med-midwest medical edition-april/may 2011

www.AveraCancer.org • 1000 E 23rd Street • 1-877-AT-AVERA (1-877-282-8372)

Look no further.

Live With Compassion

A bREAST CAnCER diAgnoSiS CAn fEEl likE ThE bEginning of A long jouRnEy. You deserve the peace of mind that comes with knowing someone who understands the road ahead.

That’s why the Avera Breast Center teams each patient with Carole Chell, CNP, a breast health navigator who serves as your compass; a guide who helps you to manage all aspects of your journey. From initial diagnosis through follow-up care, she provides: • Certified Nurse Practitioner support throughout your care and beyond; • a link between you and the comprehensive team handling your case; • education about the latest treatment options; • a friendly, understanding ear—whenever you need it.

Best of all, Carole is committed to understanding your unique needs and assisting you during your individual course of treatment. It’s all part of our compassionate approach to breast care—one you can feel confident is headed in the right direction.

ouR nEw fACiliTy iS now opEn in ThE pRAiRiE CEnTER.

CaROLE CHELL, BREast HEaLtH NavigatOR

ContentsApril / May 2011

Midwest Medical Edition

Regular Features

2 | VP, Sales & Marketing /Editor’s Page

14 | Medicine & the Arts Violinist Shirley Kunkel

27 | Grape Expectations The Nose Knows By Heather Taylor Boysen

30 | News & Notes News from around the region

32 | Learning Opportunities Upcoming Symposiums, Conferences and CME Courses

In This Issue

4 | Reduced Readmissions: “The Next Big Thing!” By Dave Hewett

5 | New Chief at JAMA

13 | Technology: MRI-safe pacemaker Healthpoint: DSU Program helps with rural EMR

22 | Feature: Navigating the Spine at CNOS

28 | Splinting at Work: Pt. 2 by Stan Kulzerx

page 6

BIOGRAPHY

U.S. $ XX.XX

U.S. $ XX.XX

Brent admired the chimpanzee he sketched at the zoo. He regarded the animal as contemplative. He was unaware that similar animals in the wilds of Africa were the source of a virus that would lead to his death from AIDS. Brent became infected with HIV from the medicine he infused to treat his hemophilia.

At six months of age, his parents were alarmed when they discovered bruises on his chest which led to the discovery of hemophilia. From that moment forward, he received frequent intravenous infusions of Concentrate to treat recurrent bleeding episodes. Infusions of the medicine relieved pain and suff ering from bleeding. His life seemed normal. Unexpectedly, Brent’s life changed after the discovery of HIV contamination of the medicine.

� e medicine was manufactured from the plasma of paid blood donors. Unbeknownst to Brent, the plasma was polluted with HIV. � e SIV in chimpanzees changed to become HIV in humans. But the chimpanzees were not the cause of the transfer of SIV in animals to HIV in humans. � e change from SIV in animals to HIV in humans was the result of human activity. � e change came about with the production of the hepatitis B vaccine.

Who was responsible for the pollution of the hemophilia medicine with HIV and hepatitis viruses? Was Brent’s death preventable?

!"#$"%&'()*$+,-./.00&1234567&*6-/2.3

!"

#$

"%

&'(

)*$

+,-./.00&1

234567&*6-/2.3

w w w . i u n i v e r s e . c o m

After fi nishing medical school, Everett Winslow Lovrien, MD completed specialty training in pediatrics and the new fi eld of medicine, medical genetics. For twenty-eight years, he was on staff at a clinic that supervised the medical care of a genetic disorder, hemophilia. � is book is based upon his experiences. Now retired, he lives in Oregon.

8!"#!$%&'($)*&!"#$"%&'()*$+

� e events in this story do not take place in the “dark old days.” � e setting is during the times of modern medicine in the 1980s and 1990s. Events in Brent’s life are set down as he would have described them if he had lived a few more years. Experiences related are real, although exact conversations, Brent’s intimate thoughts, and details of events may not be completely factual. Some of the names of places and living persons have been changed.

� rough his treatment, Brent met other youths and men, not exactly like him, but who had the same medical disorder and required similar medical care. He met men and boys in the clinic where he was cared for—as well as at summer camp. Some of the events in their lives are also described in this story. He also met medical doctors, nurses, physical therapists, social workers, and a list of persons who served him in the clinic. Brent had a close family and loving relatives.

� e medical condition Brent lived with, hemophilia, was treatable but not curable, and it required frequent infusions of medicine into his veins. Modern treatment with a revolutionary medicine brightened his life. But the medicine he received for treatment also led to his early death.

page 29

In RevIewDoctor Guilt?

Written by Everett Winslow Lovrien, M. D

New books by a physician examinesguilt over treatment-gone-wrong

65 Years of Progressive Care

in Yankton

Hometown HealtHcare

Cover Feature

Don’t let its size fools you. Yankton may have only 13,000 residents, but this South Dakota community is home to a dynamic and growing multi-specialty clinic that brings in patients from more than 65 miles away. The Yankton Medical Clinic’s past, present and future at the focus on this month’s MeD Cover Feature.

By Alex Strauss

Phot

o by

Kri

sti S

hank

s

A letter from the vP

A letter from the editor

Steffanie Liston-Holtrop (far right) at the Go Red event

Alex Strauss

2

From Us to YouStaying in Touch with MED

This issue marks the one-year anniversary

of MED magazine and we want to

extend a heartfelt thanks to those of

you whose readership, contributions

and advertising dollars have helped to make it

a success. MED, with all of its regional news,

features and commentaries, comes to you free thanks to the support of our

advertisers. When you let them know that you saw them in MED, that helps to

keep this publication vibrant.

It was great to see many of you at the American Heart Association’s annual

‘Go Red for Women’ Event in February. I was amazed by the show of support from

the medical community.

I am looking forward to spending some time West River at the SDMGMA confer-

ence April 18th-20th in Deadwood and hope those of you who are there will take

the time to stop by our booth. (As an extra incentive, you could win wine from Good

Spirits Fine Wine in Sioux Falls!) Does your organization have a conference or other

event coming up that MED can help you promote? Or is your practice using new

technology that you would like to share with your colleagues? MED is here to help

serve your communication needs. Let me know how I can help. —Steffanie

As a writer, I try to avoid overused phrases. But,

when talking about the Yankton Medical Clinic,

it is hard not to use the words ‘well kept secret’.

Physicians who work in South Dakota’s

largest communities may have little call to interact with this

independent practice, which quietly continues to thrive.

But, for those who live in and around the Yankton area, the

65-year-old multi-specialty clinic is no secret at all. Yankton

residents, as well as those much farther afield, have long

depended on this group’s progressive and comprehensive approach to healthcare.

This innovative clinic is the subject of this month’s MED cover feature.

It was Hippocrates himself, one of the most outstanding figures in the history

of medicine, who declared “Vita brevis, ars longa” – Life is short but art endures.

At MED, we agree. This month, we continue our look at the artistic endeavors of

medical professionals in our new Medicine & the Arts column. As with In Review

and Then & Now, the success of Medicine & the Arts relies on your suggestions

and contributions. Are you a surgeon with the soul of a poet?

A dermatologist with a penchant for painting? Let us know how

you access the artist in you and we may feature it in an upcoming

column. Drop me a brief email telling me about your art and let

me know how to get in touch. No writing required. As always,

I look forward to hearing from you. —Alex

CONTACT INFORMATION

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

Fax 605-271-5486

MAiLiNG AddRESS PO Box 90646 Sioux Falls, SD 57109

WEbSiTE MidwestMedicalEdition.com

June Issue May 5th

July/August Issue June 5th

Sept/Oct Issue August 5th

November Issue October 5th

December Issue November 5

2011 Ad / Editorial deadlines

Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLCMidwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physi-cians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to [email protected]. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to [email protected].

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

Publisher MEd Magazine, LLC Sioux Falls, South dakota

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss

Cover Design darrel Fickbohm Design/Art Direction Corbo design Web Design 5j design

Contributing Editor darrel Fickbohm

Contributing Writers Heather boysen dave Hewett Stan Kulzer

Advisory Board John berdahl, Md Mary berg, Md Michelle L. daffer, Md James M. Keegan, Md Timothy Metz, Md Patty Peters, Md Juliann Reiland-Smith, Md Luis A. Rojas, Md daniel W. Todd, Md

Don’t forget we want to hear

from you.

Write to us!

April / May 2011 3MidwestMedicalEdition.com

written by Everett Winslow Lovrien, M. D

FDA-Approved for MRI Use

www.medtronic.com

The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan leads is required for use in the MRI environment.

www.medtronic.com

World HeadquartersMedtronic, Inc. 710 Medtronic ParkwayMinneapolis, MN 55432-5604USATel: (763) 514-4000 Fax: (763) 514-4879

Medtronic USA, Inc. Toll-free: 1 (800) 328-2518(24-hour technical support for physicians and medical professionals)

Patient Line:Tel: 1 (800) 551-55447:00 am to 6:00 pm CT M-FFax: (763) 514-185524-hour information available on www.medtronic.com

UC2

0100

4100

EN

© M

edtr

onic

, Inc

. 201

1. M

inne

apol

is, M

N. A

ll Ri

ghts

Res

erve

d. P

rinte

d in

USA

. 03/

2011

Brief Statement The Revo MRI™ SureScan® pacing system is MR Conditional and as such is designed to allow patients to undergo MRI under the specified conditions for use.

IndicationsThe Revo MRI SureScan Model RVDR01 IPG is indicated for use as a system consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan 5086MRI leads. A complete system is required for use in the MRI environment.The Revo MRI SureScan Model RVDR01 IPG is indicated for the following:• Rate adaptive pacing in patients who may benefit from increased pacing

rates concurrent with increases in activity• Accepted patient conditions warranting chronic cardiac pacing include: – Symptomatic paroxysmal or permanent second- or third-degree AV block – Symptomatic bilateral bundle branch block – Symptomatic paroxysmal or transient sinus node dysfunctions with or

without associated AV conduction disorders – Bradycardia-tachycardia syndrome to prevent symptomatic bradycardia

or some forms of symptomatic tachyarrhythmias

The device is also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include:• Various degrees of AV block to maintain the atrial contribution to cardiac output

• VVI intolerance (for example, pacemaker syndrome) in the presence of persistent sinus rhythm

Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in bradycardia patients with one or more of the above pacing indications.

Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in bradycardia patients with atrial septal lead placement and one or more of the above pacing indications.The device has been designed for the MRI environment when used with the specified MR Conditions of Use.

