Minnesota Health care News March 2013

March 2013 • Volume 11 Number 3

HayfeverNancy Ott, MD

Stretch your medication dollarsTimothy Stratton, PhD

MelanomaPierre George, MD

Your Guide to Consumer Information FREE

Want to help a friend or loved one quit smoking?

MC4106-159

SMOKER SUPPORT PERSON STUDY

Join a new research study from the Mayo Clinic.

The Smoker Support Person Study will observe and support more than 1,000 people as they help their friends and loved ones quit smoking. Qualified participants will:

Receive free guidance and tools from the Mayo Clinic Contribute to Minnesota’s efforts toward a healthier, smoke-free state

Improve smoking cessation programs around the country

Not only will you be helping someone you love, but your participation could mean bringing the entire country one step closer to kicking its smoking addiction.

Call 1-800-957-2950 or email us at [email protected]

R E G I S T E R N O W

Call 1-800-957-2950 Or send us an email at supportpersonstudy@

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ELIGIBILITY REQUIREMENTS: At least 18 years old. Minnesota resident. Have access to a working

telephone. Maintain regular contact with

the smoker.

• Participants will receive free guidance and tools to help a smoker move towards quitting.

• The entire study done by phone and mail

Not only will you be helping someone you love, but your participation could mean bringing the entirecountry one step closer to kicking its smoking addiction.

Call 1-800-957-2950 or email us [email protected]

The Smoker Support Person Study will support more than 1,000 people as they help their friends and loved ones quit smoking.

Minnesota Health Care News is published once a month by Minnesota Physician Publishing, Inc. Ouraddress is 2812 East 26th Street, Minneapolis, MN 55406; phone (612) 728-8600; fax (612) 728-8601;email [email protected]. We welcome the submission of manuscripts and letters for possible publication.All views and opinions expressed by authors of published articles are solely those of the authors and donot necessarily represent or express the views of Minnesota Physician Publishing, Inc., or thispublication. The contents herein are believed accurate but are not intended to replace med-ical, legal, tax, business, or other professional advice and counsel. No part of this publica-tion may be reprinted or reproduced without written permission of the publisher. Annualsubscriptions (12 copies) are $36.00. Individual copies are $4.00.

MARCH 2013 MINNESOTA HEALTH CARE NEWS 3

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PUBLISHER Mike Starnes [email protected]

EDITOR Donna Ahrens [email protected]

ASSOCIATE EDITOR Janet Cass [email protected]

ASSISTANT EDITOR Scott Wooldridge [email protected]

ART DIRECTOR Elaine Sarkela [email protected]

OFFICE ADMINISTRATOR MaryAnn Macedo [email protected]

ACCOUNT EXECUTIVE Iain Kane [email protected]

ACCOUNT EXECUTIVE Matt Nichols [email protected]

www.mppub.com

MARCH 2013 • Volume 11 Number 3

PATIENT TO PATIENTProtect your hearingBy Janet Horvath

CALENDARWorld Autism Awareness Day

DERMATOLOGYMelanomaBy Pierre George, MD, and Juan Jaimes, MD

ENVIRONMENTALHEALTHHayfeverBy Nancy Ott, MD

PALLIATIVE CAREEasing the journeyBy Michelle Silverman

PUBLIC HEALTHNewborn screeningBy Amy Gaviglio, MS, CGC,Beth-Ann Bloom, MS, CGC, andSondra Rosendahl, MS, CGC

POLICYTobacco tax updateBy Molly Moilanen, MPP

7 PEOPLE

NEWS4C O N T E N T S

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PERSPECTIVE

10 QUESTIONS

PHARMACY Stretch your medication dollarsBy Timothy Stratton, PhD, BCPS, FAPhA

GERIATRICSMature driversBy Catherine N. Sullivan, PhD, OTR

Mark Meier,LISCW

Face It Foundation

Lindsey Thomas, MD

Hennepin CountyMedical Examiner’sOffice

Exp. Date

� Check enclosed � Bill me � Credit card (Visa,Mastercard, American Express, or Discover)

