Minnesota Health care News July 2013

July 2013 • Volume 11 Number 7

Eating disordersJillian Lampert, PhD

DentaltherapyKarl Self, DDS

StrokerehabilitationBruce Idelkope, MD

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

JULY 2013 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 Arshia Sandozi [email protected]

ACCOUNT EXECUTIVE Paula Abramson [email protected]

ACCOUNT EXECUTIVE Iain Kane [email protected]

www.mppub.com

JULY 2013 • Volume 11 Number 7

BEHAVIORAL HEALTHEating disordersBy Jillian G. Lampert, PhD, RD, LD, MPH, FAED

CALENDARMinority HealthAwareness Month

HEALTH CARE ARCHITECTURE2013 Honor Roll

SPECIAL FOCUS:STROKE REHABILITATIONStroke rehabilitationBy Bruce Idelkope, MD, and Alexander Zubkov, MD, PhD, FAHA

When the “vulnerable adult” is youBy Jen Kirchen, LSW

A stroke at 15By Judy McMillan and Michael McMillan

7 PEOPLE

NEWS4C O N T E N T S

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PERSPECTIVE

10 QUESTIONS

HEALTH PROFESSIONSDental therapyBy Karl Self, DDS, MBA

COMPLEMENTARYMEDICINEUtilizing alternative careBy Charles Sawyer, DC

Robert O.Fisch, MD

University of Minnesota,emeritus

Beau Crabb, MS, CGC

Children’sHospitals andClinics ofMinnesota

Exp. Date

� Check enclosed � Bill me � Credit card (Visa, Mastercard, American Express, or Discover)

Please mail, call in or fax your registration by 10/17/2013

MINNESOTA HEALTH CARE ROUNDTABLE MINNESOTA HEALTH CARE ROUNDTABLE

Background and focus:For the majority, end-of-lifeis the most medically managed part of life. With itcome complex issues thatinvolve economics, ethics,politics, medical science,and more. Advances in tech-nology are extending lifeexpectancies and require a redefinition of the term“end-of-life.” It now entails alonger time frame than one’sfinal weeks or hours, andprovokes debate as to whenlife is really over. Mecha-nisms exist to facilitate personal direction aroundthis topic, but there is aneed for improved coordina-tion among the entities that provide end-of-life support.

Objectives: We will discuss the significant infrastructure that supports end-of-life care. We will examine the roles of long-termcare/assisted living, palliative care, gerontology, and hospice. Wewill review the elements that go into creating advanced directives,including societal issues that make having them necessary, and thedifficulties encountered in bringing them to their current state. Wewill present a potential road map to optimal utilization of end-of-lifesupport today and how it may best be improved in the future.

Panelists include:

� Ed Ratner, MD, University of Minnesota Center for Bioethics

� Suzanne M. Scheller, JD, Elder Law and Advocacy

� Cheryl Stephens, PhD, MBA, President, CEO, Community Health Information Collaborative

� Tomás Valdivia, MD, MS, CEO, Luminat

Sponsors: Community Health Information Collaborative

Luminat • Scheller Legal Solutions

Please send me tickets at $95.00 per ticket. Mail orders to Minnesota

Physician Publishing, 2812 East 26th Street, Minneapolis, MN 55406.Tickets may also be ordered by phone (612) 728-8600 or fax (612) 728-8601.

Name

Company

Address

City, State, Zip

Telephone/FAX

Card #

Signature

Email

Thursday, October 24, 2013

1:00 – 4:00 PM • Symphony Ballroom

Downtown Mpls. Hilton and Towers

Advance careplanning

Addressing end-of-life issues

F O R T I E T H S E S S I O N

Cancer ResearchersSeek Volunteers The Masonic Cancer Center at the University of Minnesota isseeking volunteers for a cancerstudy that requires input from the general public.

The research is sponsored bythe American Cancer Society andis part of its Cancer PreventionStudy-3 (CPS-3). The study helpsscientists better understand thegenetic, environmental, andlifestyle factors that cause or prevent cancer.

Officials note that previoussuch studies have provided valu-able data on cancer, includinghelping researchers understandthe link between smoking andlung cancer.

Participation in the CPS-3 iseasy, officials say. Participantstake a survey, have their waistmeasured, and provide a smallblood sample.

“It’s amazing to imagine afuture without cancer,” saysDouglas Rausch, MD, medicaldirector of the Comprehensive

Cancer Center at HennepinCounty Medical Center (HCMC),one of many locations where peo-ple can enroll for the study. “Thisis a great opportunity to be part ofa study that just might producethe information needed to elimi-nate this widespread, life-threat-ening, and deadly disease.”

More information is availableat www.cancermw.org/cps3/TwinCities/TwinCities.html

Health GroupsPleased withLegislative SessionThe 2013 legislative session was a momentous one for the healthcare community in Minnesota.Public programs were expanded,a major new health insurancemodel was established, the to bacco tax saw a large hike, and funding was increased forhealth care providers. Health care organizations expressed satisfaction that policymakers hadworked to address the concerns of providers during the session.

The early part of the sessionsaw lawmakers working to imple-ment provisions of the AffordableCare Act (ACA) that had beenstymied last year, when theRepublican-led Legislature wasunwilling to endorse the ACA.With the Legislature controlled bythe DFL in 2013, Medicaid expan-sion was signed into law on Feb.19, ensuring that 35,000 additionalMinnesotans would have accessto Medicaid.

The Legislature then tackledhealth insurance exchanges,another key provision for expand-ing health insurance coverage touninsured Americans. The Daytonadministration had moved for-ward with planning for theexchange, but legislation wasneeded to set up the new insur-ance model. Officials estimate thatwith the passage of the exchangein early March, 300,000 currentlyuninsured Minnesotans will findcoverage. Ultimately, 1.3 millionstate residents could eventuallybenefit from the new exchange.

According to Dave Renner,director of Minnesota Medical

Association’s department of stateand federal legislation, his groupsaw progress on nearly all its pri-orities. “This was a very success-ful session,” Renner says. In addi-tion to Medicaid expansion andthe insurance exchanges, Rennerpoints to funding increases formedical education and the fund-ing for health prevention meas-ures like the State Health Im -prove ment Program. “Tobaccocontinues to be the No. 1 prevent-able cause of death and disease;obesity adds to significant healthrisks in a number of areas,” hesays. “If we can start addressingthose issues, we will go a longway toward keeping people out of the doctor’s office and out ofthe hospital.”

Lawmakers also approved a20-year, $455 million program tocreate a Destination MedicalCenter with Rochester’s MayoClinic. The funding is designed tomake Mayo Clinic competitivewith other large urban health centers such as Cleveland Clinicand Baltimore’s Johns HopkinsHospital.

N E W S

4 MINNESOTA HEALTH CARE NEWS JULY 2013

The Public Is Cordially InvitedTo an informative interactive conference with national and local medical leaders.

Date:

Saturday, August 10, 2013

Time:

8:30 am - 4:30 pm

Place:

Hubert Humphrey School

of Public Affairs

Conference Room

University of Minnesota

Minneapolis, MN

Cost:

$25.00 (lunch provided)

Registration:

http://tinyurl.com/lajk4uo

Or call Dave Racer at

651-705-8583, Ext 1.

Learn how Direct Pay Medical/Professional Practices provide affordable, quality

healthcare to you and your family:

• Gain better access to your doctor and know what your care will cost.• Hear real-life stories of practicing physicians and surgeons who have transitioned from

third-party insurance practices to a direct pay model.• Learn why many physicians, surgeons and other health care professionals are moving

to direct pay practices.

Learn first hand from MDs who are already in Direct Pay Practice:

Jane Orient, MD

Tucson, AZ

Juliette Madrigal, MD

Marble Falls, TX

Lee Beecher, MD

St. Louis Park, MN

Susan Wasson, MD

Osakis, MN

Chris Foley, MD

Minneapolis, MN

Robert Sewell, MD

Dallas, TX

Adam Harris, MD

San Antonio, TX

Merlin Brown, MD

Edina, MN

Gerard Gianoli, MD

Baton Rouge, LA

James Eelkema, MD

Burnsville, MN

Lee Hieb, MD

Lake City, IA

Plus Twila Brase (CCHF) and Authors: Lee Kurisko, MD Ralph Weber & Dave Racer, Mlitt

Sponsored by the Association of American Physicians and Surgeons (AAPS) and the Minnesota Physician and Patient Alliance (MPPA)

Bill Seeks FlexibilityFor HSAs, FSAsRep. Eric Paulsen is calling fornew legislation to promote theuse of health savings accounts(HSAs) and flexible spendingaccounts (FSAs). Paulsen, whorepresents Minnesota’s 3rdDistrict, says the federal govern-ment should simplify regulationsaround the health insurance mod-els and do away with the “use itor lose it” rule that prevents FSAfunds from rolling over from oneyear to the next.

“With health care costs on the rise, Congress should be taking steps to make it easier forAmericans to save, not limit theiroptions,” Paulsen says. “HSAs andFSAs are a great way for seniorsto plan for expenses that Medicarewon’t cover and for families toplan for health expenses likebraces or glasses. I am proud tointroduce a common sense bill that helps Minnesotans retain control of their own health careneeds.”

Paulsen’s Family and Retire-ment Health Investment Act wouldmake a number of changes to cur-rent HSA/FSA rules, includingremoving restrictions on HSA/FSAdollars used to purchase over-the-counter drugs; allowing HSA-qualified plans more flexibil ity incovering prescription medicationsfor chronic illnesses, diseases, andconditions; allowing individuals toroll over up to $500 from theirFSA account; and expanding thedefinition of qualified medicalexpenses.

NAMI, HealthPartnersPartner to ReduceMental Illness StigmaHealthPartners is working with theNational Alliance on Mental Illness(NAMI) to reduce the stigma asso-ciated with mental illness.HealthPartners, along with itsRegions Hospital in St. Paul andNAMI, is launching a public infor-mation campaign called “Make ItOK,” which seeks to encouragepeople to talk openly about men-tal illness and to ask for help.

“Mental illnesses touch us all,affecting people from every walkof life,” said Mary Brainerd,HealthPartners president and CEO.“Here in Minnesota, one in fivepeople experience a mental illnesseach year. Most people live withthe symptoms of a mental illnessfor up to 10 years before seekingtreatment, largely due to the stigma. Together, we are workingto change that and make it okay toask for help.”

The campaign will includeradio and television commercialsand print ads and the website,www.makeitok.org. The coalitionbegan offering education andcoaching sessions for businessand community groups in June.

Study FindsMinnesota SeniorsHealthiest in U.S.Minnesota is the healthiest state in the nation for seniors, a new report from United HealthFoundation says.

The foundation, a division ofMinnetonka-based UnitedHealthGroup, released its study on May 29 and found that Minnesota,Vermont, New Hampshire,Massachusetts, and Iowa are thetop five states for seniors’ health.The state with the lowest rankingfor senior health is Mississippi.

