COLUMN | WEST END HEALTHLINE

We are West 7th: Let's Get Started | 7.14
Allergies and Honey | 6.14
CenteringPregnancy | 5.14
We are West 7th! | 4.14
Lessons from Fatherhood: Lessons a Baby Taught a Doctor | 3.14
MNsure - looking forward to 2014 |1.14
Health Insurance Exchange...(MNsure) and You | 10.13
Health Insurance Exchange...Wait...What? | 9.13
Open Letter to West 7th Community | 8.13
Health Care Home Coordination | 3.13
Baby's First Dental Well Check | 2.13
Sweet Secrets about Dental Care | 12.12
Real Optimism in Healthcare | 9.12
Healing Power of Community | 8.12
Putting Women First at United Family Medicine Clinic | 6.12
Allina Health Launches Neighborhood Health Connection | 5.12
Medical Student's Perspective | 3.12
Patients by the Numbers | 2.12
Accessing the Wisdom of Winter and Beating the Winter Blues | 1.12
A Personal Perspective on Living with Bipolar Disorder | 12.11
Living a Full Catastrophe Life in the West End | 11.11
A Way Back from the Abyss | 10.11
Dealing with Trauma: Ouch! | 9.11
What is a Midlevel Provider | 8.11
Physician, Buck Thyself Up | 7.11
How Can We Work Together for a Healthier Neighborhood | 6.11
Rolfing Structural Integration A Primer (Part 2) | 5.11
Rolfing Structural Integration, A Primer (Part 1) | 4.11
Advanced Care Planning | 3.11
La Clinica los Maynards | 2.11
 
7 Reasons to Get Health Insurance

by Andrew Dixon, MD
Second Year Resident, United Family Medicine

It’s an exciting time to be a primary care doctor. While it has flaws, the Affordable Care Act (ACA or “Obamacare”) is helping more people get health insurance. However, there’s still a lot of confusion about the law’s new insurance options, and some uninsured people remain skeptical that getting health insurance is worth the cost. If you are one of these people on the fence, consider these seven benefits of getting health insurance.

1. Protect yourself against bankruptcy
A 2007 study by researchers at Harvard Medical School found that more than 60% of bankruptcies in the US were caused by medical bills. Even if you are a healthy, young athlete, you can get appendicitis or a kidney stone, leading to a five-figure hospitalization. A single bill like this can be enough to cause you to fall behind on your house or car payments, or destroy your credit rating. Health insurance helps to disperse the cost of these rare, serious events so that they don’t derail a person’s life.

2. Take advantage of new, cheaper insurance plans
The ACA opens up new, cheaper ways to obtain health insurance. If you are a single person making less than $23,000 a year, you can be covered by MinnesotaCare. Families, persons with a disability, or pregnant women are eligible if they make more than this — check the Minnesota DHS website at mn.gov/dhs for more information on your individual situation. If you make less than $48,000 a year, you can get Federal money to help you cover your monthly insurance payments. For more information, go to the MNSure website at mnsure.org or talk to MNSure Navigator (available at our clinic or through the website). You can still sign up for MNsure. The MNsure Navigators from United Family Medicine are out in the community, at festivals, farmer’s markets and other venues in the community to assist you.

3. Be healthier, live longer
The ACA requires that any health insurance cover preventative healthcare. This includes cancer screenings, vaccinations, and screenings for things like high blood pressure and diabetes. These can prevent some diseases from happening, or stop others before they become dangerous. Taking advantage of these free preventative healthcare options can help you improve your long-term health.

4. Avoid the Emergency Room
Many patients without health insurance use the ER for things that could otherwise be done at a clinic, like checking out a sore throat or renewing medications. Getting your care through the ER can mean waiting for hours and, your bills from the ER are often more than twice what they would be in a clinic. While some clinics (like UFM) see uninsured patients, others accept only insured patients. Getting health insurance would allow you to be able to receive care at a clinic where this type of care is more appropriate.

5. Improve our country’s economy
The cost of uncompensated care has added to national and state deficits for years. A Kaiser Family Foundation study showed that state and federal governments spent about $40 billion paying hospitals for uncompensated healthcare last year. By getting health insurance, you can help to reduce our national debt and strengthen our economy.

6. Lower your neighbor’s insurance premiums
If many of the people in the community without insurance were to get coverage, the monthly rates for everyone would go down. This is because insurance companies calculate your premiums based on the average money spent on the people they cover. Many people without insurance need relatively few healthcare visits, and if they joined the pool they would reduce these premiums for everyone. By getting coverage, you could help your neighbors save money.

7. Get your own personal doctor
Many uninsured people don’t have a primary care doctor due to the cost (again, UFM sees patient’s without insurance, and offers patients primary care and a medical home). Having a regular doctor means building a relationship that can benefit your health. As a primary care doctor, I have learned that the better I know my patients, the better I can make an individualized plan to fit their needs. If you don’t have health insurance, I encourage you to visit MNsure.org, or call 1-855-3MNSURE, or make an appointment with the patient advocates at United Family Medicine by calling 651-241-1000.

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We are West 7th: Let’s Get Started [IMAGE]

by Jonathon Dickman, MD, PhD

Wouldn’t it be nice to know all the wonderful resources located in the West Seventh community? For example, did you know that RiverGarden Yoga (455 West Seventh) has donation-only classes so that everyone, regardless of their ability to pay, can enjoy this refreshing exercise? Also, that Mississippi Market (1500 West Seventh) has a variety of affordable cooking and food classes so that you can learn how to eat healthier? The community member-led We Are West 7th! project is hoping to deliver all of this information to the community through the creation of an online asset map for everyone to use. The hope is that this online resource will not only reveal all the services that businesses have to offer, but will eventually expand to highlight skilled individuals and leaders in the community as well.

The We Are West 7th! project is now starting the process of creating that online asset map, and is planning to start collecting data this summer. The United Hospital Education and Research Committee and the Minnesota Academy of Family Physicians have funded this project. Thanks to their support, we are now hiring. We are looking to fill the following five positions to get the project going this summer:

1) Two senior surveyors — These people will collect data by physically going out and asking questions to each organization in the West 7th community. Anyone can apply, but preference will be given to local college students.

2) Two associate surveyors — These people will assist senior surveyors. Anyone can apply, but preference will be given to local senior high school students with good typing skills.

3) Team coordinator — This person will organize the activities of and data collected by the two surveyor teams. Anyone can apply, but preference will be given to a local community member.

Each person will be provided a stipend as compensation and is expected to work a total of 160 hours on the project (20 hours per week for 8 weeks). We also welcome volunteers who are simply interested in contributing to this project. The We Are West 7th! project is led by community volunteers who are passionate about improving the overall welfare of their neighborhood. Some of our best ideas have come from local volunteers. We would love to hear from you!

To apply for a job, or if you simply are interested in helping out, please send an email to both Marit Brock (maritbrock@gmail.com) and me (jrdickman@gmail.com) with any comments or questions regarding We Are West 7th!

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Allergies and Honey

by Kelsey Leonardsmith, MD
First Year Resident, United Family Medicine

It seems safe to declare that spring is here. Accompanying the longer days and generally cheerier moods, many of our neighbors are suffering from red, itchy eyes and drippy noses: seasonal allergies. For me, this time of year means that my backyard honeybees start to emerge from their hives. As a doctor and as a beekeeper, I’ve often heard local honey recommended as a cure for your pollen allergies. But I was wondering — does it work, and how?

In the office, I usually recommend that people with seasonal allergies try over-the-counter antihistamine medications and, if needed, a steroid nose spray during the time of year they are affected. Allergens, or the tiny particles that trigger the immune system in people with allergies, are common in our environment. Some of the most common, such as dust and pet dander, are around all year. Others such as pollen from trees and grasses cause trouble only at certain times of year. In the spring, common allergens are tree pollens such as oak, maple and elm. The most common pollen allergens, the ragweed species, won’t be around until the end of the summer.

Bees go from flower to flower collecting nectar and pollen. Many plants rely on bees to carry pollen between plants so that they can reproduce. Bees also use pollen for food and some of it ends up in the honey they make back at the hive. Some say that eating honey with pollen in it will help desensitize you and reduce allergy symptoms, the same way an allergy shot works. Honey does not spoil, and unfiltered honey will have more pollen than processed honey. And if you eat local honey, you are eating honey that contains pollen from the plants that you might be running into the most. One hole in this theory, though, is that those plants that cause the most seasonal allergies like the oak, maple and elm as well as ragweed depend on the wind, not honeybees, to bring pollen from plant to plant. Honeybees do visit the flowers of these plants and take pollen and nectar for food, but less so than other plants.

So, is it a good idea to pick up some local honey to help with your allergy symptoms? Well, one study at the University of Connecticut in 2002 compared people eating local honey, processed honey from a national brand, and syrup with artificial honey flavor. They found no difference in allergy symptoms between the three groups. A newer study just last year, however, did find that the honey-eaters had fewer allergy symptoms two month later. The difference was that they had people eat larger amounts of honey, about five to six ounces per day, in addition to taking their allergy medications.

At the end of the day, adding local honey to help out your allergies won’t hurt and there is at least some evidence that it could help. If you, like me, are still stuck with your winter cold, then honey is a great choice for you — studies have shown that honey works just as well as cough syrup.

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CenteringPregnancyTM
by Micah Johnson, MD
United Family Medicine Resident

We at United Family Medicine are very excited to introduce a new model for delivering prenatal care called CenteringPregnancy™. CenteringPregnancy™ is a type of group prenatal care developed by Sharon Schindler Rising, a nurse midwife. While working at a busy community health center in Connecticut, Sharon found that providing prenatal care in groups gave women the opportunity to participate in discussions and share wisdom in an environment where common issues related to pregnancy could be openly discussed. Here at United Family Medicine, the idea to provide group prenatal care began after we reviewed the information gathered in the Healthy West 7th Project, an assessment of the health-related needs in the West 7th Community carried out three years ago. Community participants had voiced a consistent desire for more groups, or “chats” with physicians. In this setting, folks would be able to discuss health topics in a more comfortable, less intimidating setting.

After receiving a generous grant from a local philanthropic organization, the F. R. Bigelow Foundation, we are in the process of educating staff and redesigning clinic workflow to implement CenteringPregnancy™. The group visits will replace traditional prenatal office visits by bringing together 8-12 women with similar due dates. Women and their partners will meet 10 times throughout their pregnancy at 2-4 week intervals with two resident physicians and one faculty physician. The resident physicians that lead the groups will also attend their delivery. I’d like to share a few things that we are most excited about as we begin to offer CenteringPregnancy™:

1. More time with the physician. As traditional clinic visits continue to become short and hurried based on regulations and busier schedules, this will be a chance to spend a good amount of quality time with the physician. The group visits will be scheduled for 2 hours with no waiting room time and no extra time at the end for going to the laboratory. This is compared to the typical 10-15 minutes spent with a provider during a traditional office visit.

2. Easier scheduling. Women will get their clinic visit schedule for their entire pregnancy at their first visit, with a choice for a morning or afternoon session. This will make it easier to plan for transportation and daycare.

3. Patient Empowerment. Patients will take control of their own healthcare by taking their own blood pressure, assisting with part of the assessment, and learning from peers. There will be tremendous opportunity for education and discussion in a confidential space. The relationships developed between participating women during pregnancy will be a great source of support for women and their partners.

4. Improved medical outcomes. Compared to traditional care, CenteringPregnancy™ has been proven to reduce the risk of having a preterm birth. This is likely due to increased support and education during pregnancy. It has been associated with other benefits, such as decreased need for pain medications during labor and increased patient satisfaction.

5. What about Privacy? Checking baby’s growth and listening for the baby’s heartbeat will be completed in a private area. There will always be the opportunity for a private visit with the physician either after the group meeting or at a separate, regular office visit.

We hope you will share our enthusiasm in this opportunity to continue to improve the quality of care at United Family Medicine.

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We are West 7th!

by Jonathan Dickman, MD, PhD
First Year Resident – United Family Medicine Residency Program

Last year several West 7th community members got together to discuss the need to engage local youth in recreational activities and help them feel welcome in the neighborhood. After several discussions, it became clear that there was a need to explore what local resources were already available for not only youth, but the rest of the West 7th community as well. This realization by the group reflects what was found by the “Healthy West 7th!” project, which identified a need for resource coordination as one of the priorities for improving the wellness of the neighborhood.

Indeed, community members have expressed a desire to better identify and coordinate efforts made by local businesses, associations, and key individuals. One approach to identify and interconnect existing resources in a community is Asset-Based Community Development (ABCD), which seeks to make sustainable change in neighborhoods by tapping into the strengths of local individuals and organizations. Rather than create programs defined by community deficits, ABCD promotes the capacity of the community to address these concerns. The community member-led group that initially got together to discuss engaging youth has recently formed the “We Are West 7th!” project that plans to create an online map of West 7th resources. This online asset map will lay the foundation for ABCD by creating an awareness of the rich diversity of resources already available in the neighborhood.

The vision for the We Are West 7th! project is “To foster a healthy, vibrant, welcoming neighborhood where all members are connected to each other and local resources.” To accomplish this, local youth will interview members of all local businesses, associations, and key individuals in the West 7th community. These discussions will outline available programming and opportunities in the neighborhood with a special emphasis on neighborhood priorities, as outlined in the Healthy West 7th! project (including basic needs, health education, resource coordination, nutrition, fitness, community building, volunteerism and activities for youth).

The data gathered will be categorized and displayed in an easy-to-use format, using Google mapping software. For example, a person looking for places to exercise in the West 7th community would quickly be able to find all gyms, parks, and recreation centers in the area on a map, as well as a detailed description of the services offered at each location (including the cost and times of classes). The website will be designed to be informative to community members and to provide a framework for better utilization and coordination of resources.

Excitement about highlighting the positive aspects of the neighborhood is palpable and community members have already started holding monthly meetings and volunteering for leadership positions for this project. In addition, local organizations including The West 7th Business Association, United Family Medicine, and the Fort Road Federation are eager to collaborate with this project in an effort to obtain more detailed information about the West 7th neighborhood. The plan is to start exploring the assets in the neighborhood this summer (2014).

