GreenField Health’s Health Matters: July 2006
GreenField Welcomes David Shute, MD
The Cervical Cancer Vaccine: An Update
The Shingles Vaccine
Chantix for Smoking Cessation
Take Charge of Your Life and Your Family Will Follow
A Fibromyalgia Support Group
A Wish For A Healthy, Happy Summer
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GreenField Welcomes David Shute, MD
We are delighted to welcome David Shute, MD to the clinical and consulting practices at GreenField Health. As you may know, David has been very involved in the quality improvement community in his role as the Medical Director of Oregon’s Medicare-sponsored Peer Review Organization, OMPRO (now called Acumentra) for the past seven years, and prior to that in his leadership role with the HealthFirst Medical Group. In addition to these roles, over the past three years he has been active with the Oregon Medical Association, the Oregon Health Policy Commission and the Oregon Health Information Infrastructure Workgroup. His work in spearheading both the Oregon Diabetes Collaborative and the Doctor Office Quality - IT program run by OMPRO has made a tremendous positive impact for physicians and patients alike.
As our consulting practice has continued to grow, we have received many requests from across the country to assist with redesign efforts and healthcare IT initiatives, both of which have quality improvement and change management at their core. David’s focus and experience in these areas will make him a wonderful addition to the team. We’re very excited to have him.
Throughout his years of experience holding positions of leadership within healthcare, David has continued to practice as an internist within the community. He will join us officially in September, and he will be accepting new patients between now and then for appointment times beginning in late September. Please let us know if you or a friend or relative would like to establish care with David, and we will be delighted to facilitate the process.
The Cervical Cancer Vaccine: An Update
In our June Health Matters, we discussed the cervical cancer vaccine. This vaccine is called Gardasil and is a vaccine against human papillomavirus types 6, 11, 16, and 18. It will help protect against cervical, vaginal, and vulvar cancers. It has now been approved by the US Food and Drug Administration (FDA) for use in girls and women ages 9-26.
Gardasil is administered in three injections in the upper arm over a six-month period – the initial dose, followed by a second dose two months later, and a third dose six months after the first dose. The price of the vaccine from the manufacturer is $120 per dose, meaning that a full course of 3 doses will cost $360 not including the administration fee which will be approximately $30 per dose for a total cost of approximately $450. It is not yet clear which insurance companies will begin covering the vaccine, so it could be an out-of-pocket expense for many.
It is recommended that women who receive Gardasil continue to undergo cervical cancer screening (pap smears) per the standard routine.
We cannot predict how the use of the vaccine will change over time, whether additional doses will be required years after the initial dose, or whether it will ever be covered by insurance. Because of the expense and the approved age range, we will keep a limited amount on hand at GreenField starting at the end of the summer. If you would like to receive the vaccine or if you would like for it to be administered to one of your children in the approved age range, please call or email us so that we can assure that we have the vaccine on hand.
The Shingles Vaccine
The FDA has recently approved a vaccine for the varicella zoster virus called Zostavax. Varicella zoster is the virus that causes chickenpox in children, and shingles in adults. Shingles is also known of as herpes zoster or just zoster. The varicella zoster virus is in the herpes virus family.
After causing chickenpox in childhood, the virus continues to live in the body. Shingles is a reactivation of the varicella zoster virus later in life, presumably due to a reduction in the body’s immunity to the virus as we age. Shingles can occur in all age groups, but it is more common with advanced age with the peak incidence at age 75. Approximately 10-20% of individuals will experience shingles during their lifetime, and generally it is a single episode, although a very small percentage can have subsequent recurrences. It is estimated that there are between 300,000 and 600,000 cases of shingles in the US each year.
The problem with shingles is not the recurrence itself, but the complications that come along with it. Pain is the most common early symptom of shingles, and the most common long-term complication. With the initial infection, most patients describe a deep burning sensation in the involved areas. The area might also develop numbness or a pins-and-needles sensation. While most individuals have pain at the outset, about 8% of individuals have significant continuing pain in the involved area – this is called post-herpetic neuralgia, and it can be quite debilitating, lasting for months to years. When shingles recurs on the nerves that supply the face, it can also affect the eye, causing significant visual complications.
Zostavax was developed to reduce the occurrence of shingles and the accompanying complications. The goal is to use the vaccine to boost the body’s immunity to varicella zoster virus and thus prevent shingles. In the clinical studies done thus far, it appears to significantly reduce the likelihood of shingles, but it does not completely eliminate it. It also appears to reduce the incidence and severity of post-herpetic neuralgia.
