Colorectal Cancer Screening, on the Path to Success.

On Wednesday, October 28, CHAS welcomed visitors from the American Cancer Society, Great West Division. CHAS received a grant this year through the American Cancer Society, with funding from the Anthem Foundation, to improve the colorectal cancer screening rate at CHAS Maple Street Clinic. During the first six months of the grant, Maple Street’s staff have increased their clinic’s screening rate from 8.8% to 16.7%, with a goal to achieve 25% by April 2016.

Audrey Fine, Health Systems Manager, Primary Care, Great West Division, American Cancer Society, Inc., discusses colorectal cancer screening efforts with CHAS Maple Street Clinic providers and Medical Assistants

Audrey Fine, Health Systems Manager, Primary Care, Great West Division, American Cancer Society, Inc., discusses colorectal cancer screening efforts with CHAS Maple Street Clinic providers and Medical Assistants

Oftentimes patients schedule a medical visit to address an immediate need, such as congestion or fever. However, a critical component of primary care is prevention. CHAS staff actively encourage patients to receive appropriate cancer screenings. Annual tests can detect cancer of the colon, cervix, and breast at early stages.

Audrey Fine with the American Cancer Society concluded her remarks with CHAS Maple Street Clinic medical staff by sharing a very appropriate quote that beautifully captures the impact of preventative health care:

“The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.”

 

–Donald M. Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement. Excerpted from Dr. Berwick’s plenary address at IHI’s 16th Annual National Forum on Quality Improvement in Health Care (December 2004).

 

Thank you to the American Cancer Society and Anthem Foundation for their generous financial contribution, and the Cancer Society’s excellent ongoing technical assistance, to help improve access to preventive health care for CHAS patients.

Hello November! Tips for a festively healthy fall.

Gobble, Gobble!

The turkey has spoken and November is in!

Turkey

  1. Brr, It’s Cold Out There

As colder weather approaches, remember to layer up and keep warm. Use earmuffs to protect your ears, and gloves or mittens to protect your hands as flu season is very much upon us. If you haven’t already received your flu shot, stop by your local retail pharmacy or doctor’s office and keep those germs at bay by continuing to wash your hands throughout the day. No one likes a sick turkey!

  1. Be Thankful

Thanksgiving is right around the corner. We all love a holiday meal with our families – a warm turkey or ham just out of the oven, mashed potatoes covered in creamy gravy, stuffing and don’t forget those veggies – just remember to show your thanks to your body by maintaining a healthy diet through the holidays.

  1. Friendship Never Gets Old

As the days get shorter with the new season, it’s important to remember to use the buddy system when walking or biking to and from places. Carpooling is also a great way to save on gas and help keep the environment healthy! Make new friends, and keep the old.

  1. Get Up and Get Out

Stay healthy by getting regular exercise and spending time with family. Go outside during half-times and toss the ball around; do a little jig when your team makes a touchdown; or even join your family on a stroll through the park while you pick out your favorite leaves. Whatever it may be, doing 30 minutes of regular exercise will keep your mind, body and heart happy and strong!

  1. Take Care of Your Teeth

As you just spent weeks eating all of your Halloween candy, your teeth are certainly feeling it. Be sure to brush and floss at least twice daily, and especially after eating that delicious kettle corn you’ve been looking forward to. Avoid chewing on kernels as they can get stuck in your gums and cause discomfort, tooth breakage, and sometimes even infection.

Author: Katiah Peterson

BE A CHAMPION! PLEASE IMMUNIZE!

Community Health Association of Spokane Valley Clinic

It is National Vaccine Awareness Month and that means… it’s time to talk about immunizations.

I will keep this short and sweet as we want to stay focused. Please come in and talk to a provider at any time if you have any questions or concerns about vaccination so we can discuss why they are safe and so important for you, your family and your community.

