HeartBeatPROVIDENCE

QUALITY HEALTH CARE IN THE INLAND NORTHWEST | SUMMER 2016

Read Heart Beat on your tablet or smartphone. Just go to phc.org/heartbeat for the latest issue or to sign up for email delivery.

RIGHT PLACE, RIGHT CARE

Know where to go for 7 common health issues, from chest pain to ankle sprains (hint: it’s not always the emergency department)

QUALITY TIMESacred Heart extends lifesaving stroke care to rural regions—without delay

THE NEXT DIMENSION3-D mammography helps doctors identify breast cancer earlier and more accurately

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Our mobile-friendly website gives you wait times for Providence Urgent & Emergency Care! Go to WaitTimes.phc.org.

Providence Urgent Care - open 8 a.m. to 8 p.m. daily at three convenient locations:North: Highway 2 at Hawthorne Road Downtown: Just off I-90 at Fifth & Division

Valley: One mile east of Sullivan on Indiana

Walk-ins welcome

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Looking Back, Looking Ahead

THE PROVIDENCE VISION

“CREATING HEALTHIER COMMUNITIES, TOGETHER”We continue to pioneer care delivery, working with partners to improve our communities’ health and well-being.

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EXECUTIVE EDITOR MANAGING EDITOR Sharon Fairchild Allison Milionis

MEDICAL EDITOR ASSOCIATE CREATIVE Je� Collins, M.D. DIRECTOR Matt MorganART DIRECTORCameron Anhalt PHOTOGRAPHER Gary Matoso

Elaine Couture, Regional Chief Executive

BOARD OF DIRECTORSMarian Durkin, ChairPatricia Butterfi eld, Ph.D.Ramon Canto, M.D.Je� Clode, M.D.Dan Dionne, M.D.Rich Hadley Gary Livingston, Ph.D.Keith Marton, M.D.Rob McCann, Ph.D.

Thayne McCulloh, Ph.D.Mike Moore, M.D.Je� PhilippsPaul PimentelMark Schemmel, M.D.Mary SeleckyCurt ShoemakerLarry Soehren Ron Wells

Providence Health Care Eastern Washington (PHC) is the parent organization of a number of Catholic health care ministries sponsored by the Sisters of Providence and the Dominican Sisters in Spokane and Stevens counties. These ministries include:

HOSPITALSProvidence Sacred Heart Medical CenterSacred Heart Children’s HospitalProvidence Holy Family HospitalProvidence Mount Carmel Hospital (Colville)Providence St. Joseph’s Hospital (Chewelah)

OTHER HEALTH SERVICESPAML (Pathology Associates Medical Laboratories)Providence Adult Day HealthProvidence DominiCare (Chewelah)Providence Emilie Court Assisted LivingProvidence Medical GroupProvidence Medical Park, Spokane ValleyProvidence St. Joseph Care Center & Transitional Care UnitProvidence VNA Home HealthSt. Luke’s Rehabilitation Institute

PHC is part of the Providence Health & Services health care system, which spans fi ve states from Alaska to Cali-fornia and east to Montana. For more details, visit phc.org.

MISSION STATEMENTAs people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

CORE VALUESRespect | Compassion | Justice | Excellence | Stewardship

CONNECT WITH USfacebook.com/ProvidenceSpokanefacebook.com/ProvidenceSacredHeartyoutube.com/ProvidenceSpokane twitter.com/Providence_PHC

Copyright 2016 © Providence Health Care. Online at phc.org. Published three times a year by MANIFEST LLC. Send comments to heartbeat@providence.org or Marketing & Communication, 101 W. Eighth Ave., Spokane, WA 99204.

HeartBeatPROVIDENCE

FROM THE HEART

One hundred and thirty years ago, on July 2, 1886, the blessing of the cornerstone ceremony

marked the naming of Sacred Heart Hospital, a modest wood-framed structure. The hospital was staff ed by six Sisters of Providence, who soon discovered that 31 beds weren’t enough to meet the needs of the community.

The hospital grew, eventually moving to its current site and expanding to accommodate 657 beds. Today, we’re one of the largest full-service medical facilities in the Northwest. Our continual growth ensures everyone in our region has access to the right care, from the right expert, at the right time.

Our cover story explains the many types of care we off er. Turn

to page 14 to fi nd out whether you should seek urgent care or the emergency department for a sprained ankle, and when it’s the right time to use Health eXpress.

On page 22, learn how advanced technology is essential to pro-viding exceptional health care. Thanks to 3-D mammography, early stages of breast cancer were detected in two patients at Inland Imaging in Spokane Valley.

The community benefi t report on page 26 demonstrates our investment in the health of our community and shares a story about an exciting program that covers dental care for those who can’t aff ord it on their own.

You are the reason we keep growing, advancing our services and investing in better care for all. We are honored to have cared for the community for 130 years, and we look forward to continu-ing that Mission for another 130 years, and longer.

Elaine CoutureRegional Chief Executive Providence Health Care

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4 HEART BEAT SUMMER 2016

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CONTENTS VOLUME 54, NO. 2

28 12 8

10 30

5 HEALTHY LIVINGHow to treat a cut or a sprain at home; when to see a doctor for a burn; and more.

8 INSIDERMedical students and profes-sionals collaborate to improve patient care; the moment Sacred Heart got its name.

10 CHILDREN’S HEALTHDoctors solve a life-threatening refl ux problem for baby Elliot.

12 CARDIAC REPORTSpecialized surgery is needed to fi x an expectant mother’s tricky heart condition.

26 COMMUNITYProvidence makes dental care available to people who can’t aff ord it on their own.

28 FOUNDATIONVolunteers turn a man’s 20-year medicine bottle collection into window art at Sacred Heart.

29 M.D. SPOTLIGHT Discover what fascinates this orthopedic trauma expert and cancer specialist.

30 CALENDARSave the dates for these sum-mer 2016 classes, events and activities.

31 HEALTH TIPHelp your hydration by eating more of these foods with high water content.

32 ROLE MODELA volunteer escort guides and comforts patients as they go to and from exam rooms.

Features14 WHERE TO GO

FOR CARENot every health need warrants a trip to the emergency department. Find out whom you should see for common health concerns.

18 TIME SENSITIVETechnology extends the reach of Sacred Heart’s stroke experts to rural hospitals in the region. Read one woman’s story.

22 MAMMOGRAPHY IN 3-DDetailed images from breast cancer screening lead to earlier detection and treatment.

ON THE COVER: Sometimes the emergency department is the best place to go for a health need—and sometimes it isn’t. Consult this comprehensive guide for your options. See page 14. Photo by Gary Matoso.

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HEALTHY LIVING

Even though you might use an avocado where veggies are called for—with salads, eggs and burritos—it’s not a vegetable. It’s technically a fruit, specifi cally a single-seeded berry.

3 Reasons to Advocate for AvocadosIt’s already the star of your guacamole, but the avocado

can do more than load a tortilla chip. It is superb in salads,

spread on crackers or sliced up in omelets. The compelling

health reasons to add avocados to your diet include:

1. HEALTHY FATS. The American Heart Association rec-

ommends a diet that has monounsaturated and poly-

unsaturated fats, which can help reduce bad cholesterol

levels and lower heart disease risk.

2. FIBER. A single 1-ounce serving contains 8 percent of

the recommended daily value of fi ber, a substance that

promotes healthy digestion and keeps you feeling fuller

longer (good for weight loss).

3. POTASSIUM. The nutrient-dense avocado contains

potassium, which can help lower blood pressure and

reduce risk of kidney stones.

DID YOU KNOW?

SHARE YOUR HEALTHFUL EATING TIPSHave good ideas for including healthier foods in your family’s meals? Share them with us on our Facebook page. Go to facebook.com/ProvidenceSpokane or email heartbeat@providence. org.

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HEALTHY LIVING

Got a Cut: Now What?If you experience a cut or a punc-ture wound, such as from a knife or a nail, make sure to clean and dress it to ensure that it heals as quickly as possible. Here’s how.

Step 1. Wash the area with cool water, using soap and a cloth to clean the skin around the injury. Avoid getting soap in the wound itself.