Please mail, call in or fax your registration by 04/18/2013

MINNESOTA HEALTH CARE ROUNDTABLE MINNESOTA HEALTH CARE ROUNDTABLE

Background and focus:The next step in healthcare reform involves thepatient becoming moreactively engaged withstaying healthy. New physi-cian reimbursement mod-els reward improved popu-lation health but bring newdynamics into the examroom. Incorporating patientattitude and lifestyle choices into health caredelivery is necessary, but how should it bedone? Creating conceptu-al and empirical clarityaround this question maybe best addressed by theterm Patient ActivationMeasure (PAM).

Objectives: We will exam-ine the development of

PAM, what it means and how it works. We will explore patientengagement methods that have been successful and the role ofhealth insurance companies and employers in this process. We willexplore how PAM may be used across the continuum of care andwhose job it will be to implement and track these measures. Wewill discuss the challenges that are inherent within the concept ofPAM and how it may realize its best potential.

Panelists include:

� Vivi-Ann Fischer, DC, Chief Clinical Officer, Chiropractic Careof Minnesota, Inc.

� Peter Mills, MD, CEO, nGage Health

� William Nersesian, MD, MHA, Chief Medical Officer, FairviewPhysician Associates

� Pam Van Zyl York, MPH, PhD, RD, LN, MDH Health Promotion and Chronic Disease Division

Sponsors: ChiroCare • nGage Health

T H I R T Y - N I N T H S E S S I O N

Please send me tickets at $95.00 per ticket. Mail orders to MinnesotaPhysician Publishing, 2812 East 26th Street, Minneapolis, MN 55406.Tickets may also be ordered by phone (612) 728-8600 or fax (612) 728-8601.

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Telephone/FAX

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Thursday, April 25, 20131:00 – 4:00 PM • Duluth Room

Downtown Mpls. Hilton and Towers

Patient engagement

Creating measures that work

Skin Disorders CauseMost Clinic Visits,Mayo Study FindsA Mayo Clinic study finds thatmost common causes for primarycare visits are skin issues, jointdisorders, and back pain.

Researchers used a compre-hensive study of medical recordsfrom Olmsted County over a five-year period to determine the mostcommon health issues for whichpeople see providers. The studyfound that other top diseasegroups include cholesterol prob-lems; upper respiratory conditions(not including asthma); anxiety,depression, or bipolar disorder;chronic neurologic disorders;headaches and migraines; anddiabetes.

“Surprisingly, the most preva-lent nonacute conditions in ourcommunity were not chronic con-ditions related to aging, such asdiabetes and heart disease, butrather, conditions that affect bothgenders and all age groups,” saysJennifer St. Sauver, PhD, primary

author of the study.St. Sauver found that almost

half the study population hadsome type of skin disorder. Sheadds that the finding suggeststhere should be further study ofwhy these conditions result in somany visits and whether changesin care delivery approaches mightresult in fewer clinic visits due toskin conditions.

New Dayton BudgetIncreases SpendingOn Health Gov. Mark Dayton would increasehealth and human ser vices spend-ing by $128 million over the nexttwo years, according to the bud -get he submitted to the Legisla -ture in late January. The planwould have several significantimpacts on health care in thestate, including expanding publichealth plans, increasing spendingfor medical education, and raisingthe cigarette tax.

The budget overall wouldraise both taxes and spending in

the state, while redistributing thetax burden in a way that Daytonsays is more fair to the middleclass. Administration officials sayMinnesota has been lurching fromone deficit to the next and that thestate needs to rework its tax sys-tem to stabilize its finances.

“If the investments in mybudget proposal are made, theywill yield returns in new jobs, private investments, vibrant com-munities, and additional state and local tax revenues; and theywill help keep our economy mov-ing forward,” says Dayton. “Theyrepresent my best judgmentabout what Minnesota needs togrow our economy, expand ourmiddle class, improve our qualityof life, and take care of thosemost in need.”

