Summer, 2015

Continued on page 3

Botox, best known for smoothing facialwrinkles that naturally appear with age, has turned out to be a successfultreatment for people suffering fromchronic migraines. In 2010 the FDA approved botox injections for treatingpeople suffering from these debilitatingheadaches. Dr. Jeanmarie Prunty of theNeurology Clinic began prescribingbotox to her chronic migraine patients in2011. She set aside one Friday a monthto do the treatments. Now she sees botox patients for injections three Fridays a month, with as many as 18 patients in one day.

“It’s an amazing treatment, and I knowmy patients are getting appropriate therapy,” says Dr. Prunty. “There are nointeractions with other drugs they mightbe taking, it only takes 10 minutes to dothe injections, and the treatments are justfour times a year. My patients can

Botox...For Your Migraines?

Dr. Jeanmarie Prunty

Good news for dental patients! Community Dental Clinic is purchasing a CO2 laser tool for use in a wide range of dental applications.Joshua Bratt, managing dentist at the Dental Clinic, attended a two-dayhands-on laser course at the MassachusettsAcademy of General Dentistry, and iscurrently the only dentist in Vermont tohold a certificate of standard proficiencyby the Academy of Laser Dentistry.

CO2 laser technique replaces the need for scalpel blades by cauterizingthe soft tissue, so there is little to nobleeding. “People tend to not like incisions,” says Dr. Bratt. “Lasers allowfor a much cleaner procedure and caneliminate the need for sutures. Healingtime is faster and there is less post-operative pain.”

Lasers have been used in dentistry sincethe 1990s. A CO2 (carbon dioxide)

laser penetrates less than a millimeterand can produce excellent coagulationalong with a very precise cut. CO2lasers can be used for various types ofperiodontal therapy, and in soft tissueapplications like tissue re-contouring,and crown and bridge procedures. They are helpful in some endodonticprocedures and in uncovering partiallyerupted teeth, and can be used inbiopsy techniques.

According to Dr. Bratt, a CO2 laserwill save time. “It is faster than using ascalpel and is overall a much cleanerprocedure. I am pleased that CHSLV is bringing this state-of-the-art equipment to the Dental Clinic.”

For more information on how laserscan be used in your dental procedures,contact the Dental Clinic at 802-888-7585 and schedule an appointment with Dr. Bratt to discuss your options.

CO2 Laser Dental Technology

Can Work For You

Valley Health

CHSLV Goes To The RacesCHSLV sent five teams to the VermontGovernor’s Council on Physical Fitness & Sports Corporate Cup &State Agency Race on May 14 inMontpelier. Over 4,000 people of allages, all employed in Vermont, took part in the Corporate Cup, now in its 32nd year.

Each of CHSLV’s fiveteams consisted ofthree members with awide range of runningexperience, from college athletes to fitness runners tonever-ever racers. They representedStowe Family

Practice, administration, and the Dental Clinic.

The idea of CHSLV teams at the Corporate Cup sprang from a conversation about LACiNg Up for Cancer, an event CHSLV sponsors.“Someone mentioned entering theCorporate Cup and the idea grew from there,” says Senior EHR Systems Specialist Diana Smith, whovolunteered to organize the teams, keep them motivated, and get them to the race on time.

The event was held in downtownMontpelier. “Everyone did better than they expected,” says Smith. “TheCorporate Cup is amazing and the

community supportwas fabulous. We ran through neighborhoodswhere peoplehanded us water, alive string bandplayed Irish music,kids gave us highfives. It was crazy theamount of people onthe side of the road supporting the racers.”

Smith is already planning for next year’sCorporate Cup, the second Thursday in May. “We already have teams linedup, and we hope to have all of CHSLV’s departments represented.”

Since 2003, the LamoilleArea Cancer Network(LACN) has held afundraising event calledLACiNg Up for Cancer.This year’s walk is June 27at People’s Academy inMorrisville, from 11am to11pm. Individuals andteams walk laps on theschool’s track; some try towalk the entire 12 hours,while others do as many laps as they can manage. The atmosphere is festive, with live music, guest speakers, and free food all day long and into the night.

Community Health Services of Lamoille Valley is a corporate sponsor of LACiNg Up for Cancer. They alsosponsor CHSLV teams.