Step 2. If any dirt remains in the wound after you’ve cleaned the area, use tweezers to clear it out. Sanitize the tweezers with rubbing alcohol first.

Step 3. If the cut is in an area that is likely to get dirty or be irritated by clothing, cover it with a bandage or gauze. Change the bandage daily.

Step 4. As the wound heals, leave the scab alone. (Picking at it can cause infection and scarring.)

If the cut is particularly deep, won’t stop bleeding or has edges that don’t stay together, call your doctor or go to urgent care. You might need stitches or a skin adhesive to close the wound.

Source: American Academy of Family Physicians

SEVERITY DAMAGE TREATMENT

First degree

Outer layer of skin; causes redness, swell-ing and pain.

Run cool water over the burn or soak in cool water (not ice) for five minutes. Cover with a clean bandage. Try ibuprofen or acetaminophen for pain.

Second degree

Outer and underlying layers of skin; causes redness, swelling, pain and blistering.

Run cool water over the burn or soak in cool water (not ice) for 15 minutes. Apply an anti-biotic ointment and cover with a nonstick dressing. Gently wash the area and change the dressing daily. Ibuprofen or acetaminophen can help with pain. Call your doctor if you see signs of infection.

Third degree

Deep layers of the skin. Skin can be white or blackened, even numb.

Do not apply ointments. Do not touch blistered skin or remove clothing stuck to the skin. Call 911.

Sources: MedlinePlus, FamilyDoctor.org

BURN NOTICEThe sun isn’t the only thing that poses a threat of burns to the skin. Accidents can happen with grills, fires and fireworks as people enjoy good times in good weather. Burns are classified by the depth of damage to the skin. Here’s how to identify the three levels—and what to do.

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When you have a sprain or a strain, you might be able to treat the injury at home. Start with RICE:

Rest. Stop doing the activity that caused the injury. Consider crutches to keep weight o� of a leg injury.

Ice. Every few hours for the fi rst day or two, apply a cold pack to the injury site to reduce infl ammation, pain and swelling. Keep it there for about 20 minutes at a time. (Never put ice directly on the skin—it can lead to frostbite.)

Compression. An elastic compression bandage can help prevent further swelling and bruising.

Elevation. Raise the injury higher than your heart to reduce swelling and bruising.

Sources: American Academy of Orthopaedic Surgeons, American Academy of Family Physicians

10 CALORIESThat’s all you need to cut out of your diet each day to lose 1 pound in a year.* So, think twice before popping in that innocent piece of hard candy—each one can have about 20 to 40 calories.

*10 calories lost per day is 3,650 calories in a year, when 3,500 calories equals about a pound of fat.

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Lifesaving LessonCPR can more than double a person’s chances of surviving a cardiac event, like a heart attack. Call 911 and then per-form hands-only CPR: Push hard and fast in the center of the chest. How fast? The American Heart Association recommends thinking of the song “Stayin’ Alive” and using its beat as a guide.

SIGN UP FOR A

CPR CLASSBecome confi dent in your lifesaving skills! To register for a class near you, go to courseregistration.inhs.org and type “CPR” in the search box. Online options are available.

HELP YOURSELF TO RICE

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INSIDER

8 HEART BEAT SUMMER 2016

This fall, Providence’s Family Med-icine and Internal Medicine Resi-dency clinics will move from the Fifth and Browne Medical Building to their new, 42,000-square-foot home in the Spokane Teaching Health Center in Spokane’s Uni-versity District. The residents from family medicine and internal medi-cine will be joined by colleagues in psychiatry and sports medicine.

Medical residents—doctors who are completing three- to seven-year on-the-job training programs—care for patients under the direction of medical faculty and alongside health sciences students from Washington State University, East-ern Washington University and the University of Washington.

It is a unique opportunity for students and professionals in a vari-ety of health-related fi elds to work collaboratively in providing care to patients. The clinic will include physicians, nurse practitioners, pharmacists, social workers,

physical therapists and occupa-tional therapists.

The clinic is the result of a com-munity collaboration. In 2013, Prov-idence Health Care, Empire Health Foundation and Washington State University Health Sciences Spokane formed a consortium to create the Spokane Teaching Health Center and increase the number of medical residents in eastern Washington.

“We know that the vast majority of doctors who complete their med-ical training in the Spokane region will continue to live and work in the area,” says Judy Benson, M.D., program director of Providence Internal Medicine Residency. “By increasing the number of medical resident positions in Spokane, we have a far greater opportunity to improve access to health care.”

By July, 25 new medical resident positions in eastern Washington will have been added since the consor-tium formed three years ago, bringing the total number of residents to 99.

Greater Learning Opportunities

for Medical Residents

PROVIDENCE MYCHART

Quick and Easy Access to Your Health InfoMyChart allows you to manage your health care anytime, anyplace. It’s a convenient way to view your medical record, request medical appointments and prescription refi lls, send a secure email to your provider and health care team, and pay your medical bills.

There are no fees to use MyChart. All you need is an email account and access to a computer, a web browser and an internet connection. Download the MyChart app to your smartphone to stay connected on the go.

GET STARTEDAre you a patient at a Providence clinic? Ask your provider about setting up a MyChart account, or visit phc.org and click “MyChart.”

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AIR MEDICAL TRANSPORT PARTNERSHIP EXPANDS LIFESAVING COVERAGE

In the Winter/Spring 2016 issue of Heart Beat, we featured 2-day-old Amelia, who received critical care on board a Northwest MedStar fi xed-wing aircraft. Amelia was safely transported from her home in Idaho to Providence Sacred Heart Medical Center, where she received the care she needed for a life-threatening infection. We’re pleased to say she is fully recovered.

Now, more children and adults will have expanded access to ICU-level care and transport services. In April, Northwest MedStar joined Life Flight Network to serve more communities in Washington, Idaho, Montana and Oregon. With additional fl ight teams and resources, Life Flight Network also plans to open helicopter bases in Colville and Walla Walla and add a fi xed-wing aircraft to the existing base in Moses Lake.

If you’re a MedStar member, your membership automatically trans-ferred to Life Flight Network and you gained expanded coverage to several locations throughout the nation via a reciprocal partnership. You’ll receive a renewal notice from Life Flight Network one month in advance of your membership expiration.

If you have questions or want to become a member, visit lifefl ight.org.

130 YEARS OF HEALTH CARE

How Sacred Heart Medical Center Got Its NameIf you’re the type of person who wonders what’s in a name, you might like the tale of how Sacred Heart Medical Center—then Sacred Heart Hospital—came to be 130 years ago. On July 2, 1886, community members gathered with a group of Catholic priests and sisters at Spokane’s newly constructed hospital for the blessing of the cornerstone. Mother Joseph and Sister Joseph of Arimathea were there, as well as Aegidius Junger, the Bishop of Nisqually. While giving the blessing, the bishop turned to Mother Joseph and asked for the name of the hospital.

The sister was silent. The superior of the Sisters of Provi-dence, in Montreal, had not yet sent the name for the hospital.

Quick on his feet, assistant priest Aloysius Ragaru, SJ, spoke up. “Sacred Heart Hospital,” he said. During the brief but awk-ward silence he realized that it was the day of the Feast of the Sacred Heart. Some also say he might have remembered Mother Joseph’s full name: Mother Joseph of the Sacred Heart.

The hospital opened its doors to the fi rst patient in January 1887.

Jane and Shane Harrington happily report that their daughter, Amelia, is recovered from her life-threatening illness, which required critical care transport from Idaho to Providence Sacred Heart Medical Center.

NEED A PROVIDER TODAY? SEE ONE TODAY

You can schedule a same-day appointment at Providence NorthEast Washington Medical Group in Colville. This convenient service is available Monday through Friday, 8 a.m. to 5 p.m. Call 509-684-3701 to reserve a time.

