouri. When my grandpa and grandma leave Missouri in 1967, they take the Emerson book with them. A half-century later I’m given the book, find the inscription, and hunt down Apple by finding her sister on Facebook.

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spend a half-hour chatting with Apple by phone about her family, her memories and her passion for discovering her own history. When we’re done talking, I send over a cellphone pic of the poem to Apple, bringing it all full circle. Because here’s the epigraph: Love dies. So do the men who profess it. But the words themselves, the grand pronouncements we write, can survive for centuries. And all the years can never mar the loveliness they reveal. n

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