According to documents from the office of MinnesotaManagement and Budget, thebudget calls for an 8 percentincrease in spending on healthand human services. The Daytonplan would expand eligibility andaccessibility to state health plans

at a cost of $93 million, whichwould result in coverage of anadditional 145,000 Minnesotans.The plan would give a $13 millionboost to the state’s MedicalEducation Research Costs fund. It would spend $40 million on theStatewide Health ImprovementProgram and $48 million on earlychildhood education, child place-ment services, and mental healthprograms. It would also pay for$29 million in information tech -nology updates to health care systems.

Among the Minnesotans paying higher taxes would besmokers; Dayton is calling forincreasing the cigarette tax by 94 cents per pack. Health caregroups have been calling for higher cigarette taxes for severalyears, saying a tax increase woulddiscourage smoking and therebyimprove health for manyMinnesotans.

N E W S

4 MINNESOTA HEALTH CARE NEWS MARCH 2013

952-886-7588nwhealth.edu/yourhealth

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Allina, Children’sCollaborate to OpenMother Baby Center Allina Health and Children’sHospitals and Clinics of Minnesotaunveiled their new collaborativeeffort, the Mother Baby Center, inJanuary.

Officials say the new facility is the only one of its kind inMinnesota and has capabilitiesmatched by only a few hospitalsnationwide. The four-story, 96,000-square-foot building is locatedbetween Abbott NorthwesternHospital and Children’s Hospital in Minneapolis. The facility willhave the capacity for 5,000 birthsa year and will feature a compre-hensive approach to care, begin-ning with prenatal care and con-tinuing through obstetrics, perina-tology, labor and delivery, neona-tology, and pediatrics.

“Every delivery is unique, just as the wants and needs ofexpecting families are unique—some women desire a traditionalbirth, some want an alternativeexperience such as a water birth,and others require high-end spe-cialty care for themselves or theirbaby,” says Penny Wheeler, MD,chief clinical officer of AllinaHealth and a practicing obstetri-cian. “Our goal at the MotherBaby Center is to support everymother, baby, and family in astate-of-the-art facility, surroundedby incredibly talented and com-passionate doctors, nurses, andcaregivers all committed to pro-viding a positive and life-changingexperience.”

Officials say the new facilitywill address the growing inci-dence of high-risk pregnanciesand preterm births, and will be anattractive option for older moth-ers, mothers with chronic healthproblems, and other womenwhose pregnancies may result incomplications.

Serious AdverseEvents up in 2012,Report SaysThe latest adverse events reportfrom the Minnesota Department

of Health (MDH) showed that 2012saw an increase in death and seri-ous harm occurring in health caresettings. Overall, the number ofadverse events stayed about thesame from 2011 to 2012.

Most of the increase in deathsand serious harm was related tofalls, state officials say. There were14 deaths in 2012 compared withfive in 2011, and 89 seriousinjuries compared with 84 in 2011.

The report found hospitalsand surgical centers improvedduring 2012 in a number of areas.These include the number of totalpressure ulcers (bedsores), whichdeclined by 8 percent. This is thefirst decline of this magnitude in the nine years of reporting, officials say. Medication errorsdropped by 75 percent from theprevious year and were at thelowest level in all nine years ofreporting.

“This year’s report shows that as a state we really need toredouble our efforts to reduce falls in hospitals,” says MinnesotaCommissioner of Health EdEhlinger, MD. “While falls inhealth care settings can be verydifficult to prevent, we also needto look at all opportunities to pre-vent injury when falls do occur, byfocusing interventions on eachpatient's specific risk factors.”

State health experts say thereporting system identifies prob-lem areas and helps hospitals andproviders know where to focustheir patient safety efforts.