ContraindicationsThe device is contraindicated for:• Implantation with unipolar pacing leads• Concomitant implantation with another bradycardia device• Concomitant implantation with an implantable cardioverter defibrillatorThere are no known contraindications for the use of pacing as a therapeutic modality to control heart rate. The patient’s age and medical condition, however, may dictate the particular pacing system, mode of operation, and implantation procedure used by the physician.• Rate responsive modes may be contraindicated in those patients who cannot tolerate pacing rates above the programmed Lower Rate• Dual chamber sequential pacing is contraindicated in patients with chronic or persistent supraventricular tachycardias, including atrial fibrillation or flutter• Single chamber atrial pacing is contraindicated in patients with an AV

conduction disturbance• ATP therapy is contraindicated in patients with an accessory antegrade

pathway

Warnings and PrecautionsChanges in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Use of the device should not change the application of established anticoagulation protocols.

Do not scan the following patients:• Patients who do not have a complete Revo MRI SureScan pacing system,

consisting of a SureScan device and two SureScan leads• Patients who have previously implanted devices, or broken or intermittent

leads• Patients who have a lead impedance value of < 200 Ω or > 1,500 Ω• Patients with a Revo MRI SureScan pacing system implanted in sites other

than the left and right pectoral region • Patients positioned such that the isocenter (center of MRI bore) is inferior

to C1 vertebra and superior to the T12 vertebra

See the device manuals before performing an MRI Scan for detailed information regarding the implant procedure, indications, MRI conditions of use, contraindications, warnings, precautions, and potential complications/adverse events. For further information, call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com.

Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

The First and Only Pacing System to Break the Image Barrier

Introducing the Revo MRITM Pacing System engineered with SureScan® Technology – the only pacing system to provide proven cardiac care that’s designed to be used safely with MRI.

201004100_RevoAd_8.5x11_1-pager.indd 1 3/15/11 9:03 AM

Midwest Medical Edition 4

ThefirsTThreemonthsof 2011 have focused pri-marily on state Medicaidfunding.Andwhilethescars

of that debate have yet to be fullyappreciated,weneed to ask theques-tion “so, where do we go now?” forphysicians, i would suggest that it isrelated to implementation of variousaspectsoffederalhealthcarereform.

Doctorstakeanoathto“donoharm,”howcanyouextendandamplifythatactioninthefaceofreforminadifferentway?Duetodecliningreimbursement,physicianscontinuetoworkharderyetgetpaidlesseveryyear.sohowcanyouworkmoreefficientlyandeconomically?Qualityandtransparencyare thetwoplacestostart.Thesecanbeaddressedthrough two simple words: reducedreadmissions.

AccordingtotheDartmouthAtlas,southDakotaisahighquality,lowcoststaterelativetotheamountofMedicarespendingperbeneficiary.ThiscorrelatestowheresDsitswithreadmissionsaswell.AnApril2009NewenglandJour-nalofMedicinestudyfoundthatnearlyone in every five Medicare patientsadmittedtoahospitalinayearisread-mittedwithin30daysofdischarge.in2007,thecosttoMedicareoftheseread-missionsalonewas$18billion.

inordertoreducereadmissions,part-nershipsandcollaborativeeffortsmustdevelopoutsideofthehospitalandclinicsetting.stakeholdersincludingnursingfacilitiesandhomehealthagencieswiththecommongoalofreducingrehospital-izations should assemble to reducereadmissions.secondly, thedischargeprocessshouldbeconsideredasmoreof

a“transitionalprocess.”Thisconceptalsoappliestothetransitiontoashorttermrehabilitationfacilityorlongtermcarecenter.inaddition,casemanagementforthoseindividualswhoareathighriskforreadmissionwillallowforbetterpatientcare,betteroutcomes,andlowercosts.

Physician payments will becomemorecloselylinkedtovaluewiththelaunchofaphysicianvalue-basedpay-mentsystemandimplementationofa“value-modifier”rewardingphysicianswhodeliverbettercare.ThisisestimatedtoreduceMedicarecostsbymorethan$1.9billionoverthenext10years.

TheAffordableCareActincludesarangeofprovisionstoreducewaste,fraudandabuse,suchasexpandingrecoveryAuditContractors(rAC),requiringface-to-faceencounterswithphysiciansbeforereimbursingforcertainservices,suchashomecare,andrequiringgreaterdatamatchingcapabilities.Thisisexpectedtosave$5billionover10years.

extending the program to reducehospital-acquiredinfectionswouldsave$3.2billion.southDakotahospitalsareworkingwithsDAhOtoreducecentrallineassociatedbloodstreaminfections(CLABsi)throughparticipationintheCUsPProgram.

Thechallenge toreducereadmis-sions iseveryone’s job.readmissionratesaremeasurableandwill impactreimbursement positively and nega-tively.Ateamapproachthat includesphysicians,hospitaladministrationandhealth care professionals, long termcare,andhomecarewillbenecessaryto ensuresouthDakota remains the“lowcost/highquality”statethatwearesoveryproudof.■

Reduced Readmissions:

The next Big Thingby dave Hewett, President/CEO, SdAHO

AMA Welcome Court Validation of ‘Red Flags’ RuleWAshiNGTON-AfeDerALappealscourtissuedadecisionfridaythatfur-ther validates the American MedicalAssociation’s long-standing argumentto the federal Trade Commission(fTC) that physicians who bill afterrenderingservicesarenotsubjecttotheredflagsruleascreditors.

TheUnitedstatesCourtofAppealsfor theDistrict ofColumbiaCircuitfoundthepresentregulationsofthefTCinvalidinlightoftheredflagProgramClarificationAct of 2010, passedbyCongresslastDecembertoshedmuchneeded lightonwho isconsideredacreditorunder theredflagsrule.ThecourtissuedthejudgmentinalawsuitfiledbytheAmericanBarAssociationchallengingtheapplicationof theredflagsruletoattorneys.

According to thecourt’sopinion,“…theClarificationActmakesitplainthatthegrantingofarightto‘purchasepropertyorservicesanddeferpaymenttherefore’isnolongerenoughtomakeapersonorfirmsubjecttothefTC’sredflagsrule–theremustnowbeanexplicitadvancementoffunds.inotherwords, the fTC’s assertion that theterm‘creditor,’asusedintheredflagsruleand thefACTAct, includes ‘allentitiesthatregularlypermitdeferredpayments for goods or services,’includingprofessionals‘suchas law-yersorhealthcareproviders,whobilltheir clients after services are ren-dered,’…isnolongerviable.”■


ChiCAGO – howard C. Bauchner,M.D., from Boston University schoolof Medicine, will become the nextJAMAeditor-in-ChiefonJuly1,2011.Dr.Bauchnerwillbethe16theditorinthejournal’s127-yearhistory.

Dr.Bauchneriscurrentlytheeditor-in-chiefoftheArchivesofDiseaseinChildhood,theofficialpublicationoftheroyalCollegeofPaediatricsandChildhealthintheUnitedKingdom.heisthefirstU.s.-basededitorofthatjournalandhasheldthatpositionsince2003.heisaprofessorofpediatricsandcommunityhealth sciences at BostonUniversityschoolsofMedicine(BUsM)andPublichealth.heisalsothevicechairmanofthedepartmentofpediatricsandassis-tantdean,alumniaffairsandcontinuingmedical education atBUsM.he has

servedonmanyeditorialboards,includ-ing currently for theBritishMedicalJournalandJournalWatch.

Dr.Bauchnerisalsoanaccomplishedresearcher.hehaspublishedmorethan125papers inpeer-reviewed journals.his research interests include healthpromotion, clinical trials and qualityimprovement.

Aseditor-in-Chief,Dr.BauchnerwillhaveeditorialoversightofJAMAandthenineArchivesjournals,thespecialtymedicaljournalspublishedbytheAMA.Dr.Bauchnerwaschosenafteraninter-nationalsearchconductedbyacommitteecomprisedofmembersof the JournalOversightCommittee,JAMAeditorialBoard, theAMA’sBoard of Trusteesandseniormanagementandwithhelpfromtheexecutivesearchfirm,russell

reynoldsAssoci-ates.Dr.Bauchneris followingCatherine D.DeAngelis,M.D.,M.P.h.,whoisleavingthepostafter11yearstoreturntoJohnshopkins school of Medicine inBaltimore.

“ihavetremendousrespectforJAMAand the prestige and stature it hasachieved under Dr. DeAngelis,” Dr.Bauchnersaid.“JAMAisamongtheelitemedicaljournalsintheworldandiamexcitedandhonoredbytheopportunitytobeitsneweditor.”■

March 9, 2011

Pediatrics Professor named

new Chief at JAMA

Home Infusion• Specialty Infusion• Clinical Pharmacy• Infusion Nursing•

Ongoing Monitoring • and EducationBenefit Verification• Patient Support 24/7•

Infusion Services at Home

Contact an Intake RN at 877-360-9272

Serving patients in your area and nationwide

Walgreenshealth.com

Walgreens infusion services locations are ACHC accredited. ©2011 Walgreen Co. All rights reserved. IV10524-0211

For 65 years, the residents of yankton have

enjoyed the benefits of dynamic ‘hometown healthcare’.

formed by the merger of two separate clinics, the Medical

Clinic and the yankton Clinic, both of which were estab-

lished in 1946, the yankton Medical Clinic, P.C. opened in its new incar-

nation in 1982 and has looked forward ever since.

Physically, the clinic still stands on the same spot at the corner of

Jackson and 8th streets where it was established 29 years ago, but with

continued growth and expansion of both building and staff, and the

addition of new technology and services, this clinic can never be said to

have stood still.

“yankton has a long tradition of having very progressive health care,”

says board-certified dermatologist James young, do, faoCd who

joined the yankton Medical Clinic 13 years ago. not only did the clinic

bring his and other specialties to town, but it also opened the first

ambulatory surgical Center there in the late 1980’s.

“it is important that we try to be very comprehensive, not only to

serve patients in the yankton area, but also because 25 percent of our

patients come from more than 65 miles away,” explains dr. young, past

President of the american osteopathic College of dermatology who

now serves as president of the yankton Medical Clinic Board.

By alex Strauss

65 years of Progressive Care in

YanktonHometown Healthcare

6

April / May 2011 7

The Yankton Clinic

The Medical Clinic

The YANKTON MeDiCAL CLiNiC took up 55,000square feetwhen it opened in1982. in2006, the clinicincreased its size by half, adding an additional 27,000square feet. in addition to expanded office space to

accommodate thegrowingstaffofphysiciansandphysicianassis-tants,theexpansionincludedtwonewoperatingsuitesforambulatorysurgeryandastate-of-the-artinfusioncenter.

“itwasthevisionofourboardmanyyearsagototrytomakethisclinicascomprehensiveaspossible,”saysDr.Young.“itbehoovesanorganizationlikeourstobeverycompleteifwewanttostayviable.”