We Are West 7th! needs your help! We are always looking for people with new ideas, talents and the energy to contribute to the project. We also want to know what information you would like to have displayed on the website. The We Are West 7th! project seeks to serve and be helpful for all neighbors and visitors of the West 7th community. You are welcome to attend and participate in any meeting (usually the first Saturday of the month at 10 a.m. at the Mississippi Market, 1500 West 7th St.). We have found that neighbors who attend the meetings always have unique skills and ideas and have already made significant contributions to the project.

Please feel free to contact Marit Brock (maritbrock@gmail.com) or me (jrdickman@gmail.com) with any comments or questions regarding We Are West 7th!
 
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Lessons from Fatherhood: Lessons a Baby Taught a Doctor

by Jonathan Dickman, MD, PhD
First Year Resident – United Family Medicine Residency Program

Never could I have imagined that after 13 years of college, a child almost 30 years younger than me would show that I still have much to learn. My son Joseph was born on March 17, 2012, and he seems to teach me something new every day — here are five such lessons.

Get excited about the little things
Joseph gets so excited about the little things in life. “A Ram Sam Sam” he says while shaking his blanket. He wants everyone in the room to grab an end of the blanket and sing “A Ram Sam Sam,” a song that he learned from Early Childhood Family Education (ECFE). This highly recommended sliding-fee program is educational for both children and their parents. Call 651-793-5411 for details. Joseph has taught me to take a closer look and enjoy things that I would normally take for granted.

It is not about the stuff
Joseph rarely asks about a missing toy, but he always asks “Dada?” if I am not around. This emphasized to me that kids do not really want stuff, they want you. Oftentimes Joseph simply uses toys and books as a means for me to interact with him. Moreover, this demonstrates why, starting at about two years old, using timeouts appropriately for discipline works. It provides a moment that is void of attention. These moments without you available are what children ultimately want to avoid. Joseph taught me that the best gift that I can give him when getting home from work is myself, and he has never complained about having my full attention. [If you want to learn more about using timeouts for discipline, I recommend reading the book 1-2-3 Magic by Thomas Phelan, PhD.

An ounce of prevention…
Medical school taught me all about the rare diseases, but Joseph taught me about the more common stuff in parenting. Proper skin care is at the top of the list, as diaper rash and eczema are often preventable. Use of a barrier cream has minimized Joseph’s occurrences of rashes and red butts. There are many barrier creams available, but 100% petroleum jelly (“Vaseline”) is by far the cheapest and still very effective. The key is to use it often. How often? We put it on his bottom with every diaper change. We lube his entire body at minimum after every bath and increase it to 2-3 times daily in the winter. This has drastically reduced our need for any medicated creams. I owe Joseph many thanks for this practical knowledge and my diapered patients have already greatly benefitted from barrier cream.

Learning is not linear
It took several days, but I finally got Joseph to enjoy getting his head wet in the pool. Then, he suddenly got out of the pool, ran and fell down. He was ok, but was much less interested in getting his head wet. It is hard to not feel a sense of defeat when things all of a sudden seem to move backwards. We always hear about big life moments (such as a new baby) causing a child to go back to their former ways. What I did not realize is that common everyday events can do the same (usually on a smaller scale). Thus, I learned that the process of learning the world is not a smooth uphill climb, but rather a bumpier ride that always keeps a parent on his/her toes.

Persistence pays off
Breastfeeding takes time to master. I observed the dedication between my wife and son through the first several weeks of life as they both learned together. Perhaps this work is just to give us a greater appreciation of Mother Nature’s finest mix of nutrients. Although initially frustrating, they worked hard, persisted, and succeeded in the magical process of breastfeeding. Together they taught me the importance of perseverance and the beauty of a natural nutrition that is superior to any product made in a factory. [All pregnant and breastfeeding moms should consider visiting The Baby Café at St. Luke Lutheran Church (1807 Field Ave.) on Wednesdays from noon to 2 p.m. This drop-in group is a wonderful resource that gives you a chance to talk to a lactation consultant.]

Joseph is not done teaching me lessons, but he will not be the only one for long. My wife is due with our second child in June. Soon, two children will take me back to school to learn about the more important things in life.

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MNsure - looking forward to 2014

by Connie Walsh and Angelica Diaz
United Family Medicine

United Family Medicine (UFM) was the first agency in Minnesota to have credentialed staff available to assist consumers to apply for MNsure. Since the first of November, our Navigators have seen more than a thousand persons individually or at large group functions to answer questions and hopefully alleviate some of their fears and confusion. We have also helped well over 350 households to complete the enrollment process. Because our staff is bilingual, we are able to assist a great number of our neighbors without the need of using family as interpreters.

As MNsure Navigators we have come across many people who are in need of multiple services, not just access to healthcare coverage. We are pleased to say, because of the linkages that UFM has with so many local agencies, successful referrals have been made and folks are getting their needs met. WE ARE NOT HERE TO SELL INSURANCE. Our goal is to assist and only assist you to make the best decision possible by helping you navigate the options, taking into consideration your family size and household incomes.

We at UFM are pleased to have hired Angelica Diaz, whose entire job is to work as an Outreach and Enrollment Specialist for MNsure. Angelica is bilingual, speaking Spanish and English. She works full time at UFM, Monday through Friday, 8:30 a.m.-5 p.m. Angelica comes to UFM with 11 years of experience working in the insurance industry with a focus on public programs such as Medical Assistance and Minnesota Care. You can set up an appointment with her by calling 651-241-1073. Her assistance is for ALL persons — not just patients of UFM. And the services are free.
By the time you read this article it will be after January 1. But this does not mean our job is finished. Angelica and our patient advocates will continue to help you get coverage and answer your questions. Our goal is to help any person who requests our help.

Have a happy and healthy 2014 and beyond!

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Health Insurance Exchange...(MNsure) and You

by Gina Lotzer, Tim Rumsey, MD and Angelica Diaz

This month we will look at a very helpful resource for people looking for health insurance. As part of the Affordable Care Act, the government is providing Outreach and Enrollment Specialists or Health Insurance Navigators to help people purchase insurance through MNsure. Navigators are:
  • persons who help individuals and families achieve successful enrollments into health plans through the MNsure marketplace;
  • obligated to help any consumer that contacts them for assistance.
Navigators are not insurance agents or brokers. They help people work through the process of applying and enrolling.
Ms. Angelica Diaz is an Outreach and Enrollment Specialist (Navigator) hired at United Family Medicine to assist patients and community members in enrolling in health insurance online at MNsure. You do not have to be a patient of United Family Medicine to receive assistance from Ms. Diaz. Beginning October 1, 2013, Ms. Diaz is available to help navigate the MNsure website. Her goal is not only to assist people to enroll, but also to offer answers to questions and concerns and to help ease confusion and fears regarding signing up for health insurance.

She will be at the clinic on Wednesdays and will be in the community at a variety of locations, events, fairs, etc. in order to be accessible to all. You can schedule an appointment with Ms. Diaz beginning by calling 651-241-1073. She will be able to assist Spanish speakers as well.

In addition to Ms. Diaz, the patient advocates at UFM will also be trained to assist patients at the clinic. Below are some frequently asked questions regarding the Affordable Care Act and MNsure, from The New Healthcare Reform Act brochure.

The Affordable Care Act (Obamacare)

Frequently Asked Questions

What if I already have health insurance? You don’t have to do anything — unless you lose coverage. But you may choose to shop for a new plan on your state’s health insurance Marketplace. By purchasing a plan through the online Marketplace, you may be able to get government help to pay for health insurance. Before buying from the Marketplace, find out if you can cancel your current policy without penalty.

What if I’m in a government healthcare program? You don’t have to do anything if you are covered by Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Tricare, Veteran’s Administration, Indian Health Services, or if you are part of a healthcare sharing ministry.

What if I don’t have health insurance? You must buy health insurance by January 1, 2014, either from a private insurance company or through your workplace. If you don’t buy insurance by then, you have to pay a penalty fee to the US Government. However, some people don’t have to do this. (See next two questions.)

Does everyone have to buy insurance? The following people won’t have to pay a penalty: those with health insurance already (such as Medicare, Medicaid, CHIP or workplace insurance); undocumented immigrants; people in prison; members of Indian tribes; those with religious beliefs (that allow an exemption); those who don’t earn enough to file a tax return; people who will have to pay more than 8% of their income for insurance; people under 26 who are on their parent’s health plan.

What is the penalty if I don’t buy insurance? In 2014, the penalty fee will be $95 a year for adults and $47.50 for a child (or 1% of your income, whichever is higher). A family will have to pay no more than $285. This will rise each year. This fee will be collected on tax returns.

What if I can’t afford health insurance? Every state will have a Health Insurance Marketplace website where you can compare insurance plans. If you buy insurance through your state’s Marketplace, you may get tax credits or other government aid. Single people who earn up to $45,960 in (2013) and a family of four earns up to $94,200, could get help.

How does the Marketplace work? You can shop for coverage online beginning in October. Minnesotans will be able to compare insurance plans offered at MNsure (mnsure.org or 1-855-3MNSURE (1-855-366-7873). When you apply through the site, you will find out if you can get government help to pay for insurance or if you qualify for Medicaid or other health programs. Your coverage can start January 1, 2014. Information is available at healthcare.gov.
If I don’t have insurance, must I buy it through the Marketplace? To get most kinds of government help to pay for insurance, you must buy a plan through MNsure. But you will still be able to buy insurance directly from a company or through an insurance agent. Using the Health Insurance Marketplace makes it easy to compare plans.
Is there extra help if I make very little money? If you’re under 65, you may be able to get healthcare through Medicaid. Go to healthcare.gov to see if you qualify.

Am I covered by my parents plan? Children can stay on or rejoin a parents plan until age 26 whether they live at home, live away from home, or are married. As of January 1, 2014, those under 26 can be on a parents plan even if their employer offers health insurance, unless the parents are on Medicare.

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Health Insurance Exchange...Wait...What?

by Gina Lotzer and Tim Rumsey, MD

Healthcare reform is upon us. With the realization of the Affordable Care Act (Obamacare), the landscape of healthcare is changing, ready or not. One of Obamacare’s goals is to create a marketplace for high quality, affordable health insurance for individuals and small businesses. This is the Health Insurance Exchange.

An Exchange is an online marketplace where Minnesotans can purchase private health insurance if we choose not to enroll in or don’t have the option of an employer-provided healthcare plan. The government will offer subsidies and tax credits to eligible individuals in the Health Exchange to make coverage more affordable.

Minnesotans who qualify financially can also enroll in extensions of public programs like Medical Assistance and the Children’s Health Insurance Program (CHIP).

The Exchange will perform a number of functions, including:
  • Operate a toll-free hotline and website for providing information.
  • Ensure that health insurance plans meet certain standards (for example, related to marketing, access to health care providers, and reporting on quality of care).
  • Provide information in a standard format to help consumers compare insurance companies and benefit plans.
  • Determine eligibility for individual premium tax credits, cost-sharing assistance and coverage requirement exemptions.
  • Determine eligibility for Medical Assistance.
  • Determine eligibility for small business premium tax credits.
  • Provide real-time enrollment in health benefit plans.
  • Make an electronic calculator available to display the cost of coverage.
  • Communicate with employers regarding employee tax credit eligibility, cancellation of coverage, etc.
  • Establish a Navigator program that connects Minnesotans with an individual or organization that assists consumers and businesses to navigate an Exchange (mn.gov/health-reform/topics/exchange).
In Minnesota, the Health Insurance Exchange is called MNSure. You can go to the website, mnsure.org, or call 651-284-4101 for more information. MNSure will provide health plans from multiple insurers, so you can see plans and costs side-by-side. In addition to this feature you will also be able to find quality information on clinics, hospitals and surgery centers.

This all sounds complicated and confusing. Oftentimes new, innovative ways of doing things are. You won’t have to navigate this new terrain alone however. MNSure is providing Navigators, sometimes called Outreach and Enrollment Specialists, to help people apply for a health plan. United Family Medicine is in the process of hiring an Outreach and Enrollment Specialist right now. There will be other organizations in the community to provide these Navigators as well, such as community centers, churches and other community clinics. The MNSure website will be able to guide you to one of these Navigators in the near future.

The role of the Outreach and Enrollment Specialist is to help individuals and families achieve successful enrollments in health plans through MNSure. They will also provide education on health coverage options. Outreach and Enrollment Specialists will develop, discover and attend community events to promote coverage options.

Anything new can be scary or exciting. The ultimate goal of this new way of providing healthcare is to enable all citizens in the United States to have access to high quality affordable health care. Hopefully this will lead to more people having a long, continuous relationship with their healthcare providers and fewer emergency room visits and hospital admissions. We at United Family Medicine are hoping for some positive effects coming from Obamacare — mainly extending healthcare coverage for as many Americans as possible. There may be a few bumps in the road while rolling out MNSure, and UFM is committed to helping our patients and all community members navigate the unfamiliar terrain successfully.

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Open Letter to West 7th Community
by Alexis Vosooney, MD, United Family Medicine

Upon completion of medical school, all doctors choose a specialty that they want to practice and set off to complete a specialized training program called “residency.” Any doctor will enthusiastically tell you that their chosen specialty is the most interesting, the most useful, the one that everyone should choose, and I am no different. I chose family medicine. Family doctors have the great privilege of caring for patients at every stage of life, from birth to death, and often care for different generations within the same family. They set broken bones, deliver babies, care for chronic diseases and optimize their patients’ mental health. I have spent the past three years at United Family Medicine, located in the heart of the West Seventh neighborhood, as a resident physician, learning the skills of family doctor. As I come to the end of my residency, and look forward to the next phase of my career, I realize that many people have contributed to my
education over these years.

First is the staff at our clinic, from the nurses and advocates to the lab department and billing. Medicine is no longer practiced by a doctor working alone to achieve health with their patient, but rather by a team supporting the patient in many aspects of their health. The doctor may prescribe your medications, but we know that treating the patient involves caring for your physical, social and emotional needs. The nurses who answer your phone calls, talk with your pharmacy and help coordinate transportation, the advocates who help keep you connected to community resources, and the doctor who treats your ailments and listens to your concerns, are all working together to improve your health. Teamwork is learned best through practice, and the staff at United Family is a team.