Sacred Heart Hospital in 1901, at its fi rst location by the Spokane River

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CHILDREN’S HEALTH

He was due a few weeks after Thanksgiving in 2015, but baby Elliot had other plans. Instead, he

arrived two weeks early. During his fi rst month, Elliot had bouts of excessive vomiting and diar-rhea. During one particularly bad episode, Sheila Johnston and her husband, Mike, took their newborn to the emergency department at Providence Sacred Heart Medical

Center & Children’s Hospital. Des-ignated a Level II pediatric trauma center, the hospital has the only specialized children’s emergency department in the region.

Doctors diagnosed a severe milk protein allergy and gastroesoph-ageal refl ux and put Elliot on a special formula to treat the allergy. Unfortunately, the baby’s condition did not improve; it worsened. The Johnstons made another trip to the

hospital, and Elliot was admitted a second time.

“The scariest part was Elliot’s refl ux was so severe it caused him to stop breathing on several occa-sions,” Johnston says.

SPECIALIZED TREATMENTMonica Zherebtsov, M.D.—her patients call her Dr. Z—was one of the physicians assigned to care for Elliot. As a pediatric

Feeding Baby ElliotDoctors decide on a surgical solution for a newborn’s life-threatening refl ux.

Monica Zherebtsov, M.D., visits with Elliot and his parents, Sheila and Mike Johnston.

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By Starla Collins

gastroenterologist, she specializes in treating infants and children who have difficulty eating, and she recently helped establish Sacred Heart’s Pediatric Gastro-enterology Feeding and Growth Clinic in Spokane.

Dr. Zherebtsov started Elliot on medications to control the reflux and recommended a naso-jejunal, or NJ, tube to deliver vital nutrients until the infant could tol-erate eating on his own. The small tube was inserted through Elliot’s nose and stomach and into the small intestine.

“We wanted to keep Elliot inter-ested in eating and sucking, so we gave him a bottle several times a day with very, very small amounts of formula,” Johnston says. “How-ever, even the smallest amount of fluid in his stomach led to severe reflux, which would often cause him to stop breathing. Fortunately, Dr. Z recognized these apnea episodes as life-threatening events.”

SURGERY NEEDEDDr. Zherebtsov contacted pediatric surgeon Winston Chan, M.D., at Providence Pediatric Surgery Center at Sacred Heart Children’s Hospital. After explaining the situation, both physicians agreed Elliot should have surgery as quickly as possible.

The Place to Go for Pediatric Feeding DisordersThanks to modern medicine, premature babies and infants with complex medical

needs have an increased chance of survival. This also means an increased num-

ber of infants and children living with feeding disorders. Through early assess-

ment and ongoing treatment, the Pediatric Gastroenterology Feeding and Growth

Clinic in Spokane aims to help infants and children, and their families, manage

feeding disorders.

The clinic, which opened in 2015 under the direction of Monica Zherebtsov, M.D.,

offers a centralized location for patients to see physicians and specialists in one

location, during one visit. At-home medical equipment and formula options are

provided by Providence Infusion and Pharmacy Services; feeding and swallowing

evaluations are provided by St. Luke’s Rehabilitation Institute.

Treatment plans and services include goals for feeding; training for family care-

givers; nutritional assessment and recommendations; digestion, oral-motor and

swallowing evaluations; nutritional supplements, formulas and medical equip-

ment; feeding tools such as thickeners and specialized bottles; behavior and occu-

pational therapy to encourage feeding; community support groups and resources;

and coordination of appointments.

“We needed to protect Elliot’s airway by stopping the reflux,” Dr. Zherebtsov explains. “And we needed to make sure Elliot was able to get the nutrients he needed to grow and thrive, which required a feeding tube.”

During the anti-reflux surgical procedure, Dr. Chan created a flap in Elliot’s stomach to stop the fluid from moving into the esophagus and potentially into his airway. Next, he created a port in the abdo-men through which a gastrostomy tube, or G-tube, would go directly into Elliot’s stomach. A feeding pump and tube connects to the port to deliver vital nutrition.

“Since the surgery in mid- February, Elliot has not had one apnea episode,” Johnston says. “He is hooked up to the feeding machine nearly 24 hours a day and can only tolerate just a few milliliters of food

SPECIALIZED CARE FOR INFANTS AND CHILDRENTo learn more about the Pediatric Gastroenterology Feeding and Growth Clinic in Spokane, call 509-474-5437. A physician referral is required for new patients.

through the tube at a time. The goal is to eventually wean him off of the feeding tube and for him to be able to eat on his own.”

TEAM SUPPORTTo help the Johnstons manage Elliot’s medical needs, they see the multidisciplinary team of health care professionals at the Pediatric Gastroenterology Feeding and Growth Clinic in Spokane. The team includes a physician, a social worker, an occupational therapist, a dietitian and support staff.

“Everyone is so encouraging and knowledgeable, giving us the support and tools we need,” Johnston says. “After nearly five months, Elliot is finally looking and acting like a healthy baby. We could not be more grateful to Dr. Z, the clinic staff and Sacred Heart Children’s Hospital.”

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CARDIAC REPORT

Amanda Buckles’ heart wouldn’t stop racing. She

woke up at 6 a.m. on Feb. 14, 2016, with an elevated heart rate, and by 11 a.m. it hadn’t returned to normal. Buckles called her midwife. Go to the emergency department, her midwife advised.

At the ED, Buckles was given medications to slow her heart. Nothing seemed to work at fi rst, but by around midnight the medi-cal team was able to normalize the heart rate. Fortunately, Buckles’ unborn baby—her fourth child—wasn’t aff ected. Still, Buckles found it unsettling. After many years with-out any problems, her heart was racing every day, sometimes several times. She was concerned about her baby’s health, as well as her own.

TRIGGERING TROUBLEBuckles was born with supraventric-ular tachycardia, or SVT, a condition that causes the heart to beat rapidly or erratically. Rogue electrical sig-nals between the heart’s upper and lower chambers fi re abnormally in a sort of short circuit, interfering with normal electrical signals coming from the sinoatrial node, the heart’s natural pacemaker. A rapid heart-beat brought on by exercise, stress or hormonal changes may last a few minutes to several days, potentially reducing blood supply to the body.

As a child, Buckles frequently experienced lightheadedness and fatigue. Even jumping up and down would cause her heart to race. Buckles took medication to help manage the condition. “My heart has always had a mind of its own,” she says.

READY FOR RESOLUTIONThe visit to the emergency depart-ment scared Buckles. After discuss-ing the options with her physician, she decided to have an ablation procedure, her second. An ablation is a minimally invasive technique to correct abnormal heartbeats, also known as arrhythmia. The fi rst attempt on Buckles, in 2007, was unsuccessful, but doctors were optimistic this time around.

Enter Mark Harwood, M.D., car-diologist at Providence Spokane Cardiology, and Chris Anderson, M.D., pediatric cardiologist at Providence Center for Congenital Heart Disease. Both clinics are members of Providence Spokane Heart Institute. The doctors are also cardiac electrophysiologists, meaning they specialize in diag-nosing and treating heart rhythm disorders. They use 3-D mapping to perform ablations, which is what Dr. Harwood recommended for Buckles because of her pregnancy. Although ablation procedures typ-ically use both 3-D mapping and fl uoroscopy, or X-ray technology, it was too dangerous to expose Buckles’ fetus to X-ray radiation,

Settling DownA woman with a history of racing heartbeats fi nally fi nds a specialized solution.

GET IN RHYTHMDoes your heart race or beat erratically at times? Perhaps you have an arrhythmia. Talk to your health care provider to fi nd out more.

The Buckles-Howard family, clockwise from left: Matthew, Matt, Drake, Amanda and Avery

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By Allison Milionis

so doctors would perform the 3-D mapping alone.

“I knew I was in good hands,” Buckles says. “And it was exciting to contemplate a normal heart rate and lifestyle.”

FINDING—AND FIXING—THE PROBLEMOne month after her visit to the emergency department, Buckles checked in for her procedure. She was placed under general anes-thesia, and then the medical team inserted a catheter with a miniature electromagnetic sensor in the tip into her femoral vein and guided it to her heart. Electrodes were placed on her upper body and a magnet attached under the table to create a magnetic field. As the catheter moved within the field, it sent sig-nals to a computer, much the same way a GPS system maps streets. On screen, the signals morphed into a 3-D model of Buckles’ heart.

