Minnesota Health care News January 2012

January 2012 • Volume 10 Number 1

Health carecost anxietyLee Beecher, MD

SeizuresRobert Gumnit, MD

Medicationsafety tipsJulie Johnson, PharmD

Your Guide to Consumer Information FREE

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“reminding mom to take her pills.”

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Advisory Board: Minnesota Medical Association (MMA), Minnesota Hospital Association (MHA), MinnesotaMedical Group Management Association (MMGMA), Buyers Health Care Action Group (BHCAG), MinnesotaBusiness Partnership (MBP), Minnesota Healthcare Network (MHN), Advocates for Marketplace Options forMainstreet (AMOM), Minnesota HomeCare Association (MHCA), Minnesota Physician-Patient Alliance (MPPA),Physicians Service Network (PSN), Minnesota Center for Rural Health, and Minnesota Council of Health Plans.

Minnesota Health Care News is published once a month by Minnesota Physician Publishing, Inc. Our addressis 2812 East 26th Street, Minneapolis, MN 55406; phone (612) 728-8600; fax (612) 728-8601; [email protected]. We welcome the submission of manuscripts and letters for possible publication. All viewsand opinions expressed by authors of published articles are solely those of the authors and do notnecessarily represent or express the views of Minnesota Physician Publishing, Inc., or this publica-tion. The contents herein are believed accurate but are not intended to replace medical, legal, tax,business, or other professional advice and counsel. No part of this publication may be reprinted orreproduced without written permission of the publisher. Annual subscriptions (12 copies) are$36.00. Individual copies are $4.00.

JANUARY 2012 MINNESOTA HEALTH CARE NEWS 3

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PUBLISHER Mike Starnes [email protected]

EDITOR Donna Ahrens [email protected]

ASSOCIATE EDITOR Janet Cass [email protected]

ASSISTANT EDITOR Scott Wooldridge [email protected]

ART DIRECTOR Elaine Sarkela [email protected]

OFFICE ADMINISTRATOR Juline Birgersson [email protected]

ACCOUNT EXECUTIVE John Berg [email protected]

ACCOUNT EXECUTIVE Sharon Brauer [email protected]

ACCOUNT EXECUTIVE Iain Kane [email protected]

www.mppub.com

JANUARY 2012 • Volume 10 Number 1

COMMUNICABLEDISEASEMeningitisBy Marjorie Hogan, MD

PATIENT TO PATIENTThe Chemo ZoneBy Tracy Rubietta, MBA

NEUROLOGYSeizures and epilepsyBy Robert J. Gumnit, MD

10 QUESTIONS

DENTAL HEALTHOrthodontics forsecond-graders?By Jennifer Eisenhuth, DDS, MS

PERSPECTIVE

7 PEOPLE

NEWS4C O N T E N T S

GeorgePeltier, MD

Hennepin CountyMedical Center

Robert Albee

A PartnershipOf Diabetics

NUTRITIONTips for healthyrestaurant diningBy Heidi Greenwaldt,MS, RD, LD, CNSD

PRESCRIPTION DRUGSMedication safety tipsBy Julie K. Johnson, PharmD

HEALTH INSURANCERelieving health carecost anxietyBy Lee H. Beecher, MD

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Please mail, call in or fax your registration by 04/12/2012

MINNESOTA HEALTH CARE ROUNDTABLEMINNESOTA HEALTH CARE ROUNDTABLE

Background and focus:Medications treating chronicand/or life-threatening dis-eases are frequently newproducts, which are oftenmore expensive than genericor older, branded productsthat treat similar conditions.The term specialty pharma-cy has come to be associ-ated with these medications.Exponents claim the newtechnology improves qualityof life and lowers the costof care by reducing hospital-izations. Opponents claimthe higher per-dose costspread over larger popula-tions does not justify theexpense.

The cost of research, bothfailed and successful, is reflected in product pricing. Currentfederal guidelines allow generic equivalents marketplace accessbased on the patent date, not the release date, of a product. Thisconsiderably narrows the window in which costs of advances maybe recovered. A further complicating dynamic involves the payers.Physician reimbursement policies sometimes reward utilizinglower-cost “proven” products and cast those prescribing higher-cost products as “over-utilizers,” placing them in lower-tieredcategories of reimbursement and patient access.

Objectives: We will discuss the issues that guide the earlyadoption of new pharmaceutical therapies and how they relate tomedical devices. We will examine the role of pharmacy benefitmanagement in dealing with the costs of specialty pharmacy. Wewill explore whether it is penny-wise but pound-foolish to restrictaccess to new therapies and what level of communication withinthe industry is necessary to address these problems. With the babyboomers reaching retirement age, more people than ever will betaking prescription medications. As new products come down thedevelopment pipeline, costs and benefits will continue to esca-late. We will provide specific examples of how specialty phar-macy is at the forefront of the battle to control the cost of care.

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

Please send me tickets at $95.00 per ticket. Mail orders to MinnesotaPhysician Publishing, 2812 East 26th Street, Minneapolis, MN 55406.Tickets may also be ordered by phone (612) 728-8600 or fax (612) 728-8601.

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Controlling the cost of care

Task Force UnveilsNew WebsiteThe Health Care ReformTaskForce recently appointed by Gov.Mark Dayton will promote itswork on a new website, officialsannounced last week.

The site will serve as a clear-inghouse for information onhealth care reform efforts inMinnesota, and will detail howreform efforts will affect families,businesses, and individuals. It willupdate Minnesotans not only onstate reforms but also on the fed-eral Affordable Care Act as it con-tinues to be implemented.The siteis sponsored by the task force andthe Minnesota Department ofCommerce.

The site features informationon Health Care ReformTask Forcemeetings, answers questionsabout health insurance coveragein Minnesota, features a columnby Department of Human ServicesCommissioner Lucinda Jesson,and explores a range of reformissues such as health insuranceexchanges and Medicaid expan-

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

Allied Effort byAllina, HealthPartnersSaves $6 MillionA collaborative effort betweenAllina Hospitals and Clinics andHealthPartners resulted in morethan $6 million in reduced med-ical costs in its first year, accord-ing to the two organizations.

The Northwest Metro Allianceattempted to make health caredelivery more efficient by enhanc-ing connections between healthcare providers, integrating theelectronic medical records usedby both organizations, and provid-ing better data to providers aboutperformance in comparison totheir peers.

Some specific strategiesused by the two groups includedincreasing the use of genericdrugs; reducing the rate ofinduced labor; expanding urgentcare services to reduce emer-gency department use; providing

expanded support for high-riskand complex patients; andimproving patient satisfaction.

The alliance involved 27,000patients who received care atAllina’s Mercy Hospital and eightAllina and HealthPartners clinicsin the northwest metro area.

Officials say that as a resultof the collaboration, the medicalcost growth rate for the facilitiesdropped from 8 percent to 3 per-cent. “These results show thevalue of collaboration betweenhealth care organizations to createinnovative models that can serveas an accountable care organi-zation, which are models of fed-eral and state health care reform,”says PennyWheeler, chief clinicalofficer for Allina Hospitals andClinics.

Nursing Homes JoinForces to ReduceRehospitalizationsNearly 50 Minnesota nursinghomes are joining an effort toreduce rehospitalizations among

their residents.The facilities areworking with the MinnesotaDepartment of Human Servicesto implement a program calledInterventions to Reduce AcuteCareTransfers (INTERACT).

The program, which has beenadopted by 49 of the 384 nursinghomes in Minnesota, is based anational model developed bygeriatric care experts in Georgiaand Florida.The INTERACT pro-gram provides a set of tools andpractices that help nursing homestaff make better observationsabout residents and changes intheir health status.The programalso helps nursing home staffcommunicate more clearly andaccurately with physicians if nec-essary, and provides for bettercommunication with hospital per-sonnel if a hospital admissionbecomes necessary.

“The overall goal is to reducethe inappropriate use of hospitalsand also to create a work environ-ment for staff in which they feelmore empowered and more com-mitted to doing a good job,” saysRobert Kane, MD, who leads the

N E W S

4 MINNESOTA HEALTH CARE NEWS JANUARY 2012

University of Minnesota’s Centeron Aging and is the director ofthe Minnesota Area GeriatricEducation Center (MAGEC).

Mayo Clinic SaysSmoking Ban CutsHeart Attacks, DeathsA new report by Mayo Clinicresearchers shows that the inci-dence of heart attacks and suddencardiac deaths was cut by asmuch as 50 percent in OlmstedCounty after a smoke-free ordi-nance took effect.

The new report, presentedat an American Heart Associationconference in Orlando, showsthat during the 18 months beforeOlmsted County's first smoke-freelaw for restaurants was passed in2002, the regional incidence ofheart attack was 212 cases per100,000 residents. In the 18months following a comprehen-sive smoke-free ordinance in 2007,the report says that rate droppedto 103 cases per 100,000 resi-dents—a decrease of about 45percent. Additionally, the reportfound a 50 percent decrease insudden cardiac arrest cases dur-ing that period.

“This study adds to theobservation that smoke-freeworkplace laws help reduce thechances of having a heart attack,but for the first time we reportthese laws also reduce thechances of sudden cardiac death,”says Richard Hurt, MD, director ofMayo Clinic’s Nicotine Depen-dence Center. “The study showsthat everyone, especially peoplewith known coronary artery dis-ease, should avoid contact withsecondhand smoke.”

Supreme CourtRules on NewbornScreeningA Minnesota Supreme Courtruling could limit the way statehealth officials use blood samplesdrawn from newborns.

In a divided ruling, the courtsaid that although the state canuse blood samples to screen new-

borns for disease without specificconsent from parents, the statecannot store the samples for otherresearch purposes.

Privacy advocates and agroup of parents had challengedthe state policy, and a lower courtruled that the Minnesota Depart-ment of Health (MDH) could storethe blood samples indefinitely forfurther research.

However, the Supreme Courtoverturned that finding. “Thenewborn screening statutes …expressly authorize the [MDH]Commissioner to use the bloodsamples without written informedconsent only to the extent neces-sary to conduct tests for heritableand congenital disorders and con-duct follow-up services,” the rul-ing says.

Although some predict thatMDH will be required to destroyclose to 1 million samples as aresult of the ruling, state officialsreacted cautiously. “We arereviewing the court’s decision todetermine the potential implica-tions of the ruling on the ongoingoperations of the state’s NewbornScreening Program,” saysCommissioner Ed Ehlinger, MD.“This important public health pro-gram protects Minnesota babiesfrom serious congenital and heri-table disorders.”

The case will now be sentback to the lower court to con-sider remedies for the plaintiffs.

Uninsured RateGoes Up for KidsIn MinnesotaA new report finds that Minne-sota is the only state in the nationto see an increase in the numberof uninsured children in a two-year period.

The study, published jointlyby the Georgetown UniversityHealth Policy Institute’s Center forChildren and Families and theChildren’s Defense Fund (CDF),looks at Census Bureau data from2008 to 2010. It finds that eventhough the country has gonethrough a difficult economic per-iod, most states have managed to

News to page 6JANUARY 2012 MINNESOTA HEALTH CARE NEWS 5

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reduce the number of childrenwho lack health insurance.

“During the recession, thenumber of children in povertyincreased significantly, yet thenumber of uninsured childrendecreased nationally from 6.9 mil-lion in 2008 to 5.9 million in 2010,”the report’s authors write.

The study credits governmentprograms for improving the rateof coverage among children.“The progress for children can

be attributed to the success ofMedicaid and CHIP, which havecontinued to fill the void createdby a decline in employer-basedhealth insurance, a high unem-ployment rate, and the increasingcost of private health insurance,”the report says. Overall, the num-ber of uninsured children in theU.S. decreased by 14 percent,from 6.9 million in 2008 to 5.9million in 2010.

Minnesota’s experience,however, has been different.Thereport finds that nearly 11,700fewer children had health insur-

ance in 2010 than in 2008, whichequals a change in the uninsur-ance rate for children from 5.8percent to 6.6 percent.