Andrea Phelps, office manager at Behavioral Health& Wellness, is the team organizer. “CHSLV employees have been involved in this event formany years. Then CHSLV became a corporate sponsor.Now about 30 employees and their families are participating.” This yearCHSLV teams are from

Behavioral Health and Wellness, Neurology, Community Dental Clinic,and Stowe Family Practice. Some employees walk with other teams, family, or friends.

LACiNg Up For Cancer

2

stop taking other migraine medicationthat may have unpleasant side affects,and they are not ending up in theemergency room, missing work orschool, or spending money on drugsthat aren’t working.”

Botox, or botulinum toxin type A, is the same bacteria as botulism, found in poorly sterilized canned food. In the 1970s scientists discoveredthat a highly diluted preparation of botulinum toxin type A preventedblinking spasms. Since then it’s beenused in other areas of neurology, including post-stroke spasticity.

So how does botox work for relieving migraines?

“We don’t know exactly how itworks,” says Dr. Prunty, who did herbotox injection training at a headacheconsortium. “My theory is that it’s amuscle relaxant for muscles in the forehead, temples, eyebrows, and neck.It fools the brain into thinking there isno reason for pain.”

Botox treatments are only prescribed to patients with chronic migraines,which means the headaches must occur at least 15 times a month and last a minimum of 4 hours if left untreated. For insurance to cover botoxtreatments patients must have chronicmigraines and tried at least two othermedications unsuccessfully. Once thatcriteria is met, most insurance companies will cover botox injections,which cost about $1,200 per treatment.

Botox sessions consist of 31 injectionsjust under the ski, into the muscle fiber.The needles are similar to those usedfor acupuncture. They are insertedacross the forehead, eyebrows, temples,back of scalp, down the neck, and topsof shoulders. The procedure takes 10minutes and last for 3 months.

“Compared to getting a tattoo, the discomfort is negligible,” says Dr.Prunty. “People are willing to have 10minutes of minor discomfort every 3months if it means no migraine, andthe side effects are minimal. The biggestside effects might be an achy neck for a few hours after the injections andeyebrow muscles that won’t move because they are paralyzed.”

Treatments take about two weeks tokick in. “Almost all of my patients havenoticed improvement in the firstmonth, from no headache to a verymild one that can be abated with Advil.Usually they are able to go off all othermedication they were taking for theirmigraines.”

If you suffer from chronic migraines,have tried other medications unsuccessfully, and want to give botox a try, call the Neurology Clinic at 802-888-5688 to set up a consult.Dr. Prunty performs these proceeduresone Friday a month.

“Botox... for your migraines?” Continued from front page.

“LACiNg Up is an amazing and powerful community event,” says Phelps, who has been participating foreight years with her daughter, and alsoher mother, a breast cancer survivor. Participants also sell luminaries and decorate them in memory of loved ones.The luminaries are set out after darkalong the track. “It’s a beautiful and emotional site to see” Phelps says.

In the past 12 years the event has raisedover $1.5 million for people in the Lamoille County vicinity who are undergoing treatment for cancer.

For more information about LACiNgUp for Cancer, go to lacnvt.org.

CHSLV Corporate Cup TeamsEstrogen ExpressNicki BaileyDominique CoutureCorey Perpall

Medical HomebodiesJohn BenjaminKate MyersonMelissa Volansky

Sexy B’sJulie ChaseKate-Lynn PalTracey Patoine

The Valley GirlsJessy AllenVicki EmersonAnn Reed

Stowe Step SistersShannon ChauvinCarol FanoDiana Smith

Dr. Jeanmarie Prunty performing a Botox treatment.

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What Is Analytics And Informatics?

With the increase in computerizedmedical technology, intense focus ondata, and the need for health care reform, an important field has emergedas critical: Nursing Informatics. Thisspecialty integrates nursing science,computer science, and information science to manage and communicatedata, information, knowledge, and wisdom in nursing practice, within a patient’s continuum of care.

“Informatics nurses view the electronichealth record as one tool which can assist in the management of patientcare, improve work flow, and improvepatient safety,” says CHSLV’s Analyticsand Informatics Director JenniferClapp, MS, RN. “I use my clinicalknowledge and nursing degree to identify population-level data which is used to encourage the spread of evidence-based interventions, whichwe track to measure improvements inpatient outcomes.