“The America’s HealthRankings Senior Report is a com-prehensive portrait of seniorhealth designed to inspire new,effective solutions that meet thehealth care needs of this rapidlyexpanding demographic,” saysReed Tuckson, MD, senior advisorto United Health Foundation. “We are measuring senior healthin order to help improve it. Stateswith healthy seniors have a com-bination of positive personalbehaviors and community sup-port, which demonstrate thatimproving senior health will onlycome about by acting on individ-ual, family, community, and statelevels.”

The report finds thatMinnesota’s strengths includehigh rates of annual dental visits,

News to page 6JULY 2013 MINNESOTA HEALTH CARE NEWS 5

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The Telephone Equipment Distribution Program is funded through theDepartment of Commerce Telecommunications Access Minnesota (TAM)and administered by the Minnesota Department of Human Services

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prescription drug coverage thatthe report finds reasonably com-prehensive, relatively high avail-ability of home health care work-ers, and a low rate of seniors atrisk of hunger. Minnesota’s rank-ing also reflects a large number ofseniors who report being in verygood or excellent health. Thestudy says that among the chal-lenges in Minnesota is a low per-centage of seniors with a personaldoctor or health care provider. Thereport notes that Minnesota’s sen-ior population is expected to grownearly 55 percent between 2015and 2030.

Stroke Numbers inState Remain Steady,MDH SaysThe Minnesota Department ofHealth (MDH) has released datashowing that the incidence ofstroke in Minnesota has heldsteady over the past eight years,while costs for treating strokescontinue to rise.

Stroke was the third-leadingcause of death in Minnesota as of 2010, state data show. MDHofficials say that since 2005, thenumber of stroke hospitalizationshas remained between 11,000 and 12,000 a year. They note thatduring the same time, the totalnumber of hospitalizations forheart attack declined almost 15percent from a high of 9,740 in2005.

Hospitalization data from 2011 show 11,570 hospitalizationsfor stroke for that year. The totalinpatient charges for these hospi-talizations were $414.1 million, an increase of $47 million in justtwo years.

As part of raising awarenessabout stroke, MDH is educatingMinnesotans about the warningsigns of stroke and promotingprevention as well. “The reality of stroke is that if you’re havingone, you need to get to the hospi-tal fast,” says Ed Ehlinger, MD,Minnesota commissioner ofhealth. “Our goal is for Minnesotato do a better job of managingblood pressure, cholesterol, smok-

ing, and other risk factors forstroke, so people never have toexperience this life-threateningemergency."

MDH officials say one keystrategy to help prevent strokehospitalizations is for doctors andproviders to deliver a heightenedlevel of care to patients who haveexperienced a transient ischemicattack (TIA) or a “mini-stroke.”After a TIA, patients are at a higher risk for full-blown stroke,officials say, and should work withproviders to explore treatmentoptions such as aggressively con-trolling their blood pressure, tak-ing blood-thinning medications,stopping smoking, and avoidingheavy drinking.

Community HealthClinics to ReceiveMore FundingCommunity health centers inMinnesota will get more fundingfrom the federal government aspart of the Affordable Care Act(ACA), as the new law begins

providing coverage to moreMinnesotans. Such clinics tradi-tionally have served a high per-centage of uninsured Americans.

Federal and state officials saymore than $1.6 million will beavailable to support the 16 feder-ally designated community healthcenters in Minnesota.

“Health centers have exten-sive experience providing eligibil -ity assistance to patients, are pro-viding care to 181,389 individualsin Minnesota communities, andare well-positioned to supportenrollment efforts,” says Healthand Human Services SecretaryKathleen Sebelius. “Investing inhealth centers for outreach andenrollment assistance providesone more way the Obama admin-istration is helping consumersunderstand their options andenroll in affordable coverage.”

The new funds will allow cen-ters to hire new staff, train exist-ing staff, and conduct communityoutreach events and other educa-tional activities.

News from page 5


Our Pediatric Therapies partner with families to help children gain skills and improve functioning through:

Occupational Therapy

Speech and Language Therapy

Feeding Therapy

Music Therapy

Learn more:stdavidscenter.org/therapies 952.548.8700

When it comes to your child,

getting help early is your priority.

It’s ours too.

I am passionate about being an advocate for the elderly and disabled, including in maltreatment, injury and wrongful death claims.

Other services include:• nursing home litigation

• health care agent appointments

• elder abuse and neglect

• elder mediation

• nursing home resident rights

• estate planning

• speaker

Please contact:

Suzanne M. Scheller, Esq. Scheller Legal Solutions LLC6312 113th Place NorthChamplin, MN 55316

[email protected]

Elder and Advocacy Services

www.schellerlegalsolutions.com

Judith A. Jerde, RN, senior nursing project coordinator with

HealthPartners, has been named this year’s CDC Childhood

Immunization Champion for Minnesota by the federal Centers for

Disease Prevention and Control (CDC). The award acknowledges indi-

viduals whose extraordinary efforts help improve immunizations

among children from birth to age two. Jerde’s work helped increase

the percentage of children age 18–23 months who were up to date on

vaccinations following a HealthPartners clinic visit

from approximately 80 percent before 2012 to

84.7 percent at the end of 2012.

Kristine Matson, MD, a board-certified pedia-

trician, has joined the staff at PACE Pediatrics

Clinic’s West St. Paul site; PACE is part of

Children’s Hospitals and Clinics of Minnesota.

Matson earned her medical

degree in 1983 from Sanford

School of Medicine of the University of South

Dakota and completed a residency in pediatrics

at Fairview University Medical Center. She has

worked as a pediatrician in the Northfield area

for the past 16 years.

Ronald C. Peterson, MD, PhD, a professor in

the Department of Neurology at the Mayo Clinic

and the director of the Mayo Clinic Alzheimer’s

Disease Research Center, testified before the Senate Special

Committee on Aging regarding the status of the National Alzheimer’s

Project Act, which is legislation that aims to treat Alzheimer’s disease

effectively by 2025. In his testimony, Peterson addressed such points

as the potential burden and cost of Alzheimer’s disease on the health

care system, current research that shows the benefits of early care and

treatment for the disease, and the crucial need for funding.

Lipi Ramchandani, MD, MS, has joined

Hennepin County Medical Center’s (HCMC) St.

Anthony Village Clinic. She graduated from Grant

Medical College, Mumbai, India, and completed

family medicine residency training at the

University of Minnesota, North Memorial

Program. Ramchandani

earned a master’s degree

in clinical research from the

University of Minnesota School of Public Health

in 2008. Andrew H. Schmidt, MD, an orthopedic

surgeon at HCMC, has begun his term as presi-

dent of the Orthopaedic Trauma Association,

elected by his peers who are voting members

of that international organization.

Richard Sveum, MD, an allergy specialist with Park Nicollet Clinic,

has received the Lifetime Achievement Award from the American Lung

Association in Minnesota. Sveum is a member of the health charity’s

Leadership Board, the medical board for the Lung Association’s Camp

Superkids program, and the board of the American Lung Association

of the Upper Midwest. Sveum is also a clinical professor in pediatrics

and medicine at the University of Minnesota Medical School.

Richard Ziegler, PhD, has assumed the position of executive direc-

tor of the Essentia Institute of Rural Health. Ziegler has more than 25

years of administrative experience, including serving as dean of the

University of Minnesota Medical School, Duluth.

P E O P L E


Ronald C. Peterson,

MD, PhD

Lipi Ramchandani,

MD, MS

Andrew H. Schmidt, MD

Kristine Matson, MD

H2462_68051_CMS Accepted 5/18/2013. Plan performance Star Ratings are assessed each year and may change from one year to the next. HealthPartners is a health plan with a Medicare contract. ©2013 HealthPartners

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. Stop smoking

. Keep your blood

pressure low

. Keep your

cholesterol low

. Be active for 30 minutes every day. Eat less salt. If you have diabetes, keep your blood sugar low

Prevent strokes. Lower your risk today.

This campaign was adopted from the Minnesota Stroke Partnership.

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Robert O. Fisch, MD

University of MinnesotaMedical School

Robert O. Fisch,MD, is emeritus

professor of pediatrics at the

University ofMinnesota MedicalSchool. He is alsoan internationallyexhibited painter; a collection of his

paintings withaccompanying textwas published in1994 as “LightFrom the YellowStar—A Lesson

of Love from theHolocaust.” For more

information, visitwww.yellowstarfoundation.org.

Additional booksby Dr. Fischinclude “The

Metamorphosis to Freedom,”

“Dear Dr. Fisch:Children’s Letters

to a HolocaustSurvivor,” and

“Fisch Stories—Reflections on

Life, Liberty andthe Pursuit ofHappiness.”

esilience. As a doctor, my first thought isto define this word in a way that relates tophysical health. In appendicitis, for exam-

ple, the body is usually physically resilient enoughto withstand the cure, which is surgery.But life has taught me that resilience also relatesto the mind and spirit.

Positive outlook

Born in Hungary, I survived a Nazi concentrationcamp and came to the U.S. in 1957. I have been aJew under Fascism, a bourgeois underCommunism, a rebel defeated in an uprising, arefugee among the free, and a have-not amidplenty. In spite of many traumatic and life-threat-ening experiences, personal tragedies, anddepressions, having resilience saved me.Resilience allows a personto find something good in abad experience. For exam-ple, you can learn to bemore humane as a result of experiencing inhumanetreatment.

Resilience plays an impor-tant part in everyday life. It helps people surviveand even thrive in spite of circumstances theycannot control, such as being laid off or a lovedone’s death. It enables the resilient person to copeby envisioning a future beyond his or her currenthardship. People who haven’t learned how to han-dle adversity may dwell on problems instead offocusing on finding solutions to those problems.They may also rely on unhealthy coping mecha-nisms such as overeating and other forms of sub-stance abuse.

Fostering resilience

Fortunately, it is possible to develop resilience.Consciously deciding to have a positive outlookfosters resilience and the health benefits that havebeen scientifically shown to derive from it. Thesebenefits include reduced stress and a reduced riskof heart disease, anxiety, and depression. In orderto cultivate a positive outlook, practice thesebehaviors:

• Don’t keep problems to yourself; talk about yourchallenges with supportive people.

• Make time for yourself every day to relax. Somepeople do this by listening to music, petting adog, or carving out time to be alone.

• Take care of your health by eating a healthy dietand getting enough sleep and regular exercise.Do not use substances that can mask stress, suchas alcohol and drugs.

• See the absurd in apparently bleak situationsand take humor seriously. That may seem con-tradictory, but it is part of the wisdom of theBuddhist pillar, “Let things go.” This comes intoplay when, from time to time, we all find our-selves at a crossroad where we can choose apositive outlook or a negative outlook.