Whatbeganwithjustahandfulofprimarycarephysicianshasgrownintoaregionalpracticeof39primarycaredoctorsandspecial-istsand5physicianassistants.Theseprovidersrepresentmorethan16areasofexpertise, includingprimarycare–familymedicine,internalmedicine,ob/gynandpediatrics–andmedicalandsurgicalspecialties.Comprehensivediagnosticimaging,includingMriandotherancillaryservicessuchasanonsitepharmacyownedandoper-atedbytheclinichavehelpedtomaketheYanktonMedicalClinica‘onestopshop’forhealthcare.

Bycarefullycontrollingtheirdebtandinvestingonlyintechnol-ogythattheybelieveshowsaclearbenefitforpatients,theYanktonMedicalClinichascontinuedtostandonitsown–anincreasinglyraresituationforsmall-townclinics,especially inachallengingeconomy.

“foratownof13,000,thisisquiteunique,”saysDanielMegard,MD,aboard-certifiedinternalMedicinephysicianwhojoinedtheclinic19yearsago.Dr.Megard,whositsontheclinic’sPhysicianrecruitmentandretentionCommittee,saystheclinic’sindependentstatusmakesitpossibleforproviderstoworkseamlesslywithallareaclinicsandhospitalswhennecessary.

History of Growth

Yankton Medical Clinic88

Outpatient surgery in one of YMC’s newly constructed surgical suites. The clinic was the first to open an Ambulatory Surgery Center in Yankton.

photos by Kristi Shanks

Yankton Medical Clinic9

TheYANKTONMedicalClinicoffers the gamut of primarycareandspecialtyservices.

Allergysuffererscangetevaluation,skintestingandallergyshots.Compre-hensive Audiology services includeaudiologictesting,dizzinessevaluation,hearingaidfittingandfollow-up,andanOshAhearingconservationprogram.

Chemotherapycanbepreparedandadministeredonsiteintheclinic’snewinfusion center, which also offershydrationandadministrationofotheriVmedications.inadditiontodigitalX-raycapabilities,theclinic’sdiagnos-ticimagingservicesincludea16-sliceCTscannerandanewAchieva1.5TMri,whichcanproducehighresolutionimages in less than 30 minutes.state-of-the-art digital fluoroscopyprovides exceptional image quality,particularlyforexamsofthestomachand colon. Digital Mammography,breastultrasound,breastMriandadigital stereotactic unit for breastbiopsies are central features of theACr-accreditedComprehensiveBreastCareCenter.

“Women’shealthisaveryhighprior-ityforus,”saysDr.Young.“Wehaverecentlyimplementedadedicatedphonenumber (664-PiNK) thatwomencanusetoquicklyschedulemammograms.”Mammogramsarereadbytheclinic’sboard-certified radiologist. Ob/Gyndiagnosticservicesincludestate-of-the-art3D/4Dultrasound.Theclinichastwohematologist/oncologists.

Non-invasive testing of the heart,

arteriesandveins, includingcontrastechocardiography with harmonics,are conducted in the CardiovascularLab.Thestressecholabisequippedwithadvancedtechnologyandallvascularandcardiacsonographersarecertifiedby the ArDMs. Over 500,000 labtests are performed each year in theYanktonMedicalCliniclaboratory.TheclinicalsosupportsareaemployerswithOccupationalMedicineservicesrangingfrom accident/injury treatment andpre-placement exams to drug andalcoholtesting,CPrandfirstaidcourses.

Thenewly-constructedAmbulatorysurgeryCenterfeaturesfully-equippedoperatingroomsinwhichsurgeonsper-formoutpatientproceduressuchaseartubesandtonsillectomies,colonoscopyand flexible sigmoidoscopy, herniarepair,breast,prostateandskinbiopsies,laparoscopiccholecystectomy,appen-dectomy,vasectomyandanumberofob/gynprocedures.

inaneffort toaccommodatebusyyoung families and working profes-sionals, the clinic implemented‘ConvenientCare’in1996.Designedtobe an alternative to the emergencyroomforafter-hourshealthconcerns,‘ConvenientCare’ provides care foracute,non-emergencyailmentssuchassorethroats,earaches,sprains,strainsandbrokenbones thatcanbe treatedwithoutthehighercostsassociatedorneededwithervisits.ConvenientCareisavailableonweekdayeveningsuntil9andonweekendsfromnoonto5pmtowalk-inpatients.

VarieTY oF SerViCeS

Dawn Larson, MD, FAAP, Board Certified Pediatrician Tavaya Griffth

Max Farver, MD, Board Certified in Internal Medicine, Specializing in Oncology/Hematology-Patient Robert Novak

Daniel Megard, MD, Board Certified Internal Medicine Physician, Member of YMC’s Recruitment Committee-Patient James “Jim” Snow

10

“The program is a

benefit not only to

students, but also

to us as physicians . . .

it forces you to

understand disease

processes better.

it keeps you on

your toes.”

Moving into the Future

AsTheCLiNiC’s patientloadcontinuestoincrease,plans are in the works toadd sevennewphysicians

to the existing team of 39 doctors.An internal medicine specialist, anOb/Gyn,anephrologist,acardiologist,a family medicine physician, and arheumatologist will join the practicewithinthenexttwoyears.inaddition,thegroupplanstoimplementthearea’sfirst hospitalist program to servepatients atAverasacredhearthospi-tal,beginninginearly2012.

“We are having a real recruitingboomrightnow,”saysDr.Megard.“inthelastfiveyearswehaverecruitedavariety of young doctors including

aradiologistandanorthopedicsurgeon,neitherofwhichwehad.Therheuma-tologist, nephrologist and hospitalistwho are coming also represent newspecialtyareasforus.”

Dr.Megardcredits the ‘recruitingboom’toYankton’sgoodschools,highqualityoflife,mixofnewandestab-lishedphysicians(abouttwo-thirdshavebeenwiththeclinictenyearsormore),andtheclinic’scloseinvolvementwiththesanfordschoolofMedicine.TheYanktonMedicalClinichelpstrainaboutadozen3rdyearmedicalstudentseachyearthroughthe20-year-oldYanktonAmbulatoryProgram,aprogramthatallowsstudentstosamplemultiplespe-cialties at one time, insteadofdoingseparaterotations.

“Theprogramisabenefitnotonlytostudents,butalsotousasphysicians,”saysDr.Megard,who,likemanyofthecliniccolleagues, isalsoanAssociate

Yankton Medical Clinic

Jeremy Kudera, MD, Board Eligible Orthopedic Surgeon and Jim Frerk, PA-C

ph

oto

by K

rist

i Sha

nks

Photo courtesy YMC

1111

Dr. Young

Clinical Professor with the sanfordschoolofMedicine.“Whenyouarepartofateachingprogram,itforcesyoutounderstanddiseaseprocessesbetter.itkeepsyouonyourtoes.And,bygivingusthechancetoobserveandstartget-tingtoknowthesestudentsearly,wecanbeginearlytostartrecruitingthosethatwethinkwouldbegoodadditionstoourpractice.”

BuildingontheYanktonmodel,theVermillionClinic,openedin1982, isservedbythreeprimarycareprovidersandtwophysicianassistantsandoffersspecialtyservicesincludingdermatol-ogy,ob/gyn,eNT,pulmonology,urologyandorthopedicsurgery.inadditiontoVermillion, YanktonMedical Clinic

physiciansroutinelyofferoutreachser-vices to clinics in Tyndall,Wagner,Gregory,freeman,andParkston,southDakotaandintheruralNebraskacom-munitiesofO’Neill,Creighton,Norfolk,Osmond,Plainviewandsantee.

“Because of the nature of southDakota,youhavetooffertheserviceswhen andwhere people need them,”explainsDr.Young.Theclinicplanstocontinuetoexpanditsoutreachservicesasmorephysicianscomeonboard.“itwould not work for us to just be abehemothand just sithereandmakepeoplecometous.”

Dr.Youngsaysthehopeisthattheclinic’sfiscalresponsibilitycombinedwithacommitmenttoconvenient,cost

effectivecarewillhelpkeeptheYank-tonMedicalClinicoperatingforanother65years.

“iamreallyhoping thatmyson,whojustgotacceptedtomedicalschoolwillconsidercomingheretopractice,”saysDr.Young.“ThatishowexcitediamaboutthefutureoftheYanktonMedicalClinic.”

“Medicine is likely to look a lotdifferent tenyears fromnow,”addsDr.Megard.“But ifwehaveagoodbusiness model, don’t overextendourselves,andrecruitgoodphysicians,we are confident that we are goingtobeabletocontinuetoservetheneedsof patients in this region well intothefuture.”■

Dr. Megard

Yankton Medical Clinic

YMC’s expansion included new patient care areas, more office space, and additional surgical suites


AVerA is sTreAMLiNiNG thenames of hospitals and clinicsthroughout the region in an effort toimprove identificationofAverafacili-ties and medical specialties. ThesechangesbegantotakeplaceonApril1.

ThenameofAveraMcKennanhos-pital & University health Center insiouxfallsremainsthesame.however,namesofAveraregionalhospitalswillchange toAvera(CommunityName)hospital.forexample,AveraGregoryhealthcareCenterwillchangetoAveraGregoryhospital.

AveraclinicnamesarechangingtoreflectagrowingemphasisonAveraMedicalGroup,anassociationofAveraphysicians and mid-level providers.Averaclinicswillalltakeonthename“AveraMedicalGroup”followedbythespecialtyand/orlocation.forexample,AveraMedicalGroupinternalMedicinesiouxfalls,orAveraMedicalGroupGregory.

AveraMedicalGrouphasgrownbynearly200percentsinceitsinception

threeyearsago,andisnow545membersstrong.AveraMedicalGroupnowhas130locationsinmorethan50communi-tiesthroughoutafive-stateregion.

Changes are also taking place onAvera McKennan’s main campus insiouxfallstosimplifybuildingnames,andalsotoreflectasouthCliffAvenueaddress.This,alongwithnewsignage,isaimedathelpingvisitorsfindtheirwayaroundeasier.Campusbuildingnamesandaddressesareasfollows:

Avera McKennan Hospital & University Health Center Plaza 1(formerlyAveraDoctor’s

Plaza1)1417s.CliffAve.Plaza 2 (formerlyAveraDoctor’s

Plaza2)1301s.CliffAve.Plaza 3(formerAveraCancer

institute)1315s.CliffAve.

“inourevolutionasaregionalhealthcare provider, this change is amoreuniform approach to our identityacrosstheentiresystem.Newnaming

conventionswill enable our patientsand communities to have a clearerpictureofourofferingsandourwidevarietyofspecialties,”saysMichelleLavallee, senior vice president forstrategicMarketingandCommunica-tionatAveraMcKennan.“Thischangeisalsodesignedtohelpourphysiciansand patients feel connected to theentireAverasystem”.■

Avera clinic names are changing to reflect a growing emphasis on Avera Medical Group. For example, Avera Medical Group McGreevy 69th and Western.