New Website Aims To Educate Public onInsurance ExchangesAs state lawmakers continue todevelop legislation for creating ahealth insurance exchange, theMinnesota Management andBudget (MMB) agency haslaunched a website to educate the public on the concept.

Officials say the site isdesigned to provide Minnesotanswith up-to-date information aboutthe exchange and how this newmarketplace will affect their lives,and to detail progress being made

News to page 6MARCH 2013 MINNESOTA HEALTH CARE NEWS 5

Personalized Assisted Living goes a long way toward optimizing the daily quality of life for our residents. If you have a loved one that needs a friendly environment with a personalized care plan designed just for them, call or visit a Brookdale Community near you. Because caring for our residents is what we do, and it’s always personal to us.

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The Freedom Medicare planSwitch your Medicare plan. Not your clinic.

H2462_66027_CMS Accepted 3/2/2013 HealthPartners is a health plan with a Medicare contract. ©2013 HealthPartners

You’ll likely be covered no matter where you go with a HealthPartners Freedom plan. Shop and compare health plans at healthpartners.com/medicare

in developing the exchange.“The new website is the next

step in reaching out to the publicand providing basic informationfor individuals and small busi-nesses that could use the ex -change to find affordable, high-quality health care,” says MMBCommissioner Jim Schowalter.

The website can be found atwww.mn.gov/hix/ and features avideo explaining the benefits ofthe health insurance exchangeand how it will work; a benefitscalculator that will determine ifindividuals are eligible for taxcredits; background and publicinformation about the exchange;information on analysis andgrants; and targeted pages forindividuals and families, smallbusinesses, agents and brokers,health plans, and others.

Health insurance exchangesare a key part of the AffordableCare Act’s effort to expand in surance coverage to moreAmericans. In Minnesota, MMBhas established some basic com-

ponents of the exchange as law-makers and regulators continue towork out the details of the pro-gram. As the exchange is devel-oped, consumers will be able tostay informed via the website.

“Along with public informa-tion, analysis, and quick facts, theimproved website is the first inthe nation to have an introductoryvideo. We are excited to have thiseducational tool go live for thepublic’s use,” says April Todd-Malmlov, who is executive direc-tor of the exchange.

No “July Effect,”Mayo Study SaysThere is no “July Effect,” a newstudy from Mayo Clinic inRochester says. The notion thatJuly is a dangerous time to havesurgery because that’s the monthnew residents and fellows arriveat teaching hospitals seems to bea myth, researchers say.

The report, published in theJournal of Neurosurgery: Spine,looked at seven years of data andfound that surgeries in July did

not have a significantly higherrate of deaths and postoperativecomplications. In addition, no sub-stantial July Effect was observedin higher-risk patents, thoseadmitted for elective surgery, orthose undergoing simple or com-plex spinal procedures.

“We hope that our findingswill reassure patients that they are not at higher risk of medicalcomplications if they undergospinal surgery during July ascompared to other times of theyear,” says study co-authorJennifer McDonald, PhD. “Whilewe only looked at spinal surger-ies, we think it’s likely we’d findsimilar outcomes among othersurgeries and procedures.”

Delta Dental FundsImprovements toBemidji ClinicDelta Dental has given $10,000 tohelp a dental clinic in Bemidji thatserves low-income individualsand families.

The Northern Dental Access

Center will use the funds toreplace equipment, officials say.“It’s a huge relief,” says JeanneEdevold Larson, Northern Dentalexecutive director. “After servingmore than 15,000 people, thewear and tear on our equipmenthas become an issue far soonerthan we ever expected. And whileit’s not very exciting, these fundswill help purchase a new com-pressor system that is at the heartof all the dental tools used forevery procedure. It’s becomeunreliable and is too small to han-dle our increased patient load,and without it, our services wouldstand still.”