Choices

The outlook we choose determines whether we travel a positive or negative road. That, in turn,determines our quality of life. A negative roadleads to fear, hopelessness, and despair, mingled

with envy, resentment, and anger. That outlookpoisons our thoughts,spoils personal relation-ships, and does not allow aperson to have a produc-tive and enjoyable life.

Choosing a positive road,however, leads to hope and breeds a courage thatis enriched by generosity and empathy. This routeencompasses an acceptance of our limitationsand an appreciation of the impermanence of ourexistence. Once we accept our limitations, rela-tionships and experiences become more preciousand fulfilling. Each taste, smell, and sight bringsus pleasure. The joys and sorrows we share withfellow human beings renew our strength andaffirm our desire to make the most of the gift oflife. We become more outgoing, unselfish, moreconstructive, and more creative.

We are changed for the better in all physical andmental respects.

Resilience breeds resilience

Whatever happens to us and whoever we are, we should enjoy every minute as a gift. We shouldlook for the good in every situation and in everyindividual, create good where we can, and keepsmiling.

ResilienceDeveloping the ability to cope with adversity

P E R S P E C T I V E

R

See the absurd in apparently bleak situationsand take humor seriously.



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Mr. Crabb is a board-certified genetic counselor at Children’s Hospitals andClinics of Minnesota.

Genetic counseling is a relatively new field; what can you tell usabout its history? Genetic counseling is the process of helping people understandand adapt to the medical, psychological, and familial implications of genetic contri-butions to disease. This process integrates interpretation of family and medical histories to assess the chance of disease occurrence or recurrence, education aboutinheritance, testing, management, prevention, resources, and research. Genetic coun-seling’s goal is to promote informed choices and adaptation to a risk or condition.

The first class of master’s degree genetic counselors graduated from SarahLawrence College in 1971. Eight years later, genetic counselors formed a profes -sional society, the National Society of Genetic Counselors (NSGC). There are currently more than 2,700 NSGC members.

What training and certification are required to be a genetic coun-selor? Genetic counselors are health professionals with specialized graduatedegrees and experience in the areas of medical genetics and counseling. Counselorsenter the field from a variety of disciplines, including biology, genetics, nursing, psychology, public health, and social work. A genetic counseling degree is a two-year master’s degree that combines coursework and clinical experience. Followinggraduation, genetic counselors take board-certification tests; becoming a certifiedgenetic counselor (CGC) is required for most genetic counseling positions. Coun-selors must recertify every five to 10 years. Some states have additional require-ments and a genetic counseling licensing program. Minnesota does not yet have alaw establishing licensure requirements, but efforts are underway to create one.

What are some of the reasons a person would see a genetic coun-selor? There are a variety of reasons. Someone who is pregnant or consideringchildbearing and is concerned about the health of the baby might see a geneticcounselor in a prenatal clinic. When a person is concerned that they, their child, or a family member has a genetic or inherited condition, they might visit a geneticcounselor in a specialty or pediatric clinic to discuss diagnostic testing options.Families with a history of developmental disability, birth defects, and/or mentalretardation often see a genetic counselor to learn their testing options or recurrencerisks. Sometimes, genetic counselors see individuals with a family history of cancerwho would like to know if there is a genetic explanation for that history.

Does insurance typically cover the cost of genetic counseling?Insurance typically covers the cost of a genetic counseling visit, especially whenreferred by a physician specialist. The amount of coverage provided for genetic testsvaries widely, depending on what type of insurance someone has. Genetic coun-selors coordinate testing, verify insurance coverage, and advocate for their patientsto obtain coverage for recommended testing. Many people have concerns about thepotential for discrimination based on genetic testing results. Luckily, the GeneticInformation Nondiscrimination Act (GINA) was passed in 2008 and prohibits dis-


1 0 Q U E S T I O N S

Photo credit: Bruce Silcox

Making sense of genetic informationBeau Crabb, MS, CGC

crimination in health coverage and employ-ment based on genetic information. Where do genetic counselors work?Genetic counselors work in a variety of set-tings, including university medical centers,private and public hospitals/medical facilities,diagnostic laboratories, pharmaceutical com-panies, not-for-profit organizations, and government organizationsand agencies. We work in multiple specialty areas, including prenatal,cardiovascular disease, cancer, metabolic disease, neurology, pediat -rics, infertility, and genomic medicine. Increasing demand for geneticexpertise means genetic counselors are working in administration,research, public and professional education, Internet companies andwebsites, public health, laboratory support, public policy, and con-sulting.

What are some of the ways a genetic counselor interactswith physicians? Most genetic counselors work closely with aphysician in a specialty clinic. Many specialist physicians refer theirpatients to genetic counselors, including obstetrician/gynecologists,primary care physicians, oncologists, gastroenterologists, neurolo-gists, cardiologists, ophthalmologists, and pulmonologists.

Tell us about some biomedical ethics issues raised by thefield of genetic counseling? One recurring theme is the ethicalconcept of autonomy. For example, parents may request that theirminor child be tested for an adult-onset genetic condition that runs inthe family so they can prepare for the future. Genetic counselorsguide families through the process of deciding whether to test.

Deferring predictive genetic testing of minorsfor adult-onset conditions is recommendedwhenever possible. The decision to test, whenthe test is not anticipated to impact medicalmanagement in the near term, is made on acase-by-case basis. Deferring predictive gen -etic testing until a child becomes an adult and

can choose whether or not to test preserves a child’s autonomy.

What is a challenge facing the field? Insurance coverage forrecommended genetic testing is highly variable, and genetic testing isinherently a costly endeavor. Counselors frequently have to deal withthe frustration of families who cannot afford to pay for testing out-of-pocket and whose insurance companies denied testing.

How does someone access a genetic counselor? Mostpatients get a referral from either their primary care provider or aspecialist. Genetic counselors are happy to speak with patients priorto referral to determine if a genetic counseling visit is warranted. Twowebsites help patients find a genetic counselor: the NSGC website(www.nsgc.org) and the Minnesota-specific genetic counselor associa-tion (www.mygenepool.org).

What does the future of genetic counseling hold? The race is on to offer whole-genome sequencing on a clinical basis.While this is an exciting prospect, it also increases the likelihood ofhaving ambiguous results and incidental findings. Genetic counselorswill play a critical role in helping families process the immenseamount of information that these new tests will provide.


Genetic counseling’s goal is to promote informed

choices and adaptation to a risk or condition.

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ScopeA dental therapist is a midleveldental practitioner whose respon-sibilities overlap those of dentalhygienists and dentists. Dentaltherapists work under the super-vision of a licensed dentist toprovide basic dental services,including some that were previ-ously available only from a dentist. Minnesota law allowsdental therapists to provide preventive and restorative care,as well as limited minor surgicaldental care. This includes takingX-rays, applying fluoride, placingsealants, and delivering oralhealth care instructions and disease prevention education.

For example, a dental thera-pist can restore teeth by drillingout cavities and placing perma-nent fillings and can stabilizebroken teeth by placing tempo-rary crowns. (Only a dentist mayplace a permanent crown.) Withadditional master’s-level trainingand 2,000 hours of clinical prac-tice, a licensed dental therapist

may take an examination for certification as an advanced dentaltherapist. This certification allows a dental therapist to practice incollaboration with a dentist but without on-site supervision, whichmakes it possible to offer dental services at such sites as schools andnursing homes. Other countries that utilize dental therapists reportthat the quality of dental therapists’ work is the same as that pro-vided by dentists.

TrainingTo work as a dental therapist in Minnesota requires graduationfrom a dental therapy educational program approved by theMinnesota Board of Dentistry and successful performance on thestate licensure examination. There are currently two approved train-ing programs in the state. The University of Minnesota School ofDentistry offers a 28-month full-time program; Metropolitan StateUniversity and Normandale Community College collaborativelyoperate a 26-month full-time program.

Students at the School of Dentistry take most of their coursesalongside dentistry and dental hygiene students, an environment thatmodels the working relationship in a general dental practice. Theyalso participate in interprofessional learning experiences such asclinical rotations within the community and volunteer service events.This collegial approach to education ensures a solid educational andclinical preparation, and promotes collaboration between the vari-ous dental professions, a single standard of care for patients, and asmooth transition from education into professional employmentafter graduation.

H E A L T H P R O F E S S I O N S

New profession aims to easehealth care shortages

By Karl Self, DDS, MBA

Dental therapyIf you don’t knowwhat dental ther-apy is, you’re notalone. It’s fairlynew to the U.S.,although the

profession originated in NewZealand during the 1920s, whenotherwise fit men were rejectedfor military service in World War Ibecause of the poor condition oftheir teeth. Today, more than 50 countries utilize some form of dental therapy, includingAustralia, Canada, Netherlands,and the UK. In 2011, Minnesotabecame the first U.S. state tolicense dental therapists, and it is the first state to offer trainingfor this profession.

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The first classes of dental therapists in the U.S. graduatedin 2011 from both the School of Dentistry and MetropolitanState; 27 students are now in the educational pipeline.Currently, 25 licensed dental therapists, including oneadvanced dental therapist, practice in the state, working in avariety of urban and rural settings that include communityclinics, large group practices, nonprofit clinics, and privatepractices that reach out to the underserved.

Addressing current problemsDental therapy was created specifically to extend dental careto underserved areas. Minnesota state law specifies that den-tal therapists must practice in “settings that serve low-income, uninsured, and underserved patients, or in a dental health profes-sional shortage area.” In 2011, 56 of Minnesota’s 87 counties were designated as complete or partial dental health professionalshortage areas.

This shortage is predicted to increase as more Minnesota dentists get closer to retirement. According to the MinnesotaDepartment of Health, the average age of a dentist in 2010 was 54 years, compared with an average age of 47 a decade earlier. Andthe average age of a dentist in rural Minnesota is even older (57). A recent survey found that roughly 60 percent of all Minnesota den-tists between the ages of 55 and 65 plan to retire within the next 10 years.

These statistics highlight the point that even as our state’s population continues to increase, the number of dentists in thestate may start to decline. Add to that the reality that some peoplelack dental care because of financial concerns, and that it costs less for a dental therapist to deliver services than for a dentist todo so, and it becomes clear that adding dental therapists to the

ranks of dental care providers canmake it easier for Minnesotans to find and afford dental care.

Growing needThis is important because untreated oraldiseases usually do not get better. Theytypically become more serious, morepainful, and more difficult to treat.Nationally, almost 2.5 million days ofwork and more than 51 million schoolhours are lost each year to oral illness.

Equally disturbing is that the rate ofcavities among U.S. children 2–5 years of age has recently increased. Even

worse is that in our state, the tooth-decay rate among children ishigher than the na tional average: 55 percent of Minnesota third-graders have at least one cavity, compared with 53 percent of same-aged children nationwide. Data from New Zealand and other coun-tries in which dental therapy has an established history have shownthat access to dental therapists can reduce the rate of cavities, espe-cially in children, by increasing access to dental care.