Alongside a team that included an obstetrician to monitor Buckles’ unborn baby, an anesthesiologist, technicians and nurses, Drs. Har-wood and Anderson worked in tandem, one at the bedside navi-gating the catheter, the other in the control room tracking the virtual catheter on screen.

Locating the area in her heart that was triggering the arrhythmias was not easy, however. The acces-sory pathway, a grouping of cells creating the short circuit and caus-ing the SVT, was in an abnormal, small, pouchlike vein in the back of the heart called a diverticulum. “Mapping the anatomy of the coro-nary sinus where the diverticulum was discovered was very difficult,” Dr. Anderson says.

Eventually, they were able to reach the accessory pathway in the diverticulum and destroy it using a short blast of heat in the form of radio-frequency current from the catheter. The procedure took nearly five hours; catheter ablations typi-cally take less than two hours.

A FUTURE WITHOUT X-RAY RADIATION?The success of the ablation procedure without fluoroscopy

Minimally Invasive, Maximally EffectiveAblations are just one of many minimally invasive procedures performed at

Providence Spokane Heart Institute facilities. Because physicians, nurses and

technicians there perform a high volume of cardiac procedures, they develop

a high level of expertise and produce quality results for patients. Here is a look

at the numbers:

buoyed the doctors’ belief that 3-D mapping could one day replace X-rays altogether. “We know it can be done,” Dr. Har-wood says.

Buckles’ baby was unfazed by the ordeal. The expectant mom took a couple of days to recover but was back at work by Monday. Since the ablation, she hasn’t had one episode. “I feel like a new woman with a new heart,” she says.

NUMBERS PERFORMED IN

PROCEDURE CONDITION 2014 2015

Pacemaker and implant-able cardioverter defibril-lator (ICD) implants

Irregular heartbeats 954 1,069

Percutaneous coronary intervention (PCI)

Blocked coronary (heart) arteries

1,171 1,300

Cardiovascular surgery (including coronary bypass for congenital issues)

Wide range of condi-tions in the heart and blood vessels

916 862

Transcatheter aortic valve replacement (TAVR)

Aortic stenosis, a nar-rowing of the aortic valve opening

105 117

Want to learn more about minimally invasive heart surgery?

Call the Providence Spokane Heart Institute at 509-474-3278.

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14 HEART BEAT SUMMER 2016

Whom should you see for common health issues? Read on to learn more about the options available to you.

STORY BY STEPHANIE CONNER | PHOTOS BY GARY MATOSO

the financial strain on the health care system.

But that relies on all of us knowing the best place to go when we expe-rience a medical problem. Do you know where to get the care you need?

If you experience: Chest painGo to: Emergency department

The ED’s function is to provide care for injuries that are potentially life-threatening, says Dan Getz, D.O., medical director of the emer-gency department at Providence Sacred Heart Medical Center.

Chest pain isn’t always life- threatening, but heart attacks are, and you’ll receive a much higher level of care at an ED, Dr. Getz adds.

“We have access to imaging and other specialized resources to treat the most serious health emergencies,” he says. “Chest pain can be tricky; there are a number of things it can be, so you want some-one who’s trained in emergency

W hen you need health care, you need it now. Or do you?

The truth is that not everything is a medical emergency.

Based on the results of a 2013 study from Truven Health Analyt-ics, it seems a lot of us misjudge what constitutes an emergency. Looking at insurance claims data for more than 6.5 million emer-gency department (ED) visits made by commercially insured individu-als, researchers found that 65 per-cent of ED visits were for ailments that did not require immediate attention in the ED.

When you consider that other care options, such as urgent care and primary care, are far less expen-sive, it makes sense to pause and determine whether you’re going to the appropriate place.

Getting the right care at the right time in the right place can help keep your own personal medical costs at a minimum—and reduce

WHERE TO GO FOR

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medicine who can accurately and quickly diagnose the problem and get you the treatment you need.”

A lot of times, he says, the job of an emergency physician is to rule out major medical emergencies.

“People get frustrated with that,” Dr. Getz says. “But if it’s not a life-threatening issue, you may not leave the ED with a diagnosis.”

If you need: Medication refillsGo to: Primary care“We frequently see peo-

ple who run out of their prescription medicines and come to the ED for a refill,” Dr. Getz says. “But as a policy, we don’t refill medications.”

Typically, all you need to do is call your pharmacy, and someone there will handle the authorization with your doctor’s office. If you need to be seen by your doctor first, you’ll likely be scheduled for an appointment with him or her and then receive a short-term refill to sustain you until that visit.

Another option is Providence’s telehealth service, Health eXpress (healthexpress. com), which pro-vides access to a live, on-demand video visit with a doctor or a nurse practitioner. You just need a com-puter, a smartphone or a tablet with an internet connection. And you can’t beat this: Wait times average less than five minutes.

If you experience: Ankle sprainGo to: Primary care or urgent care

If the pain isn’t significant but you need assurance that it’s not serious, contact your primary care provider. “But a lot of times, the best option for a sprain is urgent care,” says Kirk Rowbotham, M.D., chief med-ical officer for Providence Medical Group. If it turns out that it’s bro-ken, you can be placed in a splint at urgent care and then referred to an orthopedic specialist for follow-up.

And if it’s after hours or on the weekend, urgent care is the perfect place for sprains or most broken bones.

Knowing that unnecessary trips to hospital emergency departments cost big bucks, doctors as well as hospital and state Medicaid representatives created an education campaign that saved $33.6 million in Medicaid fee- for-service emergency care expenses.

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16 HEART BEAT SUMMER 2016

pressure until they stop bleeding—is all you’ll need. For a cut that won’t stop bleeding or is so deep that you think you need stitches, urgent care is the way to go. It’s less expensive than the ED, and providers at urgent care will have all the resources to stitch you up and get you on your way.

If you have a life-threatening injury—such as a stab wound or something near your chest or a major artery—you’ll most likely find yourself in an ambulance on your way to the emergency department.

One exception, Dr. Getz says: “If you have exposed bone, come to the emergency department.”

If you need: Diabetes managementGo to: Primary care (usually)

“Anything chronic is best served by your primary care physician,” Dr. Getz says. But, he adds, “if you have diabetes, your blood sugar is sky high and you’re vomiting, then come to the emergency department.”

The role of primary care, Dr. Row-botham says, is to take care of minor acute issues as well as long-term health maintenance concerns.

“We can help people manage chronic conditions, with the hope that they stay healthy and never need to go to the emergency depart-ment,” he says.

If you experience: Laceration (cut)Go to: Urgent care (probably)

For most cuts, first aid at home—cleaning them and applying

If you experience: Flu symptomsGo to: Your medicine cabinet (most people)

“If you can hold down fluids and you’re not feeling too terrible, there’s nothing a physician can really do for you,” Dr. Getz says. “With a virus like the flu, treating the symptoms is most important.”

Get some rest, drink plenty of fluids, use a humidifier if it helps you breathe and consider over-the-counter medications that target your particular set of symptoms, and wait it out, usually one to two weeks.

Of course, there are times when you need immediate care.

“If you have the worst headache of your life or a stiff neck, there might be something else going on,” Dr. Getz says.

Anyone having respiratory difficulties should go to the ED, he adds, as should someone who is very sick with shortness of breath or vomiting and has a condition that might complicate the illness—such as heart disease, diabetes or cancer.

Dan Getz, D.O., medical director of the emergency department at Sacred Heart, says you should go to the ED if you have diabetes and are experiencing high blood sugar and vomiting.

5 MinutesThe average wait time to see

a doctor or a nurse practitioner

with Health eXpress, Providence’s

telehealth service

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WHO/WHAT IT IS WHAT IT’S GOOD FOR

PRIMARY CARE PROVIDER

This practitioner is your fi rst stop in getting health care for you and your family. He or she can help with preventive care and also help you manage your overall health by knowing you and your medical history.

