Download Providence Heart Beat Magazine | Summer 2016

HeartBeat
PROVIDENCE
QUALITY HEALTH CARE IN THE INLAND NORTHWEST | SUMMER 2016
QUALITY TIME
RIGHT PLACE,
RIGHT CARE
Know where to go for 7 common
health issues, from chest pain to
ankle sprains (hint: it’s not always
the emergency department)
Sacred Heart extends
lifesaving stroke care
to rural regions—
without delay
THE NEXT
DIMENSION
3-D mammography
helps doctors identify
breast cancer earlier
and more accurately
Read Heart Beat on your tablet or smartphone. Just go to
phc.org/heartbeat for the latest issue or to sign up for email delivery.
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Our mobile-friendly
website gives you
wait times for Providence
Urgent & Emergency Care!
Go to WaitTimes.phc.org.
Providence Urgent Care - open 8 a.m. to 8 p.m. daily at three convenient locations:
North: Highway 2 at Hawthorne Road Downtown: Just off I-90 at Fifth & Division
Valley: One mile east of Sullivan on Indiana
Walk-ins welcome
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HeartBeat
FROM THE HEART
PROVIDENCE
EXECUTIVE EDITOR
Sharon Fairchild
MANAGING EDITOR
Allison Milionis
MEDICAL EDITOR
Jeff Collins, M.D.
ASSOCIATE CREATIVE
DIRECTOR
Matt Morgan
ART DIRECTOR
Cameron Anhalt
PHOTOGRAPHER
Gary Matoso
Looking Back,
Looking Ahead
Copyright 2016 © Providence Health Care. Online at
phc.org. Published three times a year by MANIFEST LLC.
Send comments to [email protected] or
Marketing & Communication, 101 W. Eighth Ave.,
Spokane, WA 99204.
Elaine Couture, Regional Chief Executive
BOARD OF DIRECTORS
Marian Durkin, Chair
Patricia Butterfield, Ph.D.
Ramon Canto, M.D.
Jeff Clode, M.D.
Dan Dionne, M.D.
Rich Hadley
Gary Livingston, Ph.D.
Keith Marton, M.D.
Rob McCann, Ph.D.
Thayne McCulloh, Ph.D.
Mike Moore, M.D.
Jeff Philipps
Paul Pimentel
Mark Schemmel, M.D.
Mary Selecky
Curt Shoemaker
Larry Soehren
Ron Wells
Providence Health Care Eastern Washington (PHC) is the
parent organization of a number of Catholic health care
ministries sponsored by the Sisters of Providence and
the Dominican Sisters in Spokane and Stevens counties.
These ministries include:
HOSPITALS
Providence Sacred Heart Medical Center
Sacred Heart Children’s Hospital
Providence Holy Family Hospital
Providence Mount Carmel Hospital (Colville)
Providence St. Joseph’s Hospital (Chewelah)
OTHER HEALTH SERVICES
PAML (Pathology Associates Medical Laboratories)
Providence Adult Day Health
Providence DominiCare (Chewelah)
Providence Emilie Court Assisted Living
Providence Medical Group
Providence Medical Park, Spokane Valley
Providence St. Joseph Care Center & Transitional Care Unit
Providence VNA Home Health
St. Luke’s Rehabilitation Institute
PHC is part of the Providence Health & Services health
care system, which spans five states from Alaska to California and east to Montana. For more details, visit phc.org.
MISSION STATEMENT
As people of Providence, we reveal God’s love for
all, especially the poor and vulnerable, through our
compassionate service.
CORE VALUES
Respect | Compassion | Justice | Excellence | Stewardship
CONNECT WITH US
facebook.com/ProvidenceSpokane
facebook.com/ProvidenceSacredHeart
youtube.com/ProvidenceSpokane
twitter.com/Providence_PHC
O
ne hundred and thirty
years ago, on July 2,
1886, the blessing of the
cornerstone ceremony
marked the naming of Sacred
Heart Hospital, a modest woodframed structure. The hospital was
staffed by six Sisters of Providence,
who soon discovered that 31 beds
weren’t enough to meet the needs
of the community.
The hospital grew, eventually
moving to its current site and
expanding to accommodate 657
beds. Today, we’re one of the largest
full-service medical facilities in the
Northwest. Our continual growth
ensures everyone in our region has
access to the right care, from the
right expert, at the right time.
Our cover story explains the
many types of care we offer. Turn
to page 14 to find out whether
you should seek urgent care or
the emergency department for a
sprained ankle, and when it’s the
right time to use Health eXpress.
On page 22, learn how advanced
technology is essential to providing exceptional health care.
Thanks to 3-D mammography,
early stages of breast cancer were
detected in two patients at Inland
Imaging in Spokane Valley.
The community benefit report
on page 26 demonstrates our
investment in the health of our
community and shares a story
about an exciting program that
covers dental care for those who
can’t afford it on their own.
You are the reason we keep
growing, advancing our services
and investing in better care for
all. We are honored to have cared
for the community for 130 years,
and we look forward to continuing that Mission for another 130
years, and longer.
Elaine Couture
Regional Chief Executive
Providence Health Care
THE PROVIDENCE VISION
“CREATING HEALTHIER COMMUNITIES, TOGETHER”
We continue to pioneer care delivery, working with
partners to improve our communities’ health and
well-being.
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CONTENTS
ON THE COVER: Sometimes the emergency
department is the best place to go for a health
need—and sometimes it isn’t. Consult this
VOLUME 54, NO. 2
28
12
18
8
10
14
30
22
Features
TO GO
14 WHERE
FOR CARE
Not every health need
warrants a trip to the
emergency department.
Find out whom you
should see for common
health concerns.
18 Technology extends the
TIME SENSITIVE
reach of Sacred Heart’s
stroke experts to rural
hospitals in the region.
Read one woman’s story.
5
HEALTHY LIVING
How to treat a cut or a sprain at
home; when to see a doctor for a
burn; and more.
28
FOUNDATION
Volunteers turn a man’s 20-year
medicine bottle collection into
window art at Sacred Heart.
8
INSIDER
Medical students and professionals collaborate to improve
patient care; the moment Sacred
Heart got its name.
29
M.D. SPOTLIGHT
Discover what fascinates this
orthopedic trauma expert and
cancer specialist.
30
CALENDAR
Save the dates for these summer 2016 classes, events and
activities.
10
CHILDREN’S HEALTH
Doctors solve a life-threatening
reflux problem for baby Elliot.
12
CARDIAC REPORT
Specialized surgery is needed to
fix an expectant mother’s tricky
heart condition.
31
HEALTH TIP
Help your hydration by eating
more of these foods with high
water content.
26
COMMUNITY
Providence makes dental care
available to people who can’t
afford it on their own.
32
ROLE MODEL
A volunteer escort guides and
comforts patients as they go to
and from exam rooms.
22 MAMMOGRAPHY
IN 3-D
Detailed images from
breast cancer screening
lead to earlier detection
and treatment.
OPPOSITE PAGE: THINKSTOCK
comprehensive guide for your options.
See page 14. Photo by Gary Matoso.
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HEALTHY LIVING
3 Reasons to
Advocate for
Avocados
It’s already the star of your guacamole, but the avocado
can do more than load a tortilla chip. It is superb in salads,
spread on crackers or sliced up in omelets. The compelling
health reasons to add avocados to your diet include:
1. HEALTHY FATS. The American Heart Association recommends a diet that has monounsaturated and polyunsaturated fats, which can help reduce bad cholesterol
levels and lower heart disease risk.
2. FIBER. A single 1-ounce serving contains 8 percent of
the recommended daily value of fiber, a substance that
promotes healthy digestion and keeps you feeling fuller
longer (good for weight loss).
3. POTASSIUM. The nutrient-dense avocado contains
potassium, which can help lower blood pressure and
reduce risk of kidney stones.
DID YOU KNOW?
Even though you might use an avocado where
veggies are called for—with salads, eggs and
burritos—it’s not a vegetable. It’s technically a
fruit, specifically a single-seeded berry.
SHARE YOUR HEALTHFUL EATING TIPS
Have good ideas for including healthier foods in your
family’s meals? Share them with us on our Facebook
page. Go to facebook.com/ProvidenceSpokane or
email [email protected].
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HEALTHY LIVING
Got a Cut:
Now What?