Minnesota has a growing number of people who have identifiedoral health care as their most important unmet need, because theyeither cannot afford the care or cannot find a dentist to provide it.Benefits of having a dental therapist on an oral health care teaminclude increasing a dental clinic’s efficiency and capacity to care for

a greater number of underservedpatients, as well as freeing dentists todevote more time to complex treat-ment needs.

Model for the countryOther states are following our lead.The Maine legislature heard testi -mony from Leon Assael, DDS, deanof the University of Minnesota Schoolof Dentistry, as it considered legisla-tion this past spring to license dental

therapists. (The proposed Maine law had not been voted on as thisissue went to press.) Approximately 20 other states across the U.S.are currently considering licensing dental therapists.

Minnesota is on the cutting edge of innovation in oral healthcare delivery. We expect to see dental therapy become more wide-spread in this state and in the nation during the next five years asthe public and dentists become more aware of the improved accessto care made possible by this new category of health care provider.

As John Powers, DDS, a dentist with Main Street Dental Carein Montevideo, notes, “In the [time] we’ve had a dental therapist,we have seen a lot of families get turned around in terms of theiroral health because of the fact that the dental therapist is seeingthem.”

Karl Self, DDS, MBA, is a clinical associate professor and the director of the Division of Dental Therapy at the University of Minnesota School of Dentistry.


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A growing trendBy Charles Sawyer, DC

Consumers are increasingly turning tohealth care providers who historicallyhave not been members of mainstreammedicine. In 2008, the National Centerfor Complementary and Alternative

Medicine and the National Center for Health Statistics releasedfindings from a 2007 National Health Interview Survey, reportingthat nearly 40 percent of Americans use some type of complement -ary or alternative health care treatment. Among the providers of thistreatment are chiropractic doctors and a group of alternative medi-cine providers that includes acupuncturists, massage therapists,naturopathic doctors, and other practitioners who until recentlycared for patients largely outside of mainstream medicine.

Do new treatment methods work?

Recent research supports the effectiveness of these new methods. Arandomized clinical trial published in the January 2012 issue ofAnnals of Internal Medicine studied three groups of patients who

sought treatment for relief of neck pain.One group was treated with spinal manipula-tion performed by chiropractic doctors, a second group did neck exercises at home,and the third group received onlymedication. Researchers found thatpatients who received chiropractictreatment and patients who did neckexercises at home had better long-termrelief of neck pain than patients whoreceived only medication. These resultsare notable because neck pain affectsnearly 75 percent of people in Americanat some point in their lives. Neck pain isone of the most frequent reasons for trips to primary care doctors,prompting millions of visits every year, according to a 2007 reportin the medical journal Spine.

C O M P L E M E N T A R Y M E D I C I N E

Utilizing alternative care

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Another study supporting the value of using an alternativetype of care was reported in October 2012 in JAMA InternalMedicine. In this study, researchers analyzed data from 29 clini-cal trials that assessed acupuncture as a treatment to reduce

chronic pain. The study comparedpain reduction in patients who

received real acupuncturewith that in patients whoreceived sham, or fake,acupuncture. Fifty percentof the patients who receivedacupuncture reported decreased

pain, compared with 30 percent ofthe patients who received shamacupuncture. The study concludedthat acupuncture was effective for thetreatment of chronic pain.

New models of care

In the Twin Cities, several sites host health professionals from differ-ent disciplines who blend new, evolving methods of care with tradi-tional medical treatment in an integrative approach to health care.Examples include the Penny George Institute for Health and Healing

at Abbott Northwestern Hospital inMinneapolis and the Whittier Clinic

and Parkside Alternative MedicineClinic, both operated byHennepin County MedicalCenter. The health clinics atNorthwestern Health Sciences

University (NWHSU) already pro-vide and continue to develop an inte-

grative model of health care. NWHSU hashealth care providers from multiple fields in one clinic, making it eas-ier for them to confer with one another about a given patient andmaking easier for patients to access more than one provider duringthe same visit. Another significant leader in the integrative healthmovement is the Center for Spirituality and Healing at the Universityof Minnesota, which educates health professionals about this newmodel of care.

Insurance coverage

Not all services provided in integrativehealth settings are covered by healthinsurance. Nonetheless, patients areincreasingly electing to pay more out ofpocket because they see the value inalternative clinical approaches thatcomplement or may even substitute forconventional medical care. Many advo-cacy groups are aggressively pressinghealth insurers to include better cover-age for alternative clinical treatments.

It is important that everyone involved in your health be aware ofall treatments you receive. Each of your health care providers needsall of your health information in order to make informed treatmentplans. This also helps one health care provider to avoid inadvertentlyprescribing medication that could interact adversely with medication

prescribed by other health care providers.Keeping all your providers “in the loop”about all your treatments promotes betterand more efficient health care.

What does the future hold?

As our health care system continues toevolve, patients can expect to see new models of integrative care. We should allbecome more knowledgeable about impor-tant health issues, especially things we can

do ourselves to become and stay healthy. One thing we can do is toincorporate a good diet with an appropriate number of calories, moreexercise, and less stress into our busy lives. Patients should ask theirhealth care providers for help in making healthy life choices.

Second, talk to your medical doctor about the care you may bereceiving from your other health care professionals and give permis-sion to all of your health care providers to share your medical infor-mation with one another. As more health care providers use electron-ic medical records, this sharing will become increasingly efficient andwill ultimately lead to better care coordination.

Finally, for consumers who will be eligible to obtain health cover-age on Minnesota’s new health insurance exchange, MNsure, begin-ning in 2014, individual purchasers should shop for health insuranceplans that include adequate access to services they feel have value,including new methods of care.

Charles Sawyer, DC, is the senior vice president at Northwestern HealthSciences University in Bloomington.


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Iwas on a plane recently when my seatmate asked me what I do for a living. This is always a loaded question, and I amsometimes tempted to say: “I sell shoes at Macy’s.” It is not

because I don’t love my work or that I am ashamed of what I do. In fact, just the opposite is true. The work I do every day isincredibly important and I love it; it helps people heal from devastating illnesses and it saves lives. The reason I hesitate toshare my profession is that I can predict what will happen when I tell someone that I work in the eating disorder field.

More often than not I hear some variation of “I wish I had an eating disorder,” as if eating disorders are harmless and represent a great new weight-loss program. I try toremain calm as I explain that eating disorders are serious illnesses that can be life threatening. There are many mythsand misconceptions about eating disorders. Increasingawareness about these illnesses is of great importance.

B E H A V I O R A L H E A L T H

Eating disordersLife threatening but treatable

By Jillian G. Lampert, PhD, RD, LD, MPH, FAED

Widespread problem

It is estimated that more than 14 million people in the U.S. sufferfrom eating disorders, with over 200,000 sufferers in Minnesota.Eating disorders are not an adolescent phase, they are not behaviorproblems, and they are not a choice. Eating disorders are not aboutvanity and they are not limited to young girls who wish to be thin.You cannot tell if someone has an eating disorder by looking at himor her because people with eating disorders range from being dramat-ically underweight to being dramatically overweight.

Eating disorders do not discriminate. They affect all ages, impact-ing children as young as elementary school age and adults well intotheir 60s and 70s. Eating disorders occur across gender, socioeco -nomic status, ethnicity, and race. They often go undiagnosed untilthey are very serious. It is not uncommon for some-one who has an eating disorder to have a co- occurring illness like anxiety, depression, post-trau-matic stress disorder, or substance abuse.

Complex illnesses

Eating disorders are serious, complicated, complex illnesses thataffect all systems in the body. People who struggle with eating disor-ders experience severe disturbances in eating behavior, such asextreme reduction of calorie intake, purging behaviors, binge eating,and/or extreme distress about body weight and shape.

The American Psychiatric Association categorizes eating disordersas follows:

• Anorexia nervosa

• Bulimia nervosa

• Binge eating disorder

• Eating disorder not otherwise specified (EDNOS)

Anorexia nervosa is characterized by an intense fear of gainingweight and the relentless pursuit of thinness. People who strugglewith anorexia nervosa are unable to maintain a healthy weight andoften see themselves as overweight even when they are starved ormalnourished. Anorexia nervosa has the highest mortality rate of anypsychiatric illness; people with this disease are up to 12 times morelikely to die as a result of their illness compared with those withoutanorexia nervosa.

Bulimia nervosa is characterized by recurrent and frequentepisodes of eating large amounts of food followed by behaviors thatcompensate for the eating binge, such as purging, fasting, laxativeabuse, and/or excessive exercise. The person who struggles withbulimia nervosa feels out of control, fears weight gain, and is typi -cally intensely unhappy with her or his size and shape. People withbulimia nervosa can appear as if they are maintaining a normalweight and cannot be identified by outward appearance.

Binge eating disorder is characterized by recurrent binge eatingepisodes during which the person feels out of control over his or hereating. The person suffering from this disorder binge eats without thepurging, laxative abuse, or other behaviors used to compensate forthe binge eating to rid the body of food. There is a great deal ofshame, guilt, and self-loathing associated with binge eating disorder.

Eating disorder not otherwise specified (EDNOS) is a diagnosisfor someone who does not meet the strict criteria for anorexia,bulimia, or binge eating disorder, although EDNOS is no less seriousor life threatening.

Causes, risks

Eating disorders are biopsychosocial in nature. This means that theyare brain disorders that involve abnormal activity in the brain andare influenced by personality characteristics, genetics, and culture. Wealso know that we live in a culture obsessed with appearance, weight,shape, and food. Living in this culture of thinness gives most people adistorted idea about the importance of size and shape and gives theimpression that there is one “right” size that must be attained to behappy, successful, accomplished, appreciated, and loved. We knowthat dieting can be a gateway for developing an eating disorderdespite decades of medical research showing that calorie-restrictivedieting seldom contributes to overall health and is rarely effective forpermanent weight loss.

Here is a simple self-scoring tool that can help you decide if you or someone you care about may at risk for developing an eatingdisorder:

• Do you feel like you sometimes lose or have lost control over howyou eat?

• Do you ever make yourself vomit because you feel uncomfortablyfull?


Eating disorders to page 19

Eating disorders are brain disorders.