Avera streamlines HoSPITAl AnD ClInIC nAMeS

Avera will change names of its community hospitals to Avera (Community Name) Hospital. For example, Avera Gregory Healthcare Center will change to Avera Gregory Hospital

A MORE COMFORTABLE MRI, FROM HEAD TO TOESiemens MAGNETOM ESSENZA MRIWith the powerful yet comfortable MAGNETOM ESSENZA, many exams can be performed with the patient’s head and feet outside of the system to help reduce discomfort and claustrophobia.

» Advanced technology provides fast exams, leading to improved workflow.

» Quality images help physicians make a more confident diagnosis.

Cassling offers Siemens imaging equipment in addition to unbeatable local service and end-to-end efficiency solutions that help increase efficiency, reduce costs and improve quality.

Contact Shane Slaughter, Cassling Account Executive(605) 321-6909 | [email protected] www.cassling.com


The reVO Mri™ sUresCAN®pacing system is the firstMr-Condi-tional pacing system designed, testedand fDA approved for use in theMri environment. Prior to the revoMri surescan pacing system, Mriproceduresforpatientswithimplantedpacemakers were not recommendedbecause these patients might faceserious complications, such as inter-ference with pacemaker operation,damagetosystemcomponents,leadorpacemaker dislodgement or change inpacingcapturethreshold.

“ThedeviceoffersflexibilityforthepatientswhomayneedMriscansfortheircareinthefutureandit’ssafe,”saidscottPham,MD,Cardiacelectro-physiologist with sanford hearthospital.

sanford heart hospital recentlybecamethefirstinsouthDakota,NorthDakota,iowaandNebraskatoimplantthenewMri-safepacemaker.Mriisoften a preferred imaging modalitybecauseitprovidesalevelofdetailandclaritynotofferedbyother imagingmodalities.

“it is federally approved, and isuspectwe’llbeusingthedevicemoreoften for the right patient,” addedPham.“forthosepatientswhoclearlydon’t need anMri or are not likelyto,we’llstillbeusingthemoreconven-tionalpacemakers.”

TherevoMrisurescanpacingsystemwasdesignedtoaddresssafetyconcernsaroundMriproceduresforpatientswhohaveimplantedpacemak-ers. Mri scanners may causetraditionalpacemakerstomisinterpretMri-generated electrical noise andwithhold pacing therapy or deliverunnecessary pacing therapy.Whenprogrammedprior to anMri scan,

the revo Mri pacing system isdesignedtobeusedsafelyintheMrienvironment.

“Medical imaging and electronicimplantabledevicessuchaspacemakersareimportanttechnologicaladvances,particularly for older people,” saidDr.Pham.“Weencourageourpatientsto talk to their doctor about whichpacingsystemisrightforthem.”■

MRI Safe Pacemaker Now Available at Sanford Heart Hospital in Sioux Falls

Scott Pham, MD

SANFORD HEART HOSPITAL IS NOW OFFERING A NEW

PACEMAKER OPTION FOR PATIENTS WHO MAY ALSO NEED

MAGNETIC RESONANCE IMAGING (MRI).


MED: Tellusalittleaboutyourhistorywiththeviolin

Dr. Kunkel:istartedviolinwheni was eleven, and i continueduntil iwasasophomore inhighschool.iplayedinalittlecollegeorchestrawheniwasinpremed,aswellasthePurduesymphonyorchestra.

While i was in practice, iplayedveryminimally—onceayearwiththeAugustanaorcom-munity orchestra just to keepmyhandin.i’dplayonceortwiceayearonpiano.Thenwheniwasa resident inrochester ididn’tplayatall. itwas just toobusyasadoctor.And that’showlifewasforme.

it was an eighty-hour workweek and i had kids. Now, i’mhigh-energy, but i had to sleepsometime.ijustalwaysthoughtthattherewouldbeatimeinmylifewheni’dgetbacktoit.

We’vealwayshadapianointhehouse,buti’vealwayslikedtheviolinbetter.Whenihadin-housecall(24hours),i’dactuallytaketheviolinintotheclinicwithme,sometimes,andplay.iwouldn’tdothatathomebecauseihadthekidsathomesotherewasjustnoquiettime.

MED: Whenyourestarted theviolin,how longdid it take togetyourchopsup.

Dr. Kunkel:firstithought,“i’mwaytoooldforthis.”iwasawreck.iwasreallynervousforthesymphonyaudition.itallcamebackmuchslowerthanithoughtitwould,buttwenty-fiveyearsisalongtimeforatalenttorest.Luckily,iwasretiredbythattimesoifinallyhadsometimetopractice.

ithinkmyfieldofOBGYNisalsoafieldofart,moresothanscience.There’salotofhumancontactandmorethanonewaytoskinacat—morethanonewaytosolveaproblem.it’screative.Now,wheni’minsurgery,i’mnotexactlyweavingdesigns,butotherwise there’sa lotofcreationgoingon.

ithinktheyareboththesamekindofdiscipline.Tobeabletoexcelinmusicorinmedicineyouhavetobededicatedandwillingtoputinthetime.Theygotogether.■

Medicine&Arts

Dr. Shirley Kunkel, retired OBGYN TheBiGGrAPereserVe, a pre-

mier wine and food tasting event tobenefit pediatric patients and theirfamilies,willtakeplace6:30-9:30p.m.Thursday,April 14 at theMuseum ofVisualMaterialsinsiouxfalls.

Thiseventisdesignedasanelitewineandfoodtastingexperience,whichalsoraisesawarenessandfundsinsupportofpediatricpatients’needs.Livemusicandasilentauctionarealsopartoftheevent.

Proceeds and donations benefitchildrenandtheirfamiliesatAveraChil-dren’s hospital & Clinics throughequipmentacquisition,staffeducation,training, and charitable health care.AmongprogramssupportedthroughBigGrapefundsarepediatricsocialworkers,Child Life specialists, the AveraChildren’sChampionprogram.

AveraChildren’sisa“hospitalwithinahospital”comprisedof114bedsdevotedtothecareofinfants,childrenandado-lescentsinAveraChildren’sLeveliiiNeonatalintensiveCareUnit(NiCU),newbornnursery,PediatricUnit, andPediatricintensiveCareUnit(PiCU),aswellasthechildandadolescentunitsattheAveraBehavioralhealthCenter.

Alongwith theAveraMcKennanfoundation,presentingsponsorsoftheeventareJJ’sWine,spirits&Cigars;Cadillacofsiouxfalls;andrepublicNationalDistributingCompany.

formoreinformationcall(605)322-8900orvisitwww.TheBigGrape.org.■

Life is short but art endures — Hippocrates ‘BIg gRAPe’ WINE TASTING

Benefit set for April 14

& Violinist

“Interview and photo by Darrel Fickbohm

Dr. Wilson Asfora

Dr. Ron Rossing

The Crabgrass Crew


local Physicians take Center Stage at annual Doctors in Concert fundraiser

ThesTAGeWAsseTONsATUrDAYMArCh12th, as theWashington Pavilion in sioux fallshosted the8thannualDoctors inConcertbenefiteventforChildren’sCarehospital&school.The

concert and silent auctionwere jointly sponsoredbyAveraand sanford. An estimated 800 people attended the event,whichraisednearly$30,000.

Children’sCarePresidentandCeODiannarajskisaidoftheevening,“it’sreallyfunforpeopletoseetheirdoctorsinthistotallydifferentrole—onstageperformingmusically.We’reluckythesebusyprofessionalsagreetodothisforourkids.”

JackBillion,MD,retiredorthopedicsurgeonandCChsboardmember,was the evening’s emcee.his easy-goingmannerwiththeaudienceandperformerssetacomfortablemoodintheGreathallforamusicalprogramthatfeaturedawalkthrougharangeofstylesandinstruments.

firstontheprogramwasapianotriobyJosephhaydenperformedbyMarianPetrasko,MD,ChrisCarlisle,MDandCarlisle’sson,Gabriel.ThepiecewasgivenafreshsoundbyDr.Petrasko’sassertivepianostyle.singerronaldrossing,MD,thenperformedselectionsrangingfromfranksinatrastandardstogospel.

Later,thestagebroughtsoundsofthefluteandharpduoofDennisKnutson,MD,anderinholland.Dr.Knutson’sflutetrilledoutsomeCelticsoundsinanespeciallybeautifultrioofsongs.TheclassicalguitarofneurosurgeonWilsonAsfora,MD,wasnextwithseveralpiecesthatseemedtohangintherichacousticsoftheGreathall.Oneselection,ChildhoodMemories,wasespeciallytouchingduringaneveningthatwouldbenefitthechildrenofCChs.

Althoughtheevening’sproceedssupportCChs,thisyear’seventwasalsodedicatedtoscottschoppertofschoppertPianoGallery(formerlyschmittMusic)ofsiouxfalls,whocontacted

Children’sCarein2003withtheideaforthisevent.schoppertisseriouslyillwithcancer.

ThenightendedwithaarollickingsurveyofAmericanpopularandcountrymusicthatfeaturedtheCrabGrassCrew,a collection of string players that included doctors LisaLafollette, MD, Tom Weisbecker, DDs, and richardBarnette,OD.■

by darrel Fickbohm

photos by Reistroffer Design

The furniture built to withstand time229 S Phillips Ave

Downtown Sioux Falls, 57104 PH. 605.373.0700

artisanhousegalleries.com

Locally owned and operated since 2003

Stickley


A NeW AssOCiATe agreement between riverView healthandsanfordhealthwill giveriverviewpatients access to anintegrated, state-of-the-art electronicMedical record (eMr)system.

riverViewhealth is an independent, community-ownedhealthcareorganizationheadquarteredinCrookston,Minnesota.riverViewconsistsofa25-bedcriticalaccesshospital,a70-bedlong-termcarefacility,a52-bedchemicaldependencytreatmentcenter,homecare,laboratoryservices,rehabilitation,communityoutreach,andanumberofprimaryandspecialtycareclinics.They systemhas entered into the associate agreementwithsanfordinfebruary.

TheeMrsystemwillallownurses,doctorsandothermedicalprofessionalstoseamlesslycollect,store,andaccessapatient’smedical informationin thesafestwaypossible.Patientswill

Sanford Health A N NOuNc ES Agreement with RiverView HealthCollaboration to Provide Patients with Integrated Electronic Medical Record


AVerAfLANDreAUMeDiCALCeNTerisnowanownedfacilityofAveraMcKennanhospital&UniversityhealthCenterinsiouxfalls.Thechangeinownership,effectiveMarch1,resultsfrom an agreement reached betweenAveraMcKennan and theCityofflandreau.Thecitygiftedthehospitalbuildingsandprop-erty toAveraMcKennan in exchange forAvera’s agreement toexpandandrenovatethefacility.