If you experience a cut or a puncture wound, such as from a knife or
a nail, make sure to clean and dress
it to ensure that it heals as quickly
as possible. Here’s how.
Step 1. Wash the area with cool
water, using soap and a cloth to
clean the skin around the injury.
Avoid getting soap in the wound
itself.
Step 3. If the cut is in an area
that is likely to get dirty or be
irritated by clothing, cover it with
a bandage or gauze. Change the
bandage daily.
Step 4. As the wound heals, leave
the scab alone. (Picking at it can
cause infection and scarring.)
If the cut is particularly deep,
won’t stop bleeding or has edges
that don’t stay together, call your
doctor or go to urgent care. You
might need stitches or a skin
adhesive to close the wound.
BURN NOTICE
The sun isn’t the only thing that poses a threat of burns to the
skin. Accidents can happen with grills, fires and fireworks as
people enjoy good times in good weather. Burns are classified
by the depth of damage to the skin. Here’s how to identify the
three levels—and what to do.
SEVERITY
DAMAGE
TREATMENT
First
degree
Outer layer of skin;
causes redness, swelling and pain.
Run cool water over the burn
or soak in cool water (not ice)
for five minutes. Cover with
a clean bandage. Try ibuprofen
or acetaminophen for pain.
Second
degree
Outer and underlying
layers of skin; causes
redness, swelling, pain
and blistering.
Run cool water over the burn
or soak in cool water (not ice)
for 15 minutes. Apply an antibiotic ointment and cover with
a nonstick dressing. Gently
wash the area and change the
dressing daily. Ibuprofen or
acetaminophen can help with
pain. Call your doctor if you
see signs of infection.
Third
degree
Deep layers of the skin.
Skin can be white or
blackened, even numb.
Do not apply ointments.
Do not touch blistered skin
or remove clothing stuck to
the skin. Call 911.
Source: American Academy of Family Physicians
Sources: MedlinePlus, FamilyDoctor.org
THINKSTOCK (4)
Step 2. If any dirt remains in the
wound after you’ve cleaned the
area, use tweezers to clear it out.
Sanitize the tweezers with rubbing
alcohol first.
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HELP YOURSELF TO RICE
When you have a sprain or a strain, you might be
able to treat the injury at home. Start with RICE:
Rest. Stop doing the activity that caused the
injury. Consider crutches to keep weight off of
a leg injury.
Ice. Every few hours for the first day or two,
apply a cold pack to the injury site to reduce
inflammation, pain and swelling. Keep it there
for about 20 minutes at a time. (Never put ice
directly on the skin—it can lead to frostbite.)
10 CALORIES
That’s all you need to cut out of your
diet each day to lose 1 pound in a year.*
So, think twice before popping in that
innocent piece of hard candy—each
one can have about 20 to 40 calories.
*10 calories lost per day is 3,650 calories in a year,
when 3,500 calories equals about a pound of fat.
Compression. An elastic compression
bandage can help prevent further
swelling and bruising.
Elevation. Raise the injury higher
than your heart to reduce
swelling and bruising.
Sources: American Academy of Orthopaedic
Surgeons, American Academy of Family Physicians
SIGN UP FOR A
Lifesaving
Lesson
CPR can more than double a
person’s chances of surviving
a cardiac event, like a heart
attack. Call 911 and then perform hands-only CPR: Push
hard and fast in the center
of the chest. How fast? The
American Heart Association
recommends thinking of the
song “Stayin’ Alive” and using
its beat as a guide.
CPR CLASS
Become confident in your
lifesaving skills! To register
for a class near you, go to
courseregistration.inhs.org
and type “CPR” in the
search box. Online options
are available.
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INSIDER
PROVIDENCE MYCHART
Quick and Easy
Access to Your
Health Info
MyChart allows you to manage your
health care anytime, anyplace. It’s a
convenient way to view your medical
record, request medical appointments
and prescription refills, send a secure
email to your provider and health care
team, and pay your medical bills.
There are no fees to use MyChart.
All you need is an email account and
access to a computer, a web browser
and an internet connection. Download
the MyChart app to your smartphone
to stay connected on the go.
Greater Learning Opportunities
This fall, Providence’s Family Medicine and Internal Medicine Residency clinics will move from the
Fifth and Browne Medical Building
to their new, 42,000-square-foot
home in the Spokane Teaching
Health Center in Spokane’s University District. The residents from
family medicine and internal medicine will be joined by colleagues in
psychiatry and sports medicine.
Medical residents—doctors who
are completing three- to seven-year
on-the-job training programs—care
for patients under the direction
of medical faculty and alongside
health sciences students from
Washington State University, Eastern Washington University and the
University of Washington.
It is a unique opportunity for
students and professionals in a variety of health-related fields to work
collaboratively in providing care
to patients. The clinic will include
physicians, nurse practitioners,
pharmacists, social workers,
physical therapists and occupational therapists.
The clinic is the result of a community collaboration. In 2013, Providence Health Care, Empire Health
Foundation and Washington State
University Health Sciences Spokane
formed a consortium to create the
Spokane Teaching Health Center
and increase the number of medical
residents in eastern Washington.
“We know that the vast majority
of doctors who complete their medical training in the Spokane region
will continue to live and work in
the area,” says Judy Benson, M.D.,
program director of Providence
Internal Medicine Residency. “By
increasing the number of medical
resident positions in Spokane, we
have a far greater opportunity to
improve access to health care.”
By July, 25 new medical resident
positions in eastern Washington will
have been added since the consortium formed three years ago, bringing
the total number of residents to 99.
GET STARTED
Are you a patient at a Providence
clinic? Ask your provider about
setting up a MyChart account, or
visit phc.org and click “MyChart.”
THIS PAGE: THINKSTOCK (2); OPPOSITE PAGE: GARY MATOSO (TOP)
for Medical Residents
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AIR MEDICAL TRANSPORT PARTNERSHIP
EXPANDS LIFESAVING COVERAGE
Jane and Shane Harrington happily report that
their daughter, Amelia, is recovered from her lifethreatening illness, which required critical care
transport from Idaho to Providence Sacred Heart
Medical Center.
In the Winter/Spring 2016 issue of Heart Beat, we featured 2-day-old
Amelia, who received critical care on board a Northwest MedStar fixedwing aircraft. Amelia was safely transported from her home in Idaho to
Providence Sacred Heart Medical Center, where she received the care
she needed for a life-threatening infection. We’re pleased to say she is
fully recovered.
Now, more children and adults will have expanded access to ICUlevel care and transport services. In April, Northwest MedStar joined
Life Flight Network to serve more communities in Washington, Idaho,
Montana and Oregon. With additional flight teams and resources, Life
Flight Network also plans to open helicopter bases in Colville and Walla
Walla and add a fi xed-wing aircraft to the existing base in Moses Lake.
If you’re a MedStar member, your membership automatically transferred to Life Flight Network and you gained expanded coverage to
several locations throughout the nation via a reciprocal partnership.
You’ll receive a renewal notice from Life Flight Network one month in
advance of your membership expiration.
If you have questions or want to become a member, visit lifeflight.org.
130 YEARS OF HEALTH CARE
How Sacred Heart
Medical Center
Got Its Name
If you’re the type of person who wonders what’s in a name, you
might like the tale of how Sacred Heart Medical Center—then
Sacred Heart Hospital—came to be 130 years ago. On July 2,
1886, community members gathered with a group of Catholic
priests and sisters at Spokane’s newly constructed hospital
for the blessing of the cornerstone. Mother Joseph and Sister
Joseph of Arimathea were there, as well as Aegidius Junger, the
Bishop of Nisqually. While giving the blessing, the bishop turned
to Mother Joseph and asked for the name of the hospital.
The sister was silent. The superior of the Sisters of Providence, in Montreal, had not yet sent the name for the hospital.
Quick on his feet, assistant priest Aloysius Ragaru, SJ, spoke
up. “Sacred Heart Hospital,” he said. During the brief but awkward silence he realized that it was the day of the Feast of the
Sacred Heart. Some also say he might have remembered
Mother Joseph’s full name: Mother Joseph of the Sacred Heart.
The hospital opened its doors to the first patient in
January 1887.
NEED A PROVIDER TODAY?
SEE ONE TODAY
You can schedule a same-day appointment
at Providence NorthEast Washington Medical
Group in Colville. This convenient service is
available Monday through Friday, 8 a.m. to 5 p.m.
