Lung Cancer Screening

Low Dose

Nationwide, lung cancer is the second most common new cancer diagnosis, as well as the leading cause of cancer-related deaths. According to the American Cancer Society, 222,500 new cases of lung cancer were found among American adults in 2017. Additionally, 155,870 will die from lung cancer this year.

In North Dakota, there were 480 cases of lung cancer diagnosed in 2016, making up about 13 percent of the 3,930 total cancer cases in the state that year. Of the 1,270 cancer deaths in 2016, 330 (about 26 percent) were from lung cancer.

According to Heidi Bender, FNP-C, pulmonology nurse practitioner and coordinator of the Lung Cancer Screening Program, smoking is the leading cause of lung cancer. But is it possible to be a non-smoker and still develop lung cancer?

“It can be,” she said, noting that exposure to radon and/or second hand smoke can contribute to the chances of developing lung cancer. (Additionally, cigar and pipe smoking, asbestos, and exposure to “some carcinogens – radioactive uranium or arsenic, for example,” in the environment can be culprits. Having a first degree relative who had lung cancer also slightly increases the risk.

One of the first steps in reducing your risk for lung cancer is to quit smoking. Cessation can lead to benefits almost right away. Within 20 minutes, your heart rate and blood pressure drops, Bender said.

“Within one to nine months, coughing and shortness of breath decreases, and lung function improves the ability to clear out mucus, clean the lungs, and reduce the risk of infection. Ten years after quitting, the lung cancer death rate is about half that of a person who is still smoking.”

Screening for lung cancer is important because some patients with lung cancer do not have symptoms, especially in the early stages, Bender said, adding that patients with advanced stages of lung cancer may present symptoms, such as shortness of breath, coughing, chest pain, coughing up blood, weight loss, or fatigue.

At Trinity Health, screening for lung cancer, using a low-dose CT scan, is now more likely to detect it in its earliest stages. The National Lung Screening Trial (NLST) demonstrated that low-dose CT scans reduce the death rate from lung cancer by 20 percent, by detecting lung cancers early.

Previous to this technology, lung cancer screening did not have formal screening and often the lung cancer wasn’t picked up early enough to make a difference in reducing the death rate, explained Scott Lewis, MD, medical director of Trinity Health’s Radiology department. “They would find cancers, but it was too late.”

Finding lung cancer early is critical because it does not often present symptoms until the cancer is in its later stages. To ensure that the screening makes a difference, Dr. Lewis said that “the right population” should be screened. If an individual meets the criteria, they would need to schedule a “shared decision-making” appointment with their primary care provider or the Pulmonology Clinic.

During the shared decision-making visit, the patient’s medical history is evaluated and a physical examination is done. The provider will discuss with the patient if they qualify for the low-dose CT and if this screening test is right for them. This meeting allows the patient and provider to make healthcare decisions together, based on clinical evidence, current medical condition, and patient values and preferences.

Jeffrey Verhey, MD, a pulmonologist with Trinity Health, explains that if a patient has no intention of evaluating an abnormal CT scan further, does not wish to undergo surgery or treatment, or has significant co-morbid conditions or health problems that would eliminate their opportunity to undergo surgery, the patient would not be screened.

Since the low-dose CT scan was introduced to screen for lung cancer at Trinity Health, 145 patients have been screened. The CT scans are done at Trinity Health’s Advanced Imaging Center, located at Health Center – Town & Country, 831 South Broadway, Minot.

If you meet the guidelines for the lung cancer screening, think you may qualify, or have questions about lung cancer screening, please contact Trinity Health’s Pulmonology Clinic at 857-5741. If symptoms of lung cancer are shown, contact your primary care provider. Please visit our website for more information: trinityhealth.org/lowdose.

Chronic Obstructive Pulmonary Disease (COPD)

Close Up Of Elderly Man Using NebulizerChronic obstructive pulmonary disease or COPD, is a common, preventable, and treatable disease characterized by persistent respiratory symptoms including shortness of breath, coughing, wheezing, or phlegm production, said Heidi Bender, FNP-C, a nurse practitioner with Trinity Health’s pulmonology team.