Second, I am immensely grateful to the senior physicians at United Family. One of the reasons that I chose family medicine was for the opportunity to be involved with patients throughout every stage of their life. Some of the doctors at United Family have been practicing in the West Seventh neighborhood for more than 30 years, caring for multiple generations. They have a commitment to medicine, to the belief that everyone deserves access to health care, to the knowledge that seeing a physician who knows you well ensures more comprehensive care. Their patients are not simply names on an appointment sheet, but people whose stories the doctors remember, whose health they are committed to maintaining. Senior physicians encourage us to take active roles in our community, to be advocates for health. Each resident has a project whose goal is to improve the health of the West Seventh neighborhood, and our faculty are champions of our projects. This support has allowed the residents to organize programs that help create community gardens, improve access to and knowledge about fitness programs in the neighborhood, support for homeless people who are trying to quit smoking, just to name a few.

Lastly, the group that has most influenced my training and future practice, the patients. United Family has a diverse and loyal patient population that has enhanced my training experiences. A medical school professor once told me, “The patient teaches you — ask yourself what you learned from each patient.” He was correct. Medical school teaches us about a disease; how it occurs, what its course may be, treatment options. Residency allows for the interaction with patients, to put a face to different events; diagnosing and splinting a broken bone, caring for a mother throughout pregnancy and delivering her child, talking with a family about end-of-life care. We remember the childhood developmental milestones because we watched for them in the babies that we delivered and cared for as they grew. We saw the pride that a patient can have when they take charge of their disease; getting their diabetes in good control, maintaining their sobriety. Patients teach you that sometimes listening and allowing people to share their fears and concerns is more effective than simply offering a pill and moving on to the next patient on your schedule. Our patients have helped to train the next generation of doctors, and for the residents, it has been a great privilege to care for them.
As I move on to the next chapter of my professional life, I can only hope that I will be fortunate enough to develop life-long relationships with patients, their families and the community in which I practice. I am grateful that United Family Medicine and the West Seventh neighborhood have given me such an excellent education.
Cheers, Alex

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Health Care Home Coordination [IMAGE]

Health Care Home Coordination is an effort at United Family Medicine Clinic to provide the best care possible to our patients. This program was initiated at the Clinic in June 2011. In December 2012, United Family Medicine became certified by the Minnesota Department of Health (MDH) as a Health Care Home. As a health care home, our work is vital to achieving MDH’s “Triple Aim — goals of improved population health, patient experience of care and affordability, by decreasing per capita cost.” The main focus of the program is to engage our clients in an active collaboration that promotes a team concept in health care.

It is United Family’s hope that by forming a collaborative effort in health care our clients’ health will improve. The most important aspect of health care home coordination is active participation by our clients, voicing their hopes and goals for their health care. Our clients’ input is required in order to address what is important to them.
Because health care home coordination is in its formative stages, the administration and providers at United Family Medicine have decided to focus initially on those patients with uncontrolled diabetes and those who find themselves using Emergency Departments at hospitals for their primary care to treat chronic heath issues. It is the Clinic’s hope that by focusing on those two groups, processes will be put in to action that will eventually allow staff to provide access to a wider group of patients.

UFM has two Care Coordinators — one bilingual in Spanish — who work closely with the patient and their care provider. Between the Coordinator, the provider, and the patient, a plan of care is developed and implemented. This plan of care is the focus by which care coordination is developed and tracked. The Care Coordinator is the main point of contact for the patient and all patient concerns flow through the Care Coordinator. This allows the patient quicker access to their provider and more immediate addressing of their concerns. By coordinating patient care, it is the intent that all medical records are available to the provider and patient when visiting the clinic. This includes lab and test results, and visits with outside providers. This will allow the patient to receive the treatment needed when it is needed, and where it is needed.

To put health care home in context, here is a quick story about a patient who enrolled in UFM’s health care home who was reluctant to enroll because he was concerned that it would intrude on his privacy and make him answer to somebody else. This patient had always done things for himself and did not want to lose control of the decision-making regarding his health care. After the Care Coordinator reviewed the benefits with the patient, the patient realized this could provide him some long-term benefits and improve his overall health.

In the fast paced world we live in, it is easy to lose sight of doctor appointments and easier to ignore tests and referrals, and it can become daunting to keep track of everything. One of the issues the gentleman above faced was just that. We described how we could work together as a team, provide him assistance making and keeping appointments and tracking outside records, and explaining medical terminology in terms he could understand, and that these features of the program could be more helpful than he had ever imagined. The patient understands he is in charge of his health care; we are here to help with the coordination. The patient realizes he has not lost control of his health care, but finds this support has freed him up to be concerned with what matters most — his own health.

If you have any questions about this new and very important program, please feel free to contact United Family Medicine. Ask to speak with a Care Coordinator. We will be happy to speak to you about UFM’s health care home program and how it may benefit you and your health. You can also speak to your provider at your next office visit. Hope to see you soon.

UNITED FAMILY MEDICINE, 1026 West Seventh, 651-241-1000.


Baby’s First Dental Well Check

by Phuong-Giang T. Pham DDS, Dental Health Director, UFM

Your baby’s first years are full of firsts: first smile, first step, first word and many other memorable firsts. Since February is National Children’s Dental Health Month, I want to make parents aware of another important baby’s first to check off — baby’s first dental visit. I would like to elaborate on three of the most frequent questions I get from parents about their children’s dental care.

They are just baby teeth that will eventually just fall out anyways, so does it really matter? On the contrary, baby teeth (also called primary teeth) are important to your child’s current and future dental health. A high tooth decay rate (also referred to as cavities or caries) with baby teeth can continue onto permanent teeth, potentially afflicting the child with a life-long preventable disease. Early identification and treatment of baby teeth decay is imperative in preventing other surrounding teeth from developing cavities. Untreated decay can lead to painful abscesses, which in rare instances can become life-threatening if the infection spreads systemically. Untreated cavities can also lead to early tooth loss that can lead to loss of spacing necessary for incoming permanent teeth. Inadequate spacing may cause permanent teeth to come in crowded and misaligned or crooked, and potentially affect their function and aesthetics. Besides keeping space, baby teeth play an essential role in chewing/nutrition and speech development.

When do I start brushing and flossing my child’s teeth? Taking care of your child’s oral health actually begins before teeth appear in your child’s mouth. It actually starts in infancy with cleaning your baby’s gums twice a day, usually in the morning and after the last feeding at night. There are a number of products available such as finger terry cloths and rubbery finger brushes you can use. Or you can simply use gauze or a clean, damp washcloth wrapped around your finger to gently rub and clean your baby’s gums, tongue and tissues. You do not need to use any toothpaste or cleaning agents yet — just a little water will do. Once your child has teeth present, you can switch to a small soft toothbrush. If you decide to use toothpaste, make sure to use one that is nonfluoridated until your child can adequately spit out and not swallow the paste. When your child is ready for fluoride toothpaste, make sure to use just a light smear to a small pea size amount. Flossing should be added when your child has two or more teeth adjacent to each other. There may be lots of fussing at first, but consistency will get your infant used to having his/her mouth cleaned like any other parts of the body. This will make transition to tooth brushing much easier as well as help your child develop good oral hygiene habits as they grow and carry it into their adulthood. Visit your drugstore to see examples of gum, toothbrushes and floss aids.

When do I bring my child in for his/her first dental appointment? The American Dental Association (ADA) and the Academy of General Dentistry (AGD) both recommend children be seen for their first dental appointment within the 6 months after they get their first tooth, which is usually between 12 to 18 months of age. First visits are usually about getting children familiarized with the dental setting, the doctor, the chair, the light, and the mouth mirror. It is also a great opportunity for parents to ask us questions and for us to discuss causes of tooth decay and show parents different oral homecare techniques, discuss nutrition and eating habits to prevent tooth decay.

I conclude with the following tips for you and your child’s first dental visit.
  • Schedule your child’s first dental visit sometime between when his/her first tooth comes in and his/her first birthday.
  • If possible, schedule the appointment during a time when your child is well rested and most cooperative. For most, this will be in the morning.
  • Have a positive attitude towards the visit. Keep any anxiety you or other family members may have about dental visits away from the child. Try not to bribe your child for going to the dentist or use the visit as a punishment or threat to get child’s cooperation.
  • Most importantly, make the visit a fun outing for your child and enjoy yet another moment of your child’s many firsts.

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Sweet Secrets about Dental Care

by Phuong-Giang T. Pham DDS
Dental Health Director, UFM


You may be thinking — yikes! Another piece lecturing about needing to brush for two minutes, two times a day, floss daily, and visit your dentist at least twice a year for good oral health. However, you may want to know that besides preventing cavities (or tooth decay) and gum disease, having a great smile and fresher breath, good oral hygiene habits have multiple other benefits. Here is a list of these benefits:
  • Did you know that good oral care may help you keep your mind? The Journal of the American Geriatrics Society recently published an 18-year longitudinal study showing that good oral hygiene may be associated with lower risks of developing dementia. With 13.9% of the over-71 population dealing with some degree of dementia, and increasing as the population ages, it may be worthwhile to remember to brush and floss.
  • Some studies have found good oral hygiene is linked to a decreased risk in developing respiratory infections such as pneumonia, which is the leading cause of death for patients in long term care.
  • Good oral hygiene habits started at a young age will more likely carry through a person’s lifetime. With early good habits of keeping your mouth clean, plaque free, and healthy, you are much less likely to develop dental pain, require less extensive and costly treatment, and less likely to become fearful of going to the dentist.
  • Star young! Studies published in the American Journal of Public Health show a link of poor academic performance in children with dental disease.
Now that we have covered some benefits of good oral care, read on to find out one simple way to improve your oral health. I promise you the results will be sweet! You can have your cake and eat it too! What? Are we still talking about cavity prevention? Yes, we are talking about using xylitol as a substitute for other types of sugar (glucose, sucrose, and other simple and refined sugars).

What is Xylitol?
Xylitol is natural sugar alcohol found in fruit and vegetable fibers. Xylitol is roughly as sweet as sucrose but has about a third fewer calories, and has been FDA approved as a food additive since 1963. For oral health products, xylitol is available in gum, mints, candies, syrup, mouthwash, and toothpaste. For maximum benefits of xylitol-containing products, make sure it is among the first two on the product ingredient list. You can also find xylitol sold in bulk as crystals for use in cooking or as a sweetener. It can be substituted for sugar in recipes teaspoon-for-teaspoon. However, xylitol effectiveness is greatly reduced if combined with other artificial sweeteners like sorbitol, mannitol, or maltitol.

Xylitol is beneficial to dental health
Unlike other sugars, xylitol prevents and inactivates tooth decay by inhibiting the growth of cavity-causing Streptococcus mutans bacteria, and reduces their ability to stick to teeth. Numerous scientific clinical studies since the 1970s show supporting evidence that 4-6 exposures throughout a day of 3-8 grams daily total xylitol is effective in preventing tooth decay, and also shows evidence that maternal consumption may reduce their children’s risk of acquiring tooth decay causing S. mutans bacteria, thus reducing their cavities risk.

Tips on how to get 5 exposures daily:
1. Use xylitol toothpaste or mouthwash when you wake up. 2, 3, and 4. Have a xylitol gum, mint or candy after breakfast, lunch, and dinner. 5. Use xylitol toothpaste or mouthwash before bed.


Safety data on xylitol has been extensive and dates back as far as the 1960s. So far, studies have shown no known toxicity in humans. Common side effects are a laxative effect, and temporary gastrointestinal effects such as bloating, gas, and diarrhea. These symptoms usually occur with initial use and diminish with regular intake. But be alert if you have dog(s) — keep xylitol products away from their reach. Consumption of xylitol by your dog can lead to a life-threatening low blood sugar level. It also can lead to liver failure in dogs.

Make life sweeter. Add five doses of xylitol every day. Bon appétit.

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ObamaCare Part II

It was said in this column (Sept. 2012) that the Patient Protection and Affordable Care Act – Obamacare – is a good thing. Three reasons why: expanding healthcare to at least 32 million uninsured Americans, consumer protections for the 150 million plus commercially insured Americans, and incentives for real-life, creative healthcare reforms and cost containment. But people are worried. Afraid. Confused. From donut holes to death panels. From Medicare to Free Market care.

Real concerns and good questions
  • Does Obamacare cover abortions? No.
  • Will I lose my doctor or have to change my doctor? No and no. “If you have insurance, you can keep it.” (barackobama.com). Obamacare will not change “my doctor” issues any more than current insurance plans do.
  • Does Obamacare cover illegal immigrants? No.
  • Will my health insurance premiums go up? By 2016: Non-group market will receive subsidies to reduce premiums. Small group market, 1 to -3%. Large group market, 0 to -3% (Wikipedia, 7/8/12).
  • Will businesses drop insurance for their employees? Competitive businesses who want to retain good employees will continue to offer health insurance. Obamacare will prohibit “dropping” patients off insurance because of pre-existing condition or catastrophe.
  • Will there be a doctor shortage? Yes. Up to 40,000 primary care doctors in 2014 (family practice, pediatrics, internal medicine, general gynecology). Nurse practitioners and physician assistants and doctor nurses will help. So will new models of care delivery. But a definite challenge.
  • What about this mandate to buy insurance and the penalty for refusing? “Obamacare requires most adults not covered by an employer or government sponsored insurance plan to maintain insurance coverage or pay a penalty, a provision commonly referred to as the individual mandate.” (Wikipedia 7/8/12).
  • How will it be paid for? A $750 billion dollar reduction in Medicare payments to hospitals and physicians (not patients). Obamacare will also be funded by a variety of taxes including:
  • Broaden Medicare tax base on incomes over $200,000 and $250,000 for individual and joint filers respectively.
  • Annual fee on health insurance providers.
  • Annual fee on drug manufacturers.
  • 2.3% excise tax on manufacturers of certain medical devices.