Common illnesses: fl u, colds, fever, sore throats, headaches, skin irritations • minor injuries: minor cuts/burns, sprains, minor bone fractures • physical exams, vaccinations and health screenings

URGENT CARE CLINIC

If your primary care provider isn’t available or it’s after your primary care o� ce hours and you need care right away, go to an urgent care clinic for non-life-threatening medical issues that could become worse if not treated immediately. Open 8 a.m. to 8 p.m. No appoint-ment is needed. People are seen on a fi rst-come, fi rst-served basis. Locations: 421 S. Division St. and 551 E. Hawthorne Road.

Common illnesses: fl u, colds, fever, sore throats, headaches, skin irritations • minor injuries: minor cuts/burns, sprains, minor broken bones

EMERGENCY DEPARTMENT (ED)

Emergency care is for serious medical conditions that are life- or limb-threatening. Time is of the essence, and EDs are open 24/7. No appointment is needed. People are seen based on the severity of their conditions.

Severe chest pain/heart palpitations • di� culty breathing • ingestion of objects or poisons • major/signifi cant trauma or injury • seizures • severe burns • severe diarrhea • uncontrollable bleeding, vomiting blood • animal bites • fainting, unconsciousness

HEALTH EXPRESS (TELEHEALTH)

This is ideal for non-life-threatening care when you can’t get in to see your primary care provider and you can’t go to urgent care. You have access to a live, on-demand video visit with a doctor or a nurse practitioner from any device with an internet connection. Go to healthexpress. com.

Sinus, ear or eye infections • cough, cold and fl u • rash and joint issues • prescription refi lls

YOUR CARE OPTIONS AT A GLANCE

WHAT IS THE WAIT?Want to know how long of a wait to expect at the emergency department? Check out the wait times at Providence’s urgent care clinics and hospital emergency departments. Go to waittimes.inhs.org.

If you need: Follow-up care after an ED visitGo to: Primary care

When you are discharged from the hospital, you’ll receive a set of instructions about your condition and what follow-up care you’ll need. That care will be managed by your primary care provider (unless you’ve been sent to a specialist).

Regardless, you won’t return to the emergency department for rou-tine follow-up.

“Providence primary care doctors as well as our urgent care centers and hospitals all use an electronic health record system that makes a patient’s medical history available to

After you leave the emergency department, where Dan Getz, D.O., is medical director at Sacred Heart, you’ll follow up with your primary care provider.

all providers,” Dr. Rowbotham says. “Plus, our registered nurse care nav-igators are responsible for following up with people who have been seen in a Providence emergency depart-ment or urgent care clinic.”

The navigator makes sure people have understood their discharge

instructions, were able to fi ll any prescriptions and know how to take those medications. The navigator also will sched-ule a follow-up appointment to make sure diseases are managed well and wounds and injuries are healing.

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18 HEART BEAT SUMMER 2016

TIMESENSITIVESENSITIVEA real-time connection between Sacred Heart’s stroke experts and rural hospitals in the region leads to lifesaving results.

STORY BY WILL MORTONPHOTOS BY GARY MATOSO

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Dennis Bippes and his wife, Christine, woke up to the sound of their coff ee maker, as they usually do. Soon, Den-

nis saw something that he didn’t expect but defi nitely recognized: the signs of stroke. As Christine was making the bed, she stared blankly into the middle of the room. “I asked her if she was OK,” he recalls, “and slurred words came out.”

Although the suddenness of the stroke is something that will take a while to get over, Dennis says, he knew what to do in that moment. He dialed 911. It was 8:15 a.m.

Christine, 75, was aware of her hus-band telling her she had to go to the hospital. Her memory of events over the next few hours, however, is fragmented. She remembers being loaded into an ambulance and then a helicopter to fl y her to Providence Sacred Heart Medical Center in Spokane. She also remembers waking up and being told that she would

Cynthia Murphy, M.D., was ready for a real-time video visit with Christine Bippes as soon as Christine arrived at her local hospital, 70 miles away.

make a full recovery, thanks to rural medicine emergency services and a real-time video connection to neurology stroke specialists at Sacred Heart.

ADDRESSING RURAL CHALLENGESThe Bippeses live 5 miles outside of Naples, a small town in northern Idaho, closer to the Canadian border than to Spokane. The ambulance had to get there from Bonners Ferry, about 10 miles away, and then travel 26 miles to Bonner General Hospital in Sandpoint.

En route, the crew called the hospital to describe Christine’s condition. The call allowed Mike Taylor, emergency department director at Bonner General, to initiate the hospital’s stroke proto-col. This included a call to neurologist Cynthia Murphy, M.D., at Sacred Heart. When the ambulance rolled in, the team was in place.

It was 9:16 a.m.

Dennis and Christine Bippes enjoy a stroll with their daughter, Jennifer McHan (right).

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20 HEART BEAT SUMMER 2016

THE CRITICAL HOURChristine had entered the “golden hour,” a window of time during an ischemic stroke (caused by a blockage in a blood vessel) when intervention with tissue plasmino-gen activator, or tPA, can minimize further damage to the brain. The drug tPA works by dissolving clots and improving blood fl ow to the deprived part of the brain, saving brain cells. It is the only treatment for ischemic stroke approved by the U.S. Food and Drug Administration.

With tPA delivery during a stroke, time is of the essence. Last year, The Joint Commission—an agency that strives to improve quality for health care organizations—began recom-mending that tPA be administered within one hour from when a patient enters an emergency department.

STROKE EXPERTISE, REMOTELYBy the time Christine was brought into the emergency department at Bonner General, Dr. Murphy had already spoken with Taylor about Christine’s symptoms over the

phone. She then “beamed in” from Spokane to the bedside in Sand-point via telestroke, a video link on her computer.

“I can lay eyes on the patient and observe speech, noting any aphasia [inability to communicate] or facial droop, and assign a number on the stroke scale,” she says.

That scale, a tool for determin-ing how the stroke has aff ected a person’s consciousness, language, vision and physical strength, for instance, allows doctors to measure the severity of the stroke.

Christine’s score was nine, which falls in the moderate range. She was conscious but had diffi culty under-standing what was being said to her (receptive aphasia) and had slacking facial muscles (ataxia). Provided she received treatment quickly, these eff ects could be reversed, but fi rst Dr. Murphy needed to see what had happened in Christine’s brain.

GETTING A CLOSER LOOKBy 9:23 a.m., a computed tomogra-phy (CT) scan had been performed and the result was posted for Dr.

Murphy and Bonner General care-givers to examine. Connected via telemedicine, the doctors were able to see the images on their computer screens in real time. The scan ruled out bleeding as the cause for Chris-tine’s stroke, but that wasn’t the whole story.

Whereas tPA is ineff ective for bleeding (hemorrhagic) strokes, the drug is not always advised for ischemic strokes. There are risks.

National studies suggest that bleed-ing into the brain occurs in about one out of 18 patients receiving tPA. When this bleeding occurs, the fatality rate climbs as high as 45 percent.

A second CT scan, this time with a special dye added, confi rmed there was a blocked blood vessel and allowed providers to make the deci-sion to give tPA more confi dently. After discussing the risks and ben-efi ts with Christine’s husband and other family members, Dr. Murphy made the call: Administer tPA.

It was 10:12 a.m., less than an hour after Christine arrived at Bonner General.

“Fifty minutes is impressive,” Dr. Murphy says, especially given that two years ago the national standards were two hours from “door to needle” for tPA—the time from arrival at the hospital to deliv-ery of treatment.

Neurologist Cynthia Murphy, M.D., assesses stroke patients in person at Sacred Heart and virtually around the region using telemedicine.

Tele-What?TELEMEDICINE is the use of elec-

tronic communications methods,

such as telephone, internet and

video conference, to exchange

medical information from one

geographic site to another.

TELESTROKE is the use of

telemedicine specifi cally for

stroke care.

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To Recognize Stroke, Act FASTFAST is an easy way to remember and

identify the most common symptoms

of a stroke. Recognizing these signs

and dialing 911 right away can make a

difference in getting someone to care

quickly and result in a better recovery.

Face: Ask the person to

smile. Does one side droop?

Arms: Ask the person to

raise both arms. Does one

arm drift downward?

Speech: Ask the person

to repeat a simple phrase.