According to the American Lung Association, COPD is the third leading cause of death in the United States. “More than 11 million people have been diagnosed with COPD, but millions more may have the disease without even knowing it,” the Association states on its website.

“The most common cause of COPD is cigarette smoking, although not all cases are caused by smoking,” Bender said. “A genetic lung disease called Alpha-1 Antitrypsin Deficiency, or occupational exposures (second-hand smoke), increases your risk of developing COPD.”

COPD is diagnosed through a breathing test called spirometry, which measures how quickly and how much air a patient is able to exhale; someone with COPD would not be able to exhale as quickly or as much air. Spirometry can be performed by a general healthcare provider or through the Trinity Health Pulmonary clinic.

The most important treatment for COPD is smoking cessation. Breathing medications and inhalers are utilized to improve the symptoms of COPD, as well as potentially, oxygen therapy, if necessary, Bender said.

“Keeping current on flu and pneumonia vaccinations, maintaining physical activity, attending pulmonary rehabilitation, and maintaining a healthy weight, are important life strategies to improve COPD,” Bender said.

COPD is a nonreversible condition, but there are ways to improve the symptoms. “There is no cure for it, but the symptoms are manageable,” Bender said.

Trinity Health’s Cardiopulmonary Rehab, located at Health Center – West, can help. Staff there evaluates patients to develop an individualized rehabilitation program based on the following elements:

• Physical conditioning – Monitored physical activity to increase endurance, strengthen muscles used for breathing, and improve overall fitness and sense of well-being.

• Education – Teaching sessions by healthcare professionals to provide knowledge about lung disease, medications, and self-management.

• Nutrition – Practical suggestions by registered dietitians to help patients cope with the fatigue and listlessness that can accompany chronic lung disease.

Patients must have a physician’s referral to receive pulmonary rehabilitation services. Once a referral has been issued, patients are assessed to determine if they may benefit from a pulmonary rehab program.

If you have a concern about your breathing, or are feeling short of breath, you may want to talk to your provider about getting tested for COPD – especially if you are a smoker or have been a smoker.

If you show symptoms of COPD, please speak with your primary care provider. You can also schedule an appointment with the Trinity Health Pulmonology Clinic – which includes Jeffrey Verhey, MD; Heidi Bender, FNP-C; and locum physicians Robert Durkin, DO, and Rashpal Singh, MD – by calling 857- 5741.

The Pulmonology Clinic is located at Health Center – East, Suite 203 20 Burdick Expressway West, Minot.

Great American Smokeout November 16

A great way to improve your chances of not developing COPD is by participating in the American Cancer Society’s Great American Smokeout on November 16, advised Heidi Bender, FNP-C, a nurse practitioner with Trinity Health’s pulmonology team.

Cigarette smokers “may use the date to make a plan to quit, or they may plan in advance and quit smoking that day,” the American Cancer Society says on its website. “The Great American Smokeout event challenges people to stop using tobacco and helps people learn about the many tools they can use to help them quit and stay quit.”

More information about the Great American Smokeout can be found at www.cancer.org.

Skin Brachytherapy: Effective and Aesthetically

XOFT ControllerThe Trinity CancerCare Center has a new tool for treating non-melanoma skin cancer, one that’s notable for producing an outcome that is visually pleasing as well as effective.

The center recently acquired a Xoft® Electronic Brachytherapy System®, an innovative form of radiation therapy that delivers a high dose of cancer-killing X-rays to a tightly targeted area of the skin. Michael Grant, MD, a board-certified radiation oncologist, said the technique, called skin brachytherapy, is ideal for treating cancers on areas of the body that are cosmetically sensitive.