Distortions
  • Death Panels: Term used by Governor Sarah Palin for what actually was to be payment to doctors for discussing advanced directives with patients. So much distortion arose that this language was removed from the bill. It has resurfaced lately over independent panels advising physicians about billing and appropriate care.
  • Job Killer: The Congressional Budget Office (CBO) estimates Obamacare would “reduce the amount of labor used in the economy by about 800,000 jobs – mainly from workers who would feel no longer dependent on their employers for healthcare – and retire or work part time. There will also be a huge increase in healthcare related jobs.
  • Government Takeover: “Let’s be blunt. The word for that is a lie” (Bill Keller, NY Times, 7/15/12). Obamacare will deliver 30 million new customers to the private insurance industry.
  • Socialized Medicine: See above. There are new insurance regulations (“protections”) and individual insurance mandates. But the government is not taking over hospitals and clinics and doctor’s offices.
  • Obamacare may be a good thing, but it is a complex, poorly understood bill. Polls have indicated that a majority of Americans did not support the overall bill, but specific elements were very popular (Wikipedia 7/8/12).

56% of Americans were against the law, 44% for. 61% favored allowing children to stay on their parents’ insurance until age 26. 82% favored banning insurance companies from denying coverage to people with pre-existing conditions (Reuters-Ipsos Poll 6/2012).

What do doctors think about Obamacare? Some are against it, some are for it, some don’t know. “This will allow us to see our patients earlier and not when they are so sick. This is a win for patients.” AMA President-elect Dr. Andris Hoven.
“The Affordable Care Act has really set the tone for delivery systems to deliver higher value. This does reinforce that this is the right path.” Billings, Montana clinic CEO, Dr. Nicholas Walter.

“It’s a great step forward for the country and I think it will help tens of millions of Americans.” Former Center for Medicare/Medicaid Services head, Dr. Donald Berwick.

“There will not be enough caregivers to respond to the needs entitled by the law.” Dr. Joel Thurm, Retired, Veterans Affairs Department, Davidson, NC.

“The whole thing remains unconstitutional…it will destroy the healthcare system”. U.S. Senator Rand Paul, MD. (All quotes reported in Modern Healthcare 7/2/12.)

For almost 40 years we at United Family Medicine have seen what it means to be uninsured, underserved or sick and elderly. Cutting pills in half or taking them every third day. ER visits at the last minute. Cancer: hell without insurance, delaying preventive care. People: fellow human beings suffering who needn’t.

There is help, a solution. It’s called The Patient Protection and Affordable Care Act. Obamacare.

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Real Optimism in Healthcare

by Tim Rumsey, MD

I woke up this last beautiful 4th of July feeling very strange. I woke up optimistic. I hadn’t been ill or irresponsible. It was indeed July 4, 2012. Maybe it was the humidity. Two real stories started it all. A patient, not United Family’s but a friend’s son, was very ill. Life-threateningly ill. Over one year he had multiple, lengthy hospitalizations, outpatient treatments, ups and downs and near-death moments. He is still here and doing fairly well. His medical bills reached nearly a quarter of a million dollars. They were paid by his full-time working parents’ insurance. He is 25 years old and newly covered by the extension of insured coverage under one’s parents to age 26. And that government takeover, end-of-the-world Obamacare made it happen.

And this. A good friend got bone marrow cancer. She took leave from her job secondary to what would be a year from Hades. Biopsies and chemo. Long stays in hospital isolation rooms, lots of doctor visits, lots of cancer-world worry and waiting. There was even an insurance-covered referral and eventual stem cell transplant at the Mayo Clinic. She is now in remission. A medical miracle. Her insurance? Medicaid and Medicare. Good insurance. Government insurance. Government insurance (Medicaid) that an estimated 16 million uninsured Americans will be eligible for in 2014. Obamacare, again.

Strangely, my optimism keeps growing. Insurers will no longer be able to deny coverage because of the dreaded “pre-existing conditions” or remove the insured if they get a major, severe illness. The Medicare drug benefit donut-hole will be shrunk and eventually eliminated. Meanwhile seniors will soon be getting donut-hole rebates and another 16 million Americans — working poor Americans — will be able to get affordable health coverage from insurance exchanges.

Obamacare will increase coverage for routine preventive services and end of life counseling. Obamacare is already fostering creative, real-life, meaningful health care reforms like electronic medical records, the Medical Home model, evidence-based care and support for community health centers.

I’m not confused. I really am optimistic.

I have had the extraordinary privilege of being an intimate witness to 37 years of the real lives of thousands of fellow West Seventhers and St. Paulites. Human beings and their misery, suffering and worry. Their joys. Births and deaths. I’ve been in hospital ICUs at 3 a.m. Clinic exam rooms and waiting rooms all day long. There were house calls and curbside consults. Meetings in school basements, churches and neighborhood centers. And all the while people suffering and worrying. Rich and poor and everyone in between. Every race and most creeds. A hundred year-olds and one-second olds. Leveled by the loss of a child or spouse. Infected by misery. But just as often spared from appendices or gall bladders about to burst. Quality of life — cataract surgery and hip replacement. Powerful, loving family deaths and terrifying, chaotic ends of life. Most of all, I learned the beautiful history of West Seventh and her people. In short, the value of relationships between providers, patients and their neighborhood through a community clinic like United Family Medicine.

This bravado is simply to say my optimism is viewed through a magnifying glass, not rose-colored glasses. There are real worries and real challenges with the big changes in healthcare — that’s next month’s column. But that magnifying glass focuses on the opportunities Obamacare will give to all Americans.

It was a good 4th of July this year. At day’s end, exclamation points were supplied by fireworks, both legal and ill.

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Healing Power of Community

There is no doubt in the healing power of being surrounded by loved ones when you are ill.

I lived in the Dominican Republic from June 2009 to June 2010 and worked at a public hospital during my time there. We felt the trembling when the earthquake struck near Port au Prince, Haiti at 5 p.m. on January 12, 2010. Growing up in the Midwest and never having felt an earthquake before, I was convinced that the garbage truck had accidentally hit our building. The first I heard of the earthquake was, surprisingly, on the Internet. Although the epicenter was a mere 160 miles from where we were living, it took a full day for us to gather information on what was happening. My friend, an emergency medicine physician, happened to be coming to vacation in the country when the earthquake occurred; when he arrived at our apartment in Santiago, we immediately began planning our trip to the border of Haiti. The devastation we saw during our month on the Haitian border was incredible, but it wasn’t the most profound thing I experienced. I hope to illustrate the amazing resilience and strength that the victims of the earthquake drew from each other and from their community by offering a few stories.

On our arrival to the small hospital less than 40 miles from Port au Prince, there was one physician and more than 50 critically ill men, women and children. During the first few chaotic days, there were many who pitched in, from the Spanish doctors triaging and taking care of the most ill patients, to the Dominicans working tirelessly to carry in enough food and clean water to support both the patients and staff. Still, the most amazing workers were the entèprèt, or interpreters. They were young boys and girls who happened to know English or Spanish, and thus could interpret from Haitian Creole for the doctors and nurses. Most of the entèprèt had lost many family members in the tragedy. Still, they were walking the halls, day and night, interpreting for the doctors and nurses. Often, in the middle of the night, we would be woken by one of the entèprèt, who would state, “Can you come to check on this patient, I think they are sick.” They were working tirelessly for their people, their family, and their community.

A week into our stay, I was able to participate in an intense and amazing healing ceremony. As the sun broke over the mountains in the east, I stepped out onto the balcony of the bunkhouse where I slept. There was a makeshift tent set up below me in which individuals were recovering from surgery. Just outside of this tent, at least 50 Haitians, as well as volunteer nurses from Canada, Japanese orthopedists, Puerto Rican doctors, and disaster relief personnel from Spain were gathered in a large circle holding hands. There was one individual holding a microphone and translating the Haitian Creole into Spanish so we could join in the spontaneous ceremony. They initially broke into a traditional Haitian song as people gathered. After this, the microphone migrated through the crowd. At each stop, patients and family members would tell their own personal story of the disaster. Many Haitians described witnessing family members and friends trapped under the rubble. Eventually, they would painfully describe having to leave their loved ones in order to take care of others or themselves. One particular story stuck with me. A young 17 year old man described being trapped under the rubble for 72 hours. He was trapped with his younger sister, who had sustained more severe injuries than he had during the initial collapse of their home. He had given her the small amount of water that he was able to retrieve, but it hadn’t been enough. As he cried while recounting how he had to leave her when the rescue organization pulled him from the rubble, the entire group gathered around him. They offered their own stories and understanding of the pain he was going through. It was by sharing communal experiences that the community was able to gather enough strength to begin to recover from the devastation they had endured.

As my wife and I settle in to the West Seventh neighborhood, we have already met many members of the community. It has been very exciting to see how members of the West Seventh community care for and support their neighbors. Take a moment this week to help out someone who needs the caring love of a neighbor. By becoming a closer community we will only grow stronger.

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Putting Women First at United Family Medicine Clinic
by Raiza Beltran, MPH

It is not often that women are encouraged to put themselves before their families or work. But when they meet Connie Walsh, the lead patient advocate at United Family Medicine Community Clinic, that is exactly what she tells them. With more than 20 years of experience working with families from St. Paul’s West Seventh neighborhood, Walsh finds that women consistently place their own priorities and their health below those of their children, families or work. “When we talk to women, we tell them they are entitled to preventive health care services, even if they think they can’t afford it.” Walsh is referring to the Sage and SagePlus programs from the Minnesota Department of Health. Offered at United Family Medicine since 2004, Sage provides free breast exams, mammograms and Pap tests to women who do not have health insurance or whose insurance doesn’t cover the full cost of these services. Women who qualify for Sage may also receive a free heart health screening through SagePlus.

Since collaborating with Sage, more than a thousand women have received a free mammogram and Pap test at United Family Medicine. More than 520 women enrolled in Sage also took part in SagePlus. Women in SagePlus received a blood pressure, blood glucose, and cholesterol test and were assessed for their risk for diabetes, stroke and heart disease. These tests and clinic visits were completed at no cost to the patient. Walsh considers the screening programs “highly successful” and the need for these services increases each year. Due to the rising demand, and in an effort to make the programs more accessible to women who have limited mobility or free time in their schedules, Sage, United Family Medicine, and the Shakopee Mdewakanton Sioux community collaborated to bring quarterly screening events at the clinic. Usually held on a Friday, the screening events allow women to receive all of the services offered by Sage and SagePlus at one visit. The Mdewakanton mobile mammography unit is stationed at the clinic so women do not have to make a second appointment for their mammogram. “We try to make the screening events easy and fun for the women.”

“Screening events like these along with a dedicated staff members have made partnering with United Family Medicine clinic valuable and rewarding,” says Dr. Gay Lynn Richards, the regional coordinator for Sage. Dr. Richards points to the clinic’s patient advocates who address not only a woman’s medical needs but her financial, physical and emotional needs as well. Patient advocates like Walsh can recognize if a woman in her office is experiencing barriers that prevent her from getting the care she needs. “It could be the financial piece. Women think that since they don’t have health insurance, they can’t get preventive services,” says Walsh. “If they are new Americans and our health care system is a new experience for them, we make sure that they only see women providers, and we have bilingual health care workers to help them.” By reducing barriers to care, the staff at United Family Medicine is improving the cancer screening and cardiovascular screening rates among women in St. Paul. The clinic is also an important ally in reaching underserved women. “Who they serve and how they serve patients, their commitment to their patients, is the reason for their success” says Dr. Richards.
Genta Sebastian, a St. Paul resident who received free screening services at United Family Medicine, strongly advises women to put their health at the top of their list. A former sixth-grade teacher, Sebastian currently does not have health insurance. But she says that not having insurance should not stop women from taking advantage of free services. “You have to be proactive, you have to do it yourself. If you don’t take care of yourself, you won’t be there for the people who are already counting on you. I have to hold on — my family deserves it, they deserve me, and I deserve them.”

To see if you’re eligible or to make an appointment for a free mammogram and pap test, call Sage at 1-888-6-HEALTH (1-888-643-2584). Mention promo code UFC2 and you may qualify for a $20 incentive. You can also call this number to learn about SagePlus, a heart-health program, and Sage Scopes, a colorectal-cancer screening program. Sage also offers tobacco cessation tools in conjunction with the Minnesota QUITPLAN Helpline.

Raiza Beltran, MPH, is a Health Program Representative for the Sage Screening Program at the Minnesota Department of Health.

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Allina Health Launches Neighborhood Health ConnectionTM 

The Neighborhood Health ConnectionTM is a new community program presented by Allina Health that helps people establish and enhance social networks to improve health. The program gives people tools to create healthy neighbors groups, and offers fun and creative ways to make them and their communities healthier. More than 50 years of research shows that people with strong community connections and social support are healthier and happier. The Neighborhood Health ConnectionTM helps build relationships that are vital to health.

The primary vehicle for Allina’s initiative is the Healthy Neighbors Group. This is a group of people living in the same area who want to make themselves and their neighborhood healthier by getting to know each other and participating in healthy activities together. A group can be as big or small as its members choose. The goal is to make new connections and strengthen existing ones with friends and neighbors nearby.

Anyone can start a Healthy Neighbors Group. While most groups are started by community residents, organizations or groups working on specific projects are encouraged to start healthy neighbors groups too. Individual group initiators and facilitators can commit as much time as they would like. Allina recommends that the leader facilitate at least one healthy activity per month with the healthy neighbors group, but that is a minimum and more is fine. For example, a walking club might walk two to three times a week; once a month could be enough if the activity is a healthy potluck. It is up to the group.

The Neighborhood Health ConnectionTM will have a dedicated website that offers multiple tools including a guide to starting a healthy neighbors group as well as sample fliers, a toolkit and more. There will also be an opportunity to apply for money to support a Healthy Neighbors Project that requires additional resources (such as inviting a Zumba instructor to a meeting or purchasing tools to start a community garden), apply to be part of a community pedometer challenge and/or request Allina Health to conduct a health screening in your community. Deadline for applications is June 8, 2012.

These activities will take place in local neighborhoods or wherever the groups decide to hold their activities. The Neighborhood Health ConnectionTM is about getting people connected with others to engage in healthy activities.

The website launched in late April at neighborhoodhealthconnection.org, and the whole project kicked off on April 29 at the Minneapolis Farmers Market.

Also, as part of its general community health improvement work, Allina Health recently donated $4,000 to the Healthy West 7th Gardening and Nutrition Project to help pay for materials and supplies needed to prepare garden plots, build raised beds and to help the program grow throughout the West End.