Northern Dental opened in2009 as a community response to a shortage of dental care available for people enrolled inMinnesotaCare or MedicalAssistance in northern Minnesota.Officials say some patients travelas many as 100 miles to the clinic.In 2011, 9,900 patients wereserved; officials estimate therewas a 30 percent increase inpatients served for 2012.

News from page 5


Appointments:

Online or Call 651-439-8807

Providing care at multiple modern clinics in Minnesota and Wisconsin

In 2008, Tanzanian missionaries brought little Zawadi Rajabu to the U.S. to seek treatment for her two severely clubbed feet. A physician referred Zawadi to Dr. Mark T. Dahl of St. Croix Orthopaedics. Using the Ilizarov Method, Dr. Dahl surgically changed the course of Zawadi’s feet and her life.

Dr. David Palmer and Russ McGill, OPA-C, recently traveled to Tanzania on another of their frequent medical missionary trips. They dedicated an entire day to checking in on their partner’s patient. To their delight, they were greeted by 6-year-old Zawadi her face aglow, her healed feet dancing toward them.

Supporting Our Patients.Supporting Our Partners.Supporting You.

David Palmer, M.D.& Zawadi’s brother

Russ McGill, OPA-C& Zawadi

mute aviding carorP

innen clinics in Multiple moder

onsiniscWesota and

Lakeview Hospital, Stillwater, recently presented

Physician Recognition Awards to Lawrence

Morrissey, MD, and Theodore Haland, MD.

Morrissey, a board-certified pediatrician, practices

at the Stillwater Medical Group main campus.

He was recognized for his long commitment to

Lakeview Hospital as well as his commitment to

patient-centered care and to the St. Croix Valley

community. Haland is a board-certified family

medicine physician who practices as a hospitalist at Lakeview Hospital

and is the hospital’s medical director for both

hospice and for information systems. He was

recognized for his commitment to Lakeview

Hospital leadership and the community.

Hennepin County Medical Center has re cen -

tly hired several physicians. Jason Bydash, DO,

graduated from Michigan State University

College of Osteopathic Medicine. He completed

his internal medicine residency training at Saint

Vincent Mercy Medical Center in Toledo, Ohio, where he also served as

chief resident. He earned a nephrology fellowship at the University of

Minnesota. Lisa Fish, MD, has joined the medical

staff at Hennepin County Medical Center. She

cares for patients with all types of endocrine

problems and has a particular interest in endo-

crine and diabetes issues during pregnancy.

Fish graduated from medical school at Brown

University in Providence, R.I., and completed her

residency in internal medicine at the University

of Minnesota, where she

also completed a fellowship in endocrinology.

Uchemadu Nwaononiwu, MD, is now providing

family medicine care at HCMC’s Downtown

Medicine Clinics and Whittier Clinic. Originally

from Nigeria, Nwaononiwu completed his family

and community medicine residency training at

Hennepin County Medical Center. He worked in

various capacities in both rural and urban settings

as a general practitioner before his residency train-

ing in the United States. Susy Rosenthal, MD, MPH, is now seeing

patients at Whittier Clinic. She attended medical school at Sackler

School of Medicine in Tel Aviv, Israel, and completed her residency in

pediatrics at Maimonides Medical Center in Brooklyn, N.Y. She had

been in private practice in the Twin Cities since 2003.

Michael Guyette took over as president and

CEO of Blue Cross and Blue Shield of Minnesota

in January. Guyette most recently served as head

of national accounts for Aetna in Hartford, Conn.

Before that, he held leadership positions at Blue

Cross and Blue Shield of Florida. Blue Cross and

Blue Shield of Minnesota is the state’s largest

commercial health insurer.

Jakub Tolar, MD, PhD, has been named direc-

tor of the University of Minnesota’s Stem Cell Institute. He is an asso-

ciate professor in the Department of Pediatrics, Blood and Marrow

Transplantation, where he holds the Albert D. and Eva J. Corniea Chair

and is director of Stem Cell/Gene Therapies.