“Skin brachytherapy uses a high dose of low-energy X-ray to effectively treat skin cancer as an alternative to surgical resection or MOHS,” Dr. Grant explained. “It’s a very good treatment option for non-melanoma cancers on the head, neck, and face – obviously visible areas where you want to avoid scarring or noticeable grafts. It’s particularly excellent for cancers on the nose, ears, and other facial features that don’t lend themselves to surgical closure.”

One in five people will develop skin cancer at some point in their lives, according to the Skin Cancer Foundation. The most common forms are non-melanoma cancers like basal cell carcinoma and squamous cell carcinoma.

Besides delivering a good cosmetic result, skin brachytherapy is non-invasive and pain-free. It reduces the risk of recurrence if there are remaining cancer cells; and the higher dose means that a good outcome can be achieved with fewer trips to the CancerCare Center.

“We see a lot of skin cancer among farmers, ranchers, and others who are exposed to the sun through their occupations. Many drive in from communities over 100 miles away. If we can reduce their treatments to twice a week instead of five days a week – that’s a much smaller time commitment and a huge savings for them,” Dr. Grant said.

During the brachytherapy treatment, a small, lightweight surface applicator is placed directly on the target lesion where the radiation is to be delivered. The applicator is connected to the Xoft radiation source and the unit is activated, delivering a carefully calibrated dose of low-energy X-ray to the target area. Each treatment regimen and dosage depends on tumor size, type, depth, and other criteria.

“It’s very precise in its ability to control the depth of radiation over critical structures such as facial nerves,” Dr. Grant noted. The system also comes with unique shielding tools, such as an iron-impregnated cloth that can be draped over and around facial contours to protect healthy tissue.

Unlike its larger cousin, the linear accelerator, the Xoft® unit uses no isotopes, eliminating the need for heavily shielded environments and giving radiation oncologists the flexibility to deliver therapy in a broader range of clinical settings. Because it’s isotope free, clinicians can remain in the room throughout treatment.

Dr. Grant says the Xoft system also has applications for other types of cancer. Special applicators are expressly designed for treating gynecological cancers, for example. It’s all part of the center’s mission to continually strive to provide the most effective cancer fighting therapies with the lowest side-effect profiles.

“This fits our mission in a couple of ways,” Dr. Grant added. “It allows us to offer a service to the community that wouldn’t otherwise be available, and it provides a very good option for patients who aren’t great candidates for surgery or don’t want to travel long distances for treatment.”

The Trinity CancerCare Center is located at 831 South Broadway, Suite 113, in Minot.

Westhope Clinic Scheduled to Close

Pledging support for its affected employees, Trinity Health announced it will close Trinity Community Clinic – Westhope effective December 8, 2017.  The announcement came following an assessment regarding the clinic’s future amid declining reimbursements and the need to contain costs.

“This has been a difficult decision, one that we actually delayed for quite some time,” said Thomas M. Warsocki, FACHE, Vice President of Physician Services.  “We’ve been in a prolonged period of declining reimbursements, and operating expenses at the Westhope clinic have exceeded revenues for some time.  Given industry projections and critical priorities within our care system, we determined we could no longer sustain this resource imbalance.”

Warsocki said patients will be notified of the decision and provided with alternatives for continuing their medical care.  Trinity Health has two other primary care clinics in north central North Dakota located in Mohall and Kenmare.  He also said that every effort will be made to help ease the transition for employees displaced by the closure.  

“Trinity Health recognizes that without the support and loyalty of the staff, the clinic wouldn’t have remained open as long as it did,” Warsocki said.  “Dr. Kenneth Kihle and the clinic staff have been the heroes.  They sustained the clinic and really took ownership of it – often going far beyond their normal duties to keep the clinic functioning and maintained.” 

The health clinic has served the Westhope community since 2001 under the Trinity Health banner, offering primary care services to patients three days per week at the leased facility in Westhope.  Its only physician, Dr. Kenneth Kihle, has also served patients at St. Andrew’s Health Center in Bottineau on a weekly basis. 