Call 509-684-3701 to reserve a time.
Sacred Heart Hospital in 1901, at its
first location by the Spokane River
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CHILDREN’S HEALTH
Feeding Baby Elliot
Doctors decide on a surgical solution for
a newborn’s life-threatening reflux.
Center & Children’s Hospital. Designated a Level II pediatric trauma
center, the hospital has the only
specialized children’s emergency
department in the region.
Doctors diagnosed a severe milk
protein allergy and gastroesophageal reflux and put Elliot on a
special formula to treat the allergy.
Unfortunately, the baby’s condition
did not improve; it worsened. The
Johnstons made another trip to the
hospital, and Elliot was admitted a
second time.
“The scariest part was Elliot’s
reflux was so severe it caused him
to stop breathing on several occasions,” Johnston says.
SPECIALIZED TREATMENT
Monica Zherebtsov, M.D.—her
patients call her Dr. Z—was
one of the physicians assigned
to care for Elliot. As a pediatric
Monica Zherebtsov, M.D., visits with Elliot
and his parents, Sheila and Mike Johnston.
GARY MATOSO
H
e was due a few weeks
after Thanksgiving in
2015, but baby Elliot had
other plans. Instead, he
arrived two weeks early. During
his first month, Elliot had bouts
of excessive vomiting and diarrhea. During one particularly bad
episode, Sheila Johnston and her
husband, Mike, took their newborn
to the emergency department at
Providence Sacred Heart Medical
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By Starla Collins
gastroenterologist, she specializes
in treating infants and children
who have difficulty eating, and
she recently helped establish
Sacred Heart’s Pediatric Gastroenterology Feeding and Growth
Clinic in Spokane.
Dr. Zherebtsov started Elliot
on medications to control the
reflux and recommended a nasojejunal, or NJ, tube to deliver vital
nutrients until the infant could tolerate eating on his own. The small
tube was inserted through Elliot’s
nose and stomach and into the
small intestine.
“We wanted to keep Elliot interested in eating and sucking, so we
gave him a bottle several times a
day with very, very small amounts
of formula,” Johnston says. “However, even the smallest amount of
fluid in his stomach led to severe
reflux, which would often cause him
to stop breathing. Fortunately, Dr. Z
recognized these apnea episodes as
life-threatening events.”
SURGERY NEEDED
Dr. Zherebtsov contacted pediatric
surgeon Winston Chan, M.D., at
Providence Pediatric Surgery Center
at Sacred Heart Children’s Hospital.
After explaining the situation, both
physicians agreed Elliot should have
surgery as quickly as possible.
SPECIALIZED CARE
FOR INFANTS AND
CHILDREN
To learn more about the
Pediatric Gastroenterology
Feeding and Growth Clinic in
Spokane, call 509-474-5437.
A physician referral is required
for new patients.
“We needed to protect Elliot’s
airway by stopping the reflux,”
Dr. Zherebtsov explains. “And we
needed to make sure Elliot was able
to get the nutrients he needed to
grow and thrive, which required a
feeding tube.”
During the anti-reflux surgical
procedure, Dr. Chan created a flap
in Elliot’s stomach to stop the fluid
from moving into the esophagus
and potentially into his airway.
Next, he created a port in the abdomen through which a gastrostomy
tube, or G-tube, would go directly
into Elliot’s stomach. A feeding
pump and tube connects to the
port to deliver vital nutrition.
“Since the surgery in midFebruary, Elliot has not had one
apnea episode,” Johnston says. “He
is hooked up to the feeding machine
nearly 24 hours a day and can only
tolerate just a few milliliters of food
through the tube at a time. The goal
is to eventually wean him off of the
feeding tube and for him to be able
to eat on his own.”
TEAM SUPPORT
To help the Johnstons manage
Elliot’s medical needs, they see the
multidisciplinary team of health
care professionals at the Pediatric
Gastroenterology Feeding and
Growth Clinic in Spokane. The
team includes a physician, a social
worker, an occupational therapist,
a dietitian and support staff.
“Everyone is so encouraging
and knowledgeable, giving us
the support and tools we need,”
Johnston says. “After nearly five
months, Elliot is finally looking
and acting like a healthy baby.
We could not be more grateful to
Dr. Z, the clinic staff and Sacred
Heart Children’s Hospital.”
The Place to Go for
Pediatric Feeding Disorders
Thanks to modern medicine, premature babies and infants with complex medical
needs have an increased chance of survival. This also means an increased number of infants and children living with feeding disorders. Through early assessment and ongoing treatment, the Pediatric Gastroenterology Feeding and Growth
Clinic in Spokane aims to help infants and children, and their families, manage
feeding disorders.
The clinic, which opened in 2015 under the direction of Monica Zherebtsov, M.D.,
offers a centralized location for patients to see physicians and specialists in one
location, during one visit. At-home medical equipment and formula options are
provided by Providence Infusion and Pharmacy Services; feeding and swallowing
evaluations are provided by St. Luke’s Rehabilitation Institute.
Treatment plans and services include goals for feeding; training for family caregivers; nutritional assessment and recommendations; digestion, oral-motor and
swallowing evaluations; nutritional supplements, formulas and medical equipment; feeding tools such as thickeners and specialized bottles; behavior and occupational therapy to encourage feeding; community support groups and resources;
and coordination of appointments.
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CARDIAC REPORT
The Buckles-Howard family, clockwise
from left: Matthew, Matt, Drake, Amanda
and Avery
As a child, Buckles frequently
experienced lightheadedness and
fatigue. Even jumping up and down
would cause her heart to race.
Buckles took medication to help
manage the condition. “My heart
has always had a mind of its own,”
she says.
READY FOR RESOLUTION
A woman with a history of racing heartbeats
finally finds a specialized solution.
Amanda Buckles’ heart
wouldn’t stop racing. She
woke up at 6 a.m. on Feb. 14, 2016,
with an elevated heart rate, and by
11 a.m. it hadn’t returned to normal.
Buckles called her midwife. Go to
the emergency department, her
midwife advised.
At the ED, Buckles was given
medications to slow her heart.
Nothing seemed to work at first,
but by around midnight the medical team was able to normalize the
heart rate. Fortunately, Buckles’
unborn baby—her fourth child—
wasn’t affected. Still, Buckles found
it unsettling. After many years without any problems, her heart was
racing every day, sometimes several
times. She was concerned about her
baby’s health, as well as her own.
TRIGGERING TROUBLE
Buckles was born with supraventricular tachycardia, or SVT, a condition
that causes the heart to beat rapidly
or erratically. Rogue electrical signals between the heart’s upper and
lower chambers fire abnormally in a
sort of short circuit, interfering with
normal electrical signals coming
from the sinoatrial node, the heart’s
natural pacemaker. A rapid heartbeat brought on by exercise, stress
or hormonal changes may last a few
minutes to several days, potentially
reducing blood supply to the body.
GET IN RHYTHM
Does your heart race or beat erratically at times? Perhaps you have
an arrhythmia. Talk to your health care provider to find out more.
GARY MATOSO
Settling Down
The visit to the emergency department scared Buckles. After discussing the options with her physician,
she decided to have an ablation
procedure, her second. An ablation
is a minimally invasive technique
to correct abnormal heartbeats,
also known as arrhythmia. The first
attempt on Buckles, in 2007, was
unsuccessful, but doctors were
optimistic this time around.
Enter Mark Harwood, M.D., cardiologist at Providence Spokane
Cardiology, and Chris Anderson,
M.D., pediatric cardiologist at
Providence Center for Congenital
Heart Disease. Both clinics are
members of Providence Spokane
Heart Institute. The doctors are
also cardiac electrophysiologists,
meaning they specialize in diagnosing and treating heart rhythm
disorders. They use 3-D mapping
to perform ablations, which is what
Dr. Harwood recommended for
Buckles because of her pregnancy.
Although ablation procedures typically use both 3-D mapping and
fluoroscopy, or X-ray technology,
it was too dangerous to expose
Buckles’ fetus to X-ray radiation,
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By Allison Milionis
so doctors would perform the 3-D
mapping alone.
“I knew I was in good hands,”
Buckles says. “And it was exciting
to contemplate a normal heart rate
and lifestyle.”
