Download Food for Life: Reconnecting with the Three Sisters

Dinehtah
Diabetes Quarterly
Spring 2016
News on Diabetes Prevention and Wellness Across the Navajo Area
Food for Life: Reconnecting
with the Three Sisters
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Community Role Models:
An Educator
Gets Educated
By Margilene Barney, Navajo Nation Special
Diabetes Project nutritionist
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Planted by children, the Navajo Nation Special Diabetes Program community garden behind the Kayenta
Senior Center, being tended by staff member Nathaniel Brown. (Three Sisters graphic courtesy of Elayne
Sears for www.MotherEarthNews.com.)
he Three Sisters style of planting utilizes the
three main agricultural crops Native Americans
are known for growing: winter squash, maize (corn),
and climbing beans, containing complex carbohydrates, essential fatty acids and all eight essential
amino acids, allowing most Native American tribes
to thrive on a plant-based diet. Traditional plantbased foods are full of nutrition and many have healing properties. Animal-based foods were used when
available through hunting. Diabetes, obesity, and
health problems commonly seen even in young people and children today, were rare in centuries past,
and healthy foods can make them rare once again.
In April 2009 the Navajo Nation Special Diabetes
Project (NNSDP) and the Washington, D.C.-based
Physicians Committee for Responsible Medicine
(PCRM) started a collaboration when Dr. Neal
Barnard, PCRM President, met with NNSDP nutritionists in Window Rock and introduced the concepts and benefits of a plant-based diet. As it
turns out, the Three Sisters plant-based traditional
foods are a great OLD approach to health.
In September 2010 the reintroduction of plantbased food choices for Navajo began with the
Food for Life Classes for NNSDP staff, presented
by Dr. Barnard. Barnard is author of the book Dr.
Neal Barnard's Program for Reversing Diabetes. The
Food for Life Program came from research conducted by Dr. Barnard, and has been cited by the
American Diabetes Association’s annual Clinical
Practice Guidelines for the past six years.
Caroline Trapp, DNP, CDE,
ANP-BC, FAANP, Director of
Diabetes Education and Care
at PCRM, presented the plantbased diet, with a food demonstration by Chef Walter
Whitewater, who has trained
under several renowned chefs.
He’s now at Red Mesa Catering
in Santa Fe, and cooks with
Dr. Caroline Trapp
traditional Native Americans
foods. He shared that he started cooking when he
wanted to provide more healthy food for his
grandmother.
In the Food for Life classes the NNSDP staff
learned that food has the power to heal our bodies. However, some foods have the power to hurt.
Many traditional foods have healing properties;
these were the foods focused on, with a modern
approach to eating the foods that people ate and
enjoyed many years ago – foods that protected
people from diabetes and other diseases now
common, like heart disease and cancer.
Dr. Trapp stated, “Food is our focus because in
fact, this new approach has been shown to help
many people, those with diabetes or at risk for diabetes, to get healthy, lose weight, and feel great.”
In October 2010 the NNSDP, in partnership with
PCRM, hosted an eight-week course on a plantbased, meatless diet, Food for Life – Cooking to
Live in the Beauty Way, an exciting new approach to
preventing and treating diabetes.
The weekly, two-hour Food for Life classes offered
lectures, videos, discussions, and demonstrations
of plant-based cooking. Instructors were Edbert
Little and Chef Whitewater. Barnard and Trapp
kicked off the classes in October and returned for
the final session in December. The Chef’s Cooking
Class was filled with nutritional instruction. Attendees participated in cooking demonstrations and
enjoyed tasting the foods prepared.
The topics during the course included: A
Reason for Hope for People With Diabetes by Dr.
Barnard; New Recipes Using the Three Sisters;
Healthy Recipes With Commodities; Grocery Store
Tour and Healthy-in-a-Hurry Recipes; Grains – the
Staff of Life; Health From Head to Toe; Stocking Up:
Canning/Freezing/Drying/Sprouting; Holidays and
Feast Days; Living in Beauty: Staying Healthy/
Feeding Your Family/Sharing Knowledge.
Three Sisters, continued on page 2.
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Chef Walter Whitewater of Santa Fe serves traditional dishes using corn, squash and beans to
NNSDP staff during a "Food for Life" class.
Role Model, continued on page 2.