“It’s been an honor and a privilege to serve the Westhope community,” Warsocki added.  “Dr. Kihle and the clinic staff can be proud of the service they’ve provided the community.”

Trinity Health Receives County Approval for New Hospital and Medical Park Bond Financing

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Trinity Health received approval today from the Ward County Board of Commissioners to issue up to $380 million in Health Care Revenue Bonds as a second step toward financing a new hospital and medical park in southwest Minot. 

The County Commission approved up to $63 million for Trinity Health in August to refinance existing long-term debt at a lower interest rate, and to cover preliminary construction costs.

Trinity President/CEO John M. Kutch says this second bond issuance will be used in combination with operating funds and private philanthropy to finance construction of the new healthcare complex, including architectural, construction, equipment, and other costs associated with the new campus buildings. 

“We’re excited to take this important next step toward constructing an extraordinary facility that will serve our communities for decades to come,” Kutch said.  “We’ve worked hard over many months to achieve a design that is viable and sustainable, and yet represents the future of how patient-centered health care should be delivered.”

He says teams of department leaders have worked productively with the project manager, Yates Construction, and architects and other contractors to refine the project with the goal of delivering exceptional care at the most reasonable cost.  Trinity Health officials are still targeting the construction project, slated to include a new hospital and medical office building, to begin next spring. They project it will take approximately three years to build out the new campus. 

The proposal to Ward County Commissioners doesn’t impose any responsibility on the county to pay off the bonds.  Approval merely allows Trinity Health to issue tax-exempt bonds, which are a less expensive way to finance projects

Understanding Diabetes

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Forty-nine thousand North Dakota adults have diabetes. That is about one out of every 11 adults in the state — or the entire population of Minot (2016 census estimates).

The American Diabetes Association (ADA) states that an estimated 20.8 million adults and children have diabetes, and a third of them may not even know it.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin (Type 1 diabetes) or when the body cannot effectively use the insulin it produces (Type 2 diabetes). People who have diabetes are at higher risk of serious health complications, such as blindness, kidney failure, heart disease, stroke, or the loss of toes, feet, or legs.

Family history, age, and lifestyle (including diet, weight, and/or lack of physical exercise) can contribute to the risk of developing diabetes, explained Michelle Fundingsland, RD, LRD, a dietitian with the Trinity Health Center for Diabetes Education.

To help combat diabetes, a lifestyle change program called Weigh2Change, is available through the Center for Diabetes Education. This class is “for people who are overweight, 45 years of age or older, have a parent or sibling that has Type 2 diabetes, or those who are physically active fewer than three times a week,” Fundingsland said. “Those are the people at risk for prediabetes.”

Prediabetes, a condition which serves as a precursor for Type 2 diabetes, can be the warning sign that can help a person change their lifestyle before diabetes sets in and becomes irreversible. A person with diabetes has a blood sugar level higher than normal, but it is not high enough for a diabetes diagnosis, explained Susan Burkhart, RN, MSN, CDE, BC-ADM, a diabetes educator with the Center for Diabetes Education.

More than 100 million American adults have diabetes or prediabetes, a report from the Centers for Disease Control and Prevention stated. The North Dakota Department of Health estimates that 202,000 North Dakotans over the age of 20, or four out of 10, have prediabetes. Without weight loss and moderate physical activity, 15 to 30 percent of people with prediabetes will develop Type 2 diabetes within five years.

The lifestyle change program is “a year-long commitment,” something that Fundingsland said she likes because it gives participants the chance to see their lifestyles during North Dakota’s four distinct seasons. (For example, a person may eat more and become less active during the winter months.)

Through the class, weight, food, and daily activity are tracked, Fundingsland explained, noting that these records “really help people understand what they are taking in.” The goal of the class “is for a seven percent weight loss and increase activity to 150 minutes per week. With this program, you can delay the diagnosis of Type 2 diabetes, and in some cases, you can prevent it.”