“It’s surprising to see a statelike Minnesota losing ground inits efforts to protect children’shealth care,” says Joan Alker, co-executive director of the George-town University research institute.“Minnesotans are not used to see-ing their state on the bottom ofthe list. But I’m sure they will beable to overcome this setback andget back up to the top, as stateleaders have demonstrated astrong commitment to children’shealth care coverage in the past.”

Experts in Minnesota blamepoor economic conditions for therise in uninsured children.

“Health insurance premiumshave increased much faster thanwages and now, on average, costabout 17 percent of medianhousehold income in our state,”says Amy Crawford, director ofCDF–Minnesota. “Those costs areputting health insurance out ofreach for more and more Minne-sotans.We need to strengthen

our public health coverage pro-grams like Medical Assistanceand MinnesotaCare to make surechildren are not falling throughthe cracks.”

HCMC Burn CenterOpens in MinneapolisHennepin County Medical Center(HCMC) has officially opened itsnew Burn Center, a 16,000-square-foot facility that doubles the sizeof its former burn center.

Officials say the facility isdesigned to serve patients fromthe entire Upper Midwest at atime when hard economic timesfor hospitals means that somehave closed specialty units suchas burn centers.

The $12 million expansionand remodeling of the BurnCenter and adjacent 12-room,7,000-square-foot SurgeryTraumaand Neurology team center areprojects funded by bonds fromHennepin County.

The center will treat patientswith severe burn injuries andcomplex wounds such as frost-

bite, hypothermia, inhalationinjuries, plastic reconstruction,complex wounds, and road rash.

The center will also include astate-of-the-art hyperbaric cham-ber (the only one in Minnesota),which will be used to treat emer-gency cases of carbon monoxidepoisoning and burn wounds.

A multidisciplinary teamapproach will be used for allburn center patients, officials say.Inpatient care will include accessto general and plastic surgeons;nurses in the burn intensive careunit; adult and pediatric special-ists; rehabilitation services; anddietary and nutritional support topromote healing and recovery.

“We have a burn-trainedphysician or physician’s assistantpresent every day, including mostholidays,” says HCMC burn sur-geon Anne Lambert, MD. “Thisintensive, coordinated, and con-sistent care is why HCMC’s BurnCenter is so successful at its ulti-mate goal: restoring the lives ofour patients.”

News from page 5


Elizabeth Klodas, M.D.,F.A.S.C.C is a preventive

cardiologist. She isthe founding Editor inChief of CardioSmartfor the American

College of Cardiologywww.cardiosmart.org,a published author

and medical editor forwebMD. She is a member

of several nationalcommittees on improving

cardiac health and afrequent lecturer on

the topic.

Preventive Cardiology Consultants isfounded on the fundamental belief thatmuch of heart disease can be avoidedin the vast majority of patients, andsignificantly delayed in the rest, by prudentmodification of risk factors and attainablelifestyle measures.

We are dedicated to creating a true part-nership between doctor and patient workingtogether to maximize heart health. Wespend time getting to know each patientindividually, learning about their lives andlifestyles before customizing treatmentprograms to maximize their health.

Whether you have experienced any typeof cardiac event, are at risk for one, or

are interested in learning how to preventone, we can design a set of just-for-yousolutions.

Among the services we provide

• One-on-one consultations withcardiologists

• In-depth evaluation of nutrition andlifestyle factors

• Advanced and routine blood analysis

• Cardiac imaging including (as required)stress testing, stress echocardiography,stress nuclear imaging, coronary calciumscreening, CT coronary angiography

• Vascular screening

• Dietary counseling/Exercise prescriptions

Now accepting new patients

A unique perspective on cardiac care

To schedule an appointment or to learn more about becominga patient, please contact:

Preventive Cardiology Consultants6545 France Avenue, Suite 125, Edina, MN 55435

phone. 952.929.5600 fax. 952.929.5610 www.pccmn.com

David Perdue, MD, has been named medical

director of the American Indian Cancer Foun-

dation, a nonprofit organization established to

address the cancer inequities faced by

American Indian and Alaska Native communi-

ties through education and improved access to

prevention and treatment. Perdue, a member of

the Chickasaw tribe, practices with Minnesota

Gastroenterology, PA, where he has focused on

decreasing colorectal and other gastrointestinal cancer disparities in

American Indian and Alaska Native populations. In addition, he co-

chairs the Minnesota Intertribal Colorectal Cancer Council and the

Minnesota Colon CancerTask Force. He is also a member of both the

University of Minnesota Masonic Cancer Center and the Mayo

Clinic’s Spirit of Eagles Cancer Research Network.

ChristopherWenner, MD, has been recognized by the Regional

Extension Center for Health InformationTechnology (REACH) for his

leadership in the nationwide transition to electronic health records

(EHR).Wenner, a solo family physician in Cold Spring, is one of the

first providers in Minnesota to attest to meaningful use for the

Medicare EHR Incentive Program.Wenner will receive one of the

first incentive payments in Minnesota made to professionals and

hospitals when they adopt, implement, upgrade, or demonstrate

meaningful use of a certified electronic health record.

The Alzheimer’s Association Minnesota–North Dakota Chapter

announced recent hires for the Northern Minnesota office in Duluth.

Lisa Sanders was hired as program manager. Sanders previously

was with Arrowhead Area Agency on Aging Senior LinkAge Line

and holds a master’s degree in community health education. Wendy

Ruhnke was hired as community engagement manager. She previ-

ously served as development director of theYWCA for five years.

Mark Blegen, PhD, an associate professor of exercise and

sport science at St. Catherine University, St. Paul, has been elected

president of the Northland American College of Sports Medicine

(NACSM). NACSM is one of 10 regional affiliates of the American

College of Sports Medicine (ACSM), a professional group for health

and fitness-related professionals. Blegen, who is a fellow of the

ACSM, teaches classes in exercise physiology, nutrition, biomechan-

ics, fitness assessment, and strength and conditioning, and is a co-

director of the university’sWomen’s Health Integrative Research Lab.

William Payne, MD, has been named medical director of

LifeSource, a Minneapolis-based organ and tissue donation organiza-

tion. Payne was instrumental in the formation of

the organization in 1987 and has served on the

LifeSource board of directors since the group

began. Payne has stepped down from his role as

surgical director of the adult liver transplant

program at the University of Minnesota Medical

Center, Fairview, but will continue to see

patients at the U of M.

The Minnesota Alliance for Patient Safety

(MAPS) has hired Nancy Kielhofner, RN, as executive director.

Kielhofner most recently was director of quality, safety, and accredi-

tation at Allina Hospitals and Clinics. She served as MAPS culture

workgroup co-chair during the past year. Kielhofner’s hiring is part

of a MAPS reorganization that will expand its scope of patient-safety

efforts to include not only hospitals but also nursing homes, long-

term care, assisted living, ambulatory clinics, and hospice care.

P E O P L E


David Perdue, MD

William Payne, MD

Health care …naturallyThe clinics of NorthwesternHealth Sciences University offernatural health care solutions atthree Twin Cities locations.We also partner to provide freeservices at community clinics.

• Acupunctureand Oriental medicine

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Many services are covered by health insurance.

Visit our website or call to find out moreabout locations, hours and services:

nwhealth.edu/patients • 952-885-5444

A diagnosis of

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

We provide free cancer relatedlegal information on a widerange of topics.

Please visit our web site tofind out more:

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We are a nonprofit organization funded entirely

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Robert AlbeeA Partnership Of

Diabetics

Robert Albeeco-founded theAmerican IndianCommunityDevelopmentCorporation in

1992 and workedthere until his

retirement in 2007.He has also

worked in televi-sion and radioproduction atTwin Cities

PublicTelevisionand KFAI-FM.Albee createdWisconsin’s LacCourte Oreilles

(LCO) tribal stationWOJB-FM andedited the LCO

Journal. As a grantwriter, he has

assisted start-uporganizations bywriting approxi-

mately $40 millionin grants, and hasbeen a PeaceCorpsman inAfghanistan.

eople who have just gotten a diagnosis ofdiabetes for themselves or a loved one canfeel overwhelmed by the flood of new infor-

mation they need to process and the new tasksthey must suddenly add to their daily routine. Forthose of us living with diabetes 24/7, it helps toknow we are part of a community of other diabet-ics who understand what we are going throughand who can provide advice and emotional sup-port. This sense of community helps day-to-day,makes long-term management more successful,and is an important part of a carefully constructednetwork of family, social, and community-basedresources that effectively complement assistancefrom one’s chosen health care providers.

Community-based supportIn 2010, my wife, Sharon, and I created A Partner-ship Of Diabetics (A-POD) to provide sustainable,community-based support, strategies, planning,and tools to assist us in effective diabetes self-management. There is no magic involved: A-PODpresents a series of full-dayworkshops (“POD-Tensives”)for up to 25 people toacquaint them with A-PODand our 12 strategies foroptimized management. Aperson need attend onlyonce. POD-Tensives are fol-lowed by weekly Meetups toreinforce the 12 strategies.Most importantly, Meetupsprovide an opportunity for one diabetic to talkwith another at check-ins, where each of us shareshow we are personally progressing or strugglingwith our efforts to manage our condition.

Compared with an average of one hour of annualcontact with primary health care professionals,A-POD participants who consistently attendA-POD Meetups can clock 84 or more hours peryear in which to meet with other people with dia-betes and the health care professionals who joinus. One of the topics is a discussion of healthy eat-ing and physical activity, and our new location atthe Phillips Community Center has a fitness centerand a kitchen/dining room. So we can demon-strate healthier practices instead of just talkingabout them. Soon there will be a swimming poolin the building as well.

Everyone benefits

When we share, support, and challenge eachother, we discover how similar, and yet howunique, each of us is as a diabetic. Those whochoose to be silent and listen are honored just asmuch as those who talk.There are tears and laugh-

ter, but at the end of the day, each of the partici-pants who stays with the program experiencesprogress with his or her diabetes management.

A-POD is not just for those who need help andsupport. It also allows those who have success-fully managed their condition to mentor and sharetheir hard-earned skills with the community. Tim,an insulin-dependent type 1 diabetic, is approach-ing 43 years of success in his management andspends countless hours mentoring others onlinevia diabetes-specific websites. He benefits fromthis just as much as those he mentors.

No English neededA-POD was created in Minneapolis’ Phillips neigh-borhood, which has a broad range of age and eth-nicities. There, A-POD recently initiated a SomaliWomen's DiabetesWorkshop for participants whospoke little or no English.We recruited four SomaliAmericans, including two health care profession-als, to translate and help with presentations andlistening sessions. Each part of the program has

a facilitator who providesdemonstrations. This POD-Tensive workshop will be fol-lowed by another specifical-ly for Somali men, andanother for people of anyculture who speak and readEnglish.

Based on evidenceClinics and other medical

facilities have been slow to refer patients to A-POD despite the fact that it is based on evidence-based programs. These programs work for dia-betes as successfully as for weight loss, chemicaldependency, and chronic disease self-manage-ment. Allina Health Systems provided initial finan-cial support through its Minneapolis-basedBackyard Initiative and was recently joined infunding by Novo Nordisk, a global manufacturerof insulin and other diabetes-related products andservices. Novo provides scholarships for thosewith incomes too low to participate in this inex-pensive program of long-term support.Experienced health care professionals are presentat each session. We are truly “Controlling OurDiabetes for Life!”

To participate in an upcoming A-POD Meetup orPOD-Tensive, contact Robert Albee [email protected] events are held at thePhillips Community Center, 2323 11th Ave. So.,Minneapolis. Our schedule is published atwww.meetup.com. Just type in “Diabetes” andyour Zip Code, and it will take you to A-POD.

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

P E R S P E C T I V E

P

When we share, support,and challenge each otherwe discover how similar,

and yet how unique,each of us is.

Victoza® helped me take my blood sugar down…

Model is used for illustrative purposes only.

and changed how I manage my type 2 diabetes.Victoza® helps lower blood sugar when it is high by targeting important cells in your pancreas—called beta cells.

While not a weight-loss product, Victoza® may help you lose some weight.

And Victoza® is used once a day anytime, with or without food, along with eating right and staying active.