Allina will also host Neighborhood Health ConnectionTM orientation sessions mid-May in many communities around Minnesota and Western Wisconsin. Please consider attending one of the St. Paul orientation events listed below (other orientation times/locations listed at neighborhoodhealthconnection.org/events).
  • St. Paul Orientation Event 1: May 21, 6-7 p.m.
  • St. Paul Orientation Event 2: May 24, 6-7 p.m.
Both sessions are at the West 7th Community Center, 265 Oneida St. Information at neighborhoodhealthconnection.org.


Healthy West Seventh Reviews Mission and Objectives

Healthy West 7th seeks to improve the health and wellness of St. Paul’s West End in measureable ways by building relationships throughout our community founded on the unique strengths of our neighborhood.

Objectives
We will adopt a broad definition of health focused on the eight priorities identified as areas of unmet need by our neighborhood in the initial Healthy West 7th survey:
  • Basic Needs
  • Health Education
  • Resource Coordination
  • Nutrition
  • Fitness
  • Community-Building
  • Volunteerism
  • Activities for Youth
Education will be the foundation of our work; we will enable individuals and families to make and sustain optimal decisions about their health.

Operating Principles
1) We will be deeply rooted in the community:
a) Our efforts will be highly visible and well coordinated.
b) Our work will be driven by and for community members (individuals, families, non-profits, businesses, and more).
2) Embracing a spirit of inclusion, we will recruit diverse partners in our work.
3) Avoiding replication, we will connect with ongoing neighborhood efforts before creating new initiatives.

Our work has already begun! We are starting a community garden on Sholom’s campus, a demonstration garden at West 7th Community Center, and promoting organic vegetable gardening in public and private open spaces in the neighborhood. This eventually will be paired with education about nutrition and healthy food preparation. Other initiatives will eventually follow.
To prepare for our gardening work, Healthy West 7th is offering the Urban Gardener Training Program through Mississippi Market and taught by the Ramsey County Master Gardeners. Join us for future classes:
  • May 14: Growing vegetables.
  • June 4: Gardening in small spaces.
  • June 18: Dealing with pests: bugs & weeds.
$5 per person per class. Registration required. Scholarships available. Visit msmarket.coop/events or Mississippi Market’s store to register.

Applications for a plot in the community garden (at Sholom’s St. Paul Campus, off Otto St.) will begin on May 1: please visit healthywest7th.wordpress.com or call 651-241-1085 for more information. Plots will cost $25 plus volunteer hours for garden upkeep. Scholarships and/or payment by extra volunteer hours are available. Plots will be granted on a first-come, first-served basis with preference given to residents of the West End.

We are in need of volunteers to help us get ready for the planting season. If you can offer time or services, please call 651-241-1085 or e-mail healthywest7th@unitedfamilymedicine.org.

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A Medical Student’s Perspective

by Kathleen Mahan

It was my first home visit. The concept was new to me because I thought home visits were things of the past. I was still sorting out my feelings about this. How personal. How strange. How outdated this seemed. Instead of remaining in the comforting confines of the clinic with similarly dressed staff — whom I had grown to know, glistening examination rooms, and abounding medical supplies — we would be entering a patient’s apartment. A place that, likely, lacked the seeming sterility of the clinic, with little medical assistance nearby if needed. With unfamiliar faces in the halls who would be dressed with the apparel of the city. A place which keeps my patient. A place where she spends most of her time. Those four walls and roof surround her day and night. Sheltering her from the outside, and within which are her worries, her burdens, her joys, and her dreams.

The walls I will be seeing are the walls which provide protection, comfort, maybe anguish, frustration. How trusting she must be to invite us into her home! What qualifications give us this privilege? Is it the white jackets we wear, or the knowledge we have garnered through the years and have shared with her, which allow her to open her door to essentially two strangers? Perhaps we are not strangers, and if not, what words describe this relationship? Most doctors do not visit their patients’ homes. If the relationship is strictly a professional one, then why is she greeting us at the door with such ease? She welcomes us inside from the cold. Dr. R. and I step across the open threshold.

The apartment is small, L-shaped, with only one additional door leading to the bathroom. The wall paint is peeling. Personal effects are minimal, with no pictures of family members, friends, or loved ones. Did this lack of intimacy make it easier to invite us inside? Her friendliness has never been scarce. Dr. R. answers a phone call so I am able to take my time. Besides, he has done a ton of home visits. I take the details in and converse with her. She seems a little nervous. When the medical concerns are discussed she relaxes. A little. She tells me she does not like to leave her home for fear of being harassed and bullied in the streets. Her tiny home is situated in the heart of the city, and there are always people milling around. This is why she has missed several appointments at the clinic. She did not relate this over the phone when I asked.

The sounds of the city are easy to come by here. To some they motivate, promising adventure, action, and mystery. To the owner of this small apartment in the heart of the city, these sounds bind her inside her home. As we leave, she remains behind. Inside her home with the peeling paint.

Kathy Mahan is a third-year medical student rotating at United Family Medicine. This reflection is used with the patient’s permission.

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Patients by the Numbers

by GINA LOTZER

We patients can be just a bunch of numbers. There is our weight, height, temperature, blood pressure, pulse, cholesterol, hemoglobin, eyesight. I could go on and on. Lately, we are being given another number when we go to see the doctor — our BMI.

My first thought was “Oh great! Yet another number that will, no doubt, be too high!” But after hearing more about this number and learning more about BMI here at United Family Medicine, where I work as an administrative assistant, I have begun to realize that this particular number affects virtually all of the other numbers. By working on lowering my BMI I can reduce my blood pressure, cholesterol and pulse, not to mention that pesky weight number!

BMI stands for body mass index. This is a ratio of height and weight. When calculated, this number provides our percentage of body fat. This relatively new number replaces an older term used for years, “ideal weight.” Lowering this ratio means that the patient is exchanging fat for muscle, resulting in a leaner, healthier body. This results in all sorts of positive numbers at checkups. Having a lower BMI also reduces the risk of many chronic diseases, such as diabetes and heart disease, as well as joint problems associated with higher weights. The Centers for Disease Control estimates that 33% of adults in the U.S. are obese. At least I’m not alone.

One of the unfortunate aspects of BMI is that it is not too hard to wind up in the “obese” range. That’s where I land. It’s important for me to remember, however, that this is just a number, not a judgment. This information is given to me to do with what I will. I make the choice to change what I am doing to lower this number and thus become a healthier individual.

There is a push starting in this country to make BMI the fifth vital sign, along with body temperature, blood pressure, pulse and respiratory rate. The more we patients hear about our BMI at office visits, the more we will begin to accept hearing this number and taking it in the spirit in which it is given; that being the spirit of helpfulness and concern.

Let me tell you, it was not wonderful to hear that my BMI is in the obese range. It was an eye-opener and it grabbed my attention. In this New Year one of my resolutions is to lower my BMI number, not just to overweight, but to average (ah, to be average again!). I have always had an exceptionally low cholesterol number. Lately, however, this number has been slowly climbing. Funny, so has my BMI! Instead of concentrating on all the various numbers that result from my visit to my provider, I could just work on lowering one — my BMI, and I’ll hit the jackpot on those other numbers too.

So next time I am at my doctor’s office for a check-up, I won’t wince and then glare at my nurse or doctor. I’ll just say, “Thanks for the info.” And my next visit will be filled with wonderfully LOW numbers all around!

Above is an example of the numbers associated with BMI and the range from underweight to obese. Your provider or nurse can explain more about this number if you are interested in finding out more about it. Remember this is just one more piece of information to keep us strong and healthy.



Accessing the Wisdom of Winter, and Beating the Winter Blues

by Paula Coyne, MA
Licensed Psychologist at United Family Medicine

Can we use winter to enhance our health and vitality? How can we possibly enhance our well-being in the winter, in this time of cold and dark? Isn’t winter a hardship to be endured, a setback in our vitality? How can we tell if we have dipped into the Winter Blues, or a seasonal depression?

In the cycle of the seasons, winter’s wisdom calls us to become quieter, more introspective. This is a time for naturally sleeping more, yearning for comfort foods, releasing the past year of experiences but reflecting on the learnings, sharing stories with friends and family, and dreaming of what we want to create anew in the spring. When we lived closer to nature, as all people did over millennia, we kept to the rhythms of the sunrise and sunset. We slowed down during wintertime. Like the trees and the animals, we drew ourselves in and became reflective.

In our current lifestyle, we are expected to continue with all our usual high activity level; light switches turn on, we get up in the dark, stay up long after sunset, and our productivity is expected to continue on unchanged.

In the words of C. Geraghty, this isn’t a time to be literally asleep, but a time to become more dormant. “All of nature must at some point rest and fall fallow. Striving to resist the in turning of the season can be an exhausting and sometimes futile undertaking. During this season it is often wise to work with the environment instead of against it. Take stock, watch, gain power from the seed ideas and plans that you are germinating. One cannot live a meaningful life without taking time to ponder it first.

“To many, darkness either of day or the mind is frightening. An abyss, an unknown dark place of great depth, would seem a frightening prospect. But what if you did look there, in the place of lacking, what would you see or feel? What would it be like to sit with it, even for a few minutes a day, to wait for an image — anything that you could hold in your mind or write on paper? What would you find there — the name of a friend you would like to contact, an unresolved question to consider, or the knowing that there are more desirable paths that you would like to take in life? Perhaps this darkness is actually a fertile place, if we are willing to sit with it long enough to hear its secrets. In the darkness, the mystery of life can be fruitful.” [See about.com. C. Geraghty: “Winter Blues,” Health’s Disease and Conditions, updated 2007.]

But how about when one’s introspection and the slowing down of winter become unhealthy? Many of us have a touch of what could be called the Winter Blues. Up to 25% of people in the northern United States report some features of Seasonal Affective Disorder (SAD) — we are eight times more likely to experience SAD than people in the southern states. Only 2 or 3% of those with symptoms have severe enough problems to warrant treatment. It is more common among women, begins during young adult years and can continue throughout life. The symptoms start to show up in the fall, may intensify as the winter progresses, and lighten up in the spring as we return to longer periods of sunlight. In order to be diagnosed with SAD, the pattern needs to have been occurring for at least two years.

Symptoms of SAD
Feeling disinterested in doing things you usually enjoy.Craving starchy foods like potatoes and bread; gaining weight.Having trouble getting up in the morning, and wanting a nap.Feeling tired and slowed down much of the time.Decreased sexual desire and function.Trouble concentrating.Women may have worse than usual premenstrual symptoms.Feeling better in the spring may be excessive, bordering on mania.People with SAD can even have suicidal thoughts and feelings.Causes of SAD aren’t completely clear, but it is known that our exposure to light influences our serotonin levels, which fall to their lowest levels in the winter. Light also effects the natural circadian rhythms in the body. These rhythms regulate body functions such as mood, appetite, and sleep. Again, we are a part of nature and are influenced by its cycles more than we may be aware.


Diagnosis and Treatment of SAD

See your healthcare provider or a mental health professional if you have some of these symptoms and they are affecting your functioning, especially if there are any thoughts of suicide. The most effective treatment for SAD includes increasing exposure to sunlight or artificial light that is like sunlight. Medication and psychotherapy are also helpful.

Light therapy is sometimes an insured benefit; a light box is portable and can be used at home for about 30 minutes in the morning as you read. Some people buy special light bulbs and install them at home. Therapeutic light bulbs range in lux (a measure of light) from 2,500-10,000. The use of light needs to be monitored so one does not become manic! Using it later in the day, in the night, or to excess can interfere with sleep.

Prevention and Self Care
  • For all of us throughout winter, it is important to maintain our self care.
  • Get regular exposure to sunlight between fall and spring.
  • Get support; stay connected with family and friends.
  • Manage stress in healthy ways: Practice deep relaxed breathing each day, do some stretching at home, take walks, take up a hobby, make a point in engaging in pleasurable healthy activities each day. Watch a comedy, Laugh!
  • Avoid alcohol usage and other substances. DO NOT turn to caffeine to boost energy; this increases anxiety, irritability, reactivity, and interferes with sleep cycles.
  • Stop smoking.
  • Eat healthy meals three times a day, including leafy greens, fruit, protein. Drink water.
  • Keep a regular sleep schedule and aim for about eight hours per night.
  • Exercise: take walks, try out some yoga, use an exercise DVD, join the gym or visit West Seventh or Jewish Community Centers to use their facilities; Dance!
  • Wherever you are in your self care habits, make a beginning now to treat yourself better. Choose one or more of the above practices, and decide to take action to make some improvements in your self care. You deserve it!
  • Get immediate help if you have any thoughts or feelings about wanting to harm yourself or others. Ramsey County Crisis Line is available 24/7: 651 266-7900.
  • So find the beauty of this winter season, take some time for dreaming and reflection. And if you are finding any of the symptoms discussed above, take action now to make it a healthier and happier winter for you and your loved ones.
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A Personal Perspective on Living with Bipolar Disorder

by John Lotzer

I was born into a wonderful family. As far as I can recall, none of my family members have ever been diagnosed with a mental illness, so they had no reason to believe that I would be afflicted by bipolar disorder. It was called “manic depression” back then, which is a terrible term that implies one is crazy. People attributed the ups and down to “moodiness.”

So, I thought I was moody back then, which was considered a character defect; a flaw in my being for which I was personally responsible. No one back then was aware of how to treat it. It made me feel ashamed of myself. Looking back, I realize that my symptoms started in the late 1960s when I was just a teenager. I was not diagnosed properly until I was 46, more than 30 years later. This caused me a lot of shame, and a lot of severe emotional pain that stayed with me for most of my life. My life seemed hopeless.

How did the doctors determine that I had bipolar disorder? They looked at the symptoms I was having that may have caused the condition. During a manic episode the person’s mood is elevated and he or she may have feelings of invincibility, or spend money compulsively and irrationally. While in a depressive episode one may feel sad or empty, lose interest in activities that used to be enjoyable, feel fatigued, and have feelings of worthlessness and thoughts of suicide. Then the doctor can determine the best treatment procedures.

Today we realize that bipolar is a chronic, permanent, and life threatening illness if it is not treated properly, made possible by advancements in medications and behavioral therapies. Although bipolar disorder is a disruptive, long-term condition, one can keep his or her moods in check by strictly following a treatment plan that includes medications and psychological counseling. Often, one’s condition may seem to be hopeless, yet it responds well to treatment so that one can structure a life worth living.