Is the speech slurred?

Time: If you observe any

of these signs, call 911

immediately.

With Dr. Murphy coordinating her care in advance of her arrival, Christine was flown by helicopter to Sacred Heart and in surgery 45 minutes after receiving tPA. The patient underwent an endovascular procedure to remove the clot and later that afternoon was resting in a recovery room with her family around her.

Therapies such as tPA are not used much by hospitals that can-not provide timely access to stroke experts. Telestroke makes it possi-ble. “It brings experience to us with a quick phone call,” says Taylor of Bonner General. “Having a specialist

Because of her local hospi-tal’s connection to experts at Sacred Heart, Christine Bippes received timely treatment for her stroke.

ASK SOMEONE WHO KNOWS STROKEIf you have questions or concerns about stroke, talk to your primary care physician.

Far Reach in the RegionSacred Heart Medical Center and

other primary stroke centers are

equipped with the resources and per-

sonnel to provide people who have

acute stroke with timely, adequate

assessments and emergency stroke

treatments. But most rural hospitals do

not have such capabilities.

That’s where the Providence

Telestroke Network comes into play. In

a “hub and spoke” model, specialists at

Sacred Heart, a certified primary stroke

center, are able to visit in real time via

telemedicine with patients in smaller

hospitals throughout the region.

involved in the decision-making lifts a huge burden.”

MAKING PROGRESS IN RECOVERYChristine’s stroke occurred in the language center of her brain, which has affected her ability to choose and say the correct words or phrases. “Sometimes, what I say isn’t what I mean, and I don’t always realize it,” she says.

By working with her speech therapist in Bonners Ferry, how-ever, Christine is making progress. Her reading ability is nearly back to normal, and she continues to work on speech and writing. Now, it’s only occasional words rather than whole phrases that seem out of place when she’s conversing with friends and family. There is work ahead, but Christine is grateful that she can continue to get better.

? ?? ?

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22 HEART BEAT SUMMER 2016

Breast tomosynthesis helps doctors identify cancers earlier, in more treatable stages. And the technology

is available right here in Spokane Valley.

Lynn Tennican, 74, went to her OB-GYN last fall for her annual well-woman checkup. As predicted,

her doctor recommended she get a mammogram.

“I said, ‘You know, I’ve had mam-mogram after mammogram after mammogram, and they’ve never found anything.’ So I declined,” she says. “It wasn’t more than two weeks later that I noticed a lump in my left breast.”

Tennican called her doctor and asked to have the mammogram after all. She had the screening done at Spokane Valley Inland Imaging center at Providence Medical Park.

Inland Imaging features tomo-synthesis, what’s commonly referred to as 3-D mammography, regarded as the latest technology in breast imaging.

“It turns out the lump I’d felt in my left breast was an innocent [noncancerous] cyst,” she says.

STORY BY SHELLEY FLANNERY | PHOTOS BY GARY MATOSO

“But there was a tiny nodule in my right breast that they wanted to explore further.”

A biopsy of that nodule revealed stage 1 breast cancer. In November, Tennican had surgery to remove the nodule and then underwent radiation therapy.

Tennican was fascinated. Grow-ing up the daughter of a doctor (her father started medical school the day she was born), she’s been inter-ested in medicine her whole life and

Mammographyin

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practiced as a physical therapist for much of it. In her spare time, she likes to study medical journals.

“The cancer didn’t scare me at all,” she says. “None of these pro-cesses did—the imaging, surgeries, radiation or anything. I don’t find it threatening.”

Tennican won’t know whether she is cancer free until she goes for her six-month scan. But she already knows where she’s going to have it.

Lynn Tennican is fascinated by the process that providers used to identify and treat her breast cancer.

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24 HEART BEAT SUMMER 2016

“Inland Imaging makes it so easy to be a patient,” she says. “They’re very generous to spend their time explaining everything. We are so, so fortunate to have them in this city. They are right at the top of the lad-der in machinery and staff .”

A GOOD THINGBarbara Hayden’s story is similar to Tennican’s. The 71-year-old faith-fully went for her mammograms every year but stopped for several years while she was taking care of her signifi cant other, who was ill and required multiple surgeries.

“I was trying to keep him alive, so I just didn’t have time to keep up with my screenings,” Hayden says. “I have no idea what it was that told me to go in for a mammogram when I did. But it’s a good thing.”

Hayden’s 3-D mammogram revealed “suspicious tissue” in one of her breasts.

“Two weeks later they went in and took out three cancer cells—stage 0,” she says. “If we had waited a year, it would’ve been a diff erent story.”

Hayden underwent radiation ther-apy and has a good chance of being cancer free at her next scan, thanks to 3-D mammography, which doctors used to catch her cancer early.

“I’m just fi nding it intriguing the advances they are making,” Hayden

AGE

Providence Sacred Heart

Medical Center and Inland

Imaging recommend women

start having screening mammo-

grams at age 40 and continue

every year after that.

Barbara Hayden appreciates having “such amazing technology” in Spokane.

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Mammograms: When to Start?There has been much controversy and confusion in recent years about

when a woman should start getting mammograms and how often

she should get them. After the U.S. Preventive Services Task Force

changed its guidelines for starting screenings from age 40 to age 50

and for frequency from one year to two years, mammogram rates have

declined. Among women ages 40 to 49, rates fell nearly 10 percent, and

for women ages 50 to 64 they fell 6 percent, according to a study pub-

lished in 2015 in the Journal of Clinical Oncology.

Lowering mammography rates is a trend that health care providers

would like to see reversed.

“Screening mammography is the only method that shows mortality

[death] and morbidity [illness] benefits,” says Florence Gin, M.D.,

a radiologist and co-chief of breast imaging services at Inland Imag-

ing. “The bottom line is women who have screening-detected breast

cancers live longer.”

Providence Sacred Heart Medical Center and Inland Imaging fol-

low the American College of Radiology and Society of Breast Imaging

screening guidelines for breast cancer: A woman should begin screen-

ing mammograms at age 40 and then continue annually for as long as

she is in good health.

says. “From what I understand, 3-D mammograms have fewer false positives. We’re very lucky to have access to such amazing technology in Spokane.”

IMPROVEMENT IN MAMMOGRAPHYBoth Tennican and Hayden have every reason to marvel at how far breast cancer detection has come.

“When breast imaging first started, you were lucky if you could find large cancers,” says Florence Gin, M.D., a radiologist and co-chief of breast imaging services at Inland Imaging. “There were no special techniques or dedicated machines. The cancers that were found were typically at advanced stages.”

Since modern mammography was introduced in the late 1960s, images have gotten clearer, but traditional X-rays have their lim-itations. “Regular film screening mammography is a 2-D image. We see breast tissues stacked on top of each other, and we’re trying to look through it,” Dr. Gin says.

3-D mammography represents an improvement.

“We take a 15-degree arc around the breast and get 15 pictures,” Dr. Gin says. “From those pictures, we make 1-millimeter slices. So instead of looking through all those layers, you’re looking at very small slices of the breast.”

Those small slices of breast image enable radiologists to spot the littlest areas of concern. And the smaller the cancer at detection, the more likely it is to be at an ear-lier, more treatable stage.

BENEFITS FOR ALL WOMEN3-D mammography is too new to have data on long-term success, but early research is promising. There is potential for 3-D mam-mography to increase detection rates, lower recall rates for false positives and decrease biopsy and

workup rates for noncancerous lumps and lesions.

Because of the detailed images provided by 3-D mammography, many physicians recommend it for women with dense breast tissue. “But really,” Dr. Gin says, “there are benefits for all women.”

Not all communities are fortu-nate enough to have the technol-ogy nearby.

“No one is sure why, but Wash-ington state has a higher rate of breast cancer than some other states,” Dr. Gin says, “so we are

SCHEDULE YOUR MAMMOGRAMIdentifying breast cancer early provides you with the best chances of survival. For women older than 40, a yearly mammogram should be a part of your health care routine. To schedule a mammogram, call Inland Imaging at 509-455-4455.

especially focused on serving our community to the best of our abilities.”