FINDING—AND FIXING—
THE PROBLEM
One month after her visit to the
emergency department, Buckles
checked in for her procedure. She
was placed under general anesthesia, and then the medical team
inserted a catheter with a miniature
electromagnetic sensor in the tip
into her femoral vein and guided it
to her heart. Electrodes were placed
on her upper body and a magnet
attached under the table to create
a magnetic field. As the catheter
moved within the field, it sent signals to a computer, much the same
way a GPS system maps streets. On
screen, the signals morphed into a
3-D model of Buckles’ heart.
Alongside a team that included
an obstetrician to monitor Buckles’
unborn baby, an anesthesiologist,
technicians and nurses, Drs. Harwood and Anderson worked in
tandem, one at the bedside navigating the catheter, the other in the
control room tracking the virtual
catheter on screen.
Locating the area in her heart
that was triggering the arrhythmias
was not easy, however. The accessory pathway, a grouping of cells
creating the short circuit and causing the SVT, was in an abnormal,
small, pouchlike vein in the back
of the heart called a diverticulum.
“Mapping the anatomy of the coronary sinus where the diverticulum
was discovered was very difficult,”
Dr. Anderson says.
Minimally Invasive,
Maximally Effective
Ablations are just one of many minimally invasive procedures performed at
Providence Spokane Heart Institute facilities. Because physicians, nurses and
technicians there perform a high volume of cardiac procedures, they develop
a high level of expertise and produce quality results for patients. Here is a look
at the numbers:
NUMBERS PERFORMED IN
PROCEDURE
CONDITION
2014
2015
Pacemaker and implantable cardioverter defibrillator (ICD) implants
Irregular heartbeats
954
1,069
Percutaneous coronary
intervention (PCI)
Blocked coronary
(heart) arteries
1,171
1,300
Cardiovascular surgery
(including coronary
bypass for congenital
issues)
Wide range of conditions in the heart and
blood vessels
916
862
Transcatheter aortic valve
replacement (TAVR)
Aortic stenosis, a narrowing of the aortic
valve opening
105
117
Want to learn more about minimally invasive heart surgery?
Call the Providence Spokane Heart Institute at 509-474-3278.
Eventually, they were able to
reach the accessory pathway in the
diverticulum and destroy it using
a short blast of heat in the form of
radio-frequency current from the
catheter. The procedure took nearly
five hours; catheter ablations typically take less than two hours.
A FUTURE WITHOUT
X-RAY RADIATION?
The success of the ablation
procedure without fluoroscopy
buoyed the doctors’ belief that
3-D mapping could one day
replace X-rays altogether. “We
know it can be done,” Dr. Harwood says.
Buckles’ baby was unfazed by
the ordeal. The expectant mom
took a couple of days to recover
but was back at work by Monday.
Since the ablation, she hasn’t
had one episode. “I feel like a
new woman with a new heart,”
she says.
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WHERE TO GO FOR
STORY BY STEPHANIE CONNER | PHOTOS BY GARY MATOSO
Whom should you see
for common health
issues? Read on to
learn more about
the options available
to you.
W
hen you need
health care, you
need it now.
Or do you?
The truth is that not everything
is a medical emergency.
Based on the results of a 2013
study from Truven Health Analytics, it seems a lot of us misjudge
what constitutes an emergency.
Looking at insurance claims data
for more than 6.5 million emergency department (ED) visits made
by commercially insured individuals, researchers found that 65 percent of ED visits were for ailments
that did not require immediate
attention in the ED.
When you consider that other
care options, such as urgent care
and primary care, are far less expensive, it makes sense to pause and
determine whether you’re going to
the appropriate place.
Getting the right care at the right
time in the right place can help
keep your own personal medical
costs at a minimum—and reduce
the financial strain on the health
care system.
But that relies on all of us knowing
the best place to go when we experience a medical problem. Do you
know where to get the care you need?
If you experience:
Chest pain
Go to: Emergency
department
The ED’s function is to provide
care for injuries that are potentially
life-threatening, says Dan Getz,
D.O., medical director of the emergency department at Providence
Sacred Heart Medical Center.
Chest pain isn’t always lifethreatening, but heart attacks are,
and you’ll receive a much higher
level of care at an ED, Dr. Getz adds.
“We have access to imaging
and other specialized resources
to treat the most serious health
emergencies,” he says. “Chest pain
can be tricky; there are a number of
things it can be, so you want someone who’s trained in emergency
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Knowing that unnecessary trips to
hospital emergency departments cost
big bucks, doctors as well as hospital
and state Medicaid representatives
created an education campaign that
saved $33.6 million in Medicaid feefor-service emergency care expenses.
medicine who can accurately and
quickly diagnose the problem and
get you the treatment you need.”
A lot of times, he says, the job of
an emergency physician is to rule
out major medical emergencies.
“People get frustrated with that,”
Dr. Getz says. “But if it’s not a
life-threatening issue, you may not
leave the ED with a diagnosis.”
If you need:
Medication refills
Go to: Primary care
“We frequently see people who run out of their prescription
medicines and come to the ED for a
refill,” Dr. Getz says. “But as a policy,
we don’t refill medications.”
Typically, all you need to do is
call your pharmacy, and someone
there will handle the authorization
with your doctor’s office. If you
need to be seen by your doctor first,
you’ll likely be scheduled for an
appointment with him or her and
then receive a short-term refill to
sustain you until that visit.
Another option is Providence’s
telehealth service, Health eXpress
(healthexpress. com), which provides access to a live, on-demand
video visit with a doctor or a nurse
practitioner. You just need a computer, a smartphone or a tablet with
an internet connection. And you
can’t beat this: Wait times average
less than five minutes.
If you experience:
Ankle sprain
Go to: Primary care
or urgent care
If the pain isn’t significant but you
need assurance that it’s not serious,
contact your primary care provider.
“But a lot of times, the best option
for a sprain is urgent care,” says
Kirk Rowbotham, M.D., chief medical officer for Providence Medical
Group. If it turns out that it’s broken, you can be placed in a splint at
urgent care and then referred to an
orthopedic specialist for follow-up.
And if it’s after hours or on
the weekend, urgent care is the
perfect place for sprains or most
broken bones.
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Dan Getz, D.O., medical
director of the emergency
department at Sacred Heart,
says you should go to the
ED if you have diabetes and
are experiencing high blood
sugar and vomiting.
One exception, Dr. Getz says: “If
you have exposed bone, come to the
emergency department.”
If you need: Diabetes
management
Go to: Primary
care (usually)
“Anything chronic is best served by
your primary care physician,” Dr.
Getz says. But, he adds, “if you have
diabetes, your blood sugar is sky
high and you’re vomiting, then come
to the emergency department.”
The role of primary care, Dr. Rowbotham says, is to take care of minor
acute issues as well as long-term
health maintenance concerns.
“We can help people manage
chronic conditions, with the hope
that they stay healthy and never
need to go to the emergency department,” he says.
If you experience:
Laceration (cut)
Go to: Urgent care
(probably)
For most cuts, first aid at home—
cleaning them and applying
pressure until they stop bleeding—
is all you’ll need. For a cut that
won’t stop bleeding or is so deep
that you think you need stitches,
urgent care is the way to go. It’s
less expensive than the ED, and
providers at urgent care will have
all the resources to stitch you up
and get you on your way.
If you have a life-threatening
injury—such as a stab wound or
something near your chest or a
major artery—you’ll most likely
find yourself in an ambulance
on your way to the emergency
department.
5 Minutes
The average wait time to see
a doctor or a nurse practitioner
with Health eXpress, Providence’s
telehealth service
If you experience:
Flu symptoms
Go to: Your medicine
cabinet (most people)
“If you can hold down fluids and
you’re not feeling too terrible, there’s
nothing a physician can really do for
you,” Dr. Getz says. “With a virus
like the flu, treating the symptoms is
most important.”
Get some rest, drink plenty of
fluids, use a humidifier if it helps
you breathe and consider over-thecounter medications that target your
particular set of symptoms, and wait
it out, usually one to two weeks.
Of course, there are times when
you need immediate care.
“If you have the worst headache
of your life or a stiff neck, there
might be something else going on,”
Dr. Getz says.
Anyone having respiratory
difficulties should go to the ED,
he adds, as should someone who
is very sick with shortness of
breath or vomiting and has a
condition that might complicate
the illness—such as heart disease,
diabetes or cancer.