 

  1. Starting in September CHAS will have flu shots available for anyone who comes to any of our clinics. We will be here and ready to go to help keep you healthy thus If you have an appointment prior to the start of September you can come back in at anytime for a nurse visit to get your annual flu vaccination. If you are wondering “Do I need a flu shot” this post from a nurse who questioned her need for the vaccine while pregnant  may be just for you. http://www.voicesforvaccines.org/nurses-vaccinate-to-protect-families-and-patients/

 

  1. Please ask our medical staff at every visit if you need any vaccines. We should check every time you come in so we take every opportunity to keep you protected and healthy. If you don’t ask, who will? One question and 30 seconds of your time could save your life or the life of someone you love.

 

  1. For Teens- In 2014, nationally, 4 out of 10 teen girls and 6 out of 10 teen boys had not even started the HPV vaccine (Gardisil) series making them vulnerable to cancers caused by HPV. Your teenager also needs to shots to protect them from meningitis and a TDaP to protect them from tetanus and Pertussis (whooping cough). Please start asking about HPV and if your teen starts this vaccine series, please remind them to finish it.

 

  1. Be a Champion! This month, I encourage everyone to be a champion for vaccine Please look up just one vaccine, any one of your choice and become passionate about it for your community. Be familiar with the results of getting such an infection and how not getting immunized can impact your community. Please go to http://www.immunize.org/vaccines/ this site will give you discussion points about each illness, pictures of what the illness looks like, and tons of resources to access so you can learn everything you need to know about vaccination. Let’s work together to make our community as safe as it can be. Please look at this resource  http://www.voicesforvaccines.org/ too as it helps you see each illness through the eyes of families and individuals affected by each preventable illness.

National Health Center Week: Aug 9-15

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This year’s National Health Center Week theme is Celebrating Our Legacy, Shaping Our Future. The theme is timely, as Community Health Centers across the nation are celebrating the program’s 50th anniversary. Each year health centers celebrate National Health Center Week to recognize the important work accomplished in communities where patient-led organizations are continually removing barriers to primary and preventive care.

CHAS is one of more than 1,300 Community Health Centers. Founded in 1994 in response to demand for healthcare services for low income and uninsured individuals in Spokane, Washington, CHAS has grown steadily from a small Health Care for the Homeless clinic to its current configuration of 11 health center sites serving more than 55,000 patients throughout Eastern Washington and Northern Idaho.

A look back at recent CHAS accomplishments provides a glimpse of how our organization is helping to shape the future of primary health care access in our community:

  • In May 2013 the American Pharmacists Association Foundation recognized CHAS nationally with the Pinnacle Award for CHAS’s pharmacist-medical team integration that has resulted in safer and more effective medication use for patients.
  • CHAS opened a clinic in Moscow, Idaho – Latah Community Health – in June 2013. Primary medical, behavioral health, and pharmacy services are provided at this site where 55% of patients are uninsured.
  • Since the state health insurance Marketplaces opened in October 2013, CHAS in-person assistors have helped enroll more than 27,000 individuals. Even with increased insurance coverage, during CY2014 CHAS provided more than 12,000 uninsured patients access to over 26,000 visits.
  • In August 2014 CHAS received a competitive patient-centered medical home capital grant to renovate CHAS’s Denny Murphy Clinic in downtown Spokane. This site serves as the home base for CHAS’s homeless outreach program. Modernizing the space to increase provider collaboration will lead to improved patient outcomes for Spokane’s most vulnerable residents.
  • CHAS’s approach to effectively integrate behavioral health services in the primary medical setting was recognized through a competitive national grant award in July 2014.
  • CHAS was recognized by the U.S. Health Resources and Services Administration in December 2014 as a “National Quality Leader”. This prestigious recognition was only designated to 57 health center organizations out of more than 1,300 health centers nationally. National Quality Leader health centers are the highest performers compared with national standards and benchmarks in key clinical areas.
  • In March 2015 CHAS opened a new site – Perry Street Clinic – in Spokane’s East Central neighborhood. During the first year of operation, the clinic is projected to provide over 14,000 encounters for more than 4,600 patients.

Looking back at these highlights, each accomplishment demonstrates how CHAS continues to implement the organization’s mission: to improve the overall health of the communities we serve by expanding access to quality health and wellness services. Over the past 50 years health centers like CHAS have been increasing access to affordable, high-quality, cost effective health care to medically vulnerable and underserved people throughout the United States. Like CHAS’s recent award and grant recognitions, our nation continues to recognize the invaluable contributions of the health center program. In April 2015 Congress passed bi-partisan legislation extending funding for Community Health Centers for the next two years. Politicians may be divided over our nation’s health care system, but they are united in support for health centers.