Inland Imaging has been desig-nated a breast imaging center of excellence by the American Col-lege of Radiology, the only such facility in Spokane.

“We are accredited in mam-mography, stereotactic biopsy, breast ultrasound and breast ultrasound biopsy, and breast MRI,” Dr. Gin says. “We want to make sure we’re doing the best for our patients and keep getting better and better.”

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26 HEART BEAT SUMMER 2016

TH

INK

ST

OC

K

COMMUNITY

Looking at Health in New WaysPutting a DENT in emergency department dental cases.

Spend a day in the emergency department at any city hos-pital and you are likely to see someone come in with

a dental emergency. Because most emergency departments are not set up to provide dental care, doctors usually can provide pain relief and little else.

Providence caregivers in Spo-kane wanted to do more for these people, many of whom have no dental insurance and are unable to afford dental care on their own. In its research, Providence found that dental issues, which often lead to other serious illnesses, were the fourth most common reason for low-income and homeless patients to visit its hospital emergency departments. Working with Better Health Together in eastern Wash-ington, the Community Cares: Dental Emergencies Needing Treat-ment program (DENT for short) was born in July 2014.

The group is attacking the prob-lem in multiple ways:

Attracting more dentists in the area, particularly those who will accept Medicaid patients.

Systematically referring emer-gency department patients to dentists.

Coaching patients on what to expect during a dental appointment.

Patients in emergency depart-ments at Providence Sacred Heart Medical Center & Children’s

GOING FURTHER, GETTING RESULTSBesides arranging dental refer-rals for emergency department patients, Providence provides community benefit funds to its DENT partner organization, Bet-ter Health Together, to pay DENT community health workers. If patients lack medical insurance, Providence staff members will help them apply for dental insurance. By working with community part-ners on all aspects of the DENT plan, Providence hopes to signifi-cantly improve health care for the people of eastern Washington.

In one year, the DENT program had remarkable results:

The number of dentists accept-ing Medicaid patients in the region increased from 22 to 55.

Hospital and Providence Holy Fam-ily Hospital who have dental prob-lems are asked if they will accept a referral to DENT. If a patient agrees, a request is faxed to a DENT community health worker. In most cases, the health worker will reach the patient within 48 hours and schedule that person for an emer-gency dental appointment. If the patient needs pain medication, it is usually prescribed prior to dis-charge from the hospital emergency department.

During the call, the DENT com-munity health worker coaches the patient on how to prepare for the dental appointment and reminds the patient to be on time, make arrangements for child care during the appointment and follow the dentist’s care plan.

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Providence Health Care’s 2015 Community Benefit FundsProvidence’s total community benefit for the eastern Washington region was $103 million, maintaining a community commitment to serve those who are poor and vulnerable.

CATEGORY AMOUNT

Unfunded portion of government-sponsored medical care

$68,051,893

Free and discounted medical care $13,121,199

Community health, grants and donations $2,891,973

Education and research programs $12,321,726

Subsidized services $7,018,513

TOTAL COMMUNITY BENEFIT $103,405,304

Includes Providence St. Joseph Care Center & Transitional Care Unit, Providence Emilie Court Assisted Living and Providence VNA

Unfunded portion of government-sponsored medical care ($68M) Answering the call of our Mission to care for everyone, Providence serves a large and growing population of Medicaid patients to ensure access to care. The unfunded portion of Medicaid is the difference between the cost of care and what is paid by the government. Providence financial counselors helped more than 3,500 community members across Washington, including Spokane and Stevens counties, enroll in the coverage that best met their needs.

Free and discounted medical care ($13.1M) Providence provides free and discounted care for patients who are uninsured, underinsured or otherwise unable to pay for their health care.

Community health, grants and donations ($2.9M) Providence partners with community organizations to identify the community’s greatest needs, then uses this research to strategically invest in organizations and programs like the Community Cares: Dental Emergencies Needing Treatment (DENT) program that address health in new ways.

Education and research programs ($12.3M) By providing funding for health-related education and research programs, Providence is helping increase the number of students and medical residents who stay in the region after completing their education. It’s an investment in the future health of our community. In addition, Providence community benefit supports the Providence Medical Research Center, which has hundreds of active research projects bringing clinical trials to thousands of people each year.

Subsidized services ($7M) Subsidized services such as the Women’s Health Center, which provides health care to low-income women, are provided despite a financial loss, because they fulfill critical care and service gaps in the community.

The number of follow-up emer-gency dental appointments each month increased from 51 to 312.

The percent of patients referred to the program with scheduled den-tal appointments increased from 26 to 92 percent.

Nearly all patients who were referred and scheduled for dental appointments by DENT did not return to the emergency depart-ment for dental pain or infection, therefore saving significant dollars in avoidable hospital emergency department use.

MANY OPPORTUNITIES TO TOUCH LIVESDENT is just one example of the many creative and unique commu-nity programs for which Providence Health Care provides financial support as part of its community benefit program.

Each year, Providence Health Care directs its community benefit contributions to treat patients and their families, connect families with preventive care, fill gaps in com-munity services and offer hope in difficult times. The goal is to reach beyond the walls of its hospitals and doctor offices to touch lives when relief, comfort and care are needed and to improve the overall health of the communities it serves.

$70 million

Community contributions by Providence Health Care above and beyond its tax

exemption as a not-for-profit organization

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28 HEART BEAT SUMMER 2016

GA

RY

MA

TO

SO

Buried TreasureOne man’s unearthed glass bottles are transformed into art at Sacred Heart.

In 1986, landscaper Brian Martin rode his bike past some men who were digging at an old dumpsite near the Spo-kane River, just east of Division Street. Intrigued, he decided to find out for himself what might lie beneath the

soil’s surface. After finding an old whiskey crock in perfect condition, Martin was hooked.

Over the next 20 years, Martin excavated more than 15,000 discarded glass bottles—many of them medicinal—from unoffi-cial Spokane dumps. Most came from the site where the River-point Campus is now located.

Thanks to the help of local artists Valerie Wahl and Laura Thayer, a small fraction of his collection has been trans-formed into an art piece, which hangs in the recently remodeled Cardiac Inten-sive Care Unit at Providence Sacred Heart Medical Center.

With inscriptions such as “Dr. Pierce’s Golden Med-ical Discovery,” “Hamlin’s Wizard Oil” and “The Great Dr. Kilmer’s Swamp Root,” these distinctive bottles are a reminder of the various medical “cure-alls” used by Spokane’s early residents. Most of the bottles are estimated to be from the late 19th and early 20th centuries, and they represent Spokane pharmacies as well as drugstores in other eastern Washington towns.

Martin’s excavation technique: dig a hole as deep as 20 feet, descend using a flexible ladder, then dig laterally upon finding a vein of material. He would haul up buckets of dirt, hoping they would reveal unbroken treasures.

Health challenges eventually halted Martin’s work. He received cancer treatment at Sacred Heart in 2012 and, moved by his expe-rience as a patient, bequeathed a portion of the proceeds from the sale of his home to Providence Health Care Foundation.

Martin died in late 2014, but his legacy is reflected in the col-orful medicinal bottles on display in the CICU.

FOUNDATION LEAVE A LEGACYHelp provide health care for future generations by including Providence in your estate plan. Call Providence Health Care Foundation at 509-474-4594 or visit phc.org/giving to learn how.

“Who needs to travel thousands of miles to find the new? The most mysterious place on Earth is right beneath our feet.” —William Bryant Logan

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Q: What fascinates you most about bones?A: Bones are able to heal even after great trauma. They make me look good at times; when a bone is injured, my job is to give it the support it needs to heal properly, but Mother Nature actually does a lot of the work for me.

Q: What’s it like to work in both orthopedic trauma and oncology?A: There is urgency to both of these specialties. Nobody plans to break a hip or to have a tumor discovered in his femur—these things just happen, and they have to be taken care of right away. With trauma, I have to be ready every day to fix almost any major bone in the body, from the wrist to the scapula (shoulder blade) and from the pelvis to the toes. With cancer, there is a great deal of anxiety that goes along with the diagnosis, so I try to see patients as quickly as possible to help put them at ease.