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n 2008 I was introduced to the Physicians
Committee’s Food for Life curriculum. I
attended the eight-week class and I heard
about eating a plant-based or vegan diet –
avoiding foods that come from animals. In the
beginning, I really didn't understand what the
class was about. At
that time I was not at
all serious about changing my diet. For example, every chance my
colleagues and I got
together to eat, they
would ask, "Where
shall we eat?" I would
always suggest the flea
market for mutton stew
Margilene Barney,
with fry bread. I was
October 2015
thinking about all the
vegetables in the stew, and not that they were
swimming in grease from the mutton. “That would
be vegan,” I thought! I did try vegan for a little
while, or so I thought. But I was still eating a
lot of low fat cheese, cow's milk, ice cream and
egg whites.
Surprise, I was way off! Whatever kind of
diet I thought I was on, I could not resist the
fried foods and fatty mutton meat that I grew
up with. I also ate plenty of the inexpensive
processed, fast foods that were available. I
honestly thought a diet is not a diet without
meat, cheese or milk products.
I'm a nutritionist and I know about the "Choose
My Plate" diet, and I just couldn't see a diet
without meat. During the time I thought I was
on a vegan diet I did lose some pounds, and I
was very happy and proud that I lost some
weight. But, I gained back all of those pounds
and more!
In November 2013 I was diagnosed with diabetes. I didn’t want to believe it – “Me, diabetes? It can’t be, I’m a nutritionist,” I kept saying to myself. Because of this, I was ashamed.
I did not want to believe it. I was in denial.
As I say this, I remember enjoying greasy
fried bread with delicious fatty mutton stew,
fried liver and onions with buttered biscuits,
blood sausage, mutton ribs, BBQ spare ribs
and all the fast food.
One day, all of a sudden I didn't feel well. I
kept telling the health care professional that my
body is aching, I felt very tired and I slept every
chance I got. I wasn't happy anymore. I felt
this way for over a year. When the healthcare
providers ran blood work on me I was diagnosed
with high cholesterol, high blood pressure, and
diverticulitis. They prescribed pills of all sizes. I
remembered thinking that all of the cosmetics
that used to be in my hand bag were now
replaced with medications.
A caring co-worker asked me if I knew what I
was teaching about when I was teaching about
fiber foods. I really thought about it. What was
happening to my body with all the high cholesterol, low fiber food I was eating?
In October 2015 I put my own foot down, no
ifs or buts about it. I attended the Native Food
for Life meal demonstrations at the 2015 Navajo
In the fall 2015, NNSDP nutritionists with
Yolanda Ellis Bileen developed the powerful Diné
Power Plate brochure full of nutritional information,
recipes and a shopping list, encouraging use of
Native foods. At the October Navajo Nation 2015
Research Conference, and again in December at
the New Mexico Diabetes Advisory Council,
NNSDP nutritionists presented the Food for Life
Curriculum and the Diné Power Plate brochure to
health educators, informing the participants how to
use plant-based food to live
healthier, explaining that the
real problem foods are animal
products and refined foods.
In November 2015, just 14
days after Vice President Nez
spoke with nutritionist
Margilene Barney at the NN
Research Conference, Navajo
Yolanda
Nation President Russell Begaye
Ellis
Bileen
issued a proclamation encouraging the Diné people to eat more plant-based meals
to prevent diabetes based on the PCRM’s Food
for Life In Indian Country message.
Work continues with the NNSDP and PCRM
efforts to reduce the burden of type 2 diabetes
among the Navajo.
Dr. Trapp met with the Gallup Indian Medical
Center Diabetes Program Staff, Dietitians,
Nutritionist, and the NNSDP staff in April 2016. The
Food for Life Curriculum is being updated to follow
the U.S. Centers for Disease Control's Diabetes
Prevention Program (DPP) model which incorporates information that is meaningful to Native
Americans. The forthcoming Food for Life curriculum and Diné Power Plate will then be available for
use by everyone. NSDP and GIMC SDPI Diabetes
Programs plan to use these tools as an integral part
of their programs in 2017.
Role Model continued from page 1.
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Three Sisters, continued from page 1.
Dinehtah Diabetes Quarterly, Spring 2016
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Page 2
Nation Research Conference presented by the
Navajo Nation Special Diabetes Program (NNSDP),
taught by Dr. Caroline Trapp and Chef Amber
Poupore of the Physicians Committee for Responsible Medicine. Since that conference I’ve helped
to spread the word about the Dine Power Plate
that NNSDP nutritionists adopted from the Food
for Life curriculum. I am a very strong believer in
the healing power that the Power Plate foods have
to help prevent diabetes, heart disease and even
cancer.