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

FOR TYPE 2 DIABETES

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

Non-insulin • Once-daily

Indications and Usage:Victoza® is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes when used along with diet and exercise. Victoza® is not recommended as the first medication to treat diabetes. Victoza® is not insulin and has not been studied in combination with insulin. Victoza® is not for people with type 1 diabetes or people with diabetic ketoacidosis. It is not known if Victoza® is safe and effective in children. Victoza® is not recommended for use in children.

Important Safety Information:In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice. It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early. Do not use Victoza® if you or any of your family members have a history of MTC or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). While taking Victoza®, tell your doctor if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.Inflammation of the pancreas (pancreatitis) may be severe and lead to death. Before taking Victoza®, tell your doctor if you have had pancreatitis, gallstones, a history of alcoholism,

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

Victoza® may cause nausea, vomiting, or diarrhea leading to dehydration, which may cause kidney failure. This can happen in people who have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration.The most common side effects with Victoza® include headache, nausea, and diarrhea. Nausea is most common when first starting Victoza®, but decreases over time in most people. Immune system-related reactions, including hives, were more common in people treated with Victoza® compared to people treated with other diabetes drugs in medical studies.

Please see Brief Summary of Important Patient Information on next page.

If you need assistance with prescription drug costs, help may be available. Visit pparx.org or call 1-888-4PPA-NOW.You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call 1-800-FDA-1088.Victoza® is a registered trademark of Novo Nordisk A/S. © 2011 Novo Nordisk 0611-00003312-1 August 2011

Important Patient Information

This is a BRIEF SUMMARY of important information about Victoza®. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about Victoza®, ask your doctor. Only your doctor can determine if Victoza® is right for you.

WARNING

During the drug testing process, the medicine in Victoza® caused rats and mice to develop tumors of the thyroid gland. Some of these tumors were cancers. It is not known if Victoza® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people. If MTC occurs, it may lead to death if not detected and treated early. Do not take Victoza® if you or any of your family members have MTC, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). This is a disease where people have tumors in more than one gland in the body.

What is Victoza® used for?

• Victoza®isaglucagon-like-peptide-1(GLP-1)receptoragonistusedtoimprovebloodsugar(glucose)controlinadultswithtype2diabetesmellitus,whenusedwithadietandexerciseprogram.

• Victoza®shouldnotbeusedasthefirstchoiceofmedicinefortreatingdiabetes.

• Victoza®hasnotbeenstudiedinenoughpeoplewithahistoryofpancreatitis(inflammationofthepancreas).Therefore,itshouldbeusedwithcareinthesepatients.

• Victoza®isnotforuseinpeoplewithtype1diabetesmellitusorpeoplewithdiabeticketoacidosis.

• ItisnotknownifVictoza®issafeandeffectivewhenusedwithinsulin.

Who should not use Victoza®?

• Victoza®shouldnotbeusedinpeoplewithapersonalorfamilyhistoryofMTCorinpatientswithMEN2.

What is the most important information I should know about Victoza®?

• Inanimalstudies,Victoza®causedthyroidtumors.Theeffectsinhumansareunknown.PeoplewhouseVictoza®shouldbecounseledontheriskofMTCandsymptomsofthyroidcancer.

• Inclinicaltrials,thereweremorecasesofpancreatitisinpeopletreatedwithVictoza®comparedtopeopletreatedwithotherdiabetesdrugs.Ifpancreatitisissuspected,Victoza®andotherpotentiallysuspectdrugsshouldbediscontinued.Victoza®shouldnotberestartedifpancreatitisisconfirmed.Victoza®shouldbeusedwithcautioninpeoplewithahistoryofpancreatitis.

• Seriouslowbloodsugar(hypoglycemia)mayoccurwhenVictoza®isusedwithotherdiabetesmedicationscalledsulfonylureas.Thisriskcanbereducedbyloweringthedoseofthesulfonylurea.

• Victoza®maycausenausea,vomiting,ordiarrhealeadingtothelossoffluids(dehydration).Dehydrationmaycausekidneyfailure.Thiscanhappeninpeoplewhomayhaveneverhadkidneyproblemsbefore.Drinkingplentyoffluidsmayreduceyourchanceofdehydration.

• Likeallotherdiabetesmedications,Victoza®hasnotbeenshowntodecreasetheriskoflargebloodvesseldisease(i.e.heartattacksandstrokes).

What are the side effects of Victoza®?

• Tellyourhealthcareproviderifyougetalumporswellinginyourneck,hoarseness,troubleswallowing,orshortnessofbreathwhiletakingVictoza®.Thesemaybesymptomsofthyroidcancer.

• Themostcommonsideeffects,reportedinatleast5%ofpeopletreatedwithVictoza®andoccurringmorecommonlythanpeopletreatedwithaplacebo(anon-activeinjectionusedtostudydrugsinclinicaltrials)areheadache,nausea,anddiarrhea.

• Immunesystemrelatedreactions,includinghives,weremorecommoninpeopletreatedwithVictoza®(0.8%)comparedtopeopletreatedwithotherdiabetesdrugs(0.4%)inclinicaltrials.

• Thislistingofsideeffectsisnotcomplete.YourhealthcareprofessionalcandiscusswithyouamorecompletelistofsideeffectsthatmayoccurwhenusingVictoza®.

What should I know about taking Victoza® with other medications?

• Victoza®slowsemptyingofyourstomach.Thismayimpacthowyourbodyabsorbsotherdrugsthataretakenbymouthatthesametime.

Can Victoza® be used in children?

• Victoza®hasnotbeenstudiedinpeoplebelow18yearsofage.

Can Victoza® be used in people with kidney or liver problems?

• Victoza®shouldbeusedwithcautioninthesetypesofpeople.

Still have questions?

Thisisonlyasummaryofimportantinformation.Askyourdoctorformorecompleteproductinformation,or

• call1-877-4VICTOZA(1-877-484-2869)

• visitvictoza.com

Victoza® is a registered trademark of Novo Nordisk A/S.

DateofIssue:May2011Version3

©2011NovoNordisk140517-R3June2011


N U T R I T I O N

Understanding menu terms

Restaurants may have menu symbols that identifyhealthy items, but foods that restaurants call“healthy” may range from 500 to 750 calories.While the lower end of that range should fit mostpeople’s needs for weight loss, 750 calories is highfor a healthy meal. And while a 250-calorie differ-ence may not seem big, 100 extra calories a daycan produce a 10-pound weight gain in a year.

If your weight loss plan is to consume 1500calories daily and you eat one, 750-calorie“healthy” choice, you’ve just consumed half yourdaily calories at one meal. If you do not chooseone of the restaurant’s healthy options, you couldeasily consume your entire daily allotment of calo-ries at one meal. It is better to consume caloriesmore evenly throughout the day.

Restaurants may not list sodium content ontheir menus, although 2010 Dietary Guidelinesfrom the U.S. Department of Agriculture and U.S.Department of Health and Human Services recom-mend reducing sodium intake to fewer than 2300milligrams of sodium per day. The typical dailyAmerican diet contains approximately 6000 to8000 milligrams of sodium.

These guidelines also recommend reducingintake to 1500 milligrams of sodium per day forpersons who are 51 and older and those of anyage who are African American or have hyperten-sion, diabetes, or chronic kidney disease. The1500-milligram per day recommendation appliesto about half the U.S. population, including chil-dren and the majority of adults. Requesting thatyour meals be prepared without salt or monosodi-um glutamate (MSG), which is used at many Asianestablishments, can significantly reduce the amountof sodium you consume.

Plan before you go

What else can you do to monitor calories, sodium,and other nutrients when dining out if limitednutrition information is available? First, read themenu online when you are not hungry—beforegoing to the restaurant—to review healthy options.

Tips to page 34

TIPSfor healthy

restaurant diningBy Heidi Greenwaldt,MS, RD, LD, CNSD

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A trip to the pharmacy canbe one of the most importanthealth care visits you make.You may not be feeling welland may be in a hurry. Butplease allow enough time at thepharmacy to ensure that youreceive the correct medicationand get all the information youneed. Take the time to speakwith your pharmacist if you arenot completely clear on instruc-tions, or forgot to mentionanother medicine you are taking

or other medical conditions to the prescribing physician.The pharmacist will ask you for identifying information (home

address, etc.) to make sure that it matches the information in yourpharmacy record. This is to ensure that the pharmacy dispenses theright medication to the right person. Just as at the doctor’s office,your information is private and is not shared with anyone otherthan your doctor (whom the pharmacist would contact if he or shehad questions or concerns) and your health insurance company (forpayment information).

Make sure to provide all of the current information about thepatient, other medications, changes in health or doses since the lastpharmacy visit, and of course, current insurance information.

Many prescriptions are sent to the pharmacy electronically,which is usually more efficient and less prone to error. However, justbecause they are sent electronically does not mean that prescriptionsare filled faster. Allow ample time for the pharmacy to check to makesure your prescription is compatible with other medications you maybe taking and to fill it according to standard safety procedures.

Advocate for yourself—ask questions

Ask the pharmacist for further instructions or an explanation if thelabel is unclear. Ask the pharmacist for any additional informationfor the medicine you’re taking. Mention any pertinent information,such as other medications you’re taking, any changes in health ordosage, etc.

• Ask questions regarding a new medication; discuss the risks andbenefits with your doctor or pharmacist.

• Ask your physician or pharmacist about possible side effects. Isthe medicine sedating? Should you take it with food? Not takewith milk or calcium?

• Tell your doctor or pharmacist about all of your allergies, espe-cially medication-related allergies.

• Tell your doctor or pharmacist about all nonprescription drugs,vitamins, herbal remedies, and other dietary supplements youtake, because some may interfere with the effectiveness of yourprescription drug.

• Ask how long it might take to reach therapeutic level (i.e., when itmight “kick in”), and what you can expect by the time you stoptaking the medicine.

• Examine the label and contents when you pick up a new prescrip-tion. Ask the pharmacist about anything on the label you do notunderstand.

• Examine the label and contents when you pick up a refill prescrip-tion, too. If the medication looks different than it has before, tellyour pharmacist immediately.

• Make sure that you know the name of the prescribing physicianand the name of his or her clinic. If you cannot read the physi-cian’s name on the prescription, it’s likely that the pharmacist willnot be able to read it, either. Therefore, ask your physician toprint his or her name on the prescription.

• If you have a common name, verify the full name on the prescrip-tion, not just first and last name.

P R E S C R I P T I O N D R U G S

Medication safety tips

Ask questions tounderstand your

prescription

By Julie K. Johnson,

PharmD

• Take themedication as

directed by thedoctor. If you are

having difficulty withyour medication schedule

(i.e., taking the medicine atthe time prescribed), talk to your

doctor or pharmacist before adjustingthe schedule yourself.

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

• Don’t increase or decrease the dose, or stop taking the medicationaltogether, without first calling your doctor.

• Don’t crush or split tablets unless you have been instructed to doso by your doctor or pharmacist. Some dosage forms are notmeant to be broken or crushed. If broken, crushed, or split

unevenly, the drug may not be releasedproperly or a coating on the tabletmeant to ensure proper release oravoidance of irritation can bedestroyed. In the occasional instancewhere your doctor or pharmacist okayssplitting or crushing, care must betaken to do so accurately. However,asking the pharmacist or doctor if split-ting or crushing is acceptable is theonly way to do this appropriately.

• Tell your doctor or pharmacist if youexperience side effects from a newprescription. Pay attention to howyou feel; if you feel different afterbeginning a new medication, call yourdoctor or pharmacist immediately.

• If you believe that you or someone inyour care is having a drug interaction,call your doctor or pharmacist imme-diately. Children are not small adults:Recent studies show that the potentialfor adverse drug events was three

times higher for children. Your pediatrician or family physician mayprescribe medication, but you—parent, guardian or day careprovider—are the person(s) responsible for administering the med-ication to children in your care.

• If you believe that you or someone in your care is having a druginteraction, call your doctor or pharmacist immediately.

• Don’t share your prescription medication with anyone, and don’ttake medicine prescribed for someone else.

• If you mistakenly take medication not prescribed for you or havetaken too much medication—prescription or nonprescription—callthe Poison Control Center immediately. The Hennepin Regional

Poison Center emergency number is 1-800-222-1222. (TTY num-ber is the same.)