I don’t have to approve of my condition, but I must accept it because there is no permanent cure. Fortunately, much of the negative stigma associated with bipolar is disappearing. This reduces any shame that is improperly implied. Today, I don’t need to be ashamed of myself. My affliction with bipolar disorder does not mean that my very being is flawed. I am not a bad person.

As for my personal experience, medical and psychological science has literally saved my life more than once. In one particular instance, I called professionals from the mental health care center; they drove to my apartment, administered some aid, and brought me into the crisis center. I didn’t want to call that number but I’m glad I did. In another instance, someone called 911 in the moment of my distress and I was taken to the hospital that way. The first incident occurred when I lived in Minnesota and the second one while I lived in Atlanta. In each case I was given excellent and friendly care from highly professional medical personnel. In each case I was examined for my physical and psychological well being. Based on the results of the doctors’ examinations, a treatment plan was structured especially for me. It was then up to me to follow the instructions if I were to get healthy again.

Several times I didn’t have health insurance or money to pay the medical bills. In each occasion I was able to count on public organizations to pay the bill. In particular, when I returned to Minnesota, jobless and in need of care, I was able to find services at 1919 University, which offers the Ramsey County services on a sliding scale based on income. There I was assigned to a psychiatrist and a therapist who helped me with medications and counseling that I so desperately needed. Since I didn’t have a job I was able to get the services for free. Today I have a job and I am contributing to Ramsey County as a taxpayer.

Here are some Mental Health Services provided in Ramsey County. If you have symptoms like those I wrote about earlier, please call and begin to get help.
* United Family Medicine: 651-241-1000.
* Open Cities Health Center: 651-290-9200.
* West Side Community Health Services: 651-222-1816.
* Ramsey County Adult Mental Health Services: 651-266-7900.
* Ramsey County Children’s Mental Health Services: 651-774-7000.

I could go through all the symptoms and the specific medications and behavioral health treatments that are available, but I think I would like to say that following a treatment plan given you by a treatment team is of the utmost importance and can help you the most. The team can be a support group for you as well as those family members and friends who are close to you. Be sure to take advantage of what is out there. Do not change or discontinue taking meds when you start to feel better. I cannot express this enough!

May God bless you and keep you well.

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Living a Full Catastrophe Life in the West End

by Paula Coyne, MA
Licensed Psychologist at United Family Medicine

This Healthline is about living your life in the present moment, whatever it is, however it is, without judgment. With compassion even. That’s the kicker for all of us.

What is a full catastrophe life?
It’s yours and it’s mine. It’s the unemployment, homelessness, it’s physical pain, the loss of a loved one, fear of the unknown, health problems, losing a home, meeting change, loneliness; it’s aging, depression, anxiety, panic attacks, not being able to sleep at night — it’s the full spectrum of what we as humans can experience. And, luckily, it is the “good stuff,” too — the falling in love, having a real friend, the joy of a birth, the soft sun shining on your face, seeing your beloved child sleeping peacefully, having a full refrigerator of food for yourself and your family, seeing — really seeing — the beautiful fall colors against this October blue sky, having a paycheck, doing something that you love.
What helps us enjoy the good stuff more and suffer less with the painful experiences? The practice called “Mindfulness.” Mindfulness means noticing and accepting whatever we are experiencing, moment to moment, without judgment, with compassion. Mindfulness is the opposite of going on automatic pilot, letting that little mind voice in our head (yes, we all have that!) run us around, running over the top of our own experience, missing the beautiful little moments of our lives as well as creating more stress-increasing resistance to the tough experiences. Mindfulness has helped humans cope with stress for thousands of years, and over the past 30 or so it has been brought into hospitals and clinics around the world, because it works. It is great for dealing with chronic pain, or any human suffering. It takes practice, but we discover that as we release resistance and judgment toward the experiences inside and even outside of ourselves, we suffer less. We discover that as we learn to shine the light of loving kindness and compassion toward ourselves, it is easier to shine it on others.

Got Stress?
The magic tool of stress reduction, the conscious breath, was right there under our noses all along. We breathe about 20,000 times in a day. Most of those breaths are unconscious, automatic, and often shallow. But as we learn to breathe with awareness, everything starts to change. We move out of automatic reactivity into an experience of more presence within ourselves. We become aware of muscle tension that can be chronic, that exacerbates pain and triggers the fight-or-flight reaction. Noticing that tension, we can choose to soften it, to open to the full, natural, deeper and slower breathing we do when we feel safe. Practicing this, our nervous system can begin to heal from the effects of stress. We feel better, we become more able to respond rather than react to stressors. We sleep better, digest food better, find ourselves more willing to laugh, more able to enjoy even the little pleasures of life, even when we still have problems and pain. With the help of our breathing awareness, we can learn to “ride the waves” of our experiences, even waves of pain, with less resistance, less suffering, with more equanimity and compassion toward ourselves and others.

Jon Kabat-Zinn first brought the Mindfulness Based Stress Reduction (MBSR) program to the University of Massachusetts Medical Center 32 years ago. The practice of mindfulness has been shown through much research over these years to be very effective in reducing perceived stress and suffering among many thousands of participants facing challenging medical and or psychiatric health issues. The eight week program is now offered at hospitals and clinics the world over. It has “been on the cutting edge of mind-body and integrative medicine for three decades.” The MBSR program introduces the mind-body awareness practices of sitting and walking meditation, breathing, the body scan, mindful eating, and yoga. Participants explore the principles of mindfulness in their daily lives through homework assignments, in eight weekly two-and-a-half hour sessions, and in a one day silent retreat.

The psychologists at United Family Medicine (UFM), Maureen Gluek and Paula Coyne, both incorporate these principles and practices into their own lives and in their therapy sessions with patients. They hope to secure funding so that the eight week MBSR program can become available to patients and staff alike at United Family Medicine. In the meantime, the University of Minnesota’s Center for Spirituality and Healing currently offers it, as does River Garden Yoga in St. Paul.

Paula offers a weekly Stress Reduction Group for patients at UFM, and began teaching yoga and meditation at 6 a.m. on Wednesday mornings at River Garden Yoga in October. Maureen will soon be offering a weekly women’s therapy group at UFM that includes mindfulness practices.

Information: (1) United Family Medicine, 1026 West Seventh, 651-241-1000. (2) MBSR at the University, csh.umn.edu or 612-624-9459. (3) MBSR and Yoga at River Garden Yoga, 455 West Seventh: 651 270 6643 or rivergardenyoga.com.

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A Way Back from the Abyss | 10.11

by Gina L.

I was a 44-year-old divorced mother of two grown daughters when just before Christmas in 2002 I found myself, (once again), in a Chisago County holding cell. The second time in less than two years. I was pulled over earlier in the evening and charged with my second DWI. Once more I had to call my oldest daughter and ask her to pick me up from jail. This time I was looking at jail-time. Merry Christmas to me!

I felt that I could explain away getting pulled over once for driving while under the influence of alcohol or drugs, but I could not come up with a reason why I chose to drink and drive again. I was done! I was heart-sick at the way I acted when I drank and bone-tired of making plans to drink “responsibly” and having those plans fly out the window after the first drink. I needed help. I was bankrupt — financially (had filed for bankruptcy in 2001), morally and spiritually. (I thought God had turned away from me because of the things I had done.) This was something I had no idea how to fix. I called my cousin who had been sober for 25 years at that time. He gave me my first glimpse of hope. I then called the Employee Assistance number and they connected me with The Haven, an outpatient treatment facility close to where I lived, which was very helpful since I had lost my driver’s license completely for three months.

While I learned a lot about myself and my disease while in outpatient treatment, I feel that my recovery really began when I stepped through the doors to attend my first AA meeting and was given my first copy of the “Big Book” of Alcoholics Anonymous. At the Haven we were given the opportunity to hear from many people from various AA clubs in the city. More often than not I found myself nodding my head at their anecdotes and more importantly being surprised at how similar their stories were to my own. They shared how they felt growing up and how they felt when they drank and I was constantly saying to myself, “that’s exactly how I felt.” One of these “angels” became my sponsor.

When I opened the Big Book of Alcoholics Anonymous it was as if I finally received the rulebook for living. Here in the first 164 pages was a blueprint on how to live life on life’s terms, not my terms (my terms having put me in jail twice in less than two years). It always seemed to me from very early on that everyone else knew what to do and when to do it and how to act except for me. When I attended my first AA meeting it was like I had finally found the place where I fit in. I realize that not all people feel this way right at the start like I did, but as the saying goes, “please don’t leave before the miracle happens.” In the eight plus years of my sobriety I have seen many miracles happen, not just my own.

I am living the life now that I always hoped for. I have a peace and serenity that nothing can shatter as long as I remain spiritually fit and I stay that way by following the 12 suggestions in AA’s Big Book. I live and work in the West 7th community and I have attended several wonderful AA meetings in our community. There is nothing quite like the conversations between one alcoholic or drug addict and another.

There is a way out of the abyss that is alcohol and drug addiction. It takes one step, one leap of faith. Once you have taken that leap, please know that that there are millions of us – alcoholics and drug addicts – waiting to reach out and catch you in the arms of AA. Please contact St. Paul Alcoholics Anonymous Intergroup Office at 651-227-5502 or aastpaul.org. Peace

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Dealing with Trauma: Ouch!

Although you may have never been chased by a lion, there is still a good chance that you have had trauma in your life. The good news is that the body knows how to give relief.

Trauma has been a part of our history for thousands of years. Whether it was physical trauma like falling and breaking a bone or emotional trauma like living through war, abuse or a natural disaster, our bodies are made to respond. If you think back to a time when you got injured or were frightened, you were feeling this response. There is an increase in our heart rate that you may feel as blood pumping fast; there is a quickening of your breathing, shorter and faster. Your eyes focused, your mind starts to think fast and specifically. These are all parts of the “readiness” response. Your body, when in trauma mode, gets ready to act.

There are also two protective mechanisms that make it easier for you to act. First, some chemicals get released that make you feel less pain, and second other chemicals get released that make you not remember as well. Amazing!

When I was a kid my friends and I had the great idea to rake all the neighbors’ leaves and then pile them next to my friend’s garage. We then began jumping into the leaves from the roof! I was a bit nervous when I was up top so I only half-heartedly jumped only to feel a quick pain and then kind of a numb feeling in my arm. As I sat on the back stairs, I felt something was not quite right. I had a sick feeling in my stomach and I could not lift my tiny headphones up with my arm. I calmly walked home to my parents to tell them I think I broke my arm. The rest was a bit of a blur when the pain got really bad and I started crying.

This story is a quick tour of acute physical trauma. My “readiness response” kicked in as well as the protective chemicals from pain and memory that helped me think through what to do and get help. Our bodies are so perfect that they can help us act in situations that can be life-threatening, both physically and emotionally.

The sad part of our body’s “readiness response” and protective chemicals is that they are only a temporary response. It gets us through the event or maybe through a series of events, but it is not obvious what happens with trauma over time.

What we do know is that our bodies store trauma and memory. Although it can be obvious — like distinct memory of a violent act — most often it is not as obvious. It can be a feeling of numbness or avoidance of certain sounds or situations, or it can simply be experiencing anxiety, stress, and agitation. You can think of these two things as a continuation of the “readiness response” and the protective chemicals. It is as if the readiness mode is chronic — in the form of agitation or anxiousness — as well as the “I need protection” mode — in the form of numbness, lack of feeling, or avoidance.

Time for another story. There is a test we can do on people’s shoulders to tell whether or not they had a bad shoulder injury. We simply have them lie back on the exam table with their arm off the table as we hold the arm and slowly move it back over the head. Patients who dislocated their shoulder will almost jump off the table, not in pain, but to make sure that you stop bending their arms. It is not something they think about, they just quick act to protect their shoulder. Patients who have not had their shoulder dislocated will just sit there and let you move their shoulder without a concern in the world. What is reassuring is that we can help the patients who had a previous injury. If we support and hold their shoulder as we bend their arm, they will sit there as if they never had the injury. The body knows when it is being supported and will not tell the person to move into protect mode.

There is similar support we can give to the physical and emotional body after trauma. Several types of medicine have found ways to help the body release from a chronic readiness mode and chronic protective state so it can return to its normal ‘happy as a clam’ state.

From the area of psychology, or counseling, there are forms of therapy that have been found helpful. From the arena of bodywork, there are exciting therapies like osteopathy and cranial sacral therapy. Many people have found these types of soft and gentle bodywork to be really helpful in releasing old trauma from the body. One particular book, “Waking the Tiger” by Peter Levine, does a good job of explaining in more detail how our bodies react to trauma with the readiness mode and protective chemicals. Finally, prayer and meditation are practices that can help relieve the effects of trauma. Get involved in your local spiritual community and ask for help in practicing prayer and meditation.

The message here is one of hope. Not only do our bodies know how to react to trauma as it is happening, but they were built to release the trauma when it is over — and although sometimes we need help in learning how to do this, there are many options available. If you feel like you or someone you know has trauma that seems stuck, even if it has been stuck for a while, do not give up. Search out your options. Ask your health provider if they are comfortable dealing with trauma or if they can recommend someone for you. Good luck, you will do great!

P.J. Lally is a fourth year medical student at the University of Minnesota currently serving the West Seventh community at United Family Medicine.

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What is a Midlevel Provider?

by Cora Peine, PA-C

Physician Assistants (PAs) and Nurse Practitioners (NPs), also known as midlevel providers, have been part of the U.S. landscape of medical care for the past few decades. Both professions are important. We are in an era of unprecedented cost and inefficiency when it comes to medicine; PAs and NPs offer excellent care to patients while reducing the economic burden. You are likely to see PAs and NPs at your local clinic and hospital. It is important to understand their history, training, and credentials.

In the mid 1960s, the country was suffering from a shortage of general practitioners (GPs), specifically in rural areas. Additionally, there were many military medical corpsmen who were extensively trained and experienced, but had limited prospects for employment once they returned from the war in Vietnam. It was through these circumstances that the Physician Assistant and Nurse Practitioner professions were born. A few PA programs started in the Eastern U.S., an NP program opened in Colorado, and gradually the programs (and thus, the professions) spread across the United States. In the mid 1990s, Minnesota opened its own PA program at Augsburg College. NP programs have opened at several universities throughout Minnesota.