The analytics, or data, role in healthcare informatics is about standardizingthe collection of comprehensive patient data. This data can then be usedto analyze how selected populations of patients are cared for. This will become even more important as health care moves from a fee-basedservice payment model to a value-based payment model. Data assists practitioners in identifying high-riskpatients who need more intensive careand/or additional resources. The goal isto provide these early interventions inthe primary care setting.

“I believe that preventative primarycare services can save patients from future burdens of expensive health care costs. Primary care gives many patients the right care, by the right person, at the right time,” Clapp explains. “Currently we are working ondeveloping standardized documentationso we can analyze accurate data for ourclinics in regards to our performancemeasures, and monitor patient outcomes. For example, we monitorthe diabetic population to identifythose patients who have not been seenfor their recommended three-monthfollow up.”

The hope for the future of informaticsis to not only be able to look at pastdata for analysis, but also to rely onelectronic health records to predict outcomes for preventative care.

eClinicalHelp Desk

The electronic health records softwarethat CHSLV uses to record, analyze, andshare medical records is called eClinical-Works. It’s a state-of-the-art tool, located“in the cloud,” that health care providersuse to record and share patient information with other health care professionals over the internet. It’s ahighly complex program, and it takes an exorbitant amount of training formedical professionals to fully understandits scope and become proficient at usingall of its features.

Diana Smith is CHSLV’s eClinicalWorksguru. She runs the eClinical Help Deskand provides software support for the entire organization’s medical team. Smithattended three weeks of training in Massachusetts to become certified ineClinicalWorks’s Help Desk. She alsoearned her certification as an eClinical-Works trainer, so she can train staff members to use the program. She alsoprovides two full days of training forevery new employee. Smith is the go-toperson for any eClinical questions and isthe conduit to eClinicalWorks’ softwareexperts in Massachusetts.

Diana also heads up the Super UsersGroup of CHSLV employees who have aspecial interest in eClinicalWorks. Theymeet twice a month to learn about theintricate layers of the program. It isCHSLV’s goal that each of their clinicshas a Super User who can troubleshootfor other employees who are not fullyadept with the program.

Diana SmithElectronic Health RecordsSpecialist

4 Jennifer Clapp, MS, RN

Being active in individual or team sportsis good for every child, and being safewhile active is just as important. Sportssafety starts with a physical exam beforethe school season begins. A doctor'sexam of a young athlete should be similar to one for any other child, butmost pediatricians will also addresssports-specific issues, includinginjuries, nutrition, and trainingand exercise programs. Theymight even discuss attitudesabout the sport.

All young athletes shouldhave a pre-participationphysical exam to make surethey are ready to safelybegin the sport. Many competitive sports teamsrequire them prior to theseason’s start. Plan ahead andschedule an exam early, preferablysix weeks before training for thesport begins. Bring all necessaryforms to the visit—school forms,camp forms, etc.

Note any past injuries the young athletehad and discuss them with your doctor.Mention any pain experienced duringpast sports seasons, as pain may be anearly sign of an overuse injury, one ofthe most common injuries in youngathletes. An overuse injury is damage toa bone, muscle, ligament, or tendonfrom repetitive stress, without allowingtime for the injury to heal. The following are the four stages of overuse injuries:

1. Pain in the affected area after physical activity.

2. Pain during physical activity, not restricting performance.

3. Pain during physical activity, restricting performance.

4. Chronic, persistent pain even at rest.

If this pattern sounds familiar, talk toyour doctor about it. A treatment planmay include making changes in howoften and when the athlete plays, controlling pain, and physical therapy.Switching sports with the seasons is a

good way to avoid overuse injuries because movement patterns are different.Make sure your children are wearingproperly fitted safety gear for their sport,and remind them that wearing protective gear does notmean it will protect

them from moredangerous or risky activities.

Take the timeto talk about

additional safe practices,such as stretching, warming

up, cooling down, gettingplenty of sleep, eating a well-balanced diet, and drinking

adequate fluids. You don’t needsugary sports drinks to stay hydrated. Water is always a

great choice.