• Store your medication as instructed in a secure but accessibleplace—i.e., out of the reach of children—away from heat, mois-ture, and freezing temperatures. The bathroom cabinet is not thebest place for medications; a better place might be the upper shelfin a linen closet or a kitchen cupboard.

• Discard outdated medications.

Bottom line

Billions of prescription medications are dispensed every year in thiscountry to treat disease, alleviate pain and discomfort, and controllifelong medical conditions. The safety of our drug distribution sys-tem is second to none, worldwide. The medication expert at yourdisposal is your pharmacist. Take advantage of the chance to speakwith one to ensure that you get the most benefit from your medica-tions. Medications are powerful tools that can be toxic if not taken,as directed, by the person for whom they were prescribed—or sim-ply a waste of money if not taken correctly.

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


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H E A L T H I N S U R A N C E

More and more frequently, I’m seeing patients with a type of anxiety not described inpsychiatric textbooks. I call this condition “health care cost anxiety.” This increas-ingly common condition has its roots in uncertainty and fear of the unknown,

not the least of which are the unknown costs of recommended medical care and medica-tions—what the patient (or the patient’s family) will need to pay out of pocket.

Health care cost anxiety arises whenyour doctor tells you that you need anMRI—but you’re not sure if your healthinsurance plan will pay or if you’ll haveto pay $3,000 out of your pocket. Itoccurs when the pharmacy clerk tellsyou that instead of the $12 copaymentyou expected, you need to pay $200to pick up your medications.

Simply being ill, or being afraid of becoming ill, causes plenty of anxiety.And when you’re already ill, getting the straight story from an insurance companyabout costs and coverage is all the more difficult. Other factors—financial stressorssuch as unemployment, worry about losing or loss of employment or health carebenefits, escalating insurance premiums, and difficulty in getting appointments withproviders who will accept your insurance plan or medical assistance—are driving anxiety abouthealth care. Clearly, in our uncertain health care insurance environment, patients need to becomemuch more involved in knowing and managing their own health care spending. This article looks athow health insurance coverage is changing, what this means for empowering patients, and some steps

patients and their familiescan take to help manage theirhealth care cost anxiety.

Insurance coverage: Paying more out of pocket

The days of first-dollar insurance coverage without copayments ordeductibles are over for most of us. In addition, although 58 percentof U.S. workers are still covered by employer-sponsored insurance,that percentage is diminishing. Many small businesses are droppingcoverage or not offering it to their new hires. A June 2011 McKinsey& Co. survey of 1,300 businesses found that 30 percent of employersplan to drop employee insurance altogether and that 60 percent willbe looking for alternatives to traditional employer-funded insuranceby 2014 if the federal health care law employer insurance mandategoes into effect. Employers are already dramatically increasing theemployee share of health costs, often requiring their employees tocome up with $1,000 to $6,000 in medical expenses before theirhealth insurance takes effect.

A shift toward high-deductible health plans

Many larger employers still offer several choices of health care insur-ance plans, but these choices are narrowing:

• A health maintenance organization (HMO) plan offers first-dollarcoverage. With Minnesota HMOs, there is no deductible to be metbefore insurance pays for health care services, and a very restrictednetwork of providers is available.

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

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• High-deductible health plans (HDHPs)offer much lower monthly insurance premi-ums than the other two plans.

HDHPs are becoming much moreprevalent because of their much lower premi-ums. They operate on the principle thathealth care insurance should cover high-costmedical services and unpredictable costswhile most low-cost forms of health care

are financed outside of an insurance pro-tection contract. There are basically two types of HDHPs:(1) Insurance policies in which high deductibles are complete-ly managed by the insurance company (e.g., Medica Solo);and (2) Insurance that is paired with a health savingsaccount (HSA) regulated by the federal Internal RevenueService (IRS). Both kinds of HDHPs require that individu-als have money from a source other than health careinsurance—such as a health care reimbursement arrange-ment (employer-funded), a health savings account (HSA),or a direct government subsidy—to cover the costs of careuntil the insurance plan deductible is satisfied. Independent

insurance agents can provide details.With the rise of HDHPs, both patients and doctors will

need to deal with the permutations of payment, costs, andrestricted options in health care services. The increasing variety

and scope of health insurance plans mean that patients (and theirdoctors) will need to know actual costs of their care and assume acollaborative role in cost management. Doing so is often a dauntingexperience in the current environment. Below are some guidelinesfor getting the cost and coverage information you need from theclinic and the pharmacy.

Learning the “rules of the road” from yourinsurance company

As of this writing, getting specific answers on benefits or alloweddollar coverage from your medical care insurance company requirespersistence and patience. The process of calling the insurance com-pany may take an hour or longer. In my office, we offer a “teamcall” with a clinic staffer (outside of the patient's appointment timewith me) to help patients or family members get this information.The call helps clarify the insurance “rules of the road,” and thisimproves the doctor-patient alliance.

When phoning the insurance company about enrollee benefitsand the schedule of allowable payments, have the policy and groupnumbers from your insurance card in front of you. Callers typicallyencounter many programmed responses and holds. When you reachan actual person, even the most pleasant and consumer-orientedinsurance company representative cannot tell you the allowable pay-ments for a specific service or specific physician. They will tell you ifthe doctor or clinic is in or out of the health plan provider network,and you are likely to be referred to a website.

Here are important questions to ask your insurance company:

• Does your insurance plan have a restricted provider network ofclinics or doctors? If so, when are these network clinics/physiciansavailable to see you? What coverage is available if you decide to usephysicians or clinics that are not in the provider network? It is veryimportant that you contact the clinic directly to see if and exactlywhen they can see you.

• What is the insurance plan deductible, and how does one satisfy thedocumentation of medical services which apply to satisfying theinsurance deductible amount? [Either the clinic or the patient sub-mits the clinic charges using current procedural terminology (CPT)codes. The CPT codes are well known to doctors and clinics andare the agreed-on descriptors of medical procedures.] Followingsubmission to the insurance company, these charges are first“denied for payment” by the insurance company, and then areaccounted towards satisfying the enrollee’s insurance deductible.

• Does your insurance plan cover this health service? For example,there are often strict limits on mental health and chemical depend-ency care, despite Minnesota and federal mental health parity legis-lation. Most Minnesota health plans require treatment at in-net-work mental health or substance abuse clinics or programs, eventhough none may be available when a patient contacts them.

• Are there providers in the network who are appropriately trainedand available to see you? The health plan will refer patients to theirwebsite for you to search out names and locations. Patients should


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Relieving health care cost anxiety to page 16

For more information• The Minnesota Department of Commerce website provides alist of licensed health care companies that market individual andfamily health care coverage in Minnesota:http://mn.gov/commerce/insurance/index.jsp(click on “Medical and Health” and “Find a Health Plan”)

• U.S. Internal Revenue Service website provides informationabout health savings accounts and high-deductible health plans:http://www.irs.gov/publications/p969/ar02.html

insist on getting personalized help from their health plan or insurancecompany in order to connect with an available provider suited totheir particular medical needs, since availability is part of an insur-ance contract.

• Do medication copayments qualify toward satisfying yourinsurance deductible? And how are they to be accounted? The

insurance company should know this. Medications are han-dled by a pharmacy benefit manager (PBM) company, so

you’ll need to go to yourretail pharmacy (armedwith your insurancecard) to learn about yourmedication copaymentsand restrictions, asexplained in the sectionbelow.

Your insuranceplan’s pharmacybenefits

When asked aboutprices, community pharmacists quote their

“retail” prices for medications they have on handor dispense. However, they can readily check on the

out-of-pocket cost of a given medication for a specific patientif they have your insurance information. With a swipe of your

insurance card, the pharmacist can instantly find out from your

health plan pharmacy benefit manager (PBM) what you must pay atthe pharmacy.

Armed with your insurance card, check with your pharmacyabout which drugs are on your insurance plan formulary that per-tain to your care needs. The formulary is a list of prescription drugs,both generic and brand name, that are covered by your health plan.The health plan will pay for a portion of the pharmacy cost, but theamount of coverage varies greatly. You do need to get the specificdetails of your copayments directly from the pharmacy. I recom-mend that you do this before the doctor or prescriber writes orrenews your prescription. Use your cell phone, even in the doctor’soffice if necessary.

Knowing the actual cost to a patient is a big deal to the doctor.Failing to consider affordability of medications for a patient meansthat an unfilled or insufficiently dosed prescription is likely to cause apoor treatment outcome. A recent Consumer Reports survey showed,unsurprisingly, that patients do not follow doctors’ recommendationswhen they believe they cannot afford them. Affordability is a majorcause of treatment and medication “noncompliance” or “nonadher-ence” when patients don’t fill the doctor’s prescriptions, skip doses,or cut pills in half without the doctor knowing.

Becoming prudent “health shoppers”

In today’s changing health care environment, patients do need toknow the specific costs of their care so that they can be prudent“shoppers” when it comes to spending their health care dollars.

Health care insurance coverage is much more complicated thanit used to be—and it will not get less so. There is also general agree-ment that helping patients decide about the personal value of healthcare services by considering costs is an important role for physiciansto play. At present, most traditional medi-cine clinics in Minnesota do not post theirfees or prices. When patients ask for costdetails, clinics may say that financial con-cerns are the business of the patient’s insur-ance company or the clinic administrator,rather than doctors or patients.

So, I advise patients to make it theirbusiness to patiently and persistently asktheir doctors about what they must pay forthe care and medications that the doctor rec-ommends. It helps when the doctor knowsthey really care. Doctors and clinics arebeginning to help patients glean insuranceand pharmacy benefits information.

Regarding shopping for health care insurance, patients and theirfamilies should consult a qualified independent insurance agent todiscuss their health care insurance options.

Everybody wins

By making medical care costs your business, you'll relieve a lot ofyour health care cost anxiety. You will help your doctor and careteam make better treatment recommendations for you and yourfamily. And, from your personal experience, you can talk to yourpolitical representatives about how to better our health care systemand make it more cost-effective.

Lee H. Beecher, MD, is president of the Minnesota Physician-Patient Alliance(www.physician-patient.org) and a psychiatrist in private practice.

Relieving health care cost anxiety from page 15

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MostMinnesotamedicineclinics donot posttheir feesor prices.

By makingmedical care costs

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10 Kidney Early Evaluation Program (KEEP)Free ScreeningFor adults 18 years or older who are atincreased risk of developing kidney dis-ease. Get a yearly screening if you havediabetes, high blood pressure, or have aparent, grandparent, brother or sister withdiabetes, high blood pressure, or kidneydisease. Space is limited; contact theNational Kidney Foundation at 651-636-7300 to schedule an appointment.Tuesday, Jan. 10, 3–7 p.m., FirstCommunity Church, 3001 Russell Ave. N.,Minneapolis

11 Lymphedema SeminarFor people who have had lymph nodessurgically removed from under their arms.Learn about causes, signs, and symptomsof lymphedema (swelling), and lifestyleprecautions that can decrease the riskof developing the condition. Free. Call952-993-5700 for more details.Wednesday, Jan. 11, 12:30–1:30 p.m.,Frauenshuh Cancer Ctr., 3931 LouisianaAve. S., St. Louis Park

16 Brain Injury Patient Education/SupportIf you have experienced a brain injury, thisgroup is designed for both you and yourfamily members. We meet on the third

Monday of the month and feature a guestspeaker. Registration is not required. Forfurther information, contact Tanya Rand at651-232-2202.Monday, Jan. 16, 6–7:30 p.m., BethesdaHospital, 559 Capitol Blvd., 7th Flr.,Indihar Conference Ctr., St. Paul

17 The Lowdown on Insulin Pumps:An Informational ClassAre you tired of multiple daily injections?Learn the advantages of insulin pumptherapy and view the latest pumps. Thisfree class is for patients with either type1 or type 2 diabetes; presented byLakeview Hospital certified diabeteseducators. Advance registration required;call 651-430-8715 or 866-727-3907.Tuesday, Jan. 17, 5–6 p.m., StillwaterMedical Group Specialty Clinic, 1500Curve Crest Blvd., Stillwater

19 Breathe Better Pulmonary Support GroupThis group is for people with chronicobstructive pulmonary disease (COPD) andtheir families. We meet the third Thursdayof each month, January to October. Formore information, call 651-982-7945.Thursday, Jan. 19, 1–3 p.m., FairviewLakes Medical Ctr., 5200 FairviewBlvd., Conference Rm. B., Wyoming

24 Family-to-Family ConnectionsThis is a free support group for familieswith children who have intellectual ordevelopmental disabilities. The groupmeets on the fourth Tuesday of eachmonth. Call The Arc at 952-920-0855to register.Tuesday, Jan. 24, 5:30–7:30 p.m., CoonRapids Evangelical Free Church, 2650128th Ave. N.W., Rm. 202, Coon Rapids

25 Miracle Voices of Central MinnesotaPeople who have had a laryngectomy canfind comfort belonging to a group thatunderstands their needs. Your family,caregivers, and friends are welcome toattend. For more information, call Mandyat St. Cloud Ear, Nose, Throat, Head andNeck Clinic at 320-252-0233 or 800-450-3223.Wednesday, Jan. 25, 6:30–8 p.m.,St. Cloud Hospital’s Conference Ctr.,1406 6th Ave. N., Aspen Rm., St. Cloud

27 Disability Bowling ProgramJoin fellow bowlers at Park Tavern onFriday afternoons. The bowling programis open to anyone with a physical disabil-ity. Games cost $1.50. Shoe rental andadaptive equipment are available. CallPark Nicollet’s INSPIRE program at 952-993-6789 to register.Friday, Jan. 27, 1:30–5 p.m., ParkTavern Bowling, 3401 Louisiana Ave. S.,St. Louis Park

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National Radon Action Month: Radon in Minnesota homes

January CalendarRadon is a colorless, odorless radioactivegas that seeps up from the earth. Wheninhaled, it gives off radioactive particles thatcan damage the cells that line the lung.