P E O P L E


Lawrence Morrissey, MD

Lisa Fish, MD

Michael Guyette

Uchemadu

Nwaononiwu, MD

Theodore Haland, MD

SMU offers bachelor completionand master’s programs in the

health & human services areas.

www.smumn.edu/hhs

Advance your career inhealth & human services

Graduate School of Health & Human Services

Harold Kaiser, M.D., Philip Halverson, M.D., Gary Berman, M.D. Allan Stillerman, M.D. Richard Bransford, M.D. Hemalini Mehta, M.D.

Mary Anne Elder, FNP-C, Research Manager

612-333-2200 x 5 www.CRIminnesota.com

Offices in Downtown Minneapolis and at WestHealth in Plymouth

If you have a 2 year history of a dust mite allergy, you may qualify for an allergy research study of

an investigational drug.

For adults and children ages 12 years and older

Qualified volunteers receive study drug and study-related testing at no cost and compensation

up to $780.00 for time and travel.

The study will consist of 9 office visits

Clinical Research Institute Since 1985

Mark Meier, LICSWFace It Foundation

Mark Meier,LICSW, is the

executive directorof Face It

Foundation, aMinneapolis-basednonprofit workingwith men to over-come depression.He is a community

faculty member in the University of Minnesota’sDepartment of

Family Medicineand Community

Health and frequently speaksabout his personal

experience withdepression,

attempted suicide,and recovery.

Face It offers peersupport groups,individual out-

reach, and consul-tation on the

management of depression.

magine for a moment that you suffer from amedical condition so serious it impacts near-ly every aspect of your daily life. It leaves you

fatigued, in pain, unable to concentrate, feelinghopeless, tearful, angry, and filled with anxiety. Itdisrupts your ability to eat, exercise, sleep, enjoyany activity, and in its severest forms makes get-ting out of bed almost impossible. Left untreated,this condition can become chronic. It’s associatedwith thousands of tragic deaths each year. And totop it off, this condition carries such stigma youcan’t bring yourself to tell those closest to youhow much pain you are in because you are tooembarrassed by the fact you can’t get over it. Thiscondition is male depression and it is very real.

Who is affected?

The National Institutes ofMental Health estimatesthat more than 6 millionmen are diagnosed withdepression each year in theU.S. and that 5 percent ofmen in this country livewith it. However, in my ex-perience as a clinical social worker and as a manwho lived with untreated depression for 14 yearsbefore getting help, I believe those numbers arelow. This is due, in large part, to the unwillingnessof many men to talk about their emotional needsand the reluctance of our society to accept thatmen can indeed suffer from serious depression.Research shows that men are more likely to mini-mize or under-report signs of depression and thatmental health professionals are less likely to rec-ognize depression in men than in women.

Perhaps you’re thinking, “Don’t we all getdepressed from time to time? Can’t people justlook at the bright side of life and get over it?” Theanswer is that depression is far different from theoccasional bad day everyone experiences.Depression, unlike a bad day, doesn’t respond toa good pep talk, nor does it go away on its own. Itaffects a person physically, emotionally, and cog-nitively, and makes “looking at the bright side”impossible.

Consequences

Unrecognized and untreated depression is costlyand dangerous. Costs include lost work time,overuse of emergency services, and exacerbationof other chronic diseases such as diabetes. These

costs approach $70 billion to $80 billion annually.In addition, men with depression often struggle intheir personal relationships, are not as involved inraising their children as they would like to be, andare at greater risk for abusing drugs and alcohol.

Untreated depression is also a significant risk fac-tor for suicide. According to the federal Centersfor Disease Control and Prevention, in 2010 therewere 36,035 suicides in the U.S. Of these, 28,450were men. That’s approximately 78 suicides eachday.

What can you do?

If you are a man wondering if you are sufferingfrom depression or if you are concerned about aman who you think might be depressed, there is agreat deal you can do. First, it is vitally important

to understand that depres-sion is a serious issue not tobe taken lightly. You need torealize that often, while youcannot see the outwardimpact of depression, on theinside, depression is wreak-ing havoc.