Community Health Association of Spokane Valley Clinic

Community Health Association of Spokane Valley Clinic

When I think of health centers, so many words come to mind: access, quality, advocacy, passion, patient-centered. I can’t sum up health centers’ legacy in just one word. Reflecting on the health center movement, it is clear that health centers have always been so much more than a doctor’s office. Yes, our patients receive medical care. But patients also get help enrolling in health insurance; they are given a bus ticket if they need help getting to their appointment; they are connected with community partners for food, clothing and housing assistance; we provide translations services; our amazing outreach workers walk outside in all weather conditions to connect with patients who don’t have a place to call home. I think the health center legacy is that we don’t just treat our patients, we fight for them. We fight for their right to access high-quality health care. We fight for continued funding for the health center program so that we can continue to see our existing patients and expand access to new patients. Regardless of a patient’s background or insurance status, we will continue to do everything we can to provide whole-person health care. What an amazing legacy to be a part of.

As we celebrate National Health Center Week 2015, I offer a humble ‘thank you’ to everyone – patients, volunteer board members, providers, advocates, elected officials – who has been part of this legacy. Here’s to the next 50 years.

– Lindsey Ruivivar, CHAS Public Policy and Development Manager

Wildfires and Children’s Lungs

With recent wildfires in the area you may be wondering what this means for your children. The smoke from wildfires contains a mixture of gasses as well as fine particles of burnt material. These can irritate your eyes, nasal passage, as well as your lungs.

Children’s airways are still developing and are much smaller than adults, and therefore are at a higher risk to be affected by poor air quality. Children breathe in more air per pound of body weight and they also tend to be more active which also leads them to breath in more air.

via Krem

via Krem

When the air quality is poor it is important to avoid going outside. If this is not possible, limit the amount of activity that is done outside. Anytime your child runs and plays, they begin to breathe faster, leading to more exposure of the dirty air to their sensitive developing airways.

Keep windows and doors shut. Make sure to run the air conditioner on the recirculate setting to prevent the dirty air from coming inside. A simple mask is not helpful. The small particulates that are present in the smoke are small enough to be allowed through a paper mask. It is also important to keep track of the air quality index where you live. You can check this out at www.spokanecleanair.org to find out the current air quality.

Symptoms of exposure to wildfire smoke can include runny nose, burning eyes, cough, shortness of breath, and nausea. If your child has asthma make sure to have their rescue inhaler available at all times since the smoke can trigger an asthma exacerbation. If any of these symptoms persist or don’t improve after going inside and resting, please seek medical care.

by Ashlee Mickelson, Physician

The Itch of a biting insect: How do I protect my child from them?

With the hot wet days and nights of summer come the biting insects, especially in those early evening hours when eating outdoors and enjoying the gentle weather of a summer evening.

Children are at risk for multiple types of insect bites; biting flies,  mosquitoes, and ticks to name a few. The best way to protect your child from these pesky critters is to apply a repellent containing DEET.

According to the AAP (American Academy of Pediatrics) DEET remains themost effective in repelling these biting insects. It can safely be applied by an adult to the children’s clothing and exposed skin.

Application of the product is best done in an open area. DO NOT spray this directly onto the child’s head and face, instead spray into the adult’s hand and rub onto the face/ears/neck avoiding contact with the eyes.  Follow directions on timing for re-application typically anywhere from 2 to 5 hours depending on the concentration of DEET in the repellant being used.

A common question heard can be: Is it safe for my young child?

The answer is simply:  Yes.  A repellent containing DEET of no more than 30% is safe for application to an infant older than 2 months of age when safely applied by a responsible adult.  Remember to always wash the child’s skin at the end of the day to remove the product to avoid irritation and wash their clothing.