Every time I presented on the Three Sisters
from the Diné Power Plate/Food for Life, I was
uncomfortable with my teaching. Why? Because I
was not living this way of eating, so I thought
about it; I thought it would be more meaningful to
experiment firsthand so I may teach others to live
a healthier life. By doing so now, “I’m living the
talk.” As I started my journey to eating with corn,
beans, and squash – The Three Sisters – I noticed
the positive changes my body went through and I
can actually give positive examples. I am now
comfortable to teach about The Three Sisters, and
other “Healing Food” for a healthier journey of life
here on Mother Earth. And, . . . I feel great!
Examples of What Margilene Eats
• Breakfast: Cold/hot cereal (blue corn mush, oatmeal, Malt-O-Meal, rice) with dried fruits, nuts/
seeds, agave, herbs/cinnamon, and soy milk.
Potatoes (with skin) and vegetables. Wheat/
blue-corn pancakes with fruits/vegetables.
• Lunch: Meatless Navajo taco, water, an occassional diet Pepsi treat. Spaghetti with vegetable
sauce accompanied with raw mixed vegetables
and hot natural Indian tea.
• Dinner: Spinach taco, homemade chili beans,
and green salad. Fruit/soy-milk smoothie.
• Snacks: Parched corn, piñons/mixed nuts/
seeds, dry roasted edamame, homemade chili
on tortilla/tortilla chips/rice or wheat crackers.
Dried/fresh fruit/vegetables.
• Beverages: Water, flavored water, flavored iced
tea, natural Indian hot tea (wild tea).
Email Caroline Trapp at: [email protected]
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Margilene Barney participates in a cooking class at
the Native Food for Life Diabetes Prevention Leadership Academy in Santa Fe, on February 4, 2016
Margilene by the Numbers
“Then” (October 2015)
• Weight: 168 pounds
• Blood sugar: 278
When I took that first step out of bed, or after a
long drive, my body and feet used to hurt. I’d be a
hunchback until I could straighten up. I had trouble
breathing just walking a short distance.
“Now” (June 2016)
• Weight: 157 pounds
• Blood sugar: 127
No more aches & pains! I move better, breathe
better, and feel better.
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Explore foods that can make a difference in the Diné Power Plate at the top of this page.
Dinehtah Diabetes Quarterly, Spring 2016
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NAVAJO AREA SWEET SUCCESS
Chinle New Moms Wellness Group – Inia Nizhoni
Page 3
Quarterly Nutrition Feature
A Bountiful
Basket
E
very second Wednesday of the month from 9:00 a.m. to 11:00 a.m., a team of
perinatal professionals – Alison Starling, Certified Nurse Midwife; Cecelia DelaVallee,
MD, Chinle Chief of OBGYN; and Lisa Jim, RN, Nurse Specialist High Risk OB/GYN; are
available to meet the needs of the postpartum mom.
All new moms with gestational diabetes, pre-diabetes or diabetes are invited to bring their babies and
family to take part in a shared medical appointment for postpartum check-ups, 75 gram glucose and A1C
tests, lactation and nutrition consultation, as well as physical therapy, Native medicine, and any other
support for the new mom and baby that may be needed.
After being seen by the team, the moms and families convene to a conference room group setting. Introductions are made, healthy foods are demonstrated and shared, and lifestyle changes are introduced. The
staff members share ideas and encourage everyone, mothers and their families, to speak up and participate during a lifestyle change discussion.
The New Mom’s Wellness Group is a way for women and their healthcare providers to assemble in an
informal setting, share stories, support one another, and achieve short and long-term health goals related to
lifestyle together.
This innovative, shared medical group geared for fun, focusing around wellness, and achieving sustained
lifestyle change, started in May 2016 with seven people participating. In the future, the plan is to: increase
and measure the rates of post-partum check-ups, the rates of 75 gram and A1C tests, the number of women
who follow up with their primary care provider, and to increase the lactation support new moms need. The
group is planning to walk together when the weather allows.
Up to half of gestational diabetes patients will develop type 2 diabetes. We hope this prenatal discussion
group is a positive force in taking care of, and contributing to, diabetes prevention for at-risk Chinle moms.