Long-term exposure to radon can lead tolung cancer. According to the MinnesotaDepartment of Health (MDH), more than21,000 lung cancer deaths in the U.S. eachyear are from radon, making it a serioushealth concern for all Minnesotans.

Radon, because it is a gas, is able to movethough spaces in the soil or fill mate-rial around a home's foundation.Minnesota homes tend to operateunder a negative pressure pulling soilgases, including radon, into the lower levelof the structure—especially during the heat-ing season. Your home can have radonwhether it be old or new, drafty or wellsealed, and with or without a basement.

MDH recommends that all Minnesotahomeowners test their homes for radon.

Radon test kits are sold at some hardwareor home supply stores. Your local healthdepartment may also offer test kits atreduced prices, or order online atwww.mn.radon.com. A radon test kit shouldcost between $5 and $25 and include labo-ratory analysis. If you choose to hire some-one to test your home, it will be moreexpensive.

A number of steps can be taken tolower the amount of radon in ahome. Experienced radon mitigationprofessionals are available and can

install appropriate control systems.

Questions?Email [email protected], or callMDH at 651-201-4601 or 800-798-9050.

Send us your news:We welcome your input. If you have an event youwould like to submit for our calendar, please sendyour submission to MPP/Calendar, 2812 E. 26thSt., Minneapolis, MN 55406. Fax submissions to612-728-8601 or email them to [email protected]. Please note: We cannot guaranteethat all submissions will be used. CME, CE, andsymposium listings will not be published.

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Meloxicam 15mg tab

Naproxen 375mg tab*

Naproxen 500mg tab*

AsthmaAlbuterol 2mg tab

Albuterol 4mg tab

Albuterol 2mg/5ml syrup

Albuterol 0.5% nebulizer soln* (20ml bottle)†

Albuterol 0.083% nebulizer soln* (25x3ml vials)†

Ipratropium 0.02% nebulizer soln* (25x2.5ml vials)† .

CholesterolLovastatin 10mg tab

Lovastatin 20mg tab*

Pravastatin 10mg tab

Pravastatin 20mg tab

Pravastatin 40mg tab*

DiabetesChlorpropamide 100mg tab*

Glimepiride 1mg tab

Glimepiride 2mg tab

Glimepiride 4mg tab

Glipizide 5mg tab

Glipizide 10mg tab*

Glyburide 2.5mg tab

Glyburide 5mg tab (blue)

Glyburide 5mg tab (green)

Glyburide, micronized 3mg tab

Glyburide, micronized 6mg tab

Metformin 500mg tab

Metformin 850mg tab

Metformin 1000mg tab*

Metformin 500mg ER tab*

Ear HealthAntipyrine/Benzocaine otic (15ml bottle)†

Fungal InfectionsFluconazole 150mg tab

Nystatin/Triamcin cream* (15gm tube)†

Nystatin/Triamcin cream* (30gm tube)†

Nystatin/Triamcin ointment* (15gm tube)†

Nystatin cream* (15gm tube)†

Nystatin cream* (30gm tube)†

Terbinafine 250mg tab*

Gastrointestinal HealthBelladonna Alkaloid/PB tab

Cimetidine 800mg tab*

Cytra2 solution

Dicyclomine 10mg cap

Dicyclomine 20mg tab

Famotidine 20mg tab

Lactulose syrup

Metoclopramide 10mg tab

Metoclopramide syrup

Promethazine 25mg tab*

Promethazine plain syrup*

Ranitidine 150mg tab

Ranitidine 300mg tab

Glaucoma & Eye CareAtropine Sulfate 1% op. soln* (5ml bottle)†

Erythromycin op. ointment (3.5gm tube)†*

Gentamicin 0.3% op. soln (5ml bottle)†

Levobunolol 0.5% op soln (5ml bottle)†

Neomycin/Polymyxin/Dexamethasone

0.1% op. ointment (3.5gm tube)†

Neomycin/Polymyxin/Dexamethasone

0.1% op. susp (5ml bottle)†

Pilocarpine 1% op. soln (15ml bottle)†

Pilocarpine 2% op. soln (15ml bottle)†

Polymyxin Sulfate/TMP op. soln* (10ml bottle)†

Sulfacet Sodium 10% op. soln* (15ml bottle)†

Timolol Maleate 0.25% op. soln (5ml bottle)†

Timolol Maleate 0.5% op soln (5ml bottle)†

Tobramycin 0.3% op. soln (5ml bottle)†

Heart Health & Blood PressureAmiloride-HCTZ 5mg-50mg tab

Atenolol-Chlorthalidone 100mg-25mg tab

Atenolol-Chlorthalidone 50mg-25mg tab

Atenolol 25mg tab

Atenolol 50mg tab

Atenolol 100mg tab

Benazepril 5mg tab

Benazepril 10mg tab

Benazepril 20mg tab

Benazepril 40mg tab

Bisoprolol-HCTZ 2.5mg-6.25mg tab

Bisoprolol-HCTZ 5mg-6.25mg tab

Bisoprolol-HCTZ 10mg-6.25mg tab

Bumetanide 0.5mg tab

Bumetanide 1mg tab

Captopril 12.5mg tab

Captopril 25mg tab

Captopril 50mg tab

Captopril 100mg tab

Carvedilol 3.125mg tab



Carvedilol 25mg tab*

Clonidine 0.1mg tab

Clonidine 0.2mg tab

Digoxin 0.125mg tab

Digoxin 0.25mg tab

Diltiazem 30mg tab

Diltiazem 60mg tab

Diltiazem 90mg tab*

Diltiazem 120mg tab

Doxazosin 1mg tab

Doxazosin 2mg tab

Doxazosin 4mg tab

Doxazosin 8mg tab

Enalapril-HCTZ 5mg-12.5mg tab

Enalapril 2.5mg tab

Enalapril 5mg tab

.........3

..........3

.........3

.........3

........3

........3

........3

........3

........ 3

.........3

........ 3

........3

........3

....................1

....................1

............................1

...........................1

........................................1

....................................................1

..............................1

..............................1

............1

............... 1

.................1

....................1

............................1

........90

........90

........90

........90

........90

........90

........90

........90

........90

........90

........90

........90

........90

........90

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......180

......180

......180

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......180

........90

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........90

........90

.....180

.....180

.....180

........90

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................30

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.........3

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..........3

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..........3

.......30

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.......30

.......30

.......30

.......30

.......90

.......90

.......84

.....90

.......42

.......60

.......90

.......60

........60

........84

...........3

...........3

...........3

360ml

.......84

.......60

.....180

.....180

.................1

................1

................1

...................1

................1

..............1

..................1

................1

................1

...................1

................1

..............1

......................................................30

.......................................................30

......................................................28

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...................................................14

...................................................20

....................................... 30

.....................................20

.....................................20

.....................................................28

.............1

..............1

...............1

.......................120ml

.............................................28

....................................20

.....................................................60

.....................................................60

........42

........90

360ml

....................................................14

..........................................................30

.............................................120ml

...........3.....................1

..........3

..........3

..........3

..........3

..........3

..........3

.......90

........................................................1

.........................1

.........................1

...................1

...........................................1

.............................................1

.......................................................30

.....180

........90

540ml

.....270

.....180

.....180

711ml

.....180

180ml

........36

540ml

......180

........90

..............................................60

......................................................30

...............................................................180ml

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

.......................................................60

..........................................................60

..............................................................237ml

...............................................60

..................................................60ml

...................................................12

.........................................180ml

.........................................................60

.........................................................30

......270

......180

360ml

...........3

...........3

...........3

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

...............................................................60

...........................................120ml

............1

.......1

1

........90

........90

........90

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...........................................................30

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........90

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........90

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........36

........18

......180

360ml

.....270

.....180

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....................................................60

....................................120 ml

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

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.........................................................30

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..........................................................30

.........................................................60

.........................................................60

Revised 10/19/11

Paying too much for prescription drugs?Our Retail Prescription Program offers 100’s of medications for as little as $4.00 for a 30-day supply*

We offer convenience, auto-refill, Easypay, Ready Reminder and more. Compare and save!

*Prices may be higher due to State restrictions. † Prepackaged drugs are covered only in unit sizes specified on Drug list. See Program Details or your Walmart Pharmacist for details.

Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages.Higher dosages cost more and some restrictions may apply.

PHARMACIES ARE CONVENIENTLY LOCATED IN EVERY MINNESOTA WALMART LOCATION

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

WALMART.COM/pharmacy

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

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

Enalapril 20mg tab

Furosemide 20mg tab

Furosemide 40mg tab

Furosemide 80mg tab

Guanfacine 1mg tab

Hydralazine 10mg tab

Hydralazine 25mg tab

Hydrochlorothiazide(HCTZ)12.5mg cap*

Hydrochlorothiazide (HCTZ) 25mg tab

Hydrochlorothiazide (HCTZ) 50mg tab

Indapamide 1.25mg tab

Indapamide 2.5mg tab

Isosorbide Mononitrate 30mg ER tab

Isosorbide Mononitrate 60mg ER tab

Lisinopril-HCTZ 10mg-12.5mg tab

Lisinopril-HCTZ 20mg-12.5mg tab*

Lisinopril-HCTZ 20mg-25mg tab*

Lisinopril 2.5mg tab

Lisinopril 5mg tab

Lisinopril 10mg tab

Lisinopril 20mg tab

Methyldopa 250mg tab*

Methyldopa 500mg tab*

Metoprolol Tartrate 25mg tab

Metoprolol Tartrate 50mg tab

Metoprolol Tartrate 100mg tab*

Nadolol 20mg tab

Nadolol 40mg tab

Prazosin HCL 1mg cap



Propranolol 10mg tab




Sotalol HCL 80mg tab*

Spironolactone 25mg tab*

Terazosin 1mg cap

Terazosin 2mg cap

Terazosin 5mg cap

Terazosin 10mg cap

Triamterene-HCTZ 37.5mg-25mg cap

Triamterene-HCTZ 37.5mg-25mg tab

Triamterene-HCTZ 75mg-50mg tab

Verapamil 80mg tab

Verapamil 120mg tab

Warfarin 1mg tab

Warfarin 2mg tab

Warfarin 2.5mg tab

Warfarin 3mg tab

Warfarin 4mg tab

Warfarin 5mg tab*

Warfarin 6mg tab

Warfarin 7.5mg tab

Warfarin 10mg tab

Men’s HealthFinasteride 5mg

Levitra 20mg (limit 10 per customer per month)