Avoid use of scented lotions/fabric softeners/detergents as these can attract those pests more.  Dressing a child in floral prints and bright colors also can attract the pests.  It’s a good idea to protect the child’s head/ears by having them wear a hat with a wide brim.  Using mosquito netting around strollers and those portable cribs also can help protect the child from those pesky flying insects.   Avoiding stagnant water is a good idea as these are frequently breeding grounds for mosquitoes.

BugBite_0

Despite your best efforts your child ends up with an itchy bite, what next?

There are many over the counter products designed for this. Some good options to use are: a topical cream such as Calamine Lotion, Hydrocortisone Cream, or Benadryl Cream.  Another simple product is to mix baking soda and water into a paste and apply to the bite.

Remember if ever there is a question your Pediatrician is just a phone call away.  🙂

Enjoy your summer stay safe and protected!!

Daniel Moorman, MD

8 reasons for men to get screened…

Community Health Association of Spokane Valley Clinic

It’s Men’s Health Month, and an important part of staying healthy is engaging in routine health care maintenance (getting the screening you are due for). At age 18 men should be screened for high blood pressure, this can be accomplished quickly by an MA in provider’s office.

Men over age 18 should also be screened for depression, this can be accomplished by a quick questionnaire in the office.

If you have smoked 100 or more cigarettes in your lifetime, you should get screened once for abdominal aortic aneurysm (AAA). AAA is a bulging in your abdominal aorta, your largest artery. An AAA may burst, which can cause dangerous bleeding and death.

Annual colon cancer screening can be done with a take home stool test called the IFIT, screening should begin at age 50.  If you have a family history of colorectal cancer, you may need to be screened earlier. Colonoscopies can also be used and if normal may need to be done only every ten years.

Get screened for diabetes (high blood sugar) if you have high blood pressure or if you take medication for high blood pressure.

Get screened one time for HCV infection if you born between 1945 and 1965 (Boomers), have every injected drugs or used drugs intra-nasally, or received a blood transfusion before 1992. If you are a current injecting drug user you should get screened on a regular basis.

If you are 35 or older, have your blood cholesterol checked regularly with a blood test. High cholesterol increases your chance of heart disease, stroke, and poor circulation. Talk to your doctor or nurse about having your cholesterol checked starting at age 20 if you use tobacco, are overweight or obese, have diabetes or high blood pressure, have a history of heart disease or a man in your family had a heart attack before age 50 or a woman before age 60.

Prostate cancer screening is no longer routinely recommended, but talk to your provider if you are having symptoms for frequent urination, urgency of urine, decreased urine stream or hesitancy of urine.

It can be difficult to make the time to get a screening, but we try to make it easy. It’s never too late to start the conversation, and it will always be worth your time to make that appointment. One appointment, screening, or check up could make all the difference. It’s time to take control of your health.

 

Article by Bill Bomberger, Deputy Medical Director

Love Them. Protect Them. Immunize Them.

Community Health Association of Spokane Valley Clinic With it being National Infant Immunization Week (NIIW), it is a great time to make sure we are promoting, encouraging, educating and reminding parents to have their children immunized. If infants are not immunized the consequences can be severe and in some cases the preventable diseases can even be fatal. It’s easy for us to believe that these preventable diseases are a thing of the past but, as we have seen with the recent cases of measles and pertussis in our community, these diseases still exist.

CHAS offers immunizations through the Vaccines for Children’s program. The program is federally funded and provides vaccinations for children through the age of 18 at no cost.

Infant immunization protects from vaccine-preventable diseases throughout their life and offers protection against the 14 diseases below:

Hepatitis A – A virus that causes liver infection.

Hepatitis B – A virus that causes liver infection. In some cases, Hepatitis B remains in the liver for life and can lead to further complications including liver cancer.

Diphtheria– A potentially fatal condition in which the airways can become blocked, restricting breathing. Also associated with heart problems and paralysis of throat muscles needed for swallowing.

Hib Disease (Haemophilus Influenzae Type b) – A serious disease which can cause meningitis and pneumonia.

Pertussis (whooping cough) – A potentially fatal bacteria that is very contagious with symptoms including persistent violent coughing and choking which can last for weeks. It is particularly worrisome in infants and young children.

Pneumococcal Disease – A potentially fatal bacterial infection which can cause pneumonia.