Asking makes a difference

As Matt, a member of a Face It peer supportgroup, said, “On the outside, I appeared to havethe perfect life. I had a good job, a great wife andkids, nice house, new cars … everything lookedperfect. But on the inside, I pretty much hatedmyself and thought I was a loser.” This is thedilemma for so many men. They think they haveeverything under control, yet they feel so miser-able. This leaves them trying desperately to “getover it” without any type of focused plan or inter-ventions. This often doesn’t work and, in turn,leaves them feeling even more depressed.

What Matt learned is that he needed to ask forhelp in order to overcome his depression. Withsupport from his physician, family, and other menwho have dealt with depression, and with efforton his part to learn new coping strategies, Matthas made great strides toward improving hisdepression. He now manages his depressioninstead of the depression managing him.

Face It is developing an online tool to help menlearn about and deal with their depression, and tointeract with other men who have dealt withdepression. Visit www.FaceItFoundation.org for more information.

Male depressionUnrecognized and untreated, it’s costly and dangerous

P E R S P E C T I V E

I

Men are more likely to minimize or under-report

signs of depression.


You call it

“reminding mom to take her pills.”

You or someone you know may be a caregiver. WhatIsACaregiver.org

We call it caregiving.

Dr. Thomas is a board-certified forensic pathologist and an assistant medicalexaminer in the Hennepin County Medical Examiner’s Office, serving Hennepin,Dakota, and Scott counties.

What is the difference between a medical examiner and a coroner?Historically, coroners originated in England as “crowners,” representatives of theCrown. Their job was to investigate sudden deaths in hopes of generating revenuefor the Crown. This institution was brought to the New World but in the earlytwentieth century, some jurisdictions realized the value of having a medical personinvolved in death investigation, rather than a politician. This was the creation ofthe office of the medical examiner.

Both medical examiners and coroners perform medicolegal death investiga-tions. In Minnesota, a coroner must be a physician and may be either appointedor elected. A medical examiner must be a forensic pathologist who is appointed bythe county board of commissioners. Forensic pathologists are doctors who arespecially trained in medicolegal death investigation. However, these terms are usedin different ways in other states.

What kind of medical training is required to become a medicalexaminer and how does your training in forensic pathology helpyou? To become a medical examiner a person needs to earn a bachelor’s degreeand a medical degree (MD or DO), and then obtain specialized training through aresidency in pathology, plus additional specialized training obtained through a fel-lowship in forensic pathology. Pathology is the study of disease while forensicpathology is the specialty that concentrates on legal aspects of medicine, disease,and injury. Training in forensic pathology teaches us to keep an open mind, thinkcritically about all aspects of a death investigation, and reach conclusions onlyafter careful consideration.

How did you become interested in this specialty? In medical school, Irealized I had the wrong personality for clinical practice. So I chose pathology andfound that what I enjoyed most were autopsies. I still find autopsies fascinating.Every person is different, and even after thousands of cases, every week or so I seesomething I have never seen before. The ways in which the human body can bediseased or injured are almost infinite.

When I moved to Minnesota I already was trained in pathology and metHennepin County Chief Medical Examiner Dr. Garry Peterson, who encouragedme to do a fellowship in forensic pathology. I feel incredibly lucky to have found a career that I love and that is so rewarding and meaningful.

You co-authored the book “Protecting the Right to be Free fromArbitrary Killing through an Adequate Autopsy and Investigationinto Cause of Death.” Please tell us more. I first met Dr. Peterson througha Minnesota International Human Rights Committee (now known as TheAdvocates) project to write an autopsy protocol that could be used internationallywhere suspicious deaths occurred. This protocol was ultimately published by theUnited Nations and has been used around the world. There were many terrific,passionate advocates for human rights involved in this project.