11 Navigating Cancer Lakeview Health presents Finding Your Waythrough Cancer, a four-week series for indi-viduals and families dealing with a cancerdiagnosis. Free. This series meets Thursdayevenings (July 11, 18, 25, and Aug. 1).Each week will address a different issue.Call (651) 430-4697 to register or for more information.Thursday, July 11, 7–8:15 p.m., LakeviewHospital, 927 Churchill St. W., Stillwater

17 Ability Support GroupWe ‘R’ Able offers this group for peoplewith a variety of health challenges. Come,share stories, and offer encouragement toothers. Donation of $1 per meeting isencouraged. For transportation needs, call Heartland Express at (763) 689-8131.For more information, call Loreli at (320) 358-1220.Wednesday, July 17, 1:30–2 p.m.,Chisago County Senior Ctr., 38790 6th Ave. N., North Branch

22 New Parent SupportAllina Health offers this support group for new parents and their infants, birth tosix months old. Come learn from an ECFE(Early Childhood Family Education) instruc-tor about feeding, development, sleepingpatterns, and childcare options. Free. Call (763) 506-1275 to register or for more information.Monday, July 22, 1–2:30 p.m., UnityHospital, Auditorium, 550 Osborne Rd.,Fridley

25 Brain Injury ClassMinnesota Brain Injury Alliance offers BrainInjury Basics: Adjustment to Brain Injury.Learn about life changes expected as aresult of brain injury and how to handle theroad ahead. $5 donation appreciated fromindividuals with brain injury or their fami-lies. For more information or to register, call(612) 378-2742.Thursday, July 25, 6–8 p.m., EducationCtr., Minnesota Brain Injury Alliance, 34 13th Ave. N.E., Ste. B001, Minneapolis

28 World Hepatitis DayJuly 28 is World Hepatitis Day.Immunization Action Coalition (IAC) offersaccess to essential information on hepatitisB, including links to CDC vaccination recommendations, patient and staff hand-outs, and other resources. Visit the IAC tolearn about vaccinations and hepatitis atwww.immunize.org

31 Assistive TechnologyPACER Center offers a free assistive tech-nology (AT) class for children with disabili-ties and their parents. Live web-streamingavailable. Call (800) 537-2237 for moreinformation. Register at www.pacer.org Wednesday, July 31, 6:30–8:30 p.m.,PACER Center, 8161 Normandale Blvd.,Bloomington

Aug.1 Eating Disorder SupportThe St. Cloud Hospital Behavioral HealthClinic offers this support group for friendsand family of those suffering from eatingdisorders. Come learn about different eat-ing disorders, and get tips on how to makemealtime less stressful. Free. Call Bette at(320) 229-4918 for more information.Thursday, Aug. 1, 4:30–6 p.m.,CentraCare Health Plaza, Leonard, Street& Deinard Rm., 1900 CentraCare Cir., St. Cloud

Aug.1 Pre-K Eye Exam DayMinnesota Optometric Association hasnamed August 1 “Pre-K Eye Exam Day.”Unlike vision screenings, eye exams checkfor eye function disorders and astigmatism.One-time, free eye exams will be offered to children entering kindergarten. For a fulllist of participating providers, checkhttp://minnesota.aoa.org

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., Minne apolis, MN 55406. Fax submissions to(612) 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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The U.S. House of Representatives pro-claimed July as National Minority MentalHealth Awareness Month in 2008. Thisproclamation was made in honor of BebeMoore Campbell to help carry out her goalof spreading mental health awareness andeliminating the stigma of mental illnessamong multicultural communities.

Herself a sufferer of mental illness,Campbell was an accomplished author,advocate, and co-founder of the NationalAlliance on Mental Illness (NAMI) UrbanLos Angeles. She said in 2005 that Americaneeded a national campaign to remove thestigma of mental illness—especially a cam-paign targeted toward African-Americans.Three years later, two years after her death,the awareness month was born.

One in four adults and one in 10 children in every community are affected by mental illness, so spreading awareness is essential in reducing the stigma associatedwith it.

If you or someone you know has amental illness, recovery is possible. For support groups and more information onmental illness, visit NAMI Minnesota atwww.namihelps.org

9 Get to Know NAMINAMI Minnesota offers this free class toteach the community about its organization.Come hear firsthand from staff and volun-teers about their work in the community, andlearn about the classes and programsoffered. For more information or to register,contact Kay at (651) 645-2948 x113.Tuesday, July 9, 11:30 a.m.–12:30 p.m.,NAMI Minnesota, 800 Transfer Rd., Ste. 31,St. Paul

Minority Mental Health Awareness Month


July Calendar

• Do you believe yourself to be fat, even when others say you are too thin?

• Does food or thoughts about food dominate your life?

• Do thoughts about changing your body or your weight dominateyour life?

• Have others become worried about your weight?

In this informal survey, two or more “yes” answers strongly indi-cate the presence of disordered eating.

Symptoms

Early warning signs of an eating disorder include:

• Skipping or avoiding meals or situations where food is present

• Avoiding specific foods or food groups

• Withdrawal from family and friends

• Preoccupation with weight, body size andshape, or specific aspects of appearance

• Unexpected shifts in weight

• Obsessing over calorie intake and caloriesburned via exercise

If you recognize these signs in yourself orsomeone you know, it may be time to seek pro-fessional assessment. It is hard to know how toapproach someone who may be struggling withan eating disorder, but remember that supportcan help the person recognize the problem and

seek treatment that will lead to recovery. One of the most importantthings support persons can do is to educate themselves about eatingdisorders. The more you know, the better you will be at supportingsomeone you care for.

Treatment

Because eating disorders are so complex, no single type of treatmentcan successfully address every person’s needs. Typically, treatment foran eating disorder involves an outpatient team of professionals. Thiscan include a therapist, dietitian, medical doctor, psychiatrist, andothers. Sometimes, treatment includes a longer-term stay in an inpa-tient or residential treatment program. Family and friends are a veryimportant part of the team.

Recovery

One of the most important messages to anyone struggling with an eating disorder isthat recovery is possible. There is help andthere is hope. Recovery can take a while andit can be hard, but full recovery happens!Studies show that, with good treatment, up to 75 percent of people can make a full andlasting recovery.

Jillian G. Lampert, PhD, RD, LD, MPH, FAED, is a dietitian and senior director for The EmilyProgram, a comprehensive eating disorder treat-ment program with multidisciplinary outpatientand inpatient treatment facilities throughoutMinneapolis/St. Paul and Duluth.

Eating disorders from page 17


One of the mostimportant messages to anyone struggling with an eating disorder is that recovery is possible.

Alcohol and drug abuse by seniors often goes unnoticed because of isolation and loneliness. As a result, the older adult continues to suffer in silence. Senior Helping Hands is a program of St. Cloud Hospital Recovery Plus and a recognized national leader providing support and services to stop the suffering. Senior Helping Hands serves individuals age 55 and older.

Services• Outreach service and consultation with family or concerned persons• Evaluation and assessment for chemical dependency and/or mental health

issues completed by qualified professionals• Volunteer support for older adults who are chemically dependent• Support from peer volunteer counselors for older adults with mental health issues

ProgramsOlder Adult Chemical Dependency Primary Treatment ProgramA comprehensive program that involves physical/psychosocial/chemical use assessments performed by professionals trained in chemical dependency and mental health, including a full time Medical Director who is an addictionist. The program provides a slow pace, holistic approach to recovery. Transportation and temporary housing are available if needed.

Chemical dependency in older adults is hard to recognizeWe help them live a healthier life

Contact Us713 Anderson Ave., St. Cloud, MN 56303(320) 229-3762 • (800) 742-HELP toll-free

www.centracare.com(Search: Senior Helping Hands)

health care architecture honor roll

innesota Physician’s 2013 HealthCare Architecture Honor Roll recognizes six outstanding

projects completed in the past year. This year’sHonor Roll projects include new clinic andhospital construction, remodeled spaces, andfacility expansions in urban, suburban, andgreater Minnesota. The medical services rangefrom routine clinic visits to specialized care.Populations served include the standardpatient rosters typically seen in family medicine clinics, as well as specializedgroups—such as new mothers and theirbabies, and children and adolescents needingindividualized psychotherapeutic care.

One urban facility remodeled anexisting space that previously housed a book retailer.

Seeking to provide a welcoming environment,many of the projects incorporate elementsfrom nature and feature eye-catching artwork.

Minnesota Physician Publishing thanks allthose who participated in the 2013 honor roll.

M


Type of facility: Medical office building/parking structure

Location: Duluth

Client: Ventas, Inc.

Architect/Interior design:Erdman; DSGW Architects,design consultant

Engineer: Erdman

Contractor: Erdman

Completion date:August 2012

Total cost: $25 million

Square feet: 175,000 sf

St. Luke’s Campus Building Awas built for the fast-chang-ing climate of health care,with an eye to the future.

The top floor of the five-floor medical office building is home to six of St. Luke’s spe cialty clinics:Gastroenterology, Neurosurgery, Orthopedics and Sports Medicine, Pediatrics,Physical Medicine & Rehab, and Plastic Surgery.

Patient exam rooms, procedure rooms, casting rooms, physician offices, lab, digital tomographic X-ray suites, a physical therapy room, and separate waitingareas for the pediatric and plastic surgery clinics are found on the fifth floor.

The main patient waiting area and a number of the patient exam rooms offerbeautiful views of Lake Superior.

The fourth floor is currently unoccupied, offering room for expansion.

The clinical space on the fourth and fifth floors comprises 70,600 square feetof the total 175,000-square-foot structure.

The lower three levels offer enclosed, climate-controlled parking for 219patient and emp loyee vehicles.

Top: Nurses’ stationRight: LobbyBottom: Entrance toMedical Building A

St. Luke’s Medical Office Building A

AmberwingType of facility: Child, adolescent, and young adult mentalhealth and chemical dependency treatment center

Location: Duluth

Client: Miller-Dwan Foundation

Architect/Interior design: John Ivey Thomas Assoc., architect; Kitchi Gammi Design, interior design

Engineer: SEH, civil; Northland Consulting Engineers, LLP,structural; The Design Group, mechanical/electrical

Contractor: Johnson Wilson Constructors

Completion date: August 2012

Total cost: $6.2 million


Amberwing–Center for Youth & Family Well-Being, built by the Miller-Dwan Foundation with more than $6 million in charitable gifts, provides individualized psychotherapeutic carefor young people and their families.

Amberwing was designed specifically to reduce the stress and stigma of mental health and chemical dependency care.Located on six wooded acres in the heart of Duluth, the facility’s central atrium and four treatment wings reflect thewelcoming warmth of a North Woods lodge. Each wing isanchored by a family-friendly kitchen and gathering area sur-rounded by separate rooms for educational therapy, talk ther -apy, play therapy, a classroom, and a living room-like space forfamily meetings. A separate wing designed for alternative ther-apies offers music, art, drama, occupational therapy, recreation,and movement therapy to enhance therapeutic outcomes.

An imaginative lobby, a community meeting area, a spiritualcenter, a treatment space for infant and toddlers, and a profes-sionally staffed parent and family resource center make up theheart of Amberwing, encouraging the community to enter.