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YOUR CARE OPTIONS AT A GLANCE
WHO/WHAT IT IS
WHAT IT’S GOOD FOR
PRIMARY CARE
PROVIDER
This practitioner is your first stop in getting health care for you
and your family. He or she can help with preventive care and also
help you manage your overall health by knowing you and your
medical history.
Common illnesses: flu, colds, fever, sore throats,
headaches, skin irritations • minor injuries: minor cuts/
burns, sprains, minor bone fractures • physical exams,
vaccinations and health screenings
URGENT CARE
CLINIC
If your primary care provider isn’t available or it’s after your primary
care office hours and you need care right away, go to an urgent care
clinic for non-life-threatening medical issues that could become
worse if not treated immediately. Open 8 a.m. to 8 p.m. No appointment is needed. People are seen on a first-come, first-served basis.
Locations: 421 S. Division St. and 551 E. Hawthorne Road.
Common illnesses: flu, colds, fever, sore throats,
headaches, skin irritations • minor injuries: minor
cuts/burns, sprains, minor broken bones
EMERGENCY
DEPARTMENT
(ED)
Emergency care is for serious medical conditions that are life- or
limb-threatening. Time is of the essence, and EDs are open 24/7.
No appointment is needed. People are seen based on the severity
of their conditions.
Severe chest pain/heart palpitations • difficulty
breathing • ingestion of objects or poisons • major/
significant trauma or injury • seizures • severe burns
• severe diarrhea • uncontrollable bleeding, vomiting
blood • animal bites • fainting, unconsciousness
HEALTH
EXPRESS
(TELEHEALTH)
This is ideal for non-life-threatening care when you can’t get in to
see your primary care provider and you can’t go to urgent care.
You have access to a live, on-demand video visit with a doctor or a
nurse practitioner from any device with an internet connection.
Go to healthexpress.com.
Sinus, ear or eye infections • cough, cold and flu • rash
and joint issues • prescription refills
WHAT IS THE WAIT?
Want to know how long of a
wait to expect at the emergency
department? Check out the
wait times at Providence’s
urgent care clinics and hospital
emergency departments. Go to
waittimes.inhs.org.
If you need:
Follow-up care
after an ED visit
Go to: Primary care
When you are discharged from
the hospital, you’ll receive a set of
instructions about your condition
and what follow-up care you’ll
need. That care will be managed by
your primary care provider (unless
you’ve been sent to a specialist).
Regardless, you won’t return to
the emergency department for routine follow-up.
“Providence primary care doctors
as well as our urgent care centers
and hospitals all use an electronic
health record system that makes a
patient’s medical history available to
After you leave the emergency
department, where Dan Getz, D.O.,
is medical director at Sacred Heart,
you’ll follow up with your primary
care provider.
all providers,” Dr. Rowbotham says.
“Plus, our registered nurse care navigators are responsible for following
up with people who have been seen
in a Providence emergency department or urgent care clinic.”
The navigator makes sure people
have understood their discharge
instructions, were able to fill
any prescriptions and know
how to take those medications.
The navigator also will schedule a follow-up appointment to
make sure diseases are managed
well and wounds and injuries
are healing.
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TIME
SENSITIVE
A real-time connection between
Sacred Heart’s stroke experts and
rural hospitals in the region leads
to lifesaving results.
STORY BY WILL MORTON
PHOTOS BY GARY MATOSO
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D
ennis Bippes and his wife,
Christine, woke up to the
sound of their coffee maker,
as they usually do. Soon, Dennis saw something that he didn’t expect
but definitely recognized: the signs of
stroke. As Christine was making the bed,
she stared blankly into the middle of the
room. “I asked her if she was OK,” he
recalls, “and slurred words came out.”
Although the suddenness of the
stroke is something that will take a
while to get over, Dennis says, he knew
what to do in that moment. He dialed
911. It was 8:15 a.m.
Christine, 75, was aware of her husband telling her she had to go to the
hospital. Her memory of events over the
next few hours, however, is fragmented.
She remembers being loaded into an
ambulance and then a helicopter to fly
her to Providence Sacred Heart Medical
Center in Spokane. She also remembers
waking up and being told that she would
Dennis and Christine Bippes
enjoy a stroll with their daughter,
Jennifer McHan (right).
make a full recovery, thanks to rural
medicine emergency services and a
real-time video connection to neurology
stroke specialists at Sacred Heart.
ADDRESSING RURAL
CHALLENGES
The Bippeses live 5 miles outside of
Naples, a small town in northern Idaho,
closer to the Canadian border than to
Spokane. The ambulance had to get
there from Bonners Ferry, about 10 miles
away, and then travel 26 miles to Bonner
General Hospital in Sandpoint.
En route, the crew called the hospital
to describe Christine’s condition. The
call allowed Mike Taylor, emergency
department director at Bonner General,
to initiate the hospital’s stroke protocol. This included a call to neurologist
Cynthia Murphy, M.D., at Sacred Heart.
When the ambulance rolled in, the
team was in place.
It was 9:16 a.m.
Cynthia Murphy, M.D., was
ready for a real-time video
visit with Christine Bippes
as soon as Christine arrived
at her local hospital,
70 miles away.
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THE CRITICAL HOUR
Christine had entered the “golden
hour,” a window of time during
an ischemic stroke (caused by a
blockage in a blood vessel) when
intervention with tissue plasminogen activator, or tPA, can minimize
further damage to the brain. The
drug tPA works by dissolving clots
and improving blood flow to the
deprived part of the brain, saving
brain cells. It is the only treatment
for ischemic stroke approved by the
U.S. Food and Drug Administration.
With tPA delivery during a stroke,
time is of the essence. Last year, The
Joint Commission—an agency that
strives to improve quality for health
care organizations—began recommending that tPA be administered
within one hour from when a patient
enters an emergency department.
STROKE EXPERTISE,
REMOTELY
By the time Christine was brought
into the emergency department at
Bonner General, Dr. Murphy had
already spoken with Taylor about
Christine’s symptoms over the
Neurologist Cynthia
Murphy, M.D., assesses
stroke patients in
person at Sacred Heart
and virtually around
the region using
telemedicine.
phone. She then “beamed in” from
Spokane to the bedside in Sandpoint via telestroke, a video link on
her computer.
“I can lay eyes on the patient and
observe speech, noting any aphasia
[inability to communicate] or facial
droop, and assign a number on the
stroke scale,” she says.
That scale, a tool for determining how the stroke has affected a
person’s consciousness, language,
vision and physical strength, for
instance, allows doctors to measure
the severity of the stroke.
Christine’s score was nine, which
falls in the moderate range. She was
conscious but had difficulty understanding what was being said to her
(receptive aphasia) and had slacking
facial muscles (ataxia). Provided she
received treatment quickly, these
effects could be reversed, but first
Dr. Murphy needed to see what had
happened in Christine’s brain.
Murphy and Bonner General caregivers to examine. Connected via
telemedicine, the doctors were able
to see the images on their computer
screens in real time. The scan ruled
out bleeding as the cause for Christine’s stroke, but that wasn’t the
whole story.
Whereas tPA is ineffective for
bleeding (hemorrhagic) strokes,
the drug is not always advised for
ischemic strokes. There are risks.
Tele-What?
TELEMEDICINE is the use of electronic communications methods,
such as telephone, internet and
video conference, to exchange
medical information from one
geographic site to another.
TELESTROKE is the use of
telemedicine specifically for
stroke care.
GETTING A CLOSER LOOK
By 9:23 a.m., a computed tomography (CT) scan had been performed
and the result was posted for Dr.
National studies suggest that bleeding into the brain occurs in about
one out of 18 patients receiving
tPA. When this bleeding occurs,
the fatality rate climbs as high as
45 percent.
A second CT scan, this time with
a special dye added, confirmed there
was a blocked blood vessel and
allowed providers to make the decision to give tPA more confidently.
After discussing the risks and benefits with Christine’s husband and
other family members, Dr. Murphy
made the call: Administer tPA.
It was 10:12 a.m., less than an
hour after Christine arrived at
Bonner General.
“Fifty minutes is impressive,”
Dr. Murphy says, especially given
that two years ago the national
standards were two hours from
“door to needle” for tPA—the time
from arrival at the hospital to delivery of treatment.