AveraMcKennanhashadahealthcarepresenceinflandreaufor18years.ThehospitalcameunderMcKennanmanagementin1993,andbecameanAveraMcKennanleasedfacilityin1999.

“Wehaveappreciatedflandreau’spartnershipwithusininnova-tiveprojectslikeAveraeiCU®CAre,eConsult,eemergency,ePharmacy,electronicMedicalrecords,andmore,”saidDr.DavidKapaska,CeOandregionalpresidentofAveraMcKennan.“Averaflandreauisknownformakingprogressivedecisionstoensurethatlocalhealthcareremainsstrong,soarearesidentshaveaccesstohighqualitycarerightintheirhomecommunity.”■

alsobegiventheopportunitytoutilizeasecureinternetbasedportaltoscheduleappointments,accesslabtestresults,andcommunicatewiththeircareteam.

“As an organization, sanford health takes anintegratedapproachtohealthcare.Workingwithotherhealthsystemstosharethesameelectronicmedicalrecords is a catalyst for providing that integratedcare,”saidDennishofer,vicepresidentforsanfordhealthinformationTechnology.

sanfordhealthhasseverallevelsofrelationshipswithareahospitals.Theserelationshipsrangefromassociate,managed, leased and owned status.Anassociate agreement with sanford health allowsriverViewhealthaccesstotheeMrsystem,whichisexpectedtobeinstalledbythefallof2012.■

Avera McKennan Assumes ownership of Avera

Flandreau Medical Center


A sTUDY COMPLeTeD BY theOfficeof theNationalCoordinatorforhealthinformationTechnology(ONC)and published in the journal healthAffairs finds growing evidence of thebenefits of health information tech-nology(hiT).Thenewstudyfindsthat92percent of articles onhiT reachedconclusions that showed overall posi-tive effects of hiT on key aspects ofcareincludingqualityandefficiencyofhealthcare.inaddition,thestudyalsofinds increasing evidence of benefitsforallhealthcareproviders,notjustthelargerhealthiT“leader”organizations(i.e.earlyadoptersofhiT).

healthPOiNT,partofDakotastateUniversitywhichworkswiththeONCassouthDakota’sregionalextensionCenter,launchedtheirMemberservices

lastsummertoallstatehealthcarepro-viderswithaspecialfocusontheruraland independent providers. health-POiNTMemberservicesoffersstudents,consumers,andhealthcareprofessionalsan opportunity to engage in a southDakotahealthiTcommunitythroughitsspecialized content, including onlinewebinars and regional workshops.Through a network of health iTProfessionals in every corner of thestate,healthPOiNTassistshealthcareprovidersinruralsouthDakotacom-munitieswithvendorselection,changemanagement,workflowoptimization,andprojectmanagement.

“What this studydemonstrates isat theverycoreofourmission,”saidKevinBoyum,OperationsManagerforhealthPOiNT. “electronic health

record (ehr) adoption is vital toimprovinghealthcare in all settings,bothlargeandsmall.”

“Thisarticlebringsusmuchmoreup-to-date, both in our confidenceregardingtheoverwhelmingevidenceofthebenefitsofadoptionanduseofhiT, and also in our understandingofproblemareas thatstillneedtobeaddressed,” said David Blumenthal,M.D.,thenationalcoordinatorforhiTandoneof theauthorsof the review.“This review is important because ithelpsuscorrectforthelaginevidencethatoccursnaturallyinthedynamichiTfield,wherechangesintechnologyandaccelerating adoption cause the oldliteraturetobecomequicklyoutdated.”

Thereviewreflectedanewbalanceof evidence between hiT “leader”

April 18-20, 2011�e Lodge | Deadwood, South Dakota

Improving the OddsforSuccess

South Dakota Medical Group Management Association Spring Conference

Featuring:Frank Cohen

Principal and Senior Analyst,The Frank Cohen Group, LLC

Elizabeth WoodcockPrincipal, Woodcock & Associates

David A. WestergaardExecutive Vice President/CFO,

Riddle’s Group Inc.

Barry CarlsonPresident, Carlson & Associates

For the full schedule or to register, visit our website at

www.sdmgma.org

new Study validates efforts of Dakota State University Health IT Initiative


Make-A-Wish Foundation® of South Dakota www.southdakota.wish.org 800-640-9198

organizationsandotherentities,especiallysmallermedicalpractices.inpreviousyears,muchevidencehascomefromthe“leaders.”Thecurrentreviewshowsincreasedevidenceofbenefitsforothersaswell.

UnderthehealthinformationTechnologyforeconomicandClinicalhealthAct(hiTeCh),partoftheAmericanrecoveryandreinvestmentActof2009,asmuchas$27billionMedicareandMedicaidincentivepaymentswillbeavailabletoeligibleprofessionals,eligiblehospitals,andcriti-calaccesshospitalswhentheyadoptcertifiedehrtechnologyandsuccessfullydemonstrate“meaningfuluse”ofthetechnol-ogyinwaysthatimprovequality,safety,andeffectivenessofpatient-centeredcare.

Positive results highlighted in the article include:Onestudy found thatat threeNewYorkCitydialysis

centers,patientmortalitydecreasedbyasmuchas48percentwhilenursestaffingdecreasedby25percentinthethreeyearsfollowingimplementationofehrs.

in an inpatient study, a clinical decision support tooldesignedtodecreaseunnecessaryredbloodcelltransfusionsreducedbothtransfusionsandcosts,withnoincreaseinpatientlength-of-stayormortality.

AnotherstudyaddressinghiTin41TexashospitalsfoundthathospitalswithmoreadvancedhiThadfewercomplica-tions,lowermortalityandlowercoststhanhospitalswithlessadvancedhiT.

Thenation’s62regionalextensionCenters(reC)shaveenrolledover50,000providersnationwide.healthPOiNTcontinuestoassistproviderswiththeadoptionandmeaningfuluseofehrs.Todate,healthPOiNThasenrolledover40%ofthestate’sprimarycareprovidersfortheirservices,puttingthemabovethenationalaverage.ifyouareaproviderconsid-eringanehradoptionorwouldlikemoreinformation,pleasevisithttp://www.healthpoint.dsu.edu.■


American Cancer Society Now Taking Applications for Research GrantsFocusing on Cancer Health DisparitiesTheAMeriCANCANCersOCieTYisinvitingresearchersinsouthDakotatoapply for grant funding for communitybasedresearchprojectsfocusedonreducingcancerhealthdisparities.fundingisavail-ableupto$100,000fortwoyearsofstudy.

TOBeeLiGiBLe,reseArChMUsT:■bedonewithsuitableexperts(thosewithin colleges, universities, publichealthandprofessionalschools,scien-tific and professional organizations,government agencies, communityhospitals,orcancercenters)

■bedonewithnonprofitorgovernmentorganizationsoutsideoftheAmericanCancer society (health and socialserviceorganizations,faith-basedorga-nizations,voluntaryassociations,civicandcitizengroups,orfederally-recog-nizedindiantribalgovernments,tribes,ortribalorganizations)

TheAmericanCancersocietycurrentlyfunds two research projects in southDakota.A$50,000grantwasawardedtoDelf schmidtGrimminger,MD at theAveraresearchinstituteincooperationwith the University of south DakotasanfordschoolofMedicinetoincreaseawareness and prevention of cervicalcancer among the Northern PlainsAmerican indians. A second grant of$50,000wasawardedtoNancyfahren-wald, PhD, at south Dakota stateUniversity to determine factors thatinfluenceruralwomen’sdecision-makinginbreastcancertreatmentinordertogener-ateadecisionsupportintervention.

formoreinformationonapplyingforgrants,visittheAmericanCancersocietyonlineatwww.cancer.org.■

A letter from President & Ceo Paul Krueger

Experiencing a wish firsthand is the best way to understand our mission. I saw it in the huge smile and eyes of 6-year-old Karley from Yankton when her mom pushed her wheelchair up the new ramp into the family’s refur-bished van for the first time. I saw at it on the faces of her parents who don’t have to lift her growing body out of her wheelchair each time they want to travel somewhere as a family. I saw it on the faces of her grandparents and family members who came to celebrate with her that day. And I saw it in the faces and tears of those who helped make the wish possible as sponsors. Hope, strength and joy – it’s what we offer to children facing life-threatening medical conditions. It is what we do best. We rely on you, the medical com-munity, to refer children to us. We want to make sure every eligible child, like Karley, receives a wish. For more information, visit www.southdakota.wish.org or call 800.640.9198 statewide or 605.335.8000.

Spotlight on Nonprofit

Make-A-wishSpreads Hope,

Strength and Joy

in South Dakota

Prevention.Diagnosis.Treatment.

100-11395-1276 1/11

Whether your patient is a child with spinal deformities or fractures, a competitive/recreational athlete with a sports injury or active adults exhibiting signs of chronic musculo- skeletal disease, the physicians at Sanford Orthopedics & Sports Medicine take a multidisciplinary approach to surgery, research and clinical consultations.

• Total Joint Replacement

• Anterior Approach Total Hip Replacement Surgery

• Sports Medicine

• Upper Extremity

• Lower Extremity

• Pediatric Orthopedics

• Foot care

Get stronger. Play smarter. Return to performance.

Visit Sanford Orthopedics & Sports Medicine Walk-in Clinic, Monday-Friday 8:00 a.m.- 4:30 p.m.

For an appointment at Sanford Orthopedics & Sports Medicine call (605) 328-2663.


JUsTAs ‘ALLrOADsLeADTOrOMe’,manyofthe body’s most complex neuromuscular or skeletalproblems can be traced directly to the spine. Nervepathwaysconvergehere,inthecenterofthebody,and

thecolumnof2dozendelicatevertebralbonesprovidesthevitalsupportstructurefortheentireskeletalsystem.

“Thespineis theareaof thebodythatreallybringsusall together,”saysNeurosurgeonQuentinDurward,MD,of CNOs in Dakota Dunes, where a team of nearly 30neurologists, neurosurgeons and orthopedic surgeons aswellasarheumatologistandtherapists,takeateamapproachtospinecases.

Dr.Durwardexplains,“Therearebones,jointsandnervesinthespine.Whenpatientscomeinwithconditionsthataffectthespine,suchaspain,deformity,numbness,weaknessorsciatica, our different areas of expertisemean that these

conditionscanbehandledfrommanydifferentdirectionsatonce,allinthesamebuilding.idon’tknowofanyotherclinicthatmanagessuchcasesthewaywedo.”