Polio – A viral infection with possible symptoms of fever, pain, sore throat, head ache and in some cases paralysis and death.

Influenza (flu) – A bacteria that can cause respiratory complications and can result in hospitalization or death. Infants, young children, pregnant women, and the elderly are at higher risk of complications related to influenza.

Measles -A potentially fatal disease caused by a virus whose symptoms include cough, fever and rash. In severe cases, measles can cause brain damage, pneumonia, and seizures.

Mumps – A virus that causes headaches, fever, pain and swelling in the salivary glands.

Rotavirus – A virus that causes severe diarrhea and vomiting which usually lasts days. Complications can include severe dehydration and possible hospitalization.

Rubella (German Measles) – A virus with of fever, rash and swollen glands. A pregnant woman with rubella is at greater risk of miscarriage and her baby may have physical defects including loss of sight or hearing and heart problems.

Tetanus (Lockjaw) – A condition caused by bacteria, which affects the muscles, causing them to spasm. A person may experience headaches, increased blood pressure, elevated body temperature and muscle pain. The jaw muscles may spasm causing the jaw to ‘lock’.

Varicella (Chickenpox) – A highly contagious virus whose symptoms cause blister-like rash, sever itching, fever. Can cause severe complications that can lead to hospitalization.

So let’s do our part in making sure that parents and caregivers are educated on the importance of vaccinating and protecting their children against vaccine-preventable diseases.

References:

www.cdc.gov

www.immunize.org

 

-By Shereen Martin, Medical Support Supervisor

Meet your provider: Deena Solomon

CHAS Dr. Solomon

I recently sat down with Perry St. Clinic’s pediatrician, Deena Solomon to get to know a little bit more about what makes her so great to work with.

Tell us about yourself…

My name is Deena Solomon, Pediatrician at the new Perry St. clinic! I am originally from New York, I grew up in Staten Island, went to medical school in Tel Aviv University in Israel, and did my residency in the pediatric department at King’s County hospital and University Medical center of Brooklyn, New York. After that, I worked as a pediatrician for 3 years in an outpatient clinic Staten Island Hospital. We moved to Spokane 6 years ago and have been a stay at home mom up until I started working at CHAS, about 6 months ago.

What initially drew you to Pediatrics vs any other branch of medicine?

CHILDREN! I love kids, I think that kids are extremely honest, which makes them so fun to work with. They always tell the truth the way they see it, and I always appreciate that about them.

Do you have children yourself?

I have 3 kids, a 7 year old son, and 2 daughters, 5 and 4 years old.

Do you have any special connection to the Perry District?

I live on the South Hill and I frequently visit the Perry District. I am excited to be in a place close to where my kids are attending school, I’m familiar with District 81 schools, sports available at those schools, parks to play at nearby, and things to do in nearby. I’m excited to relate to families in Perry and to be more conversational about what’s going on in their neighborhood. I’m especially excited to start building more relationships with families in the area.

When you aren’t taking care of kids, what are you doing?

(Laughs) When I’m not taking care of kids at CHAS, I’m taking care of my own kids at home! So, lots of outside play time. Right now, it’s all about basketball. My two oldest are involved playing at the YMCA, so most weekends are spent practicing and playing in games. But, now that the weather is getting good, it’s also going to be more about riding bikes and being out at the playgrounds. It’s basically all kids all the time.

What do you listen to get you excited for the day?

I listen to comedy talk shows, but I also enjoy quiet drives to work, since I’m always around kids at work and at home. The 10-15 minute car ride on the way here is the best way to get me prepped for the day.

What do patients/co-workers like about you?

I am pretty easy to speak to, and I think I am a good listener and people appreciate that about me. Especially parents with concerns about their children.

What’s the best advice you’ve ever received?

That’s a really easy one, one of my mentors during my rotations was a big inspiration to me, he always made a point of reminding me, “less is more when it comes to pediatrics.” When there is a question of whether you should do an invasive test, intervention, blood test or x-ray, it’s usually best to avoid it. Typically best for kids not to go through the trauma of excessive testing. He always said a children’s place is at home, if there is any way you can get a kid at home vs. in the emergency room or in the hospital for an extended time, that’s where they should be.