New USDA Dietary Guidelines
for Americans 2015 - 2020
In a Nutshell More Plants, Less Meat!
I
f you enjoy typical American fare but want to
make sure you're eating right, the U.S. Department of Agriculture (USDA) Guidelines provide
information and recommendations on a number
of healthy eating patterns – how much of different food groups and certain items within each
group to consume.
If you want to try a Mediterranean eating
pattern that has been linked to promoting longevity
and healthy brains, the Guidelines map it out.
If you want to shift from meat to vegetables,
fruits, nuts/seeds and whole grains, a balanced
vegetarian eating pattern, you can, as research
shows this also promotes health and longevity.
Sustainability & Support
O
n May 9 and 10, 2016 the Second Indian Country Breastfeeding
Conference was held in Albuquerque, New Mexico, funded by the
Kellogg Foundation, and organized by American Indian & Alaska Native
Communities and Hospitals Advancing Maternity Practices (AI/AN CHAMPS).
The two-day conference for healthcare professionals and the community
covered topics relevant to American Indian and Alaska Native breastfeeding:
sustainability of the Baby-Friendly Hospital Initiative and breastfeeding programs, breastfeeding and clinician support, historical trauma and breastfeeding, mothering through trauma, breastfeeding and illicit drug use, food
sovereignty, reforming breastfeeding education, and creating breastfeedingfriendly communities.
CHAMPS and Baby-Friendly USA Executive Director Trish MacEnroe, BS,
CDN, CLC, personally congratulated the 16 Indian hospitals (both Indian
Health Service and tribal) who have in the past few years become Baby-Friendly!
Special congratulations to the 16 Baby Friendly facilities, six in Navajo Area: Chinle Comprehensive
Health Care Facility, Chinle, AZ; Crownpoint Health Care Facility, Crownpoint, NM; Gallup Indian Medical
Center, Gallup, NM; Northern Navajo Medical Center, Shiprock, NM; Tsehootsooi Medical Center, Fort
Defiance, AZ; and Tuba City Regional Health Care Corp., Tuba City, AZ; and to our neighbors: Hopi Health
Care, Polacca, AZ; and Zuni Comprehensive Health Center, Zuni, NM.
Also, congratulations to Amanda Singer, CLC, our new AI/AN CHAMPS Consultant, and Chair of the
Navajo Nation Breastfeeding Coalition (NNBC).
If you have questions about the AI/AN CHAMPS activities contact Amanda Singer at [email protected], or the AI/AN CHAMPS Team at: [email protected].
Key Recommendations
Consume a healthy eating pattern that accounts
for all foods and beverages within an appropriate
calorie level.
A healthy eating pattern includes:
• A variety of vegetables from all of the sub
groups – dark green, red and orange, legumes
(beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt,
cheese, and/or fortified soy beverages
• A variety of protein foods, including seafood,
lean meats and poultry, eggs, legumes (beans
and peas), and nuts, seeds, and soy products
• Oils
A healthy eating pattern limits:
• Saturated fats and trans fats, added sugars,
and sodium
Other Key Recommendations
Specified limits can help individuals achieve
healthy eating patterns within calorie limits:
• Consume less than 10 percent of calories per
day from added sugars
• Consume less than 10 percent of calories per
day from saturated fats
• Consume less than 2,300 milligrams (mg) per
day of sodium
Healthy Youth
Teen’s Perseverance Leads to Success – Jenson Yazzie’s Story
Food for Life in Indian Country by Jenson Yazzie
I weighed 288 pounds! I noticed that my joints hurt, it was hard for me to get
around, and I sweated very easily. It was a chore just to get up and go clean around
the house or go outside to get wood.
Socializing with people was harder. I more or less just didn’t care what people
thought of me physically. People didn’t care about how I felt emotionally. Nobody
wanted to socialize with me. It worried me that I wasn’t healthy but I thought it was
just normal to be overweight – everybody else gets chubby.
My dad sat us down as a family and said that we are going to change our lives.
I thought, “like what are you talking about? I can’t change my life over food. I love
food. Food is my best friend.” He was just smiling and “I’m like I’m serious – I’m not
Jenson before
going to stop eating meat; are you crazy? That’s my protein.”