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Far Reach
in the Region
Sacred Heart Medical Center and
other primary stroke centers are
equipped with the resources and personnel to provide people who have
acute stroke with timely, adequate
assessments and emergency stroke
treatments. But most rural hospitals do
not have such capabilities.
That’s where the Providence
Telestroke Network comes into play. In
a “hub and spoke” model, specialists at
Sacred Heart, a certified primary stroke
center, are able to visit in real time via
telemedicine with patients in smaller
hospitals throughout the region.
Because of her local hospital’s connection to experts
at Sacred Heart, Christine
Bippes received timely
treatment for her stroke.
With Dr. Murphy coordinating
her care in advance of her arrival,
Christine was flown by helicopter
to Sacred Heart and in surgery 45
minutes after receiving tPA. The
patient underwent an endovascular
procedure to remove the clot and
later that afternoon was resting in
a recovery room with her family
around her.
Therapies such as tPA are not
used much by hospitals that cannot provide timely access to stroke
experts. Telestroke makes it possible. “It brings experience to us with
a quick phone call,” says Taylor of
Bonner General. “Having a specialist
ASK SOMEONE WHO
KNOWS STROKE
If you have questions or
concerns about stroke, talk to
your primary care physician.
To Recognize
Stroke, Act FAST
involved in the decision-making
lifts a huge burden.”
MAKING PROGRESS
IN RECOVERY
Christine’s stroke occurred in
the language center of her brain,
which has affected her ability to
choose and say the correct words
or phrases. “Sometimes, what I
say isn’t what I mean, and I don’t
always realize it,” she says.
By working with her speech
therapist in Bonners Ferry, however, Christine is making progress.
Her reading ability is nearly back
to normal, and she continues to
work on speech and writing. Now,
it’s only occasional words rather
than whole phrases that seem out
of place when she’s conversing
with friends and family. There
is work ahead, but Christine is
grateful that she can continue to
get better.
FAST is an easy way to remember and
identify the most common symptoms
of a stroke. Recognizing these signs
and dialing 911 right away can make a
difference in getting someone to care
quickly and result in a better recovery.
Face: Ask the person to
smile. Does one side droop?
Arms: Ask the person to
raise both arms. Does one
arm drift downward?
?
?
?
?
Speech: Ask the person
to repeat a simple phrase.
Is the speech slurred?
Time: If you observe any
of these signs, call 911
immediately.
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Mammography
in
STORY BY SHELLEY FLANNERY | PHOTOS BY GARY MATOSO
Breast tomosynthesis helps doctors identify cancers
earlier, in more treatable stages. And the technology
is available right here in Spokane Valley.
L
ynn Tennican, 74, went to
her OB-GYN last fall for
her annual well-woman
checkup. As predicted,
her doctor recommended she get a
mammogram.
“I said, ‘You know, I’ve had mammogram after mammogram after
mammogram, and they’ve never
found anything.’ So I declined,”
she says. “It wasn’t more than two
weeks later that I noticed a lump in
my left breast.”
Tennican called her doctor and
asked to have the mammogram
after all. She had the screening done
at Spokane Valley Inland Imaging
center at Providence Medical Park.
Inland Imaging features tomosynthesis, what’s commonly
referred to as 3-D mammography,
regarded as the latest technology
in breast imaging.
“It turns out the lump I’d felt
in my left breast was an innocent
[noncancerous] cyst,” she says.
“But there was a tiny nodule in my
right breast that they wanted to
explore further.”
A biopsy of that nodule revealed
stage 1 breast cancer. In November,
Tennican had surgery to remove
the nodule and then underwent
radiation therapy.
Tennican was fascinated. Growing up the daughter of a doctor (her
father started medical school the
day she was born), she’s been interested in medicine her whole life and
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Lynn Tennican is fascinated by
the process that providers used to
identify and treat her breast cancer.
practiced as a physical therapist for
much of it. In her spare time, she
likes to study medical journals.
“The cancer didn’t scare me at
all,” she says. “None of these processes did—the imaging, surgeries,
radiation or anything. I don’t find it
threatening.”
Tennican won’t know whether
she is cancer free until she goes
for her six-month scan. But she
already knows where she’s going
to have it.
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“Inland Imaging makes it so easy
to be a patient,” she says. “They’re
very generous to spend their time
explaining everything. We are so, so
fortunate to have them in this city.
They are right at the top of the ladder in machinery and staff.”
A GOOD THING
Barbara Hayden appreciates having
“such amazing technology” in Spokane.
Barbara Hayden’s story is similar to
Tennican’s. The 71-year-old faithfully went for her mammograms
every year but stopped for several
years while she was taking care of
her significant other, who was ill
and required multiple surgeries.
“I was trying to keep him alive,
so I just didn’t have time to keep up
with my screenings,” Hayden says.
“I have no idea what it was that
told me to go in for a mammogram
when I did. But it’s a good thing.”
Hayden’s 3-D mammogram
revealed “suspicious tissue” in one
of her breasts.
“Two weeks later they went in and
took out three cancer cells—stage 0,”
she says. “If we had waited a year, it
would’ve been a different story.”
Hayden underwent radiation therapy and has a good chance of being
cancer free at her next scan, thanks
to 3-D mammography, which doctors
used to catch her cancer early.
“I’m just finding it intriguing the
advances they are making,” Hayden
AGE
Providence Sacred Heart
Medical Center and Inland
Imaging recommend women
start having screening mammograms at age 40 and continue
every year after that.
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says. “From what I understand,
3-D mammograms have fewer false
positives. We’re very lucky to have
access to such amazing technology
in Spokane.”
IMPROVEMENT IN
MAMMOGRAPHY
Both Tennican and Hayden have
every reason to marvel at how far
breast cancer detection has come.
“When breast imaging first
started, you were lucky if you could
find large cancers,” says Florence
Gin, M.D., a radiologist and co-chief
of breast imaging services at Inland
Imaging. “There were no special
techniques or dedicated machines.
The cancers that were found were
typically at advanced stages.”
Since modern mammography
was introduced in the late 1960s,
images have gotten clearer, but
traditional X-rays have their limitations. “Regular film screening
mammography is a 2-D image. We
see breast tissues stacked on top of
each other, and we’re trying to look
through it,” Dr. Gin says.
3-D mammography represents an
improvement.
“We take a 15-degree arc around
the breast and get 15 pictures,” Dr.
Gin says. “From those pictures, we
make 1-millimeter slices. So instead
of looking through all those layers,
you’re looking at very small slices
of the breast.”
Those small slices of breast
image enable radiologists to spot
the littlest areas of concern. And
the smaller the cancer at detection,
the more likely it is to be at an earlier, more treatable stage.
BENEFITS FOR ALL WOMEN
3-D mammography is too new to
have data on long-term success,
but early research is promising.
There is potential for 3-D mammography to increase detection
rates, lower recall rates for false
positives and decrease biopsy and
Mammograms: When to Start?
There has been much controversy and confusion in recent years about
when a woman should start getting mammograms and how often
she should get them. After the U.S. Preventive Services Task Force
changed its guidelines for starting screenings from age 40 to age 50
and for frequency from one year to two years, mammogram rates have
declined. Among women ages 40 to 49, rates fell nearly 10 percent, and
for women ages 50 to 64 they fell 6 percent, according to a study published in 2015 in the Journal of Clinical Oncology.
Lowering mammography rates is a trend that health care providers
would like to see reversed.
“Screening mammography is the only method that shows mortality
[death] and morbidity [illness] benefits,” says Florence Gin, M.D.,
a radiologist and co-chief of breast imaging services at Inland Imaging. “The bottom line is women who have screening-detected breast
cancers live longer.”
Providence Sacred Heart Medical Center and Inland Imaging follow the American College of Radiology and Society of Breast Imaging
screening guidelines for breast cancer: A woman should begin screening mammograms at age 40 and then continue annually for as long as
she is in good health.
workup rates for noncancerous
lumps and lesions.
Because of the detailed images
provided by 3-D mammography,
many physicians recommend
it for women with dense breast
tissue. “But really,” Dr. Gin
says, “there are benefits for
all women.”
Not all communities are fortunate enough to have the technology nearby.
“No one is sure why, but Washington state has a higher rate of
breast cancer than some other
states,” Dr. Gin says, “so we are
especially focused on serving
our community to the best of
our abilities.”