The wooded outdoors, which is connected to a 16-acre fed eralpark, allows for nature walks in the spring and summer, out-door games, and snowshoeing in the winter. The buildingincludes an outdoor deck and a strategically designed outdoorgathering space to integrate nature into Amberwing’s treat-ment programming.

Left: A wooden, ribbed canoe suspended from the ceiling of thelobby, along with earth tones and comfortable design touches,carries out the facility’s theme of a welcoming North Woods lodge.

Top: The fireplace room provides a cozy space for youth and families to relax.

Bottom inset: The facility, built in a restful wooded area, is near a16-acre federal park.

Mother Baby CenterType of facility: Hospital

Location: Minneapolis

Client: Joint venture between Children’s Hospital and Clinics of Minnesota and AbbottNorthwestern Hospital

Architect/Interior design: HDR Architecture, Inc.

Engineer: Palanisami & Associates, Inc., structural; HDR Architecture, Inc., mechanical/electrical

Contractor: Knutson Construction

Completion date: January 2013


Square feet: 75,000 sf, new; 22,000 sf, remodeled

The Mother Baby Center combines Children’s Hospitalsand Clinics of Minnesota’s excellence in neonatal care with Abbott Northwestern Hospital’srenowned obstetrical program, enabling mothers, babies, and families to stay together and experi-ence the highest level of coordinated care.

The four-story facility is nestled between Abbott Northwestern and Children’s with a skyway thatconnects the two. The new facility has capacity for 5,000 births each year. It offers a compre-hensive approach to care, beginning at prenatal care and continuing through obstetrics, peri-natology, labor and delivery, neonatology, and pediatrics.

Combining a comforting spa-like atmosphere with state-of-the-art clinical technology, theMother Baby Center achieves an environment that balances function with the needs of fami-lies before, during, and after childbirth. The facility includes a maternal assessment center; 13labor and delivery rooms; two 24-bed postpartum units; an 11-bed high-risk antepartum unit;a 24-room/31-bed special care nursery; and three operating rooms, including an integratedoperating room for highly complex cases that is 150 feet from Children’s level III/IV NICU.

The Mother Baby Center has live telemedicine capabilities, allowing the center to extend itsexpertise beyond its physical location and advise providers at other birth centers in the region.

H O N O R R O L L 2013

Left: The signature entrance allows for a celebratory family experience.Left Inset: Rooms with a birthing tub provide moms with a variety of birthingoptions.Top: The exterior façade captures thewelcoming spirit of the Mother Baby pro-gram through color and creative forms.


Appointments:

Online or Call 651-439-8807

Providing care at multiple modern clinics in Minnesota and Wisconsin

In 2008, Tanzanian missionaries brought little Zawadi Rajabu to the U.S. to seek treatment for her two severely clubbed feet. A physician referred Zawadi to Dr. Mark T. Dahl of St. Croix Orthopaedics. Using the Ilizarov Method, Dr. Dahl surgically changed the course of Zawadi’s feet and her life.

Dr. David Palmer and Russ McGill, OPA-C, recently traveled to Tanzania on another of their frequent medical missionary trips. They dedicated an entire day to checking in on their partner’s patient. To their delight, they were greeted by 6-year-old Zawadi her face aglow, her healed feet dancing toward them.

Supporting Our Patients.Supporting Our Partners.Supporting You.

David Palmer, M.D.& Zawadi’s brother

Russ McGill, OPA-C& Zawadi

mute aviding carorP

innen clinics in Multiple moder

onsiniscWesota and

Hazelden Center forYouth and FamiliesType of facility: Addiction treatment facility

Location: Plymouth

Client: Hazelden Foundation

Architect/Interior design: HGA Architects and Engineers

Engineer: HGA

Contractor: Knutson Construction Co.

Completion date: October 2013

Total cost: $22,865,900


The Hazelden project consists of a 50,000-square-foot expansion and a 50,000-square-footrenovation of an addiction treatment facilityfor teens and young adults, ages 14–25, inPlymouth. It is nestled within a residential neighborhood surrounded bybeautiful woodland along the north shore of Medicine Lake, next toThree Rivers park grounds.

The expansion comprises a new, two-story 32-bed resident unit, gymnas -ium with rock-climbing walls and attached fitness room, a serene medita-tion area, a large auditorium, an outpatient clinic, and numerous groupand training rooms. The existing resident units/dormitories, the medicalservice unit, and the kitchen/dining area also are being transformed tomirror the elegance of the newly completed addition.

In January, Hazelden began serving patients in the new building withgreat enthusiasm. Employees and clients alike are highly satisfied withtheir brand-new space.

Landscaping is underway to enhance their experience even more with abeautiful water feature, labyrinth, fire pit, and amphitheater. The entireproject is scheduled to be complete this fall.

Top: Family waiting area

Inset: Entrance to the facility, which is nestled within a residential neighbor-hood surrounded by beautiful woodland along the north shore ofMedicine Lake in Plymouth


Dr. George Rizkalla and his caring staff look forward to treating you with personalized, gentle care!

Now offering same day crownsWe are preferred providers for most dental insurances including Delta Dental, Aetna, MetLife and more.Evening and Saturday appointments availableWalk-ins and emergencies welcomed

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HealthEast Midway ClinicType of facility: Outpatient internal medical clinic

Location: St. Paul

Client: MSP/University Medical, LLC

Architect/Interior design:HGA Architects and Engineers

Engineer: Anderson-Urlacher PA

Contractor: Welsh Construction

Completion date: April 2012



This medical clinic was built in therenovated space formerly occupiedby a book retailer. The two-storyinterior underwent many renova-tions, including skylights andpatient-friendly touches (no moreweighing patients in the publichallways). The exterior was alsoupdated to include heated side-walks by the main entrance, sopatrons don’t run the risk of slip-ping and falling.

The location was very attractive toHealthEast and real estate developerMSP on many levels. Located on thecorners of Hamline and UniversityAvenues, the new Midway clinic is

centrally located between Minneapolis and St. Paul.Neighbors like Super Target, Herberger’s, andWalmart make it a destination location for patrons.It is also located two blocks from where theCentral Corridor light rail will be, making it conven-ient for those patrons reliant on public transit.

This successful conversion of a retail space into a medical building will serve the needs of patients, providers, and HealthEast Care Systemextremely well.

Top: Floor-to-ceiling windows provide plenty of light in the waiting room.

Inset: The new facility’s location, near a number of retail stores and two blocksfrom the Central Corridor light rail (now under construction), make it conven-ient to patrons.

H O N O R R O L L 2013


Call to get help with: Planning for long-term care Remaining independent in your community Arranging for in-home services Getting help from state agencies Becoming involved in your community

Understanding Medicare

p with

A One Stop Shop for Minnesota Seniors

Riverwood Healthcare CenterType of facility: Critical access hospital (renovation)

Location: Aitkin

Client: Riverwood Healthcare Center

Architect/Interior design: HDR Architecture

Engineer: Paulson & Clark Engineering, Inc.

Contractor: Kraus-Anderson Construction Co.

Completion date: June 2013

Total cost: Withheld at owner’s request

Square feet: 24,365 sf (renovated)

Riverwood Healthcare Center is an independent, integrated hos-pital and clinic facility serving Aitkin county and nearby com-munities in northern Minnesota. Renovation in 2012–2013included remodeling of patient, specialty treatment, pharmacy,waiting areas, and staff amenities—all accomplished withoutinterruption to clinic or hospital services. Included was conver-sion of 11 existing patient rooms to single patient rooms; newlabor and delivery unit; relocated emergency room and intensive careunit; remodeled rehab space; addition of five infusion bays forchemotherapy and other medication therapies; and relocation of phar-macy, respiratory therapy, diabetes education, and wound care. In addi-tion, renovation created a new support services addition, which housesmedical records, human resources, and other services, bringing allRiverwood employees in Aitkin into one location. Infection controlswere implemented in each phase.

Other renovation work included utility and site improvements (grading,curb/gutter, courtyard pavers, landscaping) and additional parking. Theexpansion effort also facilitated an economic boost, creating 18 newpositions at the hospital and generating 130 new construction jobs witha payroll of approximately $6 million for the duration of construction. A

number of subcontractors were hired from Aitkin as well as the sur-rounding area, providing regional economic impact.

Top: Remodeled nurses’ station

Bottom: Riverwood Healthcare Center entrance at dawn


Everyonecares about

ALZHEIMER’S DISEASE.

At a Clare Bridge® community, we care for those who have been touched by Alzheimer’s and dementia. With innovative activities, home-like environments and professional staff, Clare Bridge communities deliver high-quality, full-time care. We also care enough to understand the full impact of this disease, from its destruction of the memory to the challenges and difficulties it poses for families and loved ones. And we respond accordingly. That’s why a Clare Bridge community is special.

If your family has been touched by Alzheimer’s, call or visit your nearest Clare Bridge community or log onto www.brookdaleliving.com.

We do more than care. We understand.

To learn more, visit us online at brookdale.com

BridgeClarea At ® community

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Stroke is a neurological condition that happens when a blood vessel to the brain is blocked. This blockage deprives brain tissueof the oxygen and glucose that the brain needs to function and

which is delivered by blood. This is one of the leading causes of dis-ability and death among adults. It often occurs in individuals who

have hypertension, diabetes, hyperlipidemia (excess fat in the blood), obesity, heart disease, sedentary lifestyles,

and who smoke; stroke is also seen in less commonmedical conditions. Stroke affects a broad spectrumof individuals in all age groups. An increasinglysedentary lifestyle and poor diet are increasing thenumber of young patients who suffer a stroke.

When stroke occurs, damage happens withinseconds. Medical attention can reduce damageonce a stroke is identified, but must be deliveredto the person who had the stroke within a fewhours after onset of stroke symptoms in order to produce noticeable benefit. After untreatedstroke damage has been present for 24 hours,any deficit is often permanent. It’s vital to recog-nize stroke symptoms and to get medical helpimmediately by calling 9-1-1.

What does a stroke do?

When an area of the brain is deprived ofoxygen, a central area of dead cells results.These cells are surrounded by a ring of cells

that were oxygen deprived but are not dead,which are surrounded by another ring of cells

rendered nonfunctional by the sudden shock of oxygen deprivationand resultant swelling. Each of these two areas surrounding the areaof cell death has some capacity to recover and may spontaneouslyrestore some brain function. In addition, other areas of the brainhave some capacity to compensate for the area damaged by thestroke. Most recovery happens in the first three to six months after astroke, but recovery may continue to occur for many years. Theextent of the injury relates to the size of the brain damage. Injury canbe minor, as in a transient ischemic attack, or major, with blockageof large vessels damaging a large area of the brain.