Mental HealthAmitriptyline 10mg tab

Amitriptyline 25mg tab




Benztropine 2mg tab

Buspirone 5mg tab

Buspirone 10mg tab*

Carbamazepine 200mg tab*

Citalopram 20mg tab

Citalopram 40mg tab

Fluoxetine 10mg tab*

Fluoxetine 10mg cap

Fluoxetine 20mg cap

Fluoxetine 40mg cap

Fluphenazine 1mg tab

Haloperidol 0.5mg tab

Haloperidol 1mg tab

Haloperidol 2mg tab

Haloperidol 5mg tab

Lithium Carbonate 300mg cap*

Nortriptyline 10mg cap

Nortriptyline 25mg cap

Paroxetine 10mg tab*

Paroxetine 20mg tab*

Prochlorperazine 10mg tab

Thioridazine 25mg tab

Thioridazine 50mg tab

Thiothixene 2mg cap

Trazodone 50mg tab

Trazodone 100mg tab

Trazodone 150mg tab

Trihexyphenidyl 2mg tab

Skin ConditionsFluocinonide 0.05% cream* (15gm tube)†

Fluocinonide 0.05% cream* (30gm tube)†

Gentamicin 0.1% cream (15gm tube)†

Gentamicin 0.1% ointment (15gm tube)†

Hydrocortisone 1% cream (28.35-30g tube)†

Hydrocortisone 2.5% cream (30gm tube)†

Silver Sulfadiazine 1% cream* (50gm tube)†

Triamcinolone 0.025% cream (15gm tube)†




Triamcinolone 0.1% ointment (15gm tube)†

Triamcinolone 0.1% ointment (80gm tube)†


Thyroid ConditionsLevothyroxine 25mcg tab

Levothyroxine 50mcg tab








Levothyroxine 175mcg tab*

Levothyroxine 200mcg tab*

VirusesAcyclovir 200mg cap

Vitamins & Nutritional HealthFolic Acid 1mg tab

Mag 64 64mg tab*

Magnesium Oxide 400mg tab0

Prenatal Plus qty 30*

Potassium Chloride 10% liquid

Sodium Fluoride .25mg chewable (120ct bottle) †*

Women’s HealthEstradiol 0.5mg tab

Estradiol 1mg tab

Estradiol 2mg tab

MedroxyprogesteroneAcetate 2.5mg tab

Medroxyprogesterone Acetate 5mg tab

Medroxyprogesterone Acetate 10mg tab

Alendronate SOD 35mg tab .

Alendronate SOD 70mg tab

Clomiphene 50mg tab

Sprintec 28-day tab

Tamoxifen 10mg tab

Tamoxifen 20mg tab

Tri-Sprintec 28-day tab

Other Medical ConditionsChlorhexidine Gluconate 0.12% soln (473ml bottle)†

Hydrocortisone AC 25mg suppositories*

Isoniazid 300mg tab

Lidocaine 2% viscous solution (100ml bottle)†

Megestrol 20mg tab*

Oxybutynin 5mg tab

Phenazopyridine 100mg tab

Phenazopyridine 200mg tab

Prednisone 2.5mg tab

Prednisone 5mg tab

Prednisone 10mg tab

Prednisone 20mg tab

........90

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1419ml

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...1

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................1

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.......................1

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

Revised 10/19/11

...................................................................................30

......................1

$9/30-day

$9/tablet

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

Need to change your Pharmacy?Many large employers have recently dropped Walgreens and other Pharmacies from their

Prescription Drug Benefit Plan, impacting where you can pick up your prescriptions. If this has happenedto you please contact your local Walmart for assistance on our easy prescription transfer.


Meningitis is an inflammation of the membranes covering the brain and spinalcord. It is most commonly caused by an infection, either from a virus orbacteria. Meningitis is a scary illness, both for parents and doctors, and for

good reason. In the past, a person with meningitis—sometimes called spinal meningi-tis—was at risk of serious complications, including death.Although there are other causes of inflammation of the membranes covering the

brain and spinal cord (certain drugs and rare infectious agents such as tuberculosis andfungi, for example), viral and bacterial infections are the most common.The most common form, viral meningitis, is usually less severe andwill go away without treatment.Meningitis can also be caused by several different bacteria:

• Hemophilus influenza type B (HiB)

• Streptococcus pneumonia

• Neisseria meningitidis

Knowing the specific bacteria is very important fortreatment, because the correct antibiotic must be selected.Bacterial and viral infections are often contagious, and

meningitis is no exception. Some forms of meningitis are spreadperson-to-person through respiratory or throat secretions spread by cough-ing, sneezing, or kissing. For both the Neisseria meningitidis and Hemophilusinfluenza type B forms of meningitis, close contact may be a risk factor, for exam-ple, in day care centers and households, or within romantic couples. In these cases,prophylactic (or preventive) antibiotics can be offered to exposed people.

Symptoms of meningitis

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

C O M M U N I C A B L E D I S E A S E

MeningitisEarly diagnosis

is critical

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symptoms. But persistent or new symptoms such as the followingindicate the need for immediate evaluation:

• high fever

• vomiting

• confusion or difficulty concentrating

• sleepiness or difficulty waking up

• stiff neck

• numbness, tingling,or weakness inextremities

• sensitivity to light

• spreading rash

• seizures

Infants withmeningitis are muchmore difficult toevaluate, but if theinfant or child hasany of the abovesymptoms, or is not

interested in usual pleasures such as playing and eating, or is“out of it” and does not recognize the parent, these could indi-

cate a possible serious illness and the need for immediate medicalattention.

Diagnosing meningitis

Early diagnosis of meningitis is critically important. The doctorswill draw blood and obtain a sample of spinal fluid from thepatient’s back; this is called a “spinal tap” or lumbar puncture andis the best way to identify the bacteria (or virus) causing the menin-gitis. Other tests, including CT or MRI scans of the brain, are oftenuseful. The doctors will choose the best antibiotics for bacterialmeningitis. Patients with meningitis, whether bacterial or viral, needsupportive and intensive care with close monitoring.

Development of vaccines

Before the 1990s, bacterial meningitis was fairly common. Accord-ing to the U.S. Centers for Disease Control (CDC), Hemophilusinfluenza type B (HiB) was the most common cause of meningitisbefore the vaccine was available, and led to the death of about 600children yearly. HiB also caused pneumonia, bone infections, andthroat infections.In 1985, a vaccine was developed to protect young children

against Hemophilus influenza type B. Since introduction of the vac-cine, the incidence of invasive HiB illness has decreased by 98 per-cent to just a handful of cases yearly. Now, all infants and toddlersreceive four doses of HiB vaccine at their well-child visits. Bothpneumococcal vaccine and HiB vaccine are given at 2, 4, and 6months of age, and once anytime between 12 to 15 months—sofour doses total for each vaccine.The next dramatic step in the fight against meningitis was the

development of PCV (pneumococcal conjugate vaccine), a vaccinefirst licensed in 2000 that protects children from many types ofStreptococcus pneumonia, another common bacteria that cancause meningitis, pneumonia, and other severe infections in chil-dren and others with weak immune systems. Studies are showing a

huge reduction in the number of infections caused byStreptococcus pneumonia.Adolescents and young adults from 15 to 24 years old have

been at special risk for meningitis caused by a third family of bacte-ria, Neisseria meningitidis, because they often gather in groups: indorm rooms, army barracks, or other confined areas. In 2005, avaccine protecting against many subtypes of Neisseria meningitidisbecame available. Teens now receive this Menactra vaccine at clinicvisits, and a booster is recommended four years later.In 2011, thanks to safe and effective vaccines, meningitis is

increasingly uncommon. Some of my young medical students todaymay never see a case of bacterial meningitis in their careers!

Before vaccines were available

I often recall my early years of pediatric practice and the scourgeof frequent cases of meningitis, when, despite our best efforts, chil-dren and adolescents either didn’t survive, or survived with tremen-dous, life-changing disabilities. When I was a medical student andresident in pediatrics, children and adolescents with symptoms ofmeningitis—fever, headache, irritability, stiff neck—often came tothe clinic or emergency department and were admitted to the hospi-tal for tests and intensive care. Many of these patients had long hos-pital stays, receiving antibiotics and other treatments. The compli-cated course of the illness and the frequently poor outcomes left amajor impression on me.I will never forget one little boy, Dominic, then about 2 months

old. I see him in my clinic to this day, some 20 years later. He devel-


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Meningitis to page 22

oped Hemophilus influenza meningitis before theimmunization was widely available, and is now ayoung adult with complicated special needs includ-ing profound hearing loss, developmental delay,and the inability to walk. He is wheelchair-bound.Three-year-old Marquis came to the clinic

with a fever of 104 degrees, was sleepy and vom-iting. He had Streptococcus pneumonia meningi-tis. Within hours, despite the best antibiotic treat-ment, the infection damaged the blood supply tohis extremities and he had to have his limbsamputated.Jennifer, a bright freshman at a local college,

lived in a dormitory and hung out with friendsas all teens do. One weekend during fall semester,she developed a fever, stiff neck, and confusion.Despite antibiotics and intensive care in the emer-gency department, she was unresponsive and diedwithin 48 hours of Neisseria meningitidis meningi-tis and sepsis.

Vaccination—the best prevention

Obviously, prevention of meningitis through vacci-nation is our best option. Most parents embracethe availability of safe, effective vaccines—a pow-erful tribute to public health in this country. But asurprising number of parents do not. Yes, children

and teens require many painful injections through-out their young lives, but isn’t this a small cost topay for the prevention of meningitis (and otheravoidable diseases)? If a child does happen to con-tract meningitis today, it can still—even withexcellent medical care—cause serious complica-tions such as hearing loss, blindness, brain injury,learning and developmental problems, loss oflimbs, or even death.That a vaccine is available to prevent the

tragic loss of a healthy youngster should providepeace of mind for parents and health care pro-viders. For the few parents who refuse vaccines,I can only continue to educate and persuade ...and maybe invoke the stories of Dominic,Marquis, and Jennifer.

Marjorie Hogan, MD, is board-certified in both pedi-atrics and adolescent medicine, and practices atHennepin County Medical Center. In 2009, she receivedthe Gold-Headed Cane Award from the University ofMinnesota Department of Pediatrics. This award repre-sents life-long dedication to children and the practice ofmedicine and is the highest honor the department cangrant an individual.

Meningitis from page 21


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Iclearly recall the crisp fallmorning in 2007 when Iarrived at my parents’ home

and learned the news. My motherwas upset because she did not feelwell and was sure she had cancer.I tried to reassure her that shewould be fine—after all, she wasonly 55 years old and had noother health conditions. I reasonedthat she should see her physicianimmediately, and my dad wasalready on the phone trying to getan appointment. The diagnosiscame quickly—celiac disease, notcancer.

Celiac disease is a digestivedisease that damages the smallintestine and interferes withabsorption of nutrients from food.So over the next couple of months,my mom switched to a gluten-freediet. (People with celiac diseasecannot tolerate gluten, a proteinfound in wheat, barley, and rye.)We visited a dietician, boughtcookbooks, and tried new recipes.

Something was still not right,however; Mom was losing moreweight and her stomach wasbecoming distended.

Seeking an explanationAfter more doctor visits and a tripto the ER, tests confirmed whatmy mom already knew—she hadstage IV ovarian cancer. She wasgiven only a few months to live,a year at best. My mom wasstrangely calm about her progno-sis because she had somehowalways known that she wouldtake the same journey her motherhad. (Her mother had died ofbone cancer when Mom waseleven years old.) Mom wasn’tcalm because she had given up.On the contrary, she wanted tofight, because she had a husbandwho adored her, a daughter whowas her best friend, and twograndchildren who worshippedher—not to mention family andfriends too numerous to count.

P A T I E N T T O P A T I E N T

TheChemoZone

A patient’s compassionfor others lives on

in her book

By Tracy Rubietta, MBA

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A week after Mom’s diagnosis, she underwent ninehours of surgery to remove the cancer that had spreadthroughout her body. Several months of physical therapyand chemotherapy ensued, followed by remission.Unfortunately, the cancer returned three months later.