Across the United States today, there are more than 140 Physician Assistant programs and approximately 88,000 PAs, with more than 1,000 in Minnesota. Most PAs today graduate with a master’s degree, but may also have bachelor’s degrees or certificates of Physician Assistant Studies. The military has a PA program that offers a doctorate degree. Each PA graduates from a nationally accredited program, and there is only one accrediting agency. Therefore, regardless of the degree, the training that PAs receive is very uniform. The training is rigorous, two to three years long, and encompasses both classroom and clinical (hands-on) training. They receive education in dermatology, cardiology, pulmonology, otolaryngology (study of the ears, nose, and throat), gastroenterology, hematology, neurology, psychiatry, pediatrics, geriatrics and pharmacology.

Every Physician Assistant who practices in Minnesota must pass the Physician Assistant National Certifying Exam, a computer-based, multiple-choice test comprising questions that assess basic medical and surgical knowledge, and must take a recertifying test every six years. In addition, PAs in Minnesota must complete 50 hours of continuing education yearly. They are licensed and regulated by the Board of Medical Practice. You can find specific information about your personal PA online at docboard.org/mn/df/mndf.htm. This includes the date they were first licensed and when their license expires, where they practice, and any disciplinary action taken against them.

NPs are registered nurses who go on to further graduate education and earn a master’s or a doctorate degree. Throughout the United States, there are more than 155,000 nurse practitioners, 2,500 of whom practice in Minnesota. While Physician Assistants are always taught a family practice curriculum, Nurse Practitioners specialize in a variety of areas, including acute care, adult health, family health, gerontology health, neonatal health, oncology, pediatric/child health, psychiatric/mental health, and women’s health. They take a licensing exam based on their specialty and are required to complete annual continuing education requirements.

Nurse Practitioners are licensed by the Board of Nursing. You can find specific resources about your personal NP at the Minnesota Board of Nursing website, nursingboard.state.mn.us.

Nurse Practitioners and Physician Assistants both work in a variety of family practice, specialty and subspecialty practices. Their scope of practice is similar, and they often work together. They do many procedures, including mole removal, sutures and casting. They also write prescriptions, read x-rays and can institute 72-hour mental health holds.

For both NPs and PAs, coordination of care is very important. They believe that a care plan includes the patient, their family, their social circumstances, nursing staff, and appropriate consultants. This is why so much time is spent in the interview. They review your living circumstances, alcohol, drug and tobacco use history, occupation, family history, etc. It isn’t because they are nosy, but because these things have a huge effect on your medical condition and prognosis. It helps them to develop a care plan that works for the patient.

One very important difference between the professions is that Physician Assistants are not autonomous. They do not work alone. Everything that PAs do is guided by their supervising physician who delegates responsibilities to the PA. The PA can do whatever the supervising physician does, trusts his or her PA to do, and that the PA feels comfortable doing. This supervisory agreement means that there has to be an excellent relationship between the PA and the physician. It is why, although all PAs are trained in family practice, they can work in any specialty, hospital or clinic. Through their working relationship, the PA is trained by and is trusted by their supervising physician. While most Nurse Practitioners do have a relationship with a collaborating physician, it is not legally mandated.

There is a new healthcare buzzword: “Medical Home.” It means that, in order to get the best, most efficient and cost effective care, patients need to have a primary care clinic with a team of people who know them. If your medical provider knows you and your medical, social and family history, they can help you make decisions about your care. The goal is to make decisions that are in line with your values and needs. Someone who knows you well can help you make those decisions better. Unfortunately, as in the 1960s, there are not enough primary care physicians to fulfill the role of the medical home provider. More physicians are being trained in specialties, where they are undoubtedly also needed. Therefore, there continues to be a much needed place for Nurse Practitioners and Physician Assistants.

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Physician, Buck Thyself Up | 7.11
by Tim Rumsey, MD

Enough about you patients. Let’s talk about me.

It’s been a rough six months. I woke up one morning last January and couldn’t see out of my right eye. Nothing. Even a warm shower didn’t help. You don’t have to be a doctor to know that’s bad. I had a spot on my lung and advised myself to “just watch it and repeat the chest x-ray in three months.” My bad teeth got worse. Then a hernia as big as a VW Beetle popped out.

I saw nice specialists, nice x-ray people, nice lab people. Nice anesthesia people (nice gowns you have to wear to the operating room). The front desk people were the nicest of all. Every one of them knew I was scared.

Bless you, patients. You know all about waiting and worrying and worrying and waiting.

Gerry Lauer, deceased, 89 year-old friend, patient, West Seventh clan leader, would receive me into his home on friendly visits with: “Doc, have a seat out here on the porch. Grab an old magazine. I’ll be right back in 45 minutes.” He always told me that “I’ll be right back” was the universal doctor’s lie. Gerry said he needed to bring “War and Peace” when he came to see me. And he’d nearly finish it in the waiting room.

My eye was fixed. Cataract. But I waited too long. My eye doctor told me I was a good doctor but a bad patient. My surgeon said I waited too long and that I would make a bad patient. Then I cancelled my hernia surgery …twice. Too busy. It’s still not done. (That VW needs to be towed away.) I haven’t even called the dentist yet.

I’ve had bowel changes, urine changes, midnight cravings (fulfilled) for chocolate covered glazed donuts with pink and white sprinkles. I’ve been humbled, I’ve been impatient, I’ve been put on hold and had appointments cancelled. I’ve gotten big bills. I’ve been afraid. But mostly I’ve grown to appreciate what you (we) patients go through.

A dictionary says that the noun “patient” means one who endures or suffers. A sick person, an invalid. One who is resigned, long suffering. Capable of accepting delay. A victim. A person who must undergo some action. All of the above.

Hey, everything I have is curable. I see people everyday that are really suffering and worrying. Brain tumors, end of the road cancers, pain that takes you down. Loneliness, depression, strokes, bad hearts, bad marriages, bad lives. Losing a child.

What I have is nothing. It’s time for me to buck up.

I’m going to be a better doctor. Really. I’ve been a patient.

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How Can We Work Together for a Healthier Neighorhood?
By Kate Vickery, MD

If you live in West Seventh your life expectancy is on average seven years less than people who live in Eagan and other suburban areas. According to the Wilder and Blue Cross Blue Shield Foundation study “The unequal distribution of health in the Twin Cities,” health disparities present in other areas of the U.S. are also present here (wilder.org/download.0.html?report=2337).

Our neighborhood is home to a training program for family doctors — the United Family Medicine Residency. My residency classmates and I started the Healthy West 7th project, a partnership of United Family Medicine Residency, United Family Medicine, and many different neighborhood individuals and organizations. Our big goal is to make West Seventh a healthier place to live and work (and perhaps decrease that seven year gap). Our more immediate goal is to find ways to better involve the neighborhood in the health improvement projects the residents complete each year.

After completing the first part of our project, which involved talking to many people in the neighborhood (in surveys, small groups, and one-on-one), community members met early in May to hear our findings and discuss where we go from here. Eight main themes listed in order of priority by the votes of people at the recent meeting:
  • Basic Needs: The question of critical basic needs was present in all discussions. A steady job, affordable housing, and access to good quality medical care are at the foundation of good health. People we spoke to supported programs to promote job training, advocacy for affordable housing, and real health care reform.
  • Resource Coordination: People looking for services are often unaware that what they want is already available in the neighborhood. Suggestions included postings on bulletin boards, a resource guide, and a West Seventh Facebook page.
  • Nutrition: Many people know they need to eat healthier and lose weight, but they don’t know how to do it. Ideas included low cost cooking classes, more community vegetable gardens and local branches of the farmer’s market.
  • Community Building: Social networks are an important part of our physical and spiritual health. Staying connected to our families, friends, and neighbors was an important theme. Our neighborhood can help people avoid loneliness/isolation with discussion groups, senior-youth partnerships, neighborhood gatherings — perhaps with a unique West Seventh celebration to celebrate our cultural diversity, history, and more.
  • Activities for Youth: Children are the future and need to be busy and involved in healthy activities. Important needs include low cost childcare, more fitness opportunities in and outside of school, classes about healthy eating and a theater group. We heard about services our neighborhood already has in place for senior citizens too.
  • Fitness: People told us how they motivated themselves for fitness activities, often with the help of their close family or friends. West Seventh could promote fitness as a neighborhood including: walking clubs, low cost aerobics, yoga or other classes, sports teams, more biking/walking paths, building a neighborhood pool, and more.
  • Health Education: People are looking for more reliable information about health and wellness. Everything from questions about how to eat healthy, how vitamins are important, how to raise healthy kids, and how to make sense of all your medicines. People wanted to learn more about meditation, yoga, diabetes and heart disease.
  • Volunteerism: Many spoke of how important it is to share the talents we have. It makes us all feel good and it offers our best to others in need. We have great potential to help each other out in West Seventh. Suggestions included creating a barter system or volunteer time bank, communities (homeless, those in recovery from drug/alcohol addiction) offering to teach medical residents and others about their situations, and desire to interact more with Allina employees at United Hospital.
Our project generated a lot of enthusiasm for health improvement in our neighborhood. From here we plan to form a neighborhood council to oversee resident projects and connect them with all the great efforts already underway in West Seventh. We also found an energetic group who are interested in community health improvement on a larger scale and in exploring what we all might do together to help each other be healthier. One idea we discussed was using “The Blue Zones,” a book by Dan Buettner (bluezones.com) about communities in the world who live long, happy lives. This book inspired the town of Albert Lea to launch a campaign to make their town healthier. Maybe we could do the same in West Seventh.

If you want to be a part of a council to oversee resident projects or to be a part of a larger conversation about improving the health of West Seventh, please contact Kate Vickery at 651-241-1010 or kvickery@unitedfamilymedicine.org.

We have had a great amount of support and cooperation from many in the neighborhood and beyond. Special thanks to the Minnesota Academy of Family Physicians Foundation, Allina, United Family Medicine Residency and Clinic, the West 7th Community Center, Cooper’s Foods, Mississippi Market, SOKOL Czech and Slovak Society, the Little Bohemia Neighborhood Association and the St. Paul Jewish Community Center.

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Rolfing® Structural Integration, A Primer (Part 2)

by Kelly Jones Hicks

Who Benefits from going through the Rolfing® process?
Rolfing SI is an individual endeavor, meaning there is no typical entrance into or experience of the Rolfing process. And the people who come to a Rolfing® session are as varied as their complaints. They include individuals with chronic health conditions like Temporomandibular joint disorder (TMJ), arthritis, congenital distresses, poor habits of posture and movement, as well as victims of accidents, emotional trauma and aging.

Parents bring their children to experience Rolfing when the children have physical constrictions, as well as emotional inhibitions. Mothers bring their newborns (even a one-day old), who have experienced stressful and sometimes desperately debilitating birth traumas and injuries.

Countless professional athletes and Olympians use Rolfing SI not only to enhance their performance, but also to assist them in maintaining healthy and resilient bodies. Numerous performers in the arts (opera, music, and dance) use the Rolfing process to enhance their performance and longevity as excellent performing artists.

Well-known pitcher for the Kansas City Royals, Bret Saberhagen, went through the Rolfing process. He suffered from the obvious arm and shoulder problems of a pitcher: muscle strain and tendinitis, which disabled him early in the season. In fact, he was so transformed that he went on to become a two-time Cy Young Award winner for best pitcher in the American League over the next years.

“You come into Rolfing because you have wear and tear on one part of your body or another, and after a while you have to readjust. It might not be where you are hurting. It could be somewhere else that’s affecting you. The spot where you feel pain isn’t necessarily where the pain is coming from. Rolfing isn’t a like a massage, where you sit down and it relaxes you, it’s going to feel good for the day. With a Rolfing session, you’re going to feel more intense work on your muscles. You might be sore for the rest of that day, but it’s going to help you out for a longer period of time.”

This is exactly right. Rolfing produces progressive change on the cellular level, such that the change is powerful, long lasting and sustainable over years. This differentiates Rolfing SI from most other methods of working with the physical body.

Dori G. was in her fifties when she broke her back in a car accident. The Harrington rods were surgically implanted at the Mayo Clinic caused her excruciating pain. Once she had the rods removed, her freedom of movement returned slightly but some pain remained. Through Rolfing® SI, she could stretch and move without any pain. “I went into Rolfing wanting something more than a Band-Aid approach. I was hoping for a miracle, and I got it.”

Accidents are unforeseeable traumas that demand immediate attention, and Rolfing Structural Integration can help. It can also help before an accident, before a lifetime of chronic repetition, injury and emotional trauma becomes established.

Briah has found that doing a Rolfing session on newborns and children is a wonderful gift for them, which helps induce better neuromuscular functioning, as well as confident and strong bodies. “Rolfing infants and children helps their healthy development and maturation by stimulating the integration of all body systems…” she said.

Adrian was just three weeks old when his parents brought him to Briah for a Rolfing session. He was born in a posterior position, face down, which caused stress on his head and neck. His first three weeks of life were stressful — difficult eating patterns and constant crying. After just two Rolfing sessions, his eating habits became regular and his tears were only used to signal hunger, fatigue and diaper changes.

Joey loves participating in sports. He runs track and feels some of his fast running is attributed to Rolfing SI. At age seven, his parents came to Briah with a diagnosis of ADD/ADHD. He had trouble focusing, was easily agitated and impatient, and he had low self-esteem. After the Rolfing process, Joey was less impatient, more tolerant and more cooperative. “He still remains a driven little boy — but there has been a shift in his personality.”

Briah is considered a pioneer in applying the principals of Rolfing Structural Integration on many types of animals such as dogs, cats, horses, birds of various kinds including eagles and owls; also a mountain lion, a moose, and many more domestic animals. As with her human clients, she seeks to assist them to reach their true potential. She also guides them through issues with pet rescue and trauma, as well as relief and rehabilitation from injury. In fact, she’s written the book on these subjects.

Due this spring, “Animal Healing: The Power of Rolfing® Structural Integration” will give you more reasons to include this therapeutic modality in your family’s health maintenance tool kit.