Doc McStuffins or Jake and the Neverland Pirates?

I love Doc McStuffins! The show promotes all the values I would want to promote in my own kids. They show that both male and female roles aren’t predetermined and you can do anything you put your mind to! I also appreciate the diversity of the show…plus she’s a doctor!

What makes you unique?

I think my life experience, growing up in New York, my parents emigrating from Eastern Europe, living in Israel, traveling a ton in my life, and marrying someone with a very different background than my own (because my husband is Middle Eastern). My take on everything is a little unique because of all the different experiences and backgrounds influencing my life and it gives me a unique perspective.

What do you enjoy most about working at CHAS?

I really like that everyone is really working towards the mission of CHAS, (The mission of CHAS is to improve the overall health of the communities we serve by expanding access to quality health and wellness services), and it’s really been a pleasure for me to see that everybody I have met has a really positive outlook on what they are doing and working towards that mission. I love the fact that CHAS has been around for 20 years and we are making a big difference in our community and we are continuing to expand to all areas of our community. I’m really happy to be part of that.

Deena can’t wait for the Perry St. opening on March 23rd!

 

By Matt Grebe

Multiple Sclerosis Awareness Month

Did you know March is National MS Education and Awareness Month? Multiple sclerosis affects more than 2.5 million people worldwide and is an unpredictable disease.  I recently sat down with CHAS’ chief Medical Director, Bill Lockwood to learn more about MS and how it affects the body.

What is MS?

A disease which affects mostly young adults – beginning at ages 20-40 and involves the brain and spinal cord. The underlying cause is a patient’s own immune system destroying the “myelin sheath” or insulation which surrounds nerves in the brain and spinal cord. This affects nerves ability to conduct electric signals as usual.

Who can get it?

It is usually diagnosed in people 18-40 years old and affects women approximately 3 times as much as men. There seems to be some genetic predisposition as it more often affects people of Northern European descent and is more common in family members of MS patients.  There seems to be environmental factors as well since it affects people who live in temperate climates more often than those in very cold or very warm climates.

There is no government mandated reporting requirements so estimates of total incidence may be inaccurate but in 2002 it was estimated that 400,000 people in the US had MS.

Symptoms

The damage to the myelin sheath can affect any nerve in the brain or spinal cord so the symptoms are highly variable and tend to come and go (one of the requirements for diagnosing the disease are symptoms separated by space and time. In other words, two or more discreet episodes affecting different parts of the nervous system at different times, for example, double vision which resolves, followed by arm numbness, which ultimately resolves.

Some of the symptoms include fatigue – the most common symptoms, tingling, visual changes (including double vision) balance problems, nerve pain, swallowing difficulties, trouble walking (due to imbalance or ) leg weakness), constipation, bladder problems (incontinence, or inability to empty), and cognitive (thinking) difficulties.

The symptoms tend to come and go early in the course of the disease but as time goes on, most patients will develop progressive disease, the course is different in every individual who has it.

Diagnosis

The disease is diagnosed by history and physical exam followed by an MRI and blood tests. Sometimes a lumbar puncture (spinal tap) is required. Diagnosis is usually made by a physician who specializes in diseases of the nervous system (“neurologist”). Diagnosing the disease in its early stages allows early administration of “disease modifying drugs) which can slow the course of the disease.

Treatment

Overall care of MS is provided by a care team of physicians, nurses, mental health workers, and physical and occupational therapists. Besides social and physical supports,  there are a number of medications used to treat MS.

There are two main types of medications – disease modifying drugs, and drugs to treat symptoms.

The disease modifying drugs affect the immune system and slow the progression and reduce the number and severity of exacerbations (temporary worsenings) of the disease. There are currently 15 FDA approved disease modifying drugs and at least that many in clinical trials. A total of $870 million has been spent so far in MS research.

There are a number of drugs used to  treat the symptoms of MS (as described above) such as muscle relaxers, bladder relaxers, nerve pain medications, and steroids (used to treat sudden temporary worseinings of the disease).

by Matt Grebe and William Lockwood