Fighting backMy mom fought back with more chemotherapy. Those around herwatched in awe as she not only bravely faced her cancer, but alsocomforted others about her uncertain future; she was everyone’srock. It was then that Mom decided she wanted to do more, to helpothers battling cancer. She could have just made hats to donate tocancer patients who’d lost hair from chemotherapy, or encouragedand counseled newly diagnosed cancer patients, or volunteered hertime, all of which she did. But she felt it wasn’t enough.

In the midst of chemotherapy, Mom felt she could best help oth-ers by writing a book about her chemotherapy journey. She wantedto inspire others to fight, and to answer questions for the layperson.She wanted her book to be medically accurate, so she assembled agroup of physicians, nurses, and other health care professionals toserve as her book’s medical advisory board. We would sit duringchemotherapy and discuss the contents of the book. Each time mymom experienced something new resulting from chemotherapy,she’d say, “This must be happening for a reason! I’d better add thisto the book.”

Book takes shapeShe began typing immediately, but it was hard because chemother-apy had caused neuropathy (i.e., made her hands and feet numb). Ikept offering to type for her, but she always refused, saying that itwas something she had to do.

I remember the early-morning and late-night phone calls like itwas yesterday. “Tracy, how does this sound? Am I forgetting any-thing? You know I have ‘chemo brain’!” We collaborated and she

typed. Previously a sim-ple task, typing hadbecome onerous.

In 2009, my momself-published her book,The Chemo SurvivalGuide, through an online

publishing website. She printed 50 copies and shared them with oth-ers undergoing chemotherapy. The response from patients, care-givers, and medical professionals was overwhelming.

Book’s message spreadsIn the summer of 2010, my mom asked a local publisher to publishthe book nationally because she wanted to make it available tomore patients undergoing chemo. The publisher immediately sawthe book’s potential and agreed to publish it. Despite this positivedevelopment, however, the sobering reality was that Mom’s cancerwas still spreading. She had more chemo, but by fall, the cancer hadmetastasized to her brain. More chemotherapy, radiation, and sur-gery followed.

Mom lost her battle in November 2010.

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

the publisher, whose editor asked me toexpand sections of the book. At first, Iwas reluctant. (It was my mom’s book!It was her legacy.) But after talking withmy dad and my husband, I decided todo as requested.

The Chemo Zone is a 270-pagebook in which patients can trackappointments, medications, imagingtests, lab results, side effects, weight, andbody temperature. It also provides adviceabout living with chemotherapy on a dailybasis, e.g., how to manage side effects, exer-cise, diet, intimacy, and pet care. The ChemoZone offers answers, advice, and hope topatients and those around them—just as mymom intended. The Chemo Zone is her legacy;Mom’s compassion for others will live on throughher book.

Linda Rubietta, MFA, co-author of The Chemo Zone, wasan artist and award-winning graphic designer, art director, andcreative director in the advertising industry. Tracy Rubietta, MBA,is a clinical oncology specialist for a pharmaceutical company andan advocate for cancer awareness, research, and prevention.


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

She wantedto inspire others

to fight.


What is a seizure?A seizure is a disturbance of brain function that startsand ends abruptly. Many things can cause seizures: headtrauma, a brain tumor, malformation of blood vessels, orsome other problem caused when the brain was formingin the womb. Some seizures are caused by a disturbancein brain chemicals, particularly sugar and oxygen.

Actually, anyone can have a seizure if deprived ofoxygen. Each person has an individual threshold, so ifan airplane were to suddenly depressurize, for example,a few passengers might have seizures after three minutesof oxygen deprivation. Others might not seize until after

eight or nine minutes, while most would seize somewherebetween four and six minutes. If you see someone whoyou think might be having a seizure, call 911.

Two types of seizuresThere are two basic types of seizure: epileptic andnonepileptic. An epileptic seizure is caused by a problem

within the brain, like a tumor. A nonepileptic seizure iscaused by a problem outside the brain, like a cardiac arrest,that affects the brain. If someone has epilepsy, it means heor she has had a seizure on more than one occasion or havea condition, such as a brain tumor or stroke, that has led toone seizure and puts the person at risk for more.

Classifying seizures helps determine the right treat-ment, but classification alone is insufficient. Other infor-mation, such as EEG (electroencephalogram, which is atype of medical test), familyhistory, age of onset, previ-ous head injuries, etc., isequally important.

How commonis epilepsy?Approximately one ofevery 10 Americans willhave a seizure at somepoint in their life. In poorer countries, thisnumber is much higher due to inadequate medical careand public health measures. Only about 2 percent to 3percent of Americans will have more than one seizure onmore than one occasion, and most people can controlseizures with changes in lifestyle, by using antiepilepticmedications, or by treating any underlying disease.

Today, the best estimate is that approximately 3 mil-lion people currently experience seizures or are taking

N E U R O L O G Y

Seizures and epilepsyWhat everyone should understand aboutthis fairly common neurological disorder

By Robert J. Gumnit, MD

medicine to prevent them. With that many people suf-fering from seizures, why doesn’t everyone know some-one with epilepsy? Actually, everyone probably does.Most people with epilepsy don’t disclose their condition,either because of the stigma still attached or becausethey hope they won’t have another seizure. Anyone whohas had two seizures, even if they occurred many yearsapart, probably has epilepsy.

Common triggersWhether or not seizures begin in one part of the brain (knownas focal localization or partial epilepsy), or whether they startall over the brain at once (known as generalized epilepsy), theyall share common triggers. Each individual may have some-thing that causes the seizure to occur, and each person’sseizure may be slightly different depending upon what part ofthe brain is involved. Some seizures are very difficult to recognize.

There are certain factors, however, that make it likely for any-one to experience a seizure, even someone who has never had onebefore. These are:

• Sleep deprivation: Lack of sleep is one of the most potent triggersfor seizures. Unfortunately, in America today, sleep deprivation iscommon.

• Stimulants, especially caffeine: Mixing caffeine with sleep depriva-tion is a recipe for trouble.

• Street drugs: crack, “synthetic” marijuana, methamphetamine

• Stress and anxiety: Anxiety and stress lower the seizure threshold;that’s why coaches are more likely to have a seizure on game dayand students, just before final exams.

• Hormonal changes and water retention: Some women are particu-larly sensitive to hormonal fluctuation and are thus more vulnera-ble to seizures at a certain point in the menstrual cycle.

When I worked as a neurologist at a university student healthservice, I could predict every spring that I would see a substantialnumber of students experiencing a first seizure and that there wouldbe more women than men because of hormone fluctuation.

When to see a specialistSeizures are not good for the brain; the more you have, the harderthey are to stop and the greater the risk for brain damage. Seizures

are not good for the soul, either,since they can limit social activ-ity, which can cause depressionand anxiety.

Unfortunately, manypeople with seizures gothrough life without get-ting their seizures com-pletely under control.Seizures can be scarybecause they can occur

out of the blue, but most patientswill do fine with the first medicine prescribed after they have beenaccurately diagnosed. Some patients will not respond to the first orsecond medicine prescribed, or will have an underlying disease thatrequires special treatment.

Most could be helped by epileptolo-gists (neurologists with two or moreyears of specialized training in epilepsy),but it takes 15 years on average forpatients to get to an epilepsy center foraccurate diagnosis and treatment.

The American Academy of Neurologyrecommends that a patient see a neurolo-

gist if he or she has had uncontrollable seizures for three months ormore. If the seizures are not under control within one year, patientsshould see an epilepsy specialist. We are fortunate to have not onebut four epilepsy centers in Minnesota. For a list of epilepsy centersin the U.S., go to www.naecepilepsy.org. Referrals from a medicaldoctor are usually not needed to make an appointment at mostepilepsy centers. When a person calls, however, depending on his orher insurance, a referral can be arranged if it is needed.

Robert J. Gumnit, MD, is the president of MINCEP Epilepsy Care,Minneapolis, and past president of the American Epilepsy Society.

Approximately one ofevery 10 Americans willhave a seizure at some

point in their life.

A seizureis a nonfataldisturbance

of brainfunction.

In the next issue...

• Acupuncture

• CO2

poisoning

• Cholesterol


Dr. George Peltier is chief of plastic surgery at Hennepin County Medical Center. He isboard-certified in plastic surgery and is a fellow of the American College of Surgeons.Dr. Peltier is a member of the American Society of Plastic Surgeons, the MinnesotaAcademy of Plastic Surgeons, the Midwestern Association of Plastic Surgeons, and theLipoplasty Society of North America. His special interests include reconstructive surgery,burn surgery, body contouring, and skin cancer.

Please tell us about the different kinds of burn injuries. We see patients withburn injuries caused by many different mechanisms. Certainly there is the usual thermalinjury caused by flame, burning grease, hot liquids, etc. We also see patients with frostbitefrom cold injuries. We see chemical burns that are caused by a variety of things such asanhydrous ammonia, sulfuric acid, nitric acid, etc. The most common type of burn injury isa scald injury, which tends to occur in children approximately 2 to 7 years old. These burnsoccur mainly in the kitchen, but occasionally in the bathroom as well. We see traumaticinjuries to the skin such as degloving (skin abrasion) caused by motorcycle injuries, auto-mobile injuries, etc.

What are the most common burn injuries that you see? These are superficial,second-degree burns that occur from scalding liquids or steam. They most often occur in

children, but can occur at any age. They can extend all the way from 100 percent of thebody surface area to a fraction of a percentage.

Is there a specific age group most prone to burn injuries? Small children, i.e.,those approximately 2 to 7 years old, are indeed the most frequent victims of burn injury.Their injuries occur in the bathroom and the kitchen, and are usually scald injuries.

Please give us a rough estimate of the number of burn injuries requiringmedical treatment each year in Minnesota. Do they occur more often in aspecific season? I don’t have any information to answer the first part of the question,but the second part can be answered easily enough: Most burn injuries occur during thesummer months.

What are basic things a person can do to minimize the chances of burns?Use common sense and be safe—which includes staying aware of risks. Parents should teachchildren about burn safety and make sure children are supervised at all times. Every year wecare for toddlers who are burned when they fall into campfires, or are scalded from boilingliquids or hot bath water. Alcohol intoxication unfortunately plays a huge role in burninjuries because good judgment is compromised. Avoid using accelerants on fires, and turnpot handles away from the front of the stove. These are just a few ways to avoid injury.There are many more safety tips listed on our website, www.hcmc.org/burncenter.

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


George Peltier, MD

1 0 Q U E S T I O N S

Photo credit: Bruce Silcox

&

First-degree burns are very much along the lines of a sunburnand do not result in the loss of epithelium. Second-degree burnsresult in the superficial loss of skin. The areas that are burned mayblister, and will take seven to 14 days to heal. Third-degree burnsencompass the entire depth of the skin and will take a very long timeto heal on their own, because even the hair follicles and sweat glandsare destroyed. Fourth-degree burns extend into the fascia overlyingthe muscle and into the muscle or bone. In our community, these areusually electrical conduction burns.

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

What are some of the recent advances in burn care?I think that we have many more choices for burn care than we did30 years ago. Instead of a very simple choice of topical ointments, wenow have many kinds of wound treatments that can last more than aday or two. They are more comfortable for the patient and allow usto have a better fit for the area on the body that was burned and theage of the patient and the depth of the injury.

At what point do you advise a person to seek immedi-ate medical attention for a burn? This is an excellent ques-tion. The answer may depend on the ability of the patient to takecare of a burn. A small burn in the kitchen that involves the finger-tips should be run under cold water for five to 10 minutes, and canthen be treated with Bacitracin. I don’t think these injuries need to bepresented to a medical facility. Anything more than these kinds ofsmall minor burns, however, such as that from a soldering iron,should be evaluated by a physician.

What are things that someone should and should notdo in first responding to a burn situation? The very firstthing to do is to stop the burning process—whether that means put-ting out a fire or removing hot clothing. Knowing where to go orwhat to do in a burn situation is a matter of common sense. “Stop,drop, and roll” should be taught to all children; it’s important thatthey understand that if their clothing catches fire, they must stop,drop, and roll to put out the fire. Cool tap water is excellent immedi-ate treatment for the burn; scientifically, we know that this can actu-ally reverse some of the depth of the burn injury. For a serious burn,however, call 911 for immediate medical care.