Sp INAl ExpErt ISE : D IffErENt pAthSWhen approaching spinal cases, CNOs neurologists,includingWilliamAndrews,MD,JohnGrudem,MD,Meihe,MD, James Case,MD Luis Pary,MD and JenniferPary,MDuseavarietyofstate-of-the-artdiagnostictoolstopinpoint common problems such as disc herniation andnerveimpingement.

ifnon-surgical interventioncannotprovide relief, theclinic’sfiveboard-certifiedneurosurgeons, includingDr.Durward,ralphreeder,Jr.,MD,Grantshumaker,MD,Thorirragnarsson,MDandMatthewJohnson,MD,lookforwaysto surgically remove the structures thatmay be putting

NEW TECHNOLOGY HELPS SPINE DOCTORS IMPROVE FUSION SURGERY

navigating the SpineDetailed 3D images are produced by combining preoperative CT scans with interoperative x-rays.

by Alex Strauss

ph

oto

by K

rist

i Sha

nks


pressureonspinalnervesandcausingpain.

Three of CNOs’ 13 orthopedicsurgeons–stevenMeyer,MD,WadeJensen,MDandMichaelespiritu,MD–alsohavespinalexpertiseandfocusonsurgicalmethodsforrelievingjointpain.

Notonlyarethesephysiciansavailabletoconsultwitheachother,butneurosur-geonsandorthopedicsurgeons–whorarelyworktogetherinothermarkets–may even perform themost complexspinalprocedures,suchasdeformitiesorextensivenervecompression,intandemtoensureoptimalpatientoutcomes.

Sp INAl fuSIONOneofthemostcommonproceduresdesignedtorelievespinalpainwhileincreasing the spine’s strength andstabilityisspinalfusion.spinalfusionmay be indicated for a variety ofconditionsstudieshaveshownthatitisoftenaneffectiveoptionforspondy-lolisthesis,inwhichafractureoccursinavertebraecausingittoslipforwardover the bone below. fusion of theunstablevertebraetoastableoneholdstheboneinplaceandpreventsitfromputtingpressureonspinalnerves.fusionmayalsobeconsideredforcurvatureofthespine(scoliosis)andcertainkindsofdegenerativediscdisease.

A typical spinal fusionprocedureinvolvesplacementofbonegraftmate-rialbetweenadjacentvertebrae.Oftensurgical implants, such as screws orplates,areusedtoholdthevertebrae

stableandthebonegraftinplaceuntilthebonesnaturallyfuse.Theresultisalessflexiblebutstrongerandlesspainfulspine.Althoughfusioncanbehighlyeffective at stabilizing and relievingpain, the procedure is complex andrequiresathoroughknowledgeofthedelicatestructureofthespine.

“itisextremelyimportanttopositionthescrewssothattheyarecompletelywithin the bone and don’t impingewonthenervesinanyway,”explainsDr.Durward.experienceandanunder-standingofspinalanatomy,aswellaswell-designedsurgicalscrews,arecru-cialforpatientsafety.surgeonsmayalsouseacombinationofCTimages,x-rays,and intraoperative neuromonitoringtechniques to aid them in preciseplacement.

NAvIgAtINg thE Sp INENow,inadditiontothesetools,CNOssurgeonsarealsoutilizinganadvancednew imaging system tomake spinalfusion more accurate and safe.stereotacticnavigationcombinespre-operativeCTscanswithintraoperativex-raystoprovideevenmoredetailed,3Dguidingimages.

“With the stereotactic navigationsystem,wehaveonemorewaytomakesurethatwehavebeenaccuratewiththeplacement of screws during fusionsurgery,”explainsDr.Durward.“Weareabletoascertainthateverythingwehavedoneduringsurgeryisgoingtobeeffectiveandsafe.”

functioningsimilartoacar’sGPssystem, the stereotactic navigationsystemgivessurgeonsadetailed,3dimensionalviewinsidethespineinrealtime.Theimagecanevenbeadjustedduringsurgery,toprovideaconstantflow of information that allows forcontinuousrefiningofthetreatment.Theability toplacesurgicalscrewsmorepreciselymeansthatnotonlyissuccess-ful fusionmore likely, but also thatcomplicationscanbeminimized.

in a study of the technologyconductedattheClevelandClinicandpublished in Neurosurgical focus,theauthorsobserved,“Althoughconven-tionalintraoperativeimagingtechniquessuchasfluoroscopyhaveprovenuseful,they provide only two-dimensionalimagingofacomplex3Dstructure.Con-sequently, the surgeon is required toextrapolatethethirddimensionbasedonan interpretation of the images andknowledgeofthepertinentanatomy...image-guidedspinalnavigationmini-mizesmuchoftheguessworkassociatedwithcomplexspinalsurgery.”

Althoughthestereotacticnavigationtechnologyiscurrentlybeingusedpri-marily toassistwithfusionsurgeriesatCNOs,itmayeventuallyhaveappli-cationsforcertaintypesofminimallyinvasivespineprocedures.Thesepro-cedures,aswellasnewtechniquessuchasthelateralsurgicalapproachtothespinenowbeingofferedatCNOs,con-tinuetosecure theclinic’splaceasaregionalleaderinspinetreatment.■

Orthopaedic spine surgeon, Dr. Wade Jensen discusses a spinal fusion case with Physician Assistant Batzi Mutize, PA-C.

CNOS spine surgeons will use the new stereotactic navigation technology to assist them in the precise placement of fixation devices during spine fusion.

ph

oto

by K

rist

i Sha

nks

ph

oto

by K

rist

i Sha

nks

0000239966

Finding Balance

low sex drive7 out of 10 women complaining of

low sex drive have a hormone imbalance

hot flashes8 out of 10 women complaining of

hot flashes have ahormone imbalance

depressed2 out of 3 women complaining

of depression have a hormone imbalance

Pharmacy Specialties will help you find balance again.

Call today to schedule an appointment!

2333 W. 57th Street - Suite 107 Sioux Falls, Sd | 605-334-1672


DeADWOOD, sD – sherrY BeAsMiTh, Chief executive Officer atLead-Deadwood regional hospital,was recently named the Americanhospital Association’s south Dakota2010GrassrootsChampion.

TheGrassroots Champion awardsinglesout onehospital leader fromeachstatewho,overthepreviousyear,effectivelydeliveredthehospitalmes-sagetoelectedofficials;helpedbroadenthe base of community support forhospitals;andadvocatedtirelesslyonbehalfofpatients,hospitals,and thecommunityservedbythosehospitals.

“sherry Bea smith is a highlyrespected and trusted employee ofregionalhealth,”saidTimsughrue,CeO of regional health NetworkandCOOofregionalhealth.“sheisrichly deserving of this award andrecognitionassheistotallydedicatedtoadvancinghealthcareandimprovingthecommongood.”

smithwillbehonoredatthesixthannual“BreakfastofGrassrootsCham-pions”April12inWashington,D.C.

“i’mhonoredandinvigoratedtocon-tinuemyinvolvementinhealthpolicy,sinceithassignificantimpactonallthatweserve,”saidsmith.■

rAPiDCiTY,sD–KUrTsTONe,M.D.,MedicalDirector at rapid City regional hospital (rCrh)family Medicine residency Clinic was recentlynamedthesouthDakotaAcademyoffamilyPhysi-cians(sDAfP)2011familyDoctoroftheYear.

stonehasbeenpracticingintherapidCityareasince1993workingasaflightsurgeonandChiefofhospitalservicesatellsworthAirforceBase,Medi-cal Director of Community health Center andMedicalDirectorof therCrhfamilyMedicineresidencyClinic,apositionhehasheldsince1995.

heisvaluedbymanyfamilymedicineresidents,staff,faculty,andpatientsasateacher,physician,mentor,clinicdirector,communityservant,andfriend.stoneisalsoactiveinclinicalresearchandiscurrentlyservingastheprincipalinvestiga-torofseveralstudies.

ThesDAfP’smissionistoimprovethehealthofpatients,familiesandcom-munitiesbyservingtheneedsofmemberswithprofessionalismandcreativity.■

lead-Deadwood Regional Hospital

Ceo Receives national American

Hospital Association

Award

Rapid City Doctor Named SDAFP

Doctor of the Year

kristishanksphotography.com 605-941-2554

Midwest Medical Edition 26 Midwest Medical Edition 26

www.dt-trak.com 605.853.2786

Sage Intergy Billing and Practice Management System

Sage Intergy EMR

Credentialing

Auditing

Education

Medical Coding

Claims Billing

Accounts Receivable

Full range of medical practice support services including:

Medical Practice Management Solutions

27MidwestMedicalEdition.com

Grape Expectations

by Heather Taylor boysen

As hUMAN BeiNGs werelyonourhearing,sight,smell, taste and touch toexperience our own exis-

tence.While all of us place our ownimportance on each of these senses, ifirmly believe that for me smell andtastearetwosensesthatwhenindulg-inginmypassionforwineiwouldbebereftwithout.Wineissensual,playfulandsometimesmysterious.ificouldn’tsmellitortasteitmyworldwouldjustseemalittlelessbright.

studieshaveshownthatwhenyoutastewineitisreally70-80%smellandcontrarytopopularbelief,smellsarenotregisteredinthenose,butatolfac-toryreceptorslocatedbehindthenoseandbetweentheeyesandbrain.Ourpalateor tonguecanonlyperceive5basictastes:sweet,salty,sour,bitterandumami,aJapanesewordforthesavorycharacterinfoodanddrink.Andifanyofyoucanidentifyumami,isuggestasommeliercourseisinyourfuture.

in order to smell your wine it isimportant to first release its aroma.simplyswirlingthewineyourglasswillintensifyawine’sodorbecauseitcausessomeofthealcoholinthewinetoevapo-rate.Asitevaporatesitbringswithit

theparticularscentsthatweretrappedinthewine.ifyouarenota“swirler”thenyoumaywanttopracticealittlebeforeyouattemptthisinpublic.Theeasiestwaytoswirlistoleaveyourglassonthetableandgentlyrotatethebaseofthewineglassinsmallcirclestocreateatornadoeffectintheglass.Thiswillalsoconcentratethearomasofthewineinthecenteroftheglass.Afterafewseconds of swirling immediately putyournoseintheglassandtakeseveralshort,aggressivesniffs.Don’tbeshy–puttingyournosetwoinchesabovetheglasswillnotwork!

iliketoclosemyeyeswhenisniff.itismywayofconcentratingfullyonwhatitisintheglassandthesmellsthataregallopingupmynose.ialsomightquietlyhumsoastoblockouttheenvi-ronmentaroundmejusta little.And,yes,ihavehadpeoplegivemefunnylookswhilei’mtastingwine.Maybethat’swhyiclosemyeyes?