Q: What’s new in your practice?A: In oncology, we’re developing an integrated team to provide specialized care for patients facing sarcomas and orthopedic tumors. That’s not offered in many places—I’m the only orthopedic oncologist between Seattle and Minneapolis. In trauma, we now have five orthopedic trauma specialists with deep expertise in handling the most challenging fractures. We have a surgeon who specializes in pediatric orthopedic trauma (Jim Dunlap, M.D.), a new partner who focuses on

Frame WorkYour bones support your body. Meet the man who supports your bones.

upper-extremity trauma (Jeremiah Clinton, M.D.), a surgeon focused on complex joint reconstruction (Chad Harbour, M.D.), and a multi-ligament knee injury expert (Soren Olson, M.D.). We’re also one of the only centers in the region with the expertise to treat pelvic fractures. Most people probably don’t real-ize how sophisticated the care is here in Spokane. I’m really proud of the work we do.

Q: What gives you the most satisfaction in your work?A: I can’t cure every cancer or prevent every disability, but my patients understand that I’m doing everything I can to offer the best care possible, and that I truly care about how they do. Whether they’re here for an ankle fracture or a malignant tumor, I hope I make their jour-ney as smooth as possible.

Q: What do you do in your downtime?A: I’m having a lot of fun being a daddy. Before children, I shot archery and hunted, but now I really enjoy spend-ing time with my wife and our 3-year-old son, and I’m excited that we have another one on the way.

M.D. SPOTLIGHT

ANDREW HOWLETT, M.D.,orthopedic surgeon specializing in orthopedic oncology and orthopedic traumatology, Providence Orthopedics

SEE THE BONE AND JOINT EXPERTSSacred Heart’s orthopedic physicians and surgeons are here to help with your bone and joint problems. To make an appointment at Providence Orthopedics, call 509-838-7100, or visit washington.providence.org/clinics/providence-orthopedics to learn more.

READ ON YOUR TABLET OR PHONE: PHC.ORG/HEARTBEAT 29

Nobody plans to break a hip or to have a tumor discovered in his femur—these things just happen, and they have to be taken care of right away.

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Join Providence Spokane Heart Institute and

walk or run a 5K. Train every Wednesday, June

through July, 6–7 p.m., at the Spokane Commu-

nity College track. Go to hearttostart.org to

sign up or learn more.

5K Run: Saturday, Aug. 6

Starting at INHS Wellness Center

501 N. Riverpoint Blvd., Spokane

HEART TO START

8.3 milThe number of people who fi nished a 5K race in 2014

30 HEART BEAT SUMMER 2016

TEE UP FOR TEAM ST. LUKE’SProceeds from this golf tourna-ment benefi t Team St. Luke’s, a recreation program for youths and adults with physical disabilities. The event is Thursday, Sept. 22, at Kalispel Golf and Country Club in Spokane. To sponsor or play, call 509-474-4917.

INHS COMMUNITY WELLNESS CLASSESVisit courseregistration.inhs.org for dates, times and locations for these summer off erings.

BABY-SITTING BASICSThis hands-on course for youths ages 10 to 15 is designed to give the skills and training young baby sitters need to be safe and successful.

GROUP LIFESTYLE BALANCE PROGRAMMake lasting changes to reach your healthy-lifestyle goals. You’ll meet weekly with a trained lifestyle coach and receive the support and tools you’ll need for success. Off ered in person or through a live, interactive webinar.

HONORING CHOICES CLASS (FREE)Join us for this advance-care planning workshop. Start those important conversations about your goals, values and beliefs for your future health care choices.

INBODY TESTSThe InBody machine gives you a complete picture of your body composition.

LUNCH AND LEARN (FREE)Join us on your computer, tablet or smartphone for fun, interactive presentations on varying health

Classes, Events and ActivitiesSummer 2016

CALENDAR

SEE MORE EVENTSCheck out the full calendar of events at phc.org/heartbeat. Hover over “Health Resources,” then choose “Calendar of Events.”

and wellness topics, on the third Thursday of each month.

MEDGEM TESTSGet a metabolism analysis to fi nd out how many calories your body uses per day. The Med-Gem calorimeter is the perfect test for anyone trying to lose, maintain or gain weight.

QUIT FOR GOOD: A TOBACCO-CESSATION PROGRAM (FREE)This four-week program is available via a live, interactive webinar.

TH

INK

ST

OC

K (

2)

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READ ON YOUR TABLET OR PHONE: PHC.ORG/HEARTBEAT 31

Twelve glasses. Ninety-six ounces. A half-gallon. Recommendations for daily water intake may

vary, but consuming enough to keep your body hydrated and healthy might make you feel, well, water-logged. Fortunately, the foods you eat account for about 20 percent of your total H2O needs, according to the National Academy of Sciences.

GET A GAUGEBecause it’s not easy to know how much water you’re getting from food, it’s best to rely on cues from your body to tell you whether you’re drinking enough.

First is thirst. If you’re thirsty or have a dry mouth, you have at least mild dehydration, so drink up. Bet-ter yet, sip water and eat hydrating foods (see chart) throughout the day so you don’t even reach the point of thirst.

Eat More WaterLooking for ways to stay hydrated? Fill up your plate.

Also, check your urine. It should be clear or very light yellow. If yours is any darker, you’re not getting enough fluids.

Other signs of mild to moderate dehydration include not urinating much, headache, muscle cramps, and dry, cool skin.

DEFEAT DEHYDRATIONJust as water and some foods hydrate, other drinks and foods dehydrate. For example, caffeine and alcohol are diuretics, meaning they cause your body to lose liquid.

The best beverage for hydration is—wait for it—water. If you need your coffee or tea in the morning, enjoy your cup along with a glass of water. Doing so will help replace the fluids lost by the body because of the caffeine.

Does water bore you? Add nat-ural flavor! Simply squeeze fresh fruit juice into your glass or use the drippings from sliced melons or citrus fruits. Another option for subtle flavor is to chop your favorite fruits or a vegetable like cucumbers and place them in an infuser water bottle.

HEALTH TIP

HOW MUCH WATER DO YOU NEED?Ask your provider for a recommendation of water intake based on your unique needs. For an appointment, call 509-232-8138.

Iceberg lettuce

Celery

Cucumber

Radish

Tomato

Green pepper

Cauliflower

Grapefruit

Watermelon

Spinach

Starfruit

Strawberries

Baby carrots

Cantaloupe

95%

94%

93%

92%

91%

90%

WATER CONTENTFOOD

Source: USDA National Nutrient Database

High Water MarksHere are the top foods to eat to help you

stay hydrated:

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NON-PROFIT ORG

US POSTAGE

PA I DHEART BEAT

Our Mission is to reveal God’s love for all, especially the poor and vulnerable, through our compassionate service. Our values are respect, compassion, justice, excellence and stewardship.

GA

RY

MA

TO

SO

Providence Sacred Heart Medical Center & Children’s Hospital101 W 8th AveSpokane, WA 99204

ROLE MODEL

ComforterVolunteer escort Tami Walsdorf says,

“Never underestimate the power of a warm blanket.”

Walsdorf helps patients and families fi nd their

way to and from the exam rooms in the bustling

emergency department at Providence Sacred Heart

Medical Center & Children’s Hospital. But the most

important part of her job is to provide a little comfort

while they’re there.

“Everyone who comes to the emergency depart-

ment is vulnerable,” Walsdorf says. “Everyone here is

outside their comfort zone. We try to o� er them a little

comfort, whether that’s by holding their hand or by

o� ering them a warm blanket.” The kindness of the

gesture never fails to soothe. “People instantly feel

hugged when you wrap a nice, warm blanket around

their shoulders,” she says.

In her volunteer work, Walsdorf fi nds herself con-

stantly inspired by her patients. “There’s a lot of courage

in this world,” she says. “You see it every day in the

emergency department.”

WANT TO VOLUNTEER?

If you’re interested in being a volunteer at Providence Sacred Heart Medical Center & Children’s Hospital, call 509-474-3166, or go to phc.org and click “Giving.”

Tami Walsdorf helps patients and families fi nd their way and also feel at ease.

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