“ ”Small children are the most frequent victims of burn injury.

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An 8-year-old in braces?Many adults wonder why kidsseem to be getting braces at sucha young age these days. It’sbecause parents are realizing

that proactive orthodontic evaluation can be thought of aswell-child care. Evaluating a child’s teeth early may helpdetect and fix problems faster and easier than waiting forproblems to surface. That’s why, even if your dentist doesn'tsuggest that your child have an orthodontic evaluation, youmight want to consider scheduling one anyway.

Earlier detection, easier remedyIn the past, parents were advised to wait until their childrenlost all of their baby teeth before starting orthodontic screeningor treatment. Now, orthodontists are working hard to change thatmindset for many compelling reasons. Orthodontic treatment meth-ods, materials, and technologies have changed dramatically over thepast 25 years or so, and research has determined that many orthodonticproblems can be corrected easily if identified and addressed early.

In fact, the American Association of Orthodontists recommends that chil-dren receive their first evaluation by an orthodontic specialist by age 7. While thefamily dentist may be able to detect some obvious problems, an orthodontist has

D E N T A L H E A L T H

Experts recommend initialscreening by age 7, while teethand facial bones are forming

By Jennifer Eisenhuth, DDS, MS

Orthodontics for second-graders?

Every day is a reason for a person with Down

syndrome to smile. And find joy in things the rest

of us often overlook. To learn more about the rich-

ness of knowing or raising someone with such an

enthusiasm for life, call your local Down syndrome

organization. Or visit ndsccenter.org today.

It is the mission of the Down Syndrome Association of Minnesota to provide information, resources and support to individuals with Down syndrome, their families and their communities. We offer a wide range of services, programs andmaterials at no charge. If you are interested in receiving one of our information packets for new or expectant parents, please email [email protected] or

For more information please call:

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WHO’S GOT BETTER MOVES ON THEDANCE FLOOR, YOU OR ME?

additional years of training beyond dental school and is speciallytrained to assess, detect, and address not only issues with teeth, butalso the overall growth and formation of the jaw and facial bonesthat can affect the mouth’s form and function.

What’s more, many orthodontists provide an initial exam freeof charge, so there’s really no reason to delay asking your dentist torefer you to an orthodontist. But if you’re still skeptical or over-whelmed by the prospect of yet another family appointment, hereare five good reasons to have your child assessed by an orthodonticspecialist by age 7.

1. Reduce or avoid future treatment: Advancements in orthodonticshave made it possible to correct many problems early and some-times reduce future orthodontic treatment time. In some cases,early treatment can prevent the need for invasive surgeries thatmay be required to address problems that could have been moreeasily addressed while the child’s bones were still forming andmalleable.Why begin orthodontic screening at age 7? Most children have

a mixture of baby and adult teeth and their first adult molars maybe beginning to erupt around this time, which establishes the backbite and makes it possible for an orthodontist to evaluate front-to-back and side-to-side tooth relationships. For example, the presenceof erupting incisors can indicate whether a child has an open bite,an overbite, crowding, or a gummy smile.

Frequently, it is easier to correct problems when they are de-tected and treated early because the child still is growing. When par-ents wait until all of their child’s permanent teeth are in and the

child’s facial growth is nearing completion, correcting some biteand/or profile issues can be difficult without extractions or surgery.

Examples of early “interceptive” treatments that are best donewhile a child’s mouth and face are still developing include:

• Expanders to correct crossbites, create room forcrowded erupting teeth, and reduce the need forfuture tooth removal (a much more common prac-tice years ago before expanders). An expander isan appliance that widens the upper jaw by puttinggentle pressure on the upper molars each time anadjustment is made. The orthodontist decides howoften an adjustment is needed based on how farthe jaw needs to be widened.

• Spacers to preserve room for unerupted teeth.

• Partial braces that reduce the risk of trauma toprotruding front teeth and create symmetry byinfluencing jaw growth.

2. Avoid decay or injuries: Genetic problems such asunderbite, overbite, overjet, crossbite, jaw size,tooth size, crowding, extra or missing teeth, andfacial asymmetry issues are just some of the condi-tions that can be treated more effectively whendetected early.

Timely treatment for some of these problems can reduce suscep-tibility to tooth decay or gum disease by facilitating better access toteeth for proper brushing and flossing, decrease risk of chipping due


Read usonlinewherever you are!

www.mppub.com

Orthodontics for second-graders? to page 32

10 signs that yourchild should be seen byan orthodontist1. Early or late loss of baby teeth2. Difficulty chewing or biting3. Mouth breathing4. Finger sucking or other oral habits5. Crowding, misplaced, or blocked-

out teeth6. Speech difficulty7. Protruding teeth8. Teeth that meet in an abnormal

way or don’t meet at all9. Facial imbalance or asymmetry10. Grinding or clenching of teeth

to protruding teeth, and correct speech impediments caused bybite issues.

3. Prevent extractions: Today’s orthodontists generally try to avoidextractions, which were a more common practice in the past toaddress crowding and spacing issues.A Carrière Distalizer is an example of an early

intervention appliance that can be used to preventpermanent tooth extraction in patients when they’reolder. The device starts to correct overjet, a conditionin which the patient’s bite is a full tooth ahead,before braces are applied. This is about a four-monthprocess that also can decrease the time the patient isin braces. Previously, extraction was the commontreatment for this problem.

It’s important to note that in some cases, when a patient hasmore teeth than the individual’s jaws can support, an extractionactually is beneficial to long-term orthodontic results. However, thegeneral priority is to preserve and maintain all of the permanentteeth because extractions can have long-term effects that are notapparent until well into adulthood.

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

5. Kick bad habits early: Sometimes, the position of a child’s teethis affected by oral habits that should be eliminated or correctedearly to prevent problems from developing or progressing.For instance, speech therapy may be prescribed to correct

tongue thrust, a swallowing pattern that can push the teeth forwardand apart. Oral devices can help habitual thumb or finger suckers to

kick their habit, which can cause front teeth to protrude. Addressingthese habits can help to reduce treatment time and ensure the ortho-dontic treatment is not undone once braces are removed.

It’s important to note that the majority of elementary school-aged children do not need early treatment. However, for those whodo, early screening and intervention can help prevent dental prob-lems, reduce future treatment time, and correct issues that are muchmore difficult or impossible to address later, once facial bones arefully formed.

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

Orthodontics for second-graders? from page 31


Orthodontic treatment goesbeyond aligning teeth.

Health Care ConsumerAssociation

Minnesota

Each month members of the Minnesota HealthCare Consumer Association are invited toparticipate in a survey that measures opinionsabout topics that affect our health caredelivery system. There is no charge to jointhe association, and everyone is invited.For more information, please visitwww.mnhcca.org. We are pleased to presentthe results of the December survey.

Per

cen

tag

eo

fto

tal

resp

on

ses

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

35

40

9.1% 9.1% 9.1%

36.4% 36.4%

Per

cen

tag

eo

fto

tal

resp

on

ses

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

12.7%

29.1%

23.6% 23.6%

10.9%

2. I feel there is inaccurate information in mymedical record.

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

Per

cen

tag

eo

fto

tal

resp

on

ses

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

35

12.7%

30.9%

18.2%

30.9%

7.3%

Per

cen

tag

eo

fto

tal

resp

on

ses

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

35

40

20.0%

16.4%14.5%

38.2%

10.9%

5.When physicians are mandated to collect data aboutdomestic violence, gun ownership, smoking, drinking,drug use, etc., it limits the productiveness of thephysician-patient relationship.

4. I do not feel my medical records are adequatelyprivate.

Per

cen

tag

eo

fto

tal

resp

on

ses

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

35

40

16.4%18.2%

7.3%

38.2%

20.0%

3. I limit my utilization of health care servicesbecause of potential impact on my insurancepremiums/status.

December survey results...

“A way for you to make a difference”

Join now.

SM

Welcome to your opportunity to be heard indebates and discussions that shape the futureof health care policy. There is no cost to joinand all you need to become a member isaccess to the Internet.

Members receive a free monthly electronicnewsletter and the opportunity to participatein consumer opinion surveys.

www.mnhcca.org

Health Care ConsumerAssociation

Minnesota


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

Potential pitfalls

Extras such as appetizers, soup, and bread typically just add morecalories and sodium to your daily intake because it is easy to forget toadjust entrée choices or portion sizes to account for the added caloriesand sodium. Having the breadbasket sit in front of you when you arehungry may cause you to snack on the bread (and butter) instead offilling up on your more nutritious, balanced meal. People watchingtheir calories should consume five to six ounces or servings of grainsdaily (depending on their weight, height, activity, and goals). One sliceof bread is equal to one ounce of grain, so breadbasket snacking caneasily put you over the recommended intake of grains if you alsoorder pasta or rice. If a restaurant’s standard side dish is starchy, suchas potatoes or rice, ask to substitute vegetables. That’s because vegeta-bles are rich in vitamins and minerals, low in calories, and have fiberand a high water content that help to fill you up.

Even a healthy option may be larger than you need. Ask theserver for a to-go box and put half of the meal into the box immedi-ately. People tend to nibble their food once they are full if it sits in

front of them. Another way to control portion size is to order anappetizer as your meal.

On the side

When ordering your meal, ask the server to put dressing and sauce onthe side. Just be sure to monitor your use of dressing and sauces; typi-cally, you receive more on the side than if it is served directly on food.Avoid the temptation to pour dressing or sauce onto the food yourself,as you will end up with excessive calories. Instead, dip your fork intothe sauce or dressing and then pick up pieces of the salad or entrée.

Be aware of high-calorie beverages. Don’t assume iced tea isunsweetened. Alcoholic beverages and dessert coffees can add100 to 500 calories to your meal, and some specialty beers haveas many calories in one glass as a six-pack of light beer. Some mar-garitas are equivalent in calories to consuming seven candy bars.Stick with water!

Avoid problem ingredients

If you have certain food allergies or intolerances, you need to beknowledgeable about your requirements. If you are intolerant togluten, for example, it is best to look online or call the restaurant tosee if it can accommodate your needs. Some restaurants are startingto label menu items as wheat-free or gluten-free. However, otherestablishments may have no idea what “gluten-free” means. SteveKroeker, a chef by trade, recently started following a gluten-free dietand visited a restaurant where he wasoffered whole-wheat pasta as a gluten-free alternative, even though whole-wheatcontains gluten. “Even though there aremany more gluten-free options now avail-able, it is still very misunderstood andunless you, as a gluten-free eater, have aclear understanding of what you can andcannot have, you put yourself at risk,”says Kroeker. Many sauces contain glutenand items that are sautéed may be dippedin flour, which contains gluten. Menusmay not contain this information, so youneed to request it. If your server is unsurewhether or not an item contains gluten,ask to speak to the chef or manager.

Check, please

Plan your choices before you reach therestaurant, and ask the server questions about how the food is pre-pared or if you can substitute items. Make your plate as colorful aspossible, since the more colors on your plate, the more vitamins, min-erals, and antioxidants (inflammation- and cancer-fighting com-pounds found in food) you will consume. By following these sugges-tions, you can maintain proper nutrition when dining out.

Heidi Greenwaldt, MS, RD, LD, CNSD, is a registered and licensed dietitianand is the spokesperson for the Minnesota Dietetic Association.

Cateringby Seward Co-op

100 extracalories a daycan producea 10-poundweight gainin a year.


If losing weight is on your list of resolutionsfor 2012, consider using these recommendations

for healthy eating in restaurants.

Tips from page 11

A philosophy of caring is good. A history of it is better.Caring. It would be nice if you could see it, like an amenity. Or tour it, like an apartment. But you can’t. All we can do is give you our definition: Caring is believing that everyone is someone who deserves to feel loved and valued, and be treated with dignity.

That’s not just something we say. As the nation’s largest not-for-profit provider of senior care and services, it’s what we’ve been doing for almost 90 years.

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

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

www.good-sam.com

Documents

Minnesota Health care News January 2012