Don’toverthinkitatthispoint.Whatisthefirstsmellthatcomestomind?iactually tastedaZinfandel theothernightandmyfirstthoughtwasDoubleBubbleBubbleGum.i’mnotkiddingandafterimentionedittoothertasterstheyconcurred.Thiswasnotthesmelliwaslookingforinthatparticularwineanditruinedthetastingexperienceforme.iwantedanexuberantZinfandelwithflavorsofraspberries,blackpepperandbakingspices.iwantvanillainmyChardonnay and lemon grass inmysauvignonBlanc.iamafanoffresh

turneddirtinmyPinotNoirandgreenapples in my Pinot Gris. i do notwant green peppers in my ChileanCabernets!

Usuallyafteranotherswirlandsev-eraldeepwhiffs,iletasmallamountof thewinehitmylipsandtongue.iliketoslurpalittleandletwineandairentermymouthatthesametime.Thisdoes takepractice,but itallowsevenmoreolfactoryparticipationandplea-sure.Makesureyoutasteatleasttwicebefore making a decision about thewine.Thefirstsip isonly toprepareyourpalate,thesecondsipistosavorandenjoy.Thethirdsipwillgiveyouevenmoreinformationandhopefullyopen your senses to a full throttleenjoymentofwhatisinyourglass.Youwill not bedisappointedunless yougetbubblegumwhenyouwere leastexpectingit!■

The nose Knows


Splinting At work part 2

by Stan Kulzer, OTR/L, CEES

The iNTeNTiON of a worksplintistoprovideresttothemuscles and tendons aroundthe wrist and to prevent fur-

thermotionthatmayworsensymptoms.itsoundsprettysimple.

WhAt rEAlly hAppENSThreethingsmayhappenwhilewear-

ingawristsplintatwork:The splint provides support and

remindstheindividualtoavoidawkwardwristposturing.Theygetbetter.

Theemployeecontinuestousethesame awkwardwrist postures whileworkingandactuallybendsthewristagainsttheresistanceofthesplint.Theymaygetworse.

Thesplintsucceedsinpreventingtheunwantedwristmotionbuttocompletethe job, themotion is performed byanotherjointtherebyplacingitatrisk.Thewristfeelsbetterbuttheyfileaclaimforoveruseoftheshoulder.

ExAMplETackweldinginthepostureshown

inphotonumber1(above)demonstratedwithoutweldinggloveforclarity,7.5hours a day, created numbness and

tinglinginthefingers,wristtendonitis,andforearmmusclespasm.

Awristsplintwasapplied,asshowninphotonumber2,whichpreventedtheemployeefromflexingthewrist.Thisreducedsymptoms,buttheemployeebegantohavecomplaintsofshoulderdiscomfort.

Themotionneededtoturnthewandtothecorrectorientationwastransferredtotheleftshoulder.Theshoulderisnowinabductionandinternalrotationwhichis often associated with rotator cuffpathology.

prOblEM SOlvINgPhoto number 3 shows the result

of ergonomic problem solving. Theemployeenowallowsthewandtoturninhishand–insteadofturningthewandwithhishand–andactivatesthetriggerwith his thumb instead of his indexfinger.Theotherhandassists.

Theresultisneutralwristandshoul-derposture.Thestraininbothjointswaseliminatedwiththismethod.infact,thesplintwasno longerneededbecauseneutralwristpositioningisbuiltintothenewtechnique.

OthEr fActOrSifyou’renotproblemsolvingonsite,

you’llalsomisstheweightofthecableextendingfromtheweldingwand.Thewrist and hand continually fight theresistance of the cable which addstotheoverallfatigueanddiscomfort.

Overheadtoolbalancerscanholdthecableslackandremovetheresistance.Thecablecanalsobesecuredtoahookwornofftheemployee’sbelttoallowslack.

fINAl thOughtSit’snearlyimpossibletoanticipate

theissuescreatedbysplintwearintheworkplace without seeing the actualwork.Mostoften,wefindthatasplintisnotneededatall.

in addition, there are likely otherissuesthatrequireproblemsolvingandcorrectionbeforeanemployeewithamusculoskeletalinjurywillseeresults.Thesplintalonewillnotfixeverythingandmayactuallybeintheway.

Usingergonomicspecialists–quali-fiedoccupational therapists, physicaltherapists,humanfactorsengineers,etc.–cansignificantlyreducerecoverytimeandhelpavoidunnecessarycomplica-tionsforworkerswithmusculoskeletaldisorders.■StAN KulzEr is an Ergonomic and Loss Control Specialist with RAS, a provider of workers’ compensation in the upper midwest, headquartered in Sioux Falls, SD.

In the January/February issue of MED, Stan Kulzer addressed some of the

challenges related to splinting for relief of work-related hand and wrist condi-

tions. He explores the issue further in this second part of that article.1

3

2

What You’re Reading, Watching, Hearing

In Review

March 2011 29MidwestMedicalEdition.com

Write to us!

Do you have a media review?

A book, film, or article? How about an opinion

on a current event?

Write to us at:[email protected]

Retired doctor examines guilt in AIDS-related patient deaths

Doctor Guilt? When patients die, who’s to blame?

written by Everett Winslow Lovrien, M. D

WhO’s TO BLAMe fOr the thousandsof hemophilia patients who receivedmedication for their condition that wasunknowingly infected with hiV? Who’s

toblamefor theirsubsequentdeaths fromhiV/AiDs?Aretheblooddonorsguilty?Thedrugcompaniesthatdidn’ttestthemedicine?Thedoctorswhoprescribedit?

TheCenterforDiseaseControlin2008reportedthatthecumulativenumberofpersonsintheU.s.thatdevelopedAiDsinhemophiliafrommedicinecontaminatedwithhiVtotaled13,083.sowho’stoblame?

everettWinslowLovrien,M.D.,aretiredpediatricianandmedicalgeneticist,examinesthisdilemmainhisbook,DoctorGuilt?.Thebookis inspiredbyhisexperiencesasdirectorofahemophiliaclinicfor28years,duringwhichnearly90ofhispatientsdiedofliverfailurefromhepatitisorAiDsfromhiVcontaminationofthemedicinehepre-scribedtotreatthem.

Doctor Guilt?followsBrent,ahemophiliapatientgivenanewmedicationthatwouldallowhimtoliveanormallifedespitehisdisorder.Themedicationisunexpectedlydiscov-eredtobecontaminatedwithhiV,causinghimtodieofAiDsatage17.

“All forms of medical treatment include risks,” saysDr. Lovrien. “Because of thesaturationofthemediabyphar-maceuticaladvertising,doctorsand patients must use criticalthinking when comparing thebenefits with the hazards ofmedical treatment.Theimpactofhumanactivitiesarenotalwaysapparentatthetimeofanevent.”

Lovrienalsodiscussestheorigin of hiV, includingwhereitcamefromandhowit came to cause AiDs, aman-madedisease.inaddi-tion,thebookdelvesinto

controversial topics such ascapitalism,freemarketing,costcontrols andgreedwhendrugcompaniessacrificedsafetyforprofitability.

“ihavefeltguiltyofbringingharmtoinnocentyoungpersonswhotrustedmeastheirdoctor,”Lovrienconfesses.“i intendedtorelieve themfromsufferinganddisabilityandprolongtheir lives instead they died from the medicine that iprescribed.Amiguilty?Orwasijustwrong?”■

LIGHTS, CAMERA, ACTION...for a Cure!

THANK YOU TO OUR SPONSORSPLATINUM SPONSORS

GOLD SPONSORS

SILVER SPONSORS

BRONZE SPONSORS

First PREMIER Bank & PREMIER Bankcard HenkinSchultz Communication Arts

In Memory of Eldon J. Heikes McHale Institute

Midcontinent Communications

Argus Leader GFI Productions

Gunderson’s Jewelers KARL’S

Western Commercial Printing

COPORATE TABLE SPONSORSBillion Chevrolet

Dean Karsky Agency- Farmer’s Insurance Holmes Murphy & Associates

Priebe State Farm Agency Sanford Clinic Ear, Nose & Throat South Dakota Trust Company, LLC

BIOGRAPHY

U.S. $ XX.XX

U.S. $ XX.XX

Brent admired the chimpanzee he sketched at the zoo. He regarded the animal as contemplative. He was unaware that similar animals in the wilds of Africa were the source of a virus that would lead to his death from AIDS. Brent became infected with HIV from the medicine he infused to treat his hemophilia.

At six months of age, his parents were alarmed when they discovered bruises on his chest which led to the discovery of hemophilia. From that moment forward, he received frequent intravenous infusions of Concentrate to treat recurrent bleeding episodes. Infusions of the medicine relieved pain and suff ering from bleeding. His life seemed normal. Unexpectedly, Brent’s life changed after the discovery of HIV contamination of the medicine.

� e medicine was manufactured from the plasma of paid blood donors. Unbeknownst to Brent, the plasma was polluted with HIV. � e SIV in chimpanzees changed to become HIV in humans. But the chimpanzees were not the cause of the transfer of SIV in animals to HIV in humans. � e change from SIV in animals to HIV in humans was the result of human activity. � e change came about with the production of the hepatitis B vaccine.

Who was responsible for the pollution of the hemophilia medicine with HIV and hepatitis viruses? Was Brent’s death preventable?

!"#$"%&'()*$+,-./.00&1234567&*6-/2.3

!"

#$

"%

&'(

)*$

+,-./.00&1

234567&*6-/2.3

w w w . i u n i v e r s e . c o m

After fi nishing medical school, Everett Winslow Lovrien, MD completed specialty training in pediatrics and the new fi eld of medicine, medical genetics. For twenty-eight years, he was on staff at a clinic that supervised the medical care of a genetic disorder, hemophilia. � is book is based upon his experiences. Now retired, he lives in Oregon.

8!"#!$%&'($)*&!"#$"%&'()*$+

� e events in this story do not take place in the “dark old days.” � e setting is during the times of modern medicine in the 1980s and 1990s. Events in Brent’s life are set down as he would have described them if he had lived a few more years. Experiences related are real, although exact conversations, Brent’s intimate thoughts, and details of events may not be completely factual. Some of the names of places and living persons have been changed.

� rough his treatment, Brent met other youths and men, not exactly like him, but who had the same medical disorder and required similar medical care. He met men and boys in the clinic where he was cared for—as well as at summer camp. Some of the events in their lives are also described in this story. He also met medical doctors, nurses, physical therapists, social workers, and a list of persons who served him in the clinic. Brent had a close family and loving relatives.

� e medical condition Brent lived with, hemophilia, was treatable but not curable, and it required frequent infusions of medicine into his veins. Modern treatment with a revolutionary medicine brightened his life. But the medicine he received for treatment also led to his early death.