Inland Imaging has been designated a breast imaging center of
excellence by the American College of Radiology, the only such
facility in Spokane.
“We are accredited in mammography, stereotactic biopsy,
breast ultrasound and breast
ultrasound biopsy, and breast
MRI,” Dr. Gin says. “We want to
make sure we’re doing the best
for our patients and keep getting
better and better.”
SCHEDULE YOUR MAMMOGRAM
Identifying breast cancer early provides you with the best chances
of survival. For women older than 40, a yearly mammogram should
be a part of your health care routine. To schedule a mammogram,
call Inland Imaging at 509-455-4455.
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COMMUNITY
Looking at Health
in New Ways
Putting a DENT in emergency department dental cases.
S
Hospital and Providence Holy Family Hospital who have dental problems are asked if they will accept
a referral to DENT. If a patient
agrees, a request is faxed to a DENT
community health worker. In most
cases, the health worker will reach
the patient within 48 hours and
schedule that person for an emergency dental appointment. If the
patient needs pain medication, it
is usually prescribed prior to discharge from the hospital emergency
department.
During the call, the DENT community health worker coaches the
patient on how to prepare for the
dental appointment and reminds
the patient to be on time, make
arrangements for child care during
the appointment and follow the
dentist’s care plan.
GOING FURTHER,
GETTING RESULTS
Besides arranging dental referrals for emergency department
patients, Providence provides
community benefit funds to its
DENT partner organization, Better Health Together, to pay DENT
community health workers. If
patients lack medical insurance,
Providence staff members will help
them apply for dental insurance.
By working with community partners on all aspects of the DENT
plan, Providence hopes to significantly improve health care for the
people of eastern Washington.
In one year, the DENT program
had remarkable results:
The number of dentists accepting Medicaid patients in the region
increased from 22 to 55.
THINKSTOCK
pend a day in the emergency
department at any city hospital and you are likely to
see someone come in with
a dental emergency. Because most
emergency departments are not set
up to provide dental care, doctors
usually can provide pain relief and
little else.
Providence caregivers in Spokane wanted to do more for these
people, many of whom have no
dental insurance and are unable to
afford dental care on their own. In
its research, Providence found that
dental issues, which often lead to
other serious illnesses, were the
fourth most common reason for
low-income and homeless patients
to visit its hospital emergency
departments. Working with Better
Health Together in eastern Washington, the Community Cares:
Dental Emergencies Needing Treatment program (DENT for short)
was born in July 2014.
The group is attacking the problem in multiple ways:
Attracting more dentists in the
area, particularly those who will
accept Medicaid patients.
Systematically referring emergency department patients to
dentists.
Coaching patients on
what to expect during a dental
appointment.
Patients in emergency departments at Providence Sacred Heart
Medical Center & Children’s
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The number of follow-up emergency dental appointments each
month increased from 51 to 312.
The percent of patients referred
to the program with scheduled dental appointments increased from 26
to 92 percent.
Nearly all patients who were
referred and scheduled for dental
appointments by DENT did not
return to the emergency department for dental pain or infection,
therefore saving significant dollars
in avoidable hospital emergency
department use.
MANY OPPORTUNITIES
TO TOUCH LIVES
DENT is just one example of the
many creative and unique community programs for which Providence
Health Care provides financial
support as part of its community
benefit program.
Each year, Providence Health
Care directs its community benefit
contributions to treat patients and
their families, connect families with
preventive care, fill gaps in community services and offer hope in
difficult times. The goal is to reach
beyond the walls of its hospitals and
doctor offices to touch lives when
relief, comfort and care are needed
and to improve the overall health of
the communities it serves.
Providence Health Care’s
2015 Community Benefit Funds
Providence’s total community benefit for the eastern Washington region was
$103 million, maintaining a community commitment to serve those who
are poor and vulnerable.
CATEGORY
AMOUNT
Unfunded portion of government-sponsored
medical care
$68,051,893
Free and discounted medical care
$13,121,199
Community health, grants and donations
$2,891,973
Education and research programs
$12,321,726
Subsidized services
$7,018,513
TOTAL COMMUNITY BENEFIT
$103,405,304
Includes Providence St. Joseph Care Center & Transitional Care Unit, Providence Emilie Court Assisted Living
and Providence VNA
U
nfunded portion of government-sponsored medical care ($68M)
Answering the call of our Mission to care for everyone, Providence serves a
large and growing population of Medicaid patients to ensure access to care.
The unfunded portion of Medicaid is the difference between the cost of care
and what is paid by the government. Providence financial counselors helped
more than 3,500 community members across Washington, including Spokane
and Stevens counties, enroll in the coverage that best met their needs.
Free and discounted medical care ($13.1M)
Providence provides free and discounted care for patients who are uninsured,
underinsured or otherwise unable to pay for their health care.
Community health, grants and donations ($2.9M)
Providence partners with community organizations to identify the community’s
greatest needs, then uses this research to strategically invest in organizations and
programs like the Community Cares: Dental Emergencies Needing Treatment
(DENT) program that address health in new ways.
E
ducation and research programs ($12.3M)
$70
million
Community contributions
by Providence Health Care
above and beyond its tax
exemption as a not-for-profit
organization
By providing funding for health-related education and research programs,
Providence is helping increase the number of students and medical residents
who stay in the region after completing their education. It’s an investment in
the future health of our community. In addition, Providence community benefit
supports the Providence Medical Research Center, which has hundreds of active
research projects bringing clinical trials to thousands of people each year.
S
ubsidized services ($7M)
Subsidized services such as the Women’s Health Center, which provides health
care to low-income women, are provided despite a financial loss, because they
fulfill critical care and service gaps in the community.
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FOUNDATION
Buried
Treasure
LEAVE A LEGACY
Help provide health care for future
generations by including Providence in
your estate plan. Call Providence Health
Care Foundation at 509-474-4594 or visit
phc.org/giving to learn how.
One man’s unearthed glass bottles are
transformed into art at Sacred Heart.
GARY MATOSO
I
n 1986, landscaper Brian Martin rode his bike past some
men who were digging at an old dumpsite near the Spokane River, just east of Division Street. Intrigued, he
decided to find out for himself what might lie beneath the
soil’s surface. After finding an old whiskey crock in perfect
condition, Martin was hooked.
Over the next 20 years, Martin excavated more than 15,000
discarded glass bottles—many of them medicinal—from unofficial Spokane dumps. Most came from the site where the Riverpoint Campus is now located.
Thanks to the help of local
“Who needs to
artists Valerie Wahl and Laura
travel thousands
Thayer, a small fraction of
his collection has been transof miles to find the
formed into an art piece,
new? The most
which hangs in the recently
mysterious place
remodeled Cardiac Intenon Earth is right
sive Care Unit at Providence
Sacred Heart Medical Center.
beneath our feet.”
With inscriptions such as
—William Bryant Logan
“Dr. Pierce’s Golden Medical Discovery,” “Hamlin’s
Wizard Oil” and “The Great Dr. Kilmer’s Swamp Root,” these
distinctive bottles are a reminder of the various medical “curealls” used by Spokane’s early residents. Most of the bottles are
estimated to be from the late 19th and early 20th centuries, and
they represent Spokane pharmacies as well as drugstores in
other eastern Washington towns.
Martin’s excavation technique: dig a hole as deep as 20 feet,
descend using a flexible ladder, then dig laterally upon finding a
vein of material. He would haul up buckets of dirt, hoping they
would reveal unbroken treasures.
Health challenges eventually halted Martin’s work. He received
cancer treatment at Sacred Heart in 2012 and, moved by his experience as a patient, bequeathed a portion of the proceeds from
the sale of his home to Providence Health Care Foundation.
Martin died in late 2014, but his legacy is reflected in the colorful medicinal bottles on display in the CICU.
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M.D. SPOTLIGHT
Frame Work
Your bones support your body.
Meet the man who supports your bones.
Q: What fascinates you most about bones?
A: Bones are able to heal even after great trauma. They
make me look good at times; when a bone is injured, my
job is to give it the support it needs to heal properly, but
Mother Nature actually does a lot of the work for me.
Q: What’s it like to work in both orthopedic
trauma and oncology?