Recovery potential

Predicting recovery is complicated and often uncertain early after astroke. The functional deficits of a stroke depend entirely upon theblood vessel(s) involved and what part of the brain it nourished,because each part of the brain manages a specialized function. Forexample, there is a specific area responsible for speaking and a dif-ferent one for comprehending the spoken word. Separate areas oneach side of the brain control motor and sensory functions of limbs,and there are specific areas for reading, writing, language, memory,problem solving, balance, walking, coordination, and many morefunctions.

Blockage of larger blood vessels generally predicts greater injury.Injury to the dominant hemisphere, which controls speech and lan-guage, is more difficult to recover from than injury to the right hemi-sphere because the dominant half affects our ability to understandspeech. The dominant hemisphere is usually the left hemisphere in allright-handed and in most left-handed individuals. Other factorsaffecting recovery include age, previous stroke history, co-occurring

N E U R O L O G Y

Stroke rehabilitationPatients and specialists work together to maximize potential

By Bruce Idelkope, MD, and Alexander Zubkov, MD, PhD, FAHA

Read usonlinewherever you are!

www.mppub.com

medical conditions (especially diabetes), and family support.Nonetheless, there is always recovery potential that rehabili-tation aims to maximize.

The recovery process

Stroke rehabilitation focuses on maximizing recovery andrestoring independence, and typically occurs in stroke reha-bilitation centers. These centers are separate from the acutecare hospitals where strokes are initially diagnosed and treated. The type of stroke and the expectations for recoverydrive the selection of the best-suited rehabilitation site: acutestroke rehabilitation centers, subacute stroke rehabilitationcenters, or skilled nursing rehabilitation facilities. In an acutecenter, aggressive therapy is often undertaken twice daily for10–21 days until the patient’s degree of recovery allows theindividual to go home to continue therapy as an outpatient.In a subacute setting, less intensive therapies are applied forseveral months until the patient can continue therapy as an outpa-tient. In a skilled nursing setting, expectation for recovery is low anddoes not depend on the intensity of therapy, so patients in this settingreceive limited therapy while awaiting spontaneous brain recovery.

Multidisciplinary effort

All three approaches to rehabilitation involve a multidisciplinaryteam that includes the patient’s neurologist, nursing staff, speech- language pathologists, physical therapists, occupational therapists, psychologists, social workers, recreational therapists, nutrition specialists, and other specialties as needed. Speech-language patholo-gists address language, communication, and swallowing problems, as well as general cognitive function. Physical therapists help patientsmaximize their mobility and balance. Occupational therapists helppatients relearn self-care techniques and improve cognition. Psychol-ogists focus primarily on the patient’s mood and the amount of effortthe patient invests in rehabilitation. Recreational therapists helppatients learn or relearn ways to engage in hobbies. Nutritionistsaddress any needed dietary adaptations and healthy lifestyles. Social

workers handle discharge planningand family support.

Each specialist assesses effects of the stroke and what type of ther -apy will best help the patient attainindependent, functional living. Theteam determines a treatment plan thatincorporates all the specialties. This

team also meets regularly with the medical and nursing team to measure and modify its collective approach, as well as to communi-cate with the family and other concerned individuals.

Determination maximizes recovery

It is very important to understand that rehabilitation is not limited to a few hours with a therapist. We encourage our patients to followthe exercises they are prescribed, including daily stretching exercises.It is important to do so because these exercises stimulate the brainand retrain it. It takes determined, diligent effort and perseverance on the part of the patient in order for his or her brain to learn how tocompensate for damage.

This effort pays off. One study showed that constant efforts touse a stroke-weakened hand resulted in much greater improvement in

function in that hand compared with patients who relied on theirhealthy hand for daily tasks.

Bruce Idelkope, MD, is the medical director of the Minneapolis Clinic ofNeurology Rehabilitative Services Department, and is an associate professorof neurology at the University of Minnesota Medical School. Alexander Zubkov, MD, PhD, FAHA, is the medical director of the FairviewSouthdale Hospital Stroke Program, anadjunct associate professor of neurologyat the University of Minnesota MedicalSchool, and practices with the MinneapolisClinic of Neurology.


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Rehabilitationis not limited to a few hours

with a therapist.

Stroke symptoms—Act FAST

CALL 9-1-1 immediately if you see any of these stroke symptoms

• Face: Ask the person to smile. Does one side of the face droop?• Arms: Ask the person to raise both arms. Does one drift down?• Speech: Ask the person to repeat a simple sentence. Is the speech

slurred or odd?• Time: Call 9-1-1 immediately if you observe one or more of these

symptoms.

Other common stroke symptoms

• Sudden numbness or weakness of the face, arm, or leg, especially onone side of the body

• Sudden confusion; trouble speaking or understanding• Sudden trouble seeing in one or both eyes• Sudden trouble walking, dizziness, loss of balance or coordination• Sudden severe headache with no known causeAdapted from Minnesota Stroke Association, www.strokemn.org


By Jen Kirchen, LSW

After 15 years of serving vulnerableadults as a licensed social worker, I became a vulnerable adult myself

as a result of a stroke at age 36. My lifewas turned upside down. No more car-pool for my daughters or work deadlines;the stroke left me unable to walk, talk,or even eat. Medi cal professionals whoem brace the compassion necessary tomake a difference in the lives of strokesurvivors are the most beneficial inrecovery. But what happens when thepatient is you?

Eight years ago, I met the man of mydreams and together wehave made a fam ily ofour own with my chil-dren from a previousmarriage. I am like anyother working mom: I getthe kids off to school, goto work, have meetings,and hurry home fromwork and make dinner formy family.

An average day takes afrightening turn

Nov. 16, 2010, was an average day. After dinner, Iheaded to the high school tovolunteer my time coachingmy daughter’s volleyball team.

That night I was assistingwith volleyball tryouts. Therewere multiple groups of girls trying out for the volleyballclub, and as we were waiting forthe next group to finish andcome to our station, I noticed thesudden onset of numbness in myright hand. I thought the cause

might have been a pinched nerve in my shoulder since I had beentossing so many volleyballs for the drill. I rubbed my hand, thinkingthe feeling would go away, and it tingled. I decided to go out intothe hall and get a drink of water, hoping to shake it off.

Upon attempting to reenter the gym, I went to grab the doorhandle and my right hand didn’t work; it had gone totally limp. Iwas terrified! I opened the door with my left hand and called out toone of the other coaches. She came out and asked what was wrong.By that time, my hand had gone limp and my speech had started togo. I thought, “This is a stroke,” but Icouldn’t tell her since my speech was lim -ited. She asked if I needed to go to the doc-tor and I said yes. She transported me tourgent care.

Within an hour of the onset of my firstsymptom, my whole right side was para-lyzed and I was essentially mute. I lay onthe gurney and just sobbed. My husbandarrived a short time later and was stunned.The doctor, who thought I was having an anxiety attack, asked myhusband if he wanted to drive me to the hospital. My husband re -fused. He knew something was really wrong and asked the doctorto call an ambulance.

The EMT took one look at me and told the doctor I was havinga stroke. She knew from experience; she was a stroke survivor. Shesaid we needed to get to the hospital as soon as possible. With that,I was loaded into the ambulance and transported to the hospital,

P A T I E N T P E R S P E C T I V E

When the“vulnerable adult” is you

A stroke survivor’s journey

Stroke canhappen atany age,and time is of theessence.

lights and sirens wailing. I lay there thinking that life as Iknew it was over. I feared living in a nursing facility forthe rest of my life. The EMT, knowing firsthand what Iwas going through, recognized my racing thoughts andreassured me that although it wasn’t going to be easy, Icould do it. I made the decision to recover.

At the hospital, I was given a clot-busting drug (tPA),with the hope of restoring blood flow to the part of mybrain that was deprived. If I hadn’t recognized that some-thing was wrong and gotten medical help in time, I maynot have been able to benefit from tPA. Timing is impor-tant, as tPA must be administered within three hours ofthe first symptom of stroke. I made it with a half-hour tospare.

Aftermath: connecting with others

I received occupational, physical, and speech therapy atthe hospital. By the time I was discharged on Nov. 23 (the day aftermy 37th birthday), I was able to walk on the treadmill, fry an egg,and talk in full sentences.

Since my release from the hospital, it’s been confirmed that Ihave a genetic condition that predisposes me to clotting. Initiallydoctors thought that was the reason for my stroke. Thanks to ahematologist who was hesitant to prescribe Coumadin to someoneso young and active, I went to the Mayo Clinic for a second opin-ion. It was there that they discovered a venous malformation in mybrain. The Mayo neurologist I saw said he had seen only three caseslike mine result in stroke in his 20 years of practicing medicine.

There were many challenges in my rehabilitation, and a greatdeal of hard work, but I am now about 95 percent fully functional.I still have a bit of trouble with my speech and numbness in myright hand, but I have returned to work, can play volleyball again,and have run my first 5K. I feel very lucky to be alive!

My family has never been the traditional kind. I was raised bymy mother, grandmother, and grandfather, none of whom I am cur-rently in contact with. I have always relied on friends as my chosenfamily throughout the years. My family and friends supported meunconditionally during my stroke experience. There were countlesshours spent at my bedside, meals delivered, hugs given, and overall


WHO’S A BIGGER BASEBALLFAN, YOU OR ME?You’ll find that people with Down syndromehave a passion for knowledge and learningthat can rival anyone you’ve met before.To learn more about the rewards of knowing orraising someone with Down syndrome, contactyour local Down syndrome organization.Or visit www.dsamn.org today.

©2007 NationalDown SyndromeCongress

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

For more information please call:

(651) 603-0720 • (800) 511-3696

When the “vulnerable adult” is you to page 34

Help fight against stroke• Stroke is a leading cause of death and long-term disability in the U.S.• Each year, more than 790,000 Americans experience a stroke and

almost 130,000 Americans die as a result of stroke.• Stroke occurs every 40 seconds in the U.S. Every four minutes,

someone dies of stroke.• Approximately 5 percent of all deaths in Minnesota are due to stroke,

making it the third-leading cause of death in Minnesota behind cancer and heart disease.

• Women are at higher risk for stroke. Nationwide, 425,000 womenexperience stroke each year, 55,000 more than men.

• In 2011, the estimated cost of stroke was $38.6 billion in the U.S.and was more than $387 million in Minnesota. This total includesthe cost of health care services, medications, and lost productivity.

• For more information, visit the Minnesota Stroke Association’s website (www.strokemn.org).

It all started when … Michael

I remember it was a typical day; I had apretty good breakfast that morning. Irode to school with my brother andeverything was normal.

Judy (Michael’s mother)

Michael has very little memory of theday, but he does recall earlier that morn-ing he was sitting in the locker roomschool and started to feel dizzy.

Michael

I walked through the gym hoping ateacher would be available because Iknew something was wrong. I just didn’tknow what. When I got to my locker, Ineeded a friend to help me open itbecause I couldn’t see the combination. Iwas very confused and by the time I gotto class, the teacher knew something waswrong. He sent me to the nurse and as Iwas walking up the stairs, I dropped my

books. That must have been when ithappened.