Zostavax has only recently been approved, so its use will probably evolve with time. It is currently being recommended as a single booster dose at age 60 or thereabout. We do not know if the vaccine will be covered by insurance. The cost from the manufacturer will be approximately $150.
We will be recommending this vaccine for all individuals over 60 who have not had shingles. We will begin stocking the vaccine within several weeks, so feel free to call if you are interested in getting the vaccine.
Chantix for Smoking Cessation
Everyone knows that cigarette smoking is one of the worst things that an individual can do for their health. Cigarette smoking increases the risk for a wide number of cancers, heart attacks, strokes, emphysema, stomach ulcers, pregnancy complications, and lots of other undesirable medical conditions. However, cigarettes are terribly addicting, and quitting is not easy. Existing smoking cessation methods rely on counseling, hypnosis, going cold turkey, and the like. Medications that can be helpful include nicotine itself in the form of a nicotine patch or Nicorette chewing gum, and buproprion (Zyban), an antidepressant that can help with smoking cessation.
A more effective medication to assist with smoking cessation has been approved by the FDA, and will be available by the end of the summer. The drug is varenicline with the brand name Chantix. The price for the medication has not yet been established and it is not yet known if insurers will cover it. It is widely expected to cost about $3 per day – the approximate cost of a pack of cigarettes.
Varenicline was specifically designed to connect to nicotine receptors in the brain and to reduce the addictive aspects of nicotine as the smoker is weaning off of cigarettes. Several clinical trials demonstrate that, when combined with regular smoking cessation counseling, varenicline was more effective than placebo, cold turkey methods, and Zyban.
Additional help with smoking cessation can be obtained by calling the Tobacco Quit Line at 1-877-270-7867.
Take Charge of Your Life and Your Family Will Follow
Alcoholism
Graciously shared with us by Kathy Masarie, MD - Parent and Life Coach
Isn’t it interesting how we get ourselves into a stressful, unpleasant pattern, and then we keep doing it over and over again? Sometimes we can feel as though we are completely overwhelmed by the demands around us, as if we were water randomly finding our way down a hillside—at the mercy of every rock and tree we come upon.
Do you find yourself dreaming (perseverating even) on: “If they would just….stop fighting with their siblings…do their chores without prompting…do their homework right when they get home from school…have better manners…watch less TV…..then my life would be so good?”
The odds of this happening spontaneously are on par with your odds of winning the lottery. (Read: nearly zero.)
When our plans are at the mercy of others and their behavior, we can get stuck and be vulnerable. William Glasser, author of Choice Theory says it all, “The vast majority of family unhappiness is well-intentioned parents trying to get their kids to do what they don’t want to do.” Family life can become a never-ending battle of wills with no one winning the war.
As a parent and life coach, I say it can be different. It starts with a simple premise that: the only person whose behavior I can control is my own. So what are the steps that you can take proactively to have the life you want? It starts with really thinking about what you want you to do--not what you want them to do. If mornings are an everyday nightmare, what can be restructured to make it better? If exercise is important, make a date on the calendar and respect yourself enough to keep that commitment to yourself.
If you’re looking for a place to start, find places and times where conflict repeats itself. Begin by focusing your efforts there. Talk the issue over with your family. You may be surprised at the brilliance of your children when they are presented with a problem and given an opportunity to offer their opinion.
Top Five Tips for Great Parenting
1. Keep your tank full -- take care of yourself so you can be resourceful for your family. Balance time spent supporting and connecting with your family with exercise, fun, friends and following your own passions.
2. Listen to your children with complete respect – do you listen as though you actually really value what they have to say and want to know what they are thinking? If so, you can understand their perspective and truly connect with them.
3. Be in touch with the needs and feelings behind every behavior — this includes your own and your family members’ so that you can truly give empathy and understanding.
4. Let it go and lighten up – this is good advice for a lot of things: house orderliness, house cleanliness, frequency of laundry and shopping, having chores done a certain way, and anything where there are natural consequences that don’t involve you: don’t eat (get hungry) or don’t wear warm clothes (get cold). Sometimes those lessons that come about naturally are better teachers than a parent constantly harping about things.