“When we can prevent diabetes, we reduce the risk of complications immeasurably,” Burkhart added.

To ensure the class is a good fit for a person, there is a ‘session zero,’ Fundingsland explained. “It’s an informational class to make sure the person is ready for the program. It is important for the participant to understand their readiness to change and willingness to commit to the yearlong lifestyle change program.”

For more information about the Trinity Health Center for Diabetes Education, or to take a diabetes risk assessment, visit: http://trinityhealth.org/diabetes.

Eagle Award Recipients

Three Trinity Health associates recently received the Minot Area Chamber of Commerce’s Eagle Award for Excellent Customer Service.

Vanessa Dahl and Dawn Mattern, MD, Sports Medicine “are what customer service is all about,” a nomination letter read. “Vanessa was so helpful and extremely quick to respond. She returned my phone calls and called me back even when she didn’t need to. She helped me get my son all set up for some tests and even called me back with results the same day. They even called the sports trainer at my son’s school. I couldn’t have asked for better customer service.”

Tricia Nechodom, Au.D., Audiology, was nominated for the award after going “above and beyond” to help a patient struggling to find the best hearing aids for his hearing loss.

Receiving the Eagle Award is validation of the pursuit of the mission of Trinity Health, which values exceeding professional quality standards.

 

 

Trinity Sports Medicine Enhances Service at Pepsi Rink

JonPressTrinity Sports Medicine announces it will soon provide enhanced support for athletes at its Sports Medicine Center located at the Pepsi Rink in Maysa Arena. 

Trinity Sports Medicine Manager Robyn Gust, MS/ATC, says starting November 1st a certified athletic trainer will be on hand week days from 3 to 6 p.m. in the Center to offer free initial sports injury evaluations.  The assessments will be offered on a no-appointment basis to any athlete regardless of age, school, or sport.

“We’re excited about the opportunity to increase our support for our communities by offering this service at the Pepsi Rink,” Gust said.  “Jon Sandy, a certified athletic trainer recently employed by us for this position, has over 20 years of experience providing athletic training services to the physically active population. He also has an extensive hockey background which makes this position the perfect fit to better expand our care to the youth hockey and skating programs in the area.”

The region’s leader in the diagnosis and treatment of sports injuries, Trinity Sports Medicine has served teams throughout Northwest North Dakota for over 30 years.  Certified Athletic Trainers stay current with the latest protocols and practices, working in collaboration with Dawn Mattern, MD, board certified with a fellowship in Sports Medicine.

How to Dispose of Medication Properly

medications-cure-tablets-pharmacy-51004Once medication expires, or if the medication is no longer being used, what should be done with it? Can they be thrown away like yesterday’s leftovers?

No, says Carolyn Seehafer, PharmD, Director of Pharmacy at Trinity Health. Prescriptions that are no longer needed need to be disposed of in a proper manner.

Medications that are non-controlled substances – such as aspirin or Tylenol, Lisinipril, and Warfarin – left in the original packaging can be safely deposited in designated drop box containers at participating pharmacies. At Trinity Health, two of its pharmacies – KeyCare Pharmacy, located at Health Center – Medical Arts, and B&B Pharmacy, located at Health Center-East – have these drop boxes. These drop boxes are part of the Drug Take Back Program, sponsored by Attorney General Wayne Stenejhem and the North Dakota Board of Pharmacy.

Controlled substances, such as Hydrocodone (Vicodin), Oxycodone (Oxycontin), and Zolpidem (Ambien), should be taken to the local law enforcement agency for disposal, Seehafer said. “(The drop boxes are) not 100 percent secure. For security reasons, the Attorney General wanted to have those dropped off at the local law enforcement.”

Sharps (such as syringes, lancets), thermometers, glass, and home-based care (HBC) or durable medical equipment supplies are not accepted by this program.

If you have questions, please check your pharmacist or your local law enforcement agency, contact the Attorney General’s office at (701) 328-2210, or visit www.ag.nd.gov.