Whether enrolled in a sport or not, achild should move around enough toget sweaty at least one hour every day

for a healthy heart and strong musclesand bones. A parent’s goal is to promotea well-rounded athlete who can enjoyregular physical activity for a lifetime.

Parents should remind their childrenthat sports are not just about winning.They are also about developing socialskills, learning to work as a team, building camaraderie, and being healthy.The pressure to win can be stressful forany child. Young athletes should bejudged on effort, sportsmanship, commitment, and hard work. Theyshould be rewarded for trying hard andfor improving their skills, rather thanpunished or criticized for losing a gameor competition. The main goal shouldbe to have fun and learn lifelong physical activity skills.

Schedule sports physicals at the following locations:Morrisville Family Practice802-888-5639Stowe Family Practice802-253-4853Appleseed Pediatrics802-888-7337 (PEDS

Sports Physicals For Young Athletes

Emergency Roomor Doctor’s Office?

Many ailments that people seek care for at theemergency department can actually be treatedin the primary care setting. All it takes is aphone call.

Stowe Family Practice and Morrisville Family Health Care are open during normalbusiness hours, and the nursing staff and practitioners can determine the urgency of apatient’s health concerns over the phone.Based on their assessment they will scheduleappointments as needed, and may even be ableto resolve patients’ concerns without a visit.

There is always a practitioner on call afterhours and on holidays. Just by dialing the main office number, patients can have thepractitioner paged. The on-call doctor will return patients’ phone calls and give themmedical advice. Often a trip to the emergencydepartment can be avoided.

Patients are always encouraged to go to theemergency department for any emergencies.However, the next time you are considering a trip to the emergency department and areunsure if it is the right decision, CHSLV saysto “Call Us First,” and then decide if that tripis really necessary.

In CHSLV’s spring newsletter we had anerror in the article about dual-diagnosis.We wrote: “Substance abuse is the mostcommon, clinically important disorderthat occurs in adults with mental illness.”It should have read: “Substance abuse isthe most common, clinically importantdisorder that co-occurs in adults withmental illness.” We apologize for the error and for any confusion it might have created.

Retraction

Stowe Family Practice(802) 253-4853

Morrisville Family Health Care(802) 888-5639

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Home Is AlwaysWhere Your Heart Is

Lamoille Home Health & Hospice provides high-quality in-home healthand hospice care for people of all agesin Lamoille County, where they see anaverage of 1,000 people a year. Thenon-profit agency has served LamoilleCounty for over 40 years. As a memberof the Visiting Nurses Association ofVermont, LHH&H provides a full rangeof services to every qualified LamoilleCounty resident who needs it, regardless of income or location within the county.

If you or a loved one is diagnosedwith disease, suffers a chronic condition, is welcoming a newbornhome, is in recovery after surgery,or, if you are in need of end-of-lifecare, Lamoille Home Health &Hospice can help you assess yourhome health care eligibility andprovide you with quality services.

Executive Director Kathy Demars,RN, says, “Home is preferred byover 78 percent of Vermonters fordelivery of their health care needs. We ensure that whatever services thatcan be administered in the home areprovided.” Services include nursingcare; physical, occupational and speechtherapy; medical social services; homemaker and personal care; woundcare; and maternal/child care. After-surgery care, long-term care, disease management, lactation counselors, and end-of-life hospicecare—all are available through LamoilleHome Health & Hospice.

For those with chronichealth conditions likeCOPD or congestiveheart failure, the

agency can provide tele-monitoringservices so that patients with these conditions can manage their care athome, through remote services monitored by a nursing staff.

“Lamoille County is a solid health carecommunity. We have a respected hospital, numerous community healthservices, a nationally recognized nursinghome, and, our agency has received thehonor of being named a HomeCareElite agency, “says Demars. “We are fortunate to live and receive care here in Lamoille County.”

For more information about theagency, visit online at www.lhha.orgor call them at 802-888-4651.

Dental Care AtA year ago Sandy Beynnon, RDH, of Community Dental Clinic, began seeing patients at The Manor twice amonth. Sandy provides dental hygieneexams and cleanings for patients who are not able to make the trip to the clinic due to mobility issues, transportation struggles, or the stressors related to taking the resident out of a comfortable and familiar environment.