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Rolfing® Structural Integration, A Primer (Part 1)
  [IMAGE]| 4.11
Kelly Jones Hicks

“Some individuals may experience their losing fight with gravity as a sharp pain in their back, others as the unflattering contour of their body, others as a constant fatigue, yet others as an unrelenting threatening environment. Those over 40 may call it old age. And yet all these signals may be pointing to a single problem, so prominent in their own structure, and in the structure of others, that it has been ignored; they are off balance. They are at war with gravity.”  Ida P. Rolf

Photo: Briah Anson Rolfing a baby as mother looks on.

Healthy West 7th! Community Conversation
May 7, 1-3pm. West 7th Community Center.
After months of interviews, focus groups and research, the Healthy West 7th! Project presents their results and have a discussion about health in our neighborhood.


It’s amazing what a pair of hands can accomplish to relieve stress and pain in the body, especially if those hands belong to Briah Anson, MA, Certified Advanced Rolfer™. Briah’s goal is to become one of the world’s best Rolfers™. She is a devoted Buddhist practitioner, who meets each client with the intention of alleviating a vast array of physical, mental, and emotional issues, which they bring to her table every day.

Fortunately for those in the West Seventh neighborhood, Briah’s Rolfing® Structural Integration (SI) practice is located in the brick-red Banfil Office Court (557 West 7th, 651-228-9569). Briah has a remarkably exotic personal background and a nationally known, well-respected professional reputation in Rolfing® Structural Integration.

Her focus has always been an active exploration and best expression of the mind and body. During her 31 years of Rolfing® SI, Briah has given over 30,000 sessions of this transformative body work to people of all ages, from infants to seniors. Briah said, “Rolfing® Structural Integration effectively reorganizes the neuromuscular system. The results with children are dramatic.”

Her book, “Rolfing: Stories of Personal Empowerment” presents 85 profiles of individuals from infants to seniors (age 91), families, and even animals, who have experienced relief with Rolfing® SI.

What is Rolfing® Structural Integration (SI)? The Rolfing® technique was developed by Briah’s mentor, biochemist and physiologist, Ida P. Rolf, Ph.D. In a quest to alleviate her own health issues, Dr. Rolf sought help from the early founders in the fields of chiropractic, osteopathy, cranial osteopathy, homeopathy and other progressive modalities. She had severe curvature of the spine and was prediabetic, and the traditional medical field predicted she would end up in a wheelchair by age thirty. Her quest to find a solution to her own medical problems encouraged her on a deeper level to help others as well.

Dr. Rolf’s premise began with asking, “What kind of organism will develop if the body parts are appropriately related? What happens when soft tissues and related bone structures actually function in the positions in space which their architectural design suggests most appropriate and which contributes most effectively to establishing the vertical?”
“The vertical in man’s structure is the outcome of his proprioceptive sensory awareness of movement (derived from muscular, tendon, and articular sources), and his appreciation of the gravity pull of earth. Whether consciously or unconsciously he feels this pull and responds to it. This is a subtle concept: the intellectual formulation arises out of the sensory awareness.”

“How would these more vertical individuals compare with the random, less conscious humans who tread the surface of the earth today?” She continues, “Is it perhaps too far-fetched to wonder whether one of the tap roots of human aggression and its underlying fear may be the continuous sense of insecurity which random humans unconsciously feel with reference to their environment — the gravity field?”

Dr. Rolf’s intense curiosity and deliberate research endeavors revealed to her a key understanding of Rolfing®: “I complain that people do not seem to understand my basic goals, the fundamental purpose for which Rolfing® has been developed.”

She went on, “…I as an individual am not primarily interested in the relief of symptoms, either physical or mental. To hear Rolfees tell of their unbelievable wonderful symptom alleviation, it is hard not to accept this assessment as a goal. However, I am interested in human potential; and human potential neither includes nor excludes the palliation of symptoms.”

Editor’s note: Conclusion of this article and further information in our May issue.

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Advanced Care Planning | 3.11 [IMAGE]
Andrea Westby, MD, and Luke Beckman MD, UFM Residents

We have now made it to March, and if any of you are like us, you are looking eagerly toward the first signs of spring, and have likely long forgotten your New Year’s resolutions. When the New Year begins, our culture dictates that we should also begin a “new year,” with the encouragement of New Year’s resolutions such as losing weight, drinking less alcohol, quitting smoking, and exercising more frequently. While these are admirable and important life changes that would improve our health and wellbeing, we would argue that these life changes need to be implemented in a more sustainable fashion, rather than a trendy start-time that may or may not wane by midyear.

Our challenge to you is to consider making a midyear resolution that is achievable and sustainable, and we would like to make a suggestion. For those of you who have been so far blessed with at least 65 years of life, we advocate that you consider creating a Health Care Directive. And for those of you who have not yet reached that era of your lives, consider having a conversation with those you know who are at least 65 years old about Advance Care Planning, and to begin thinking about what types of care you would want for yourself.

Andrea: I am sure that almost every healthcare provider has a patient story that comes to mind when discussing end-of-life decision-making, but I want to share a story about why I feel that Advance Care Planning and healthcare directives are so important. This story is about my own family. When I was in college, before I was even really in the medical field, I came home to spend Christmas break with my family. The evening before I arrived home, my mother had taken my grandmother to visit my grandfather in the nursing home where he was rehabilitating after a stroke. My grandmother had just recently moved into a senior living facility for a temporary stay after completing her initial chemotherapy treatment for a recurrence of non-Hodgkin’s lymphoma. This was one of those places that had a plaque on the door that the resident needed to flip over in the morning to let the staff know that they were awake and out of bed. That morning, my grandmother did not turn over her card, so the staff entered the room and found her still sitting in the chair from the night before.

She was rushed to the hospital about 45 miles away for intensive care. My mother and I met her ambulance in the emergency department, and the doctors there told us that she was probably septic from pneumonia, a lung infection that was likely worse because of her recent chemotherapy. She was very weak, and it was suggested that she have additional help to breathe, including endotracheal tube placement and ventilator. The physicians reported that it was possible that she would not need the breathing tube for a very long time if her body was able to fight the infection, but also that she may not be able to be weaned off the ventilator. My grandmother had discussed her wishes with my mother and grandfather in the past, and she had indicated that she did not want to be intubated or have CPR performed on her if they were needed to sustain her life. While my mother knew this, she struggled with the decision, but did give permission for them to try intubation for the time being. My grandfather, father, sisters, and uncle came to the hospital, and we ultimately decided that grandmother had made her wishes clear: that she would not want to live on a ventilator for any period of time at this point in her life. They took out the breathing tube, and we sat with her for the hours before she died, telling stories and letting her know how much we loved her. I am confident that this allowed my grandmother to die the death that she would have wanted.

Luke: With advances in medicine and technology we are now able to keep people alive longer, but not necessarily preserving quality of life. For some, living as long as possible is most important, and for others, providing comfort in the dying process is most important. Preferences about end of life care are very personal, but can be very difficult to discuss in many circumstances. Unfortunately, the person needing life-sustaining treatment is generally not able to express his/her desires while acutely sick, whether they are unconscious after a heart attack, confused after a stroke, or in a coma after a car accident. Discussing your preferences for end-of-life care with your loved ones and doctor(s) while you are still feeling well and can make decisions yourself will help everyone involved in decision-making in those terrible circumstances. Having those discussions increases the likelihood that you will receive the care that you want, and helps the family and loved ones with the difficult decision about when to let go. Going through a process of Advanced Care Planning can guide you and your loved ones through this sometimes difficult, but important discussion.

What is Advanced Care Planning?
Advanced Care Planning is a process of informing others of your values, preferences, and wishes related to your healthcare in case illness or injury prevents you from telling them yourself. The plan involves completing a document containing the following information:

  • Naming a Health Care Agent: This allows you to name another person to make healthcare decisions for you if you are not able to do so for yourself.
  • Health Care Directive: This gives more specific information to the healthcare agent and healthcare providers about what treatments you may want, including but not limited to cardiopulmonary resuscitation (CPR), ventilator support (breathing machine), tube feedings, IV fluids, and antibiotics.
  • Values History: This allows you to give more information about what makes life worth living, when life would no longer be worth living for you, how and where you would like to die, and spiritual or religious beliefs and traditions. This document should be signed by you and either a notary public or two witnesses, discussed with your healthcare agent, and given to your doctor. It is important to have the document available for healthcare providers at your institution in case of an emergency.
What if I change my mind about what I want? You can cancel your previous health care directive by:
  • Creating a revised version, and having it signed as above
  • Writing a statement saying that you want your directive cancelled, and sign as above
  • Telling two other people that you want your healthcare directive cancelled.
How do I go through Advanced Care Planning? There are several different ways to complete this process:
  • Contact your doctor’s office. They should have someone who can help guide you through the process, and give you some information and forms
  • Call the Office of the Ombudsman for Older Minnesotans at 1-800-657-3591, or 3. Go to caringinfo.org, to download and print state-specific forms and read more information. The Minnesota Health Care Directive is a highly respected resource in this area, developed at the University of Minnesota.
Thank you for allowing us to share our story with you, and we hope our story and this information provides you with the tools and information for you to begin having this conversation with your physician or your loved ones, or both. We believe that this is a lasting resolution that will provide you and your family peace of mind for years to come.

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La Clinica los Maynards
| 2.11[IMAGE]

by Jerry Montie, MD, Lead Physician of the Sibley Manor Clinic 
Connie Walsh, Lead Patient Advocate, United Family Medicine

In the spring of 1995, West Seventh Community Center social worker Gail Martinson heard so many stories from Latino mothers at Sibley Manor about having to go to hospital emergency rooms for routine care, that she asked our UFM clinic for help. Connie Walsh floated the idea of an on-site medical clinic at Sibley Manor itself, and it happened.

For 15 years United Family Medicine has operated a small clinic within the Sibley Manor apartment complex. The clinic is staffed by UFMJ physicians and staff Wednesdays from 1:30 to 5:30 p.m. This clinic provides access to health care for Sibley Manor residents who are new Americans unaccustomed to receiving care in our health care system, and for those with transportation difficulties (cost, small children, language barriers).

Every week we have worked, along with a family medicine resident or medical student, to provide well-child care and immunizations, prenatal care, diabetes care, physical exams, and other urgent care needs. The services are provided in a cozy two bedroom apartment at the intersection of West Seventh and West Maynard Streets. Patients are greeted by friendly staff, in English or Spanish. For other languages we provide prearranged interpreter services. Regular patients report enjoying an intimacy not experienced in larger clinic systems. The level of warmth and trust experienced by patients has been the key to our success.

Assistance getting health care coverage or arranging to be on our clinic’s sliding fee scale is also offered. Sibley Manor opened in the 1950s. The 22-acre site has 550 apartments in 55 three-story buildings. Immigrants began arriving at Sibley Manor in the 1960s when Cubans fled communism and made their way to St. Paul. They were followed by Asians in the 1970s and 1980s, then Russians, Mexicans, and Africans.

Over the years we have appreciated help from volunteer student interpreters from Bethel University, Augsburg College and the University of Minnesota. Nurses from United Hospital also have given their time and expertise. Start-up funding in the early years came from the Allina Foundation and United Hospital, but now Sibley Manor is one of UFM’s formal service sites. Owner-manager Bob Julen of Sibley Manor has been an integral, supportive partner from the beginning.

At the Sibley Clinic, or “La Clinica los Maynards” as the original moms called it, we have diagnosed and treated childhood seizures, tuberculosis, diabetes, autism, and high-risk pregnancies. Onsite prenatal classes were also an early service. While our current lab is quite basic, we have learned that much care can be provided with good diagnostic skills and strong problem solving abilities, not necessarily requiring a lot of expensive testing. When more testing is needed we send patients to our main clinic (1026 West Seventh) or to United Hospital.

Beautiful stories abound. We saw one early family through three pregnancies. They have since purchased a house in the West Seventh community. Dad is fully employed and mom is in school. Connie and I have attended their children’s baptism and confirmation celebrations.

It has been our privilege to be part of a true community health collaborative at “La Clinica los Maynards.” This collaborative promotes healthy lifestyles and preventive care to groups that have traditionally lacked access to adequate care. It is a powerful partnership with the West 7th Community Center, an extraordinary learning experience for the family medicine residents of Allina, United Hospital, and our wonderful volunteers — but most importantly with Sibley Manor residents and owners.

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How to Find a Pest Control Company You Can Trust
| 1.11  [IMAGE]

Bedbugs are migrating to public places like movie theaters and retail stores and then hitching rides home on unsuspecting consumers. Not only are bedbugs a growing problem, they are also a hard problem to get rid of. The BBB of Minnesota and North Dakota recommends doing your research to find a pest control company you can trust to get the job done efficiently. When hiring a pest control company, the BBB recommends that home and business owners consider the following: (a) Start with the BBB’s reports on exterminators; (b) Make sure the company has sufficient training and certifications. Ideally, the company will also be a member of a national or local trade association; (c) Be sure the company has liability insurance; (d) Make sure that you completely understand the extent of the infestation as well as the possible remedies and side effects of any chemicals used; (e) Read the fine print carefully. Pay close attention to any warrantees or termination fees if you’re entering into an extended contract for monitoring or future services. For more advice on hiring home maintenance professionals, visit bbb.org/us/consumer-tips-home.



Practical Steps to Preventing Flu
[IMAGE]| 12.10

Dr. Vinay Goyal's simple advice on prevention of flu remains important:

While you are still healthy and not showing any flu symptoms, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps not fully highlighted in most official communications can be practiced:
  • Frequent hand-washing.
  • “Hands-off-the-face” approach except to eat, bathe, etc.
  • Gargle twice a day with warm salt water. Use Listerine if you don’t trust salt. Simple gargling prevents proliferation. Don’t underestimate this simple, inexpensive and powerful preventative method.
  • Similar to gargling, clean your nostrils at least once every day with warm salt water. Not everybody may be good at using a Neti pot, but blowing the nose thoroughly once a day and swabbing both nostrils with cotton swabs dipped in warm salt water is very effective in bringing down viral population.
  • Boost your natural immunity with foods rich in Vitamin C, or Vitamin C tablets that contain zinc to boost absorption.
  • Drink as much warm liquid as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive.
Dr. Vinay Goyal is an intensivist (a specialist in managing Critical Care Units) and thyroid specialist with more than 20 years of clinical experience. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital and Tata Memorial. Presently, he heads the Nuclear Medicine Department and Thyroid Clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).



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