News & NotesHappenings around the region

News & NotesHappenings around the region

AverAAvera McKennan Hospital&UniversityhealthCenterwillopenAveraMedicalGroupOphthalmologyinMayinsiouxfalls.Theclinic’smedicalproviderswillbeDr.VictoriaKnudsen,retinalspecialistandDr.Jeffreystevens,generalophthalmologist.Dr.JeffstevensreceivedhismedicaldegreefromDrexelUniversityCollegeofMedicineinPhiladelphiain2006andcompletedtheophthalmologyresidencytherein2010.Dr.KnudsenreceivedhermedicaldegreefromYaleUniversityin2000,completedanophthalmologyresidencyattheUniversityofCaliforniainsanDiegoin2004,andcompletedafellowshipinvitreoretinalsurgeryattheUniversityofCaliforniainsanDiegoin2006.

The 23rd annual Avera Race AgainstBreastCancerwillbesaturday,May7,attheAveraMcKennanfitnessCenterinsiouxfalls.TheAveraraceAgainstBreastCancerincludesa10Krun,5Krun,3milewalkand1.5milefamilyfunwalk.Onlineregistrationforalleventsis$30.The5Kand10Krunsarecompetitive,officialchip-timedevents.registrationforthe5K/10Krunswillcloseonfriday,May6at6p.m.runnerswhoregisteronracedaymayparticipate,butwillnotbetimed.Lastyear’seventbrokerecordswithmorethan5,000participantswhohitthepavementtoraisemorethan$305,000.

dr. Tarek Mahrous, interventionalCardiologistatNorthCentralheartinstituteinsiouxfalls,southDakotawasrecentlyawardedfellowshipintheAmericanCollegeofCardiology.CandidatesforfellowshipmustbeBoardCertifiedininternalMedicineandCardiologyanddemonstratethatmorethan75%ofcurrentpracticeisrelatedtocardiovascularmedicine.Dr.MahrousreceivedprofessionalrecommendationsinsupportofACCfellowshipfromhispeersandtrainingdirector.hehasalsobeenappointedasaClinicalAssistantProfessorofMedicinewiththesanfordUsDschoolofMedicine.

SAnford

Jim E. Mitchell, Md hasbeenappointedVicePresidentofresearch,fargoDivisionforsanfordresearch.Dr.Mitchellisalong-timememberofthefargocommunity.inadditiontothisnewroleforsanfordresearch,hewillcontinueinhiscurrentleadershippositionsasPresidentandscientificDirectoroftheNeuropsychiatric Research institute,ChairmanoftheDepartmentofClinicalNeuroscienceandNri/LeeA.Christoferson,MDProfessorattheUniversityofNorthDakotaschoolofMedicineandhealthsciences.Dr.Mitchellwillleadthedevelopmentofprogramsthatincreasesanfordresearch’scapabilities.

becker’s Hospital Review hasnamedsanfordUsDMedicalCenteramongthetop50besthospitalsinAmerica.Thelistincludedawidespectrumoffacilitiesincludingwell-knownacademiccentersandlesserknowncommunityhospitals.TheBecker’shospitalrevieweditorialteamanalyzed,scoredandweighteddatafromoutsidesourcesonfactorsincludingpatientsafety,clinicaloutcomesandreputation.

North Country Health Services (NChs)andsanfordhealthhavefinalizedthecontractbringingthetwoorganizationstogether.NChsandsanfordBemidjiClinichaveworkedcloselyfordecades.ThisisthefirststepintheintegrationofthetwoBemidji-basedorganizations.Plansareunderwaytoexpandtheareasofheart,cancer,orthopedics&sportsmedicineandwomen’shealth,aswellasresearchandeducation.Aspartoftheaffiliation,sanfordwillinvest$70millioninresourcesoverthenexttenyearsandwillimmediatelymakea$5milliongifttotheNChsfoundation.

Sanford Chamberlain Care

CenterhasreceivedahighrankingoffivestarsoverallinU.s.News&Worldreport’s2011BestNursinghomes,availableonlineatwww.usnews.com/nursinghomes.U.s.News’sBestNursinghomesprofilesmorethan15,000facilitiesandranksthembystate,usingdataandqualityratingsfromthefederalgovernment.Therankingsareupdatedquarterly.

regionAlRapid City Regional Hospital (rCrh)isnowprovidingthelatestinhigh-techdigitalmammography.rCrhhostedanopenhouseonMarch9todisplaythenewtechnology.Other Regional Health facilities currently offering digital mammography services include BuffaloregionalMedicalClinic,Custerregionalhospital,spearfishregionalhospital,andsturgisregionalhospital.QueenCityregionalMedicalClinic,inspearfish,willprovidetheserviceinthesummerof2011.

The Lead-deadwood Regional hospital(LDrh)diabetesprogramwasrecentlyaccreditedbytheAmericanAssociationofDiabeteseducators(AADe).TheAADe’sDiabeteseducationAccreditationProgramisbasedontennationalstandardsfordiabetesself-managementeducation.

in honor of former Hospice patientednaroth,frankandPennyDarling

askedartistrichardDuboistocreateapainting.TheydonatedthepaintingtothehospicehouseinrapidCityanditnowhangsintheGreatroom.ednarothwasthemotheroffrankDarling.

Mona Elsayed, M.d., hospitalistatrapidCityregionalhospitalwasrecentlycertifiedinhospital

Medicine.ThiscertificationcomplementsherBoardCertificationininternalMedicine,whichshehasheldsince2001.elsayedjoinedrapidCityregionalhospital’shospitalistprograminNovember2010.sheisalsoanactiveclinicalinstructorforthesanfordschoolofMedicine,internalMedicineDepartment.


Medical-Based Camps for Children with Special Needs

REHABILITATION CENTER1100 W. 41st St., Sioux Falls, SD 57105 • www.cchs.org

Call (605) 782-2400 for camp details and screening appointments.

Power Mobility Camps • Session 1: June 7-8 & 13-15 Session 2: July 26-27 & August 1-3 9:00 a.m. - Noon

The latest technology in power mobility in a fun and functional setting. Children learn mobility skills for different terrains and situations using their own chair or one from the Children’s Care fleet.

Breakfast Club • June 6-30, Mondays & Thursdays 7:45 - 9:00 a.m.

For children with food aversions, sensory or oral motor difficulties, those transitioning from tube-feeding or who are picky eaters. Led by an Occupational Therapist and Speech-Language Pathologist.

Augmentative & Alternative Communication Camps• August 8-11 & August 15-18 8:00 - 10:00 a.m.

Children with speech challenges learn to communicate with voice output devices through games and outings to the zoo, a restaurant, and the Sertoma Butterfly House. Led by Speech-Language Pathologists.

Helping Hands: Constraint-Induced Camps • Call for scheduling

Children with hemiplegia practice using both upper extremities for everyday activities, including dressing, feeding, play, and arts & crafts. Led by Occupational Therapists with after-camp follow-up. Medical direction by physiatrist Julie Johnson, M.D.

Plus, Children’s Care is now offering free developmental screenings the first Wednesday of each month.

By appointment 7:30 - 9:30 a.m.

otherLori A. Hansen, Md, FACP, fACCP,YanktonMedicalClinic,P.C.BoardCertifiedPulmonologist,wasannouncedastheasthe2011WomanofDistinctionProfessionalserviceAwardwinnerduringaluncheononfebruary21attheroncalliCenteratMountMartyCollegeinYankton,sD.Dr.hansenwasrecognizedforinspiring,mentoring,andsupportingotherwomeninourcommunityinprofessionalendeavors.

Exclusively promoted and recommended by the South Dakota State Medical Association.

You’re always there for them.

We’re always here for you.

We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally

committed to protecting you from the risks you face every day.

To learn more, call 888-397-3034 or visit MMICGroup.com

Midwest Medical Edition 32 Midwest Medical Edition 32

Happenings around the region

Learning Opportunities

MED reaches more than 3500 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at [email protected].

April / May 2011April 5 2011 urology conference location: sanford,schroederAuditorium registrationisavailableonsanfordLearn–coursecodeci-1028. ifyouhavequestions,pleasecontactKathleenat605.328.6359.

April 11-12 SDhfMA Medicare hfMA boot camp location:siouxfalls,sD contact:renaeTisdall contact Email:[email protected] Website:www.sdhfma.org/meetings.htm

April 12 Advanced AWhONN fetal heart Monitor7:45 am – 5:45 pm location:AveraeducationCenter,Classroom1 Information: 605-322-8950

April 13 living with grief: Spirituality and End-of-life care12:30 – 3:30 pm location: AveraeducationCenterAuditorium continuing Education creditsavailablethroughhospitalfoundationofAmerica registration online at:www.averamckennan.org/conferences

Just for fun the big grape reserve, Wine tasting benefitApril 14 location:MuseumofVisualMaterials,siouxfalls.6:30-9:30 p.m. Information:(605)322-8900orvisitwww.TheBigGrape.org.

April 14-15 SDhIMA Spring Meeting and coding roundtable location:Chamberlain,sD contact:LauraMoller contact Email:[email protected] Website:http://www.cvent.com/events/sdhima-spring-conference/event- summary-d3933ce9118d49c8a80b245dde7bf10d.aspx

April 18 – 20 SDMgMA Spring conference location: TheLodgeinDeadwood Website:www.sDMGMA.org

April 20-21 SDAhO continuing care conference location:siouxfalls,sD contact: WendyMead contact Email:[email protected] Website:www.sdaho.org

May 6 - 7 5th Annual Sanford Sports Medicine Symposium7:00 am – 5:15 pm location:ramkotahotel Information:NikkiTerveer,605-328-6353

May 9 Neonatal resuscitation program, Sanford Employees8:30 am – 4:30 pm location:sanfordCenterforLearning&innovation

May 18 – 19 South Dakota Workers’ compensation Summit location: ramkotahotel Sponsor:howalt-McDowellinsurance

May 20, 2011 16th Annual North central heart vascular Symposium8:00 am – 5:00 pm location:siouxfallsConventionCenter credits Offered:CMeandCNe Information:605-977-5316orwww.northcentralheart.com

O R T H O P E D I C S

Medical Group

CO

RE

-197

62-M

R15

11


In whose hands will you place her?

Physicians’ Priority Line 1.888.592.7955

www.ChildrensOmaha.org

Intensive Care for Newborns

When a newborn is critically ill, a single call gives you instant access to

our neonatal intensive care specialists and a full range of pediatric and surgical

subspecialists, all supported by state-of-the-art technology and equipment.

It can also link you to our neonatal transport service team, who will arrange

for transport to Children’s Hospital & Medical Center based on the child’s

needs. Twenty-four hours a day, seven days a week, one call links you to

physician-to-physician consults, referrals and admissions. There’s no problem

too large, no child too small.

med-midwest medical edition-april/may 2011

Documents