He smiled and said, No, I’m pretty sure you are going to get better protein,
healthier protein.” He asked, “Do you know what vegan is? Vegan (a plant based
food plan) is when you have no meat products.” I was shocked – none of my meat,
my milk, my dairy, my cheese, my eggs?
What really made me change was my weight. I weighed almost 300 pounds. The
first 21 days of going vegan were the hardest for me in my life. I thought about giving
up. I thought I’ll just go back and get a burger, quick food. But we didn’t.
You are what you eat, and that is what really changed me. I lost about 80
pounds. I lost that weight quickly enough to make me to feel good about myself.
Jenson today,
I noticed my knee doesn’t hurt. I can run five miles, I can hike. I don’t get heartburn
5-1/2 years vegan.
any more, and my complexion is better. I personally l think being vegan is a spiritual
thing of being healthy, being one with your food. Mother Earth grew that plant so I can
enjoy it. Our Mother Earth – that’s where healthy food comes from.
Jenson’s dad, Eddie Yazzie said, “Jenson is an inspiration to everyone. He is so positive about life, he
looks so happy and is so happy now, everybody sees it and everybody feels it. He wasn’t like that before,
but he is that now. One day you see your kid walk in and he has a smile on his face you haven’t seen in
years. He is holding a pair of pants and says, ‘I have had these pants for three years and now I can fit into
them.’ That was the gift that I gave back to Jenson. When you give that gift to your child it is the best feeling a parent can ever feel.”
Read more about the tools Jenson used on the top of page 2 – The Dine Power Plate. And see a video
at http://www.pcrm.org/health/diets/pplate/navajo-nations-power-plate.
Drinking alcohol in excess can cause nutritional
deficiencies and addiction. If alcohol is consumed
at all, it should be consumed in moderation,
and only by adults of legal drinking age.
Americans of all ages – children, adolescents,
adults, and older adults – should meet the
Physical Activity Guidelines for Americans to help
promote health and reduce the risk of chronic
disease. Americans should aim to achieve and
maintain a healthy body weight. The relationship
between diet and physical activity contributes to
calorie balance and managing body weight.
From New Dietary Guidelines For Americans
2015-2020, 8th edition, 12/2015, and Physical
Activity Guidelines for Americans.
– Diane Hodge, MBA, RD, CSR, CDE, CLC,
HPDP-Public Health Nutritionist,
Gallup Indian Medical Center
Three Sisters planting method is depicted on
the 2009 US Sacagawea Native American dollar
coin.
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Page 4
Dinehtah Diabetes Quarterly, Spring 2016
ADVANCES
Food Nutrition Facts Label Gets a Makeover
O
n May 20, 2016 First Lady Michelle Obama and the U.S. Food and Drug
Administration (FDA) announced a major step in making sure consumers
have updated nutritional information for most packaged foods sold in the
United States.
The Nutrition Facts label on the back of food packages – that many of us
check to see how many calories and how much fat, protein, and fiber are in the
foods we eat – is getting a new look the first time in 20 years.
“This is going to make a real difference in providing families across the
country the information they need to make healthy choices,” Obama said.
Nutrition advocates cheered the new rule which had faced some fierce
opposition from the food industry.
Most food manufacturers will be required to use the new label by July 26,
2018. Smaller manufacturers will have an additional year to comply.
How Sweet It Is
A new line will tell people how much sugar has been added to a processed
food. We will know how much sugar in yogurt is natural milk sugar and how
much has been added to sweeten it.
Right now, the average American eats about 115 grams (23 teaspoons)
of added sugar a day. The new recommended daily value for added sugar
will be 50 grams – less than half that amount (about 10 teaspoons).
Food manufacturers and the sugar industry fought hard to keep added sugars
off the food label, saying that people won’t understand the changes. The Sugar
Association has said there’s no scientific basis for distinguishing between
added sugars and those that are naturally in foods. They also say there’s no
evidence that labeling these sugars will help people improve the quality of their
diets.
However, it is difficult to meet nutrient needs and stay within calorie limits if
you consume more than 10 percent of your total daily calories from added
sugars. This is consistent with the scientific evidence supporting the USDA
2015-2020 Dietary Guidelines for Americans. Added sugar displaces needed
nutrients, and contributes to overeating.
Other Key Changes
• Two important elements in making informed food choices, “calories” and
“servings,” will be larger and bolder.