5. Build a network of support – who can you call on when you need a friend or a helping hand?
a. Know the neighbors and the neighbors’ kids
b. Know your kids’ friends, teammates, classmates (and their parents!)
c. Form parent support groups and share challenges and successes with honesty (you may find out that everyone else is as dysfunctional as you are – or maybe even more so)
d. “It takes a village to raise a child” — so let the village in. Invite other adults to be involved in your kids’ lives. Most aunts, uncles, grandparents and close friends would love some extra time with the special young people in your life.
I leave you with the words of Crystal Boyd, but substituting “parent” for “dance:”
“Work like you don't need money,
Love like you've never been hurt,
And parent like no one's watching.”
Kathy Masarie MD, is a long time Friend of GreenField. She is also a pediatrician who started Balance in Life: Parent and Life Coaching. She offers ongoing seminars, classes and one-on-one coaching all in service of supporting people to find balance, fulfillment and connection in their lives. Visit www.kathymasarie.com or call 503-292-4162 for more information. You can contact coach@kathymasarie.com to get on her monthly email newsletter of upcoming events in the Portland area.
A Fibromyalgia Support Group
The Beaverton FMS Support Group provides monthly support group meetings for those with fibromyalgia and chronic fatigue. The purpose of the Beaverton FMS Support Group is to educate and motivate persons with fibromyalgia to understand their condition and work with their practitioners for successful self-management. For those who suffer from these troublesome ailments, this group may be worth checking out.
The meetings are at the Elsie Stuhr Center, 5550 SW Hall in Beaverton on the 3rd Tuesday of each month from 6:30-8:30 PM for the months between October and July (please note: they don’t meet in August or September). The contact person is Sue Starr at 503-625-4074.
Examples of their programs include “Fibro and Your Gut” presented by gastroenterologist Dr. Bill Bennetts, “Depression and Fibromyalgia” by Rebecca Ross, PhD from OHSU, and “Stretching – Key to Fitness” by Janice Hoffman, fitness instructor at OHSU.
A Wish For A Healthy, Happy Summer
Thanks as always to you for placing your trust in us, and for inviting us to come along on your healthcare journey. We hope that you’re enjoying our beautiful summer weather, and we’ll be back with more in August.
Please call or email if there is anything at all that we can do for you.
Thanks to our corporate partners
Kryptiq Corporation
Baker-Ellis Asset Management, LLC
Stahancyk, Gearing, Rackner, & Kent Law Firm
Go
to our website to learn more about these corporate sponsors
https://securemail.greenfieldhealth.com/Portal/General+Info/Corporate+Partners/Default.aspx
First Tuesday Reminder
The
schedule for our
upcoming GreenField Health First Tuesday Open House is August 1,
September 5, and October 3. This is a good introduction to our practice
for
relatives, friends or coworkers who might be interested in becoming a
GreenField patient. The sessions begin promptly at 5:30 PM on the first
Tuesday of each month. Learn more about our First Tuesday Open House
Online at: https://securemail.greenfieldhealth.com/Portal/General+Info/First+Tuesdays/default.aspx
Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller- beth.davis@greenfieldhealth.com
Chuck Kilo, MD - chuck.kilo@greenfieldhealth.com
Cynthia Ferrier, MD - cynthia.ferrier@greenfieldhealth.com
Dia Gaede, CMA, your Health Coordinator - dia.gaede@greenfieldhealth.com
Elizabeth Hays, MD - elizabeth.hays@greenfieldhealth.com
Eric Murray, MD - eric.murray@greenfieldhealth.com
Heidi Downey, your Consultant - heidi.downey@greenfieldhealth.com
Jill Arena, your Clinic Administrator - jill.arena@greenfieldhealth.com
Joel Swartzmiller, IT Manager - joel.swartzmiller@greenfieldhealth.com
Lindy Thornbloom, your Health Coordinator - lindy.thornbloom@greenfieldhealth.com
Pam Mockenhaupt, CMA, your Health Coordinator - pam.mockenhaupt@greenfieldhealth.com
Paula Koeller, MD - paula.koeller@greenfieldhealth.com
Shelly Banta, your Clinic Manager - shelly.banta@greenfieldhealth.com
Tiana Schmitt, CMA, your Health Coordinator - tiana.schmitt@greenfieldhealth.com
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GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503-292-9560
Fax: 503-292-9510
Web: http://www.greenfieldhealth.com
Questions, concerns, comments appreciated: questions@greenfieldhealth.com
copyright 2003-2006 GreenField Health
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