The Manor is funding this programusing a grant they received in 2013from the State of Vermont’s NursingHome Quality Award. The Manor purchased a dental chair, a portable dental unit, complete with sterilizationcapabilities, and allotted a special roomfor the exams. Beynnon brings a computer for record keeping, andManor employee Nancy Chamberlinassists in transporting the patient andwith any other special needs the

resident may have while gettinghis or her teeth cleaned. Beynnon reports, “Withoutthe positive collaboration between the Manor and the Community Dental Clinic

this project would not be possible. We are all here for the residents’ overall health.”

“The goal is to improve oral health atThe Manor, and decrease bacterial load in the mouth that puts patients at risk for pneumonia, respiratory infections, diabetes, and other diseases,”explains Beynnon. “I’ve seen a huge improvement in the patients’ oral hygiene in just one year.”

Beynnon continues to train the nursingstaff and assistants at The Manor on theimportance of daily attention to oralcare by brushing multiple times a dayand staying well hydrated. The Manoremployees do the best they can to workaround any physical issues that may

make it difficult for a patient to receivedental care; including treating a patientin a wheelchair and/or ones who arebedridden. For patients with dentalneeds that exceed Beynnon’s portableclinic, The Manor coordinates withCommunity Dental Clinic to get themto the clinic or to an oral surgeon.

“Community Dental Clinic is one ofonly a few dental clinics in the U.S.doing this type of program,” Beynnonsays. “We have seen 28 patients since westarted, and we are really making a difference in their overall health.”

Sandy Beynnon, RDH

7

Administration: P.O. Box 749, 66 Morrisville Plaza, Morrisville, VT 05661Phone: (802) 851-8608 CHSLV.org

Babies and children should start goingto the dentist when they get their firsttooth or by their first year, whichevercomes first. That’s the philosophy behind Community Dental Clinic’sdental protocol for kids. Their overallmessage is that baby teeth are as important to take care of as adult teeth,because children lose baby teeth slowlyand can have their baby teeth until theyare 13 or 14 years old.

“The earlier we start getting kids usedto going to the dentist, the better,” saysRegistered Dental Hygienist SandyBeynnon. The first visit to the dentist—some places call it a “happy visit”—is all about getting kids used to the environment. “The equipment is adult-sized and can be threatening for achild,” Beynnon explains. “So we havethe kids go for a ride in the chair, play

with the water, and hear some of thenoises the equipment makes. We try tomake it fun and create an environmentthat is non-threatening.”

The Community Dental Clinic staff spends time educating parentsabout their children’s normal dentalanatomy, brushing and flossing, snackingfrequency, diet, the role of fluoride, andsetting good examples by brushing andflossing regularly, all information that isimportant for a child’s future dental success. Dental decay or cavities donot have to be part of childhood.Childhood decay is 100-percent preventable with proper brushing, flossing, and routine dental visits.

Beynnon adds, “We also encourage parents to talk to their kids in a non-

threatening way aboutgoing to the dentist. Be positive, share only good experiences, be nonchalant.Avoid using words like hurt, needle, or drill, which all induce fear and anxiety. Explain that this is what we do to take care of ourselves, just like going to the pediatrician.”

For additional questions or to schedule your baby’sfirst visit with the dentist,call Community DentalClinic at 802-888-7585.

Chew On This!

Speakers included (left to right) Board Chair Valerie Valcour, RN; Dr. David Coddaire; and guest speaker Al Gobeille, Green Mountain Care Board Chair.

CHSLV Annual Meeting 2015

Annual Spirit AwardRecipients:Julie ChaseTracy ChauvinCindy DoerrKristie FlandersMichelle HubbellLeslie LlewellynKate MyersonKate-Lynn Pal Tracy PatoineAnn Reed

Unsung Hero AwardRecipient:John Benjamin, RN

(Left to right) Board Chair Valerie Valcour, RN; President/CEO Kevin Kelley,with Annual Spirit Award recipients Kristie Flanders, Kate-Lynn Pal, Julie Chase, Ann Reed, Cindy Doerr, and Michelle Hubbell.

We’re Neighbors taking care of neighbors