• Serving sizes will be updated to more closely reflect the amount of a food
people actually eat. A serving of soda will go from 8 to 12 ounces, a serving
of ice cream to two-thirds of a cup instead of one-half cup.
• “Calories from Fat” will be removed because research shows the type of fat
is more important than the amount. “Total Fat,” “Saturated Fat,” and “Trans
Fat” will continue to be required on the label.
• Package size affects what people eat. For package sizes that are between
one and two servings, such as a 20-ounce soda or a 15-ounce can of soup,
the calories and other nutrients will be required to be labeled as one serving
because people typically consume the entire package in one sitting.
• Food products that could be consumed in one sitting or multiple sittings will
have a dual column labels with “per serving” and “per package” calorie
and nutrition information. People will be more able to easily understand how
many calories and nutrients they are getting if they eat the entire box of 3ounce packages of potato chips.
National Navajo Code Talkers Day
Annually on August 14th
The Navajo Code Talkers, United States Marine Corps.,
served in some of the fiercest battles of World War II in the
Pacific. For their bravery and service, in 1982 President
Ronald Reagan set aside a day to honor them declaring
August 14 to be National Code Talkers Day.
The “new” label (shown on the right) lists 12g total sugar and 10g
added sugar. This is to give an example of how much sugar naturally
occurs in the food, and how much of the sugar has been added and the
% Daily Value.
• The FDA is also making minor changes to the Supplement Facts label found
on dietary supplements to make it consistent with the Nutrition Facts label.
Daily Values to Reflect Most Recent Science
• The daily value for fiber has been increased from 25 grams to 28 grams, for
example.
• New vitamins and minerals – vitamin D and potassium – two nutrients that
Americans tend not to get enough of, will now be on food labels.
• An abbreviated footnote is included to better explain the % Daily Value. The
% Daily Value tells you how much a nutrient in a serving of food contributes
to a daily diet. 2,000 calories per day is used for general nutrition advice.
SOURCES: Medscape Nurses – Data from a Food and Drug Administration
news release also citing the Center for Science in the Public Interest, and The
Sugar Association.
The Food and Drug Administration (FDA), an agency within the U.S. Department
of Health and Human Services, protects the public health by assuring the safety,
effectiveness, and security of human and veterinary drugs, vaccines and other
biological products for human use, and medical devices. The agency is also
responsible for the safety and security of our nation’s food supply.
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Online: www.IHI.org/ProfessionalCourses
Delphine McThomas
(505) 368-7425
[email protected]
8:00 a.m. - 4:30 p.m.
Comprehensive Diabetes Care
Workshop
San Juan College, Farmington, NM
Delphine McThomas (505) 368-7425
Bernadine Russell (928) 729-8469
September 8-9, 2016
Basic Diabetes Workshop
San Juan College, Farmington, NM
Delphine McThomas (505) 368-7425
Miranda Williams (928) 674-7806
NACA Spring into Summer 2016
Hiking Series - Old Caves Crater
Trail, Flagstaff, AZ
NACA Family Health & Wellness Center
www.nacainc.org
(928) 773-2445
NACA Spring into Summer 2016
Hiking Series - Schultz Creek Trail,
Flagstaff, AZ
NACA Family Health & Wellness Center
www.nacainc.org
(928) 773-2445
July 14-15. 2016
8:00 a.m. - 4:30 p.m.
July 16, 2016
6:30 p.m. MST
August 6, 2016
7:00 a.m. MST
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IHI Open School 2016
Online Training (Open to all)
▼
May 2016 April 30, 2017
Editor
Mona Patterson, BSN, RN, CBC
928/587-6859
Layout & Design Editor
Ron Goulet, Peak Publishing, Inc.
Flagstaff, Arizona [email protected]
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Save the Date!
Dinehtah Diabetes Quarterly
Upcoming Diabetes Events in
the Navajo Area.
Dinehtah Diabetes Quarterly Coordinator
Krista Haven, RN, PHN, CDE
[email protected] 928-674-7736
Your contributions are important to the success of
this newsletter! Deadline for submissions is at least
three weeks prior to the beginning of each new quarter.
Quarters begin on January 1, April 1, July 1, and
October 1. Distribution is approximately the 15th of
each of these months. Release forms are available if
you’d like to submit photographs or use patient names
in submitted articles.
Send ideas, photographs, and contributions for publication to Mona Patterson. Reach any of us at:
[email protected]
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