Judy

Michael experienced a complicatedmigraine, which started in the basilarartery. Normally, in a migraine, theblood vessel constricts but with Michael,the vessel started to pulse and pushedinto the cerebellum and hypothalamus.Doctors referred to it as a stroke causedby compli cated migraine.

I had just pulled in the driveway atwork when my cell phone rang. It wasthe nurse from Michael’s high school.Michael wasn’t feeling well and theythought he should go home. They toldme he was very tired and seemed “out ofit.” When I arrived at the school, therewas an ambulance outside. It neverdawned on me that it was for Michael.When I got to the door, they told me notto be alarmed but they were just beingcautious. I ran to the nurse’s office tofind Michael lying on a cot. His left eyewas wandering off, and he would notrespond even though several people werecalling his name and rubbing his chest.

A stroke at 15

Michael’s story of his “silent disability”

By Judy McMillan and Michael McMillan

P A T I E N T P E R S P E C T I V E

In the next issue...

• Retinal tears

• Compulsive gambling

• Affording long-term care


I began calling his name and he looked at me with themost distant stare. The people in the office asked me ifhe could be on drugs or had consumed alcohol. It was8:30 in the morning, he was a three-sport athlete, and Iwas sure that he had not ever used drugs or alcohol.He was only 15 years old.

The paramedics decided they needed to take him tothe emergency room.

Michael

I don’t remember much in the nurse’s office and I don’tremember anything about the ambulance ride.

Judy

When Michael arrived at the hospital he was unconscious. Theemergency room staff was convinced that Michael had been usingdrugs or alcohol even though the test results came back negative.The doctor and nurses tried different pain stimuli, but Michael didnot respond. At one point they put straight ammonia into his nos-trils and he did not respond. They did a CT scan, which showed no concerns. We asked for an MRI, but we were told it wasn’t war-ranted. The doctor came to us and told us that he believed it waspsychological and Michael was looking for attention. I said, “ThenI’m putting him in acting school because he is really good!” A nursetook us aside and talked about pseudoseizures and then they senthim home.

When we got home, Michael initially seemed a little better, butas the evening progressed, we became very concerned with Michael’sincreasingly strange and disoriented behavior. He would shove foodin his mouth. He took a whole box of candy and put it all in hismouth at one time; he tried texting his friends and it was all non-sense. He insisted that I call Joe Mauer to come and see him. “He issuch a nice guy, I know he will come and see me if he knows I amsick,” Michael mumbled. Concerned by his behavior and question-ing the results from the emergency room, we took him to his pedia-trician, who immediately had us go to Gillette Children’s Hospital,where his stroke was finally diagnosed. It affected the hypothalamusand the cerebellum. His right side was weak, he had a left-field cut,and his speech was difficult to understand. He slept most of thetime, but when he was awake he was confused and disoriented.

I remember finally getting up the courage to tell Michael whathad happened. After I explained to him that he had had a stroke, hecried and asked if he would ever get better and then fell back asleep.When he woke up, I sat by him, waiting for him to ask me more

difficult questions but instead he asked,“Why am I here?” This happened threemore times over the course of several days.Little did we know that his memory wasgoing to remain an issue for a long time.

Michael

I was homebound from school for the next three months. I began PT,OT, and speech ther apy to recover from the physical effects of thestroke, but the piece that none of us were planning on was the cogni-tive limitations. Since the stroke, I have sensory issues, my mem ory isbad, and I get overwhelmed and anxious easily. I have trouble withimpulse control. My organizational and executive functions skills arelow. My neurologist reports that I have “frontal lobe behaviors.”

Because I don’t have any physical limitations—withthe exception of a hand tremor if I become overlyfatigued or I am required to do a lot of writing or typ-ing—many people think I am all better. My disability islabeled a “silent disability.”

Judy

Devastated by the realization that my 15-year-old sonwould be living with the effects of a stroke, I began tosearch the Internet for resources. I found the MinnesotaStroke Association and contacted them for information.What I received was extreme support, resources, and

education. Our family has participated in the Strides for StrokeWalk the past two years and plan to make it a yearly event. Michaelalso attended the Strike Out Stroke event with the Minnesota Twinsand last year received the greatest thrill: He was asked to throw outthe first pitch. We feel so fortunate to have found wonderful sup-port services such as the Minnesota Stroke Association, the BrainInjury Association of Minnesota, National Stroke Association, andPACER.

Michael

My overall high school experience has been difficult. I am now onan IEP (individualized education program) and receive special edu-cation services at school. However, I have been accused of “milkingthe system” by teachers who have told my parents that they think Iam “comfortable in the forgetting mode.”


A stroke at 15 to page 32

Doctorsreferred to itas a strokecaused by

compli catedmigraine.

Strokes can occur

at any age.

My coaches, much like my teachers, thought that Iwas looking for special treatment or not giving it my best.Before the stroke, I was a three-sport athlete and eventhough I was able to participate again in football, base-ball, and wrestling, my athletic performance was not thesame. I actually was on the receiving end of bullying fromthe football and wrestling coach. I was told I was “nogood” and referred to as “a person like you.”

I am looking forward to graduating and starting anew chapter. My goal of attending a four-year college ison hold for now due to my cognitive challenges, but Iplan to attend a community college and get myParaprofessional Educator Certification so I can workwith students who are having the same type of issues thatI have experienced. As my abilities improve, I hope tosomeday become a special education teacher. I also amtaking an EMT course at our community college while inhigh school. Hopefully, someday I can help others—and,this time, be able to recall the ambulance ride.

Judy

Michael is motivated to get the word out that strokes canoccur at any age and that the cognitive disabilities orsilent disabilities are just as devastating as the physicallimitations. He will be an amazing teacher. As a parent,you only want the best for your child. Seeing him strugglephysically, rise above it, and then be destroyed emotion -

ally by the insensitive, heartless comments of people youhoped would be there for support is devastating. I am soproud that Michael has been able to turn the things thathave happened into a positive.

On this journey to recovery, we have met severalother teens that have had strokes. They, too, were misdi-agnosed initially. This is alarming and concerning andraises the issue of educating health care professionals, atall levels, that a teen who is displaying disorientation,unconsciousness, and speech difficulties may not beusing drugs or alcohol. Once those test results comeback negative, it is important to go the next step and doan MRI to determine if the person has suffered a strokeor some other type of brain injury.

Michael continues to amaze us. His strength anddetermination have made him the wonderful person he istoday. Michael has a verse framed in his room that bestdescribes who he has become:

“But it isn’t about how hard you hit. It’s about how hard you can get hit and keep moving forward.How much you can take and keep moving forward.”–Rocky Balboa, in the movie “Rocky”

Michael is now 19. He has no physical limitations butalthough he continues to deal with cognitive challenges, he isin college and has found tools to help him be successful. Hevolunteers for the Minnesota Stroke Association as a speakerto raise awareness of pediatric stroke (www.strokemn.org).

A stroke at 15 from page 31


Because I don’t

have anyphysical

limitations …many peoplethink I am all better.

Health Care ConsumerAssociation

Minnesota

Each month, members of the Minnesota HealthCare Consumer Association are invited to participate in a survey that measures opinionsaround topics that affect our health-care delivery system. There is no charge to join the association, and everyone is invited. For more information, please visit www.mnhcca.org. We are pleased to present the results of the June survey.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Yes No0

20

40

60

80

100

2.94%

97.06%

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

10

20

30

40

50

14.71%

41.18%

17.65%

23.53%

2.94%

2. I would support the idea of radical preventive medicalprocedures if genetic counseling placed my risk of developing a serious illness in a high percentile.

1. I, or someone in my family, have seen a genetic counselor.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

5

10

15

20

25

30

35

11.76%

32.35%

20.59%

2.94%

32.35%

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

10

20

30

40

50

17.65%

41.18%

26.47%

11.76%

2.94%

5. If genetic mapping indicated I was at high risk of passing on a serious illness, it would significantly impact my decision to have children.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

Agree No

opinion

Disagree Strongly

disagree

0

10

20

30

40

50

2.94%

14.71%

23.53%

8.82%

%

50.00%

3. Genetic mapping should be a required part of anymedical record.

June survey results ...

4. I feel it is important to provide newborn infants with genetic screening.

“A way for you to make a diff erence”

Join now.

SM

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

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

www.mnhcca.org

Health Care ConsumerAssociation

Minnesota


encouragement. I soon realized how much Imeant to people and how much they cared aboutme. I can definitely say I have the greatest peoplein the world surrounding me and participating in my life.

Still, after my stroke, I felt disconnected fromfriends and family who didn’t understand what Iwas going through. I sought out a young adultstroke group, hoping to identify with survivorsthat had been through the same thing. I formedsome great friendships, but the location and timelimited my continued participation after I wentback to work.

One day during one of my speech therapyappointments, a speech pathologist at Fairviewsaid it would be really great if we had a youngerstroke group there in the south metro. The staffat Fairview Ridges offered to donate the spaceand, since I had a social work background andexperience, they thought it would be a perfect fitfor me to facilitate the group.

Seven months after my stroke, I started theFairview Ridges Young Adult Support Group inBurnsville. We currently meet for an hour once amonth and discuss topics related to stroke. We have also added a“children of stroke survivors” group that meets separately at thesame location during the same time as the adult group.

Additionally, I volunteer at Courage KennyRehabilitation Institute, which is the very place atwhich I did my inpatient rehab. I find it veryrewarding to give back, offering encouragementto current stroke patients.

Through my experience I have become activein the Minnesota Stroke Association. In 2011, Iraised $1,500 for the Strides for Stroke walk andhad over 30 friends and family members walkwith me on my team, “Jen’s Journey.” I partici-pated in the walk in 2012 and 2013 walks aswell. I also contributed my story to the “StrokeMatters” spring 2012 newsletter, with the intentof helping others through sharing my experience.

My journey is full of great examples of howthe hard work and the dedication of medical pro-fessionals lead to my amazing recovery. From theEMT who offered those initial words of encour-agement to the hematologist who just didn’t feelcomfortable prescribing Coumadin, the medicalstaff involved in my case never gave up. One finalcomment: It is important to make people awareof the symptoms of stroke and to seek immediatemedical assistance if they suspect they are havinga stroke. Stroke can happen at any age, and timeis of the essence.

Jen Kirchen, LSW, lives in Apple Valley.

When the “vulnerable adult” is you from page 29


I thought, “This is a stroke,”

but I couldn’t tell her since my

speech was limited.

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

Eating disorders are complex, and it’s not always obvious if and when to seek help. If you think you or someone you care about may be struggling with an eating disorder, the experts at Melrose Center can help you find answers.

952-993-6200parknicollet.com/melrose Thousands of lives restored

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

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

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Minnesota Health care News July 2013