A: There is urgency to both of these specialties. Nobody
plans to break a hip or to have a tumor discovered in
his femur—these things just happen, and they have
to be taken care of right away. With trauma, I have to
be ready every day to fix almost any major bone in the
body, from the wrist to the scapula (shoulder blade)
and from the pelvis to the toes. With cancer, there is a
great deal of anxiety that goes along with the diagnosis,
so I try to see patients as quickly as possible to help put
them at ease.
Q: What’s new in your practice?
A: In oncology, we’re developing an integrated team to
provide specialized care for patients facing sarcomas
and orthopedic tumors. That’s not offered in many
places—I’m the only orthopedic oncologist between
Seattle and Minneapolis. In trauma, we now have five
orthopedic trauma specialists with deep expertise in
handling the most challenging fractures. We have a
surgeon who specializes in pediatric orthopedic trauma
(Jim Dunlap, M.D.), a new partner who focuses on
SEE THE BONE AND JOINT EXPERTS
Sacred Heart’s orthopedic physicians and surgeons
are here to help with your bone and joint problems.
To make an appointment at Providence Orthopedics,
call 509-838-7100, or visit washington.providence.
org/clinics/providence-orthopedics to learn more.
ANDREW HOWLETT, M.D.,
orthopedic surgeon specializing in
orthopedic oncology and orthopedic
traumatology, Providence Orthopedics
upper-extremity trauma (Jeremiah Clinton, M.D.),
a surgeon focused on complex joint reconstruction
(Chad Harbour, M.D.), and a multi-ligament knee
injury expert (Soren Olson, M.D.). We’re also one of
the only centers in the region with the expertise to
treat pelvic fractures. Most people probably don’t realize how sophisticated the care is here in Spokane. I’m
really proud of the work we do.
Q: What gives you the most satisfaction
in your work?
A: I can’t cure every cancer or prevent every disability,
but my patients understand that I’m doing everything
I can to offer the best care possible, and that I truly care
about how they do. Whether they’re here for an ankle
fracture or a malignant tumor, I hope I make their journey as smooth as possible.
Q: What do you do in your downtime?
A: I’m having a lot of fun being a daddy. Before children,
I shot archery and hunted, but now I really enjoy spending time with my wife and our 3-year-old son, and I’m
excited that we have another one on the way.
Nobody plans to break
a hip or to have a tumor
discovered in his femur—
these things just happen,
and they have to be taken
care of right away.
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CALENDAR
SEE MORE EVENTS
Check out the full
calendar of events at
phc.org/heartbeat.
Hover over “Health
Resources,” then choose
“Calendar of Events.”
Classes, Events
and Activities
Summer 2016
INHS COMMUNITY
WELLNESS CLASSES
Visit courseregistration.inhs.org
for dates, times and locations for
these summer offerings.
BABY-SITTING BASICS
This hands-on course for youths
ages 10 to 15 is designed to give
the skills and training young
baby sitters need to be safe and
successful.
GROUP LIFESTYLE
BALANCE PROGRAM
Make lasting changes to reach
your healthy-lifestyle goals.
You’ll meet weekly with a trained
lifestyle coach and receive the
support and tools you’ll need
for success. Offered in person or
through a live, interactive webinar.
HONORING CHOICES
CLASS (FREE)
Join us for this advance-care
planning workshop. Start those
important conversations about
your goals, values and beliefs for
your future health care choices.
INBODY TESTS
The InBody machine gives you
a complete picture of your body
composition.
LUNCH AND LEARN (FREE)
Join us on your computer, tablet
or smartphone for fun, interactive
presentations on varying health
and wellness topics, on the
third Thursday of each month.
MEDGEM TESTS
Get a metabolism analysis to
fi nd out how many calories your
body uses per day. The MedGem calorimeter is the perfect
test for anyone trying to lose,
maintain or gain weight.
QUIT FOR GOOD:
A TOBACCO-CESSATION
PROGRAM (FREE)
This four-week program is
available via a live, interactive
webinar.
8.3 mil
The number of people who
finished a 5K race in 2014
HEART TO START
Join Providence Spokane Heart Institute and
walk or run a 5K. Train every Wednesday, June
through July, 6–7 p.m., at the Spokane Community College track. Go to hearttostart.org to
sign up or learn more.
5K Run: Saturday, Aug. 6
Starting at INHS Wellness Center
501 N. Riverpoint Blvd., Spokane
THINKSTOCK (2)
TEE UP FOR
TEAM ST. LUKE’S
Proceeds from this golf tournament benefit Team St. Luke’s, a
recreation program for youths and
adults with physical disabilities.
The event is Thursday, Sept. 22, at
Kalispel Golf and Country Club in
Spokane. To sponsor or play, call
509-474-4917.
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HEALTH TIP
Eat More Water
Looking for ways to stay hydrated? Fill up your plate.
T
welve glasses. Ninety-six
ounces. A half-gallon.
Recommendations for
daily water intake may
vary, but consuming enough to keep
your body hydrated and healthy
might make you feel, well, waterlogged. Fortunately, the foods you
eat account for about 20 percent of
your total H2O needs, according to
the National Academy of Sciences.
GET A GAUGE
Because it’s not easy to know how
much water you’re getting from
food, it’s best to rely on cues from
your body to tell you whether
you’re drinking enough.
First is thirst. If you’re thirsty or
have a dry mouth, you have at least
mild dehydration, so drink up. Better yet, sip water and eat hydrating
foods (see chart) throughout the
day so you don’t even reach the
point of thirst.
Also, check your urine. It should
be clear or very light yellow. If yours
is any darker, you’re not getting
enough fluids.
Other signs of mild to moderate
dehydration include not urinating
much, headache, muscle cramps,
and dry, cool skin.
HOW MUCH WATER
DO YOU NEED?
Ask your provider for a
recommendation of water intake
based on your unique needs. For an
appointment, call 509-232-8138.
DEFEAT DEHYDRATION
Just as water and some foods
hydrate, other drinks and foods
dehydrate. For example, caffeine
and alcohol are diuretics, meaning
they cause your body to lose liquid.
The best beverage for hydration
is—wait for it—water. If you need
your coffee or tea in the morning,
enjoy your cup along with a glass
of water. Doing so will help replace
the fluids lost by the body because
of the caffeine.
Does water bore you? Add natural flavor! Simply squeeze fresh
fruit juice into your glass or use
the drippings from sliced melons
or citrus fruits. Another option
for subtle flavor is to chop your
favorite fruits or a vegetable like
cucumbers and place them in an
infuser water bottle.
High Water Marks
Here are the top foods to eat to help you
stay hydrated:
FOOD
WATER CONTENT
Iceberg lettuce
95%
Celery
Cucumber
Radish
94%
Tomato
Green pepper
Cauliflower
Grapefruit
Watermelon
93%
92%
Spinach
Starfruit
Strawberries
Baby carrots
Cantaloupe
91%
90%
Source: USDA National Nutrient Database
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NON-PROFIT
ORG
US POSTAGE
PAID
HEART BEAT
Providence Sacred Heart
Medical Center & Children’s Hospital
101 W 8th Ave
Spokane, WA 99204
ROLE MODEL
Comforter
Volunteer escort Tami Walsdorf says,
“Never underestimate the power of a warm blanket.”
Walsdorf helps patients and families find their
way to and from the exam rooms in the bustling
emergency department at Providence Sacred Heart
Medical Center & Children’s Hospital. But the most
important part of her job is to provide a little comfort
while they’re there.
“Everyone who comes to the emergency department is vulnerable,” Walsdorf says. “Everyone here is
outside their comfort zone. We try to offer them a little
comfort, whether that’s by holding their hand or by
offering them a warm blanket.” The kindness of the
gesture never fails to soothe. “People instantly feel
hugged when you wrap a nice, warm blanket around
their shoulders,” she says.
In her volunteer work, Walsdorf finds herself constantly inspired by her patients. “There’s a lot of courage
in this world,” she says. “You see it every day in the
emergency department.”
Tami Walsdorf helps patients
and families find their way
and also feel at ease.
If you’re interested in being a volunteer at
Providence Sacred Heart Medical Center
& Children’s Hospital, call 509-474-3166,
or go to phc.org and click “Giving.”
GARY MATOSO
WANT TO VOLUNTEER?
Our Mission is to reveal God’s love for all, especially the poor and vulnerable, through our
compassionate service. Our values are respect, compassion, justice, excellence and stewardship.
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