1 0 Q U E S T I O N S

Photo credit: Bruce Silcox

Call the coronerLindsey Thomas, MD

Why are autopsies performed andare there instances in which theyshould be performed but aren’t?Autopsies are performed to answer ques-tions of identity, cause of death, public safety or public health hazards, and whathappened. There are many other issues that we address as well. Webelieve that we are serving the living while caring for those whohave died, by providing information to families, the criminal andcivil justice systems, health agencies, and the community.

Due to a real shortage of forensic pathologists in the U.S., thereare instances where autopsies are not performed that should be.

Tell us about the work you do in the field vs. in the lab.As forensic pathologists, most of our work is done in the office andautopsy room. We do go to scenes of suspicious deaths and homi-cides, but, unlike TV, we are not involved in chasing the “badguys.” We work with law enforcement personnel, but our job is todetermine what happened, not who did it. At the scene, a medicalexaminer assists by estimating the approximate time of death andoffering a preliminary idea about the cause and manner of death.

What are some of the different ways information froma postmortem exam is used? Our data is used to preventdeaths by identifying infectious diseases, genetic abnormalities,inherited conditions, and dangerous consumer products or drugs.We identify which deaths need further investigation. Exams can alsohelp families get answers about what happened to a loved one.

During the past 10 years, whathave been the most dramaticadvances in the techno logy youuse? DNA testing is one. The DNA in adrop of sweat can prove someone’s pres-ence at a scene and the DNA in a small

fragment of bone can confirm someone’s identification. But otheradvances have also been important. Digital cameras make documen-tation easier, and cell phones and computers increase the speed ofobtaining and sharing information. Video surveillance cameras havetaught us a lot about what happens during various types of deaths.

Has technology allowed you to reexamine a previouscase to redefine the cause of death? Not so much to rede-fine the cause of death as to identify possible perpetrators of homi-cides, and, likewise, to exonerate those incorrectly accused ofcrimes. DNA enables the legal system to determine whether or notsomeone had contact with a deceased person.

You undoubtedly examine a fair number of people whodied of easily preventable causes. What advice can youshare? Don’t smoke. Don’t drink alcohol and drive, or ride in acar when the driver has been drinking. Always wear your seatbelt.Don’t take any drug that has not been prescribed to you, and don’ttake any more of any drug than absolutely necessary. Get treatedfor depression and other forms of mental illness. My final advice isto cherish every moment of your lives. One thing that medicalexaminers learn is how fleeting and precious life is.


Even after thousands of cases, every week or so

I see something I have never seen before.

Alcohol and drug abuse by seniors often goes unnoticed because of isolation and loneliness. As a result, the older adult continues to suffer in silence. Senior Helping Hands is a program of St. Cloud Hospital Recovery Plus and a recognized national leader providing support and services to stop the suffering. Senior Helping Hands serves individuals age 55 and older.

Services• Outreach service and consultation with family or concerned persons• Evaluation and assessment for chemical dependency and/or mental health

issues completed by qualified professionals• Volunteer support for older adults who are chemically dependent• Support from peer volunteer counselors for older adults with mental health issues

ProgramsOlder Adult Chemical Dependency Primary Treatment ProgramA comprehensive program that involves physical/psychosocial/chemical use assessments performed by professionals trained in chemical dependency and mental health, including a full time Medical Director who is an addictionist. The program provides a slow pace, holistic approach to recovery. Transportation and temporary housing are available if needed.

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Are you one of the morethan 875,000 Minnesotansage 45 or older who used

at least three prescription drugs last month? If so, you know that medications are not cheap.Prescription drug prices are basedon a complex equation of drugcompany research and developmentcosts, drug company marketingstrategies, patent laws, public policy, and purchasing arrange-ments between drug companies,suppliers, and insurance companies.

There is very little thatthe average consumer can doto alter this cost equation.Nonetheless, there are waysyou might be able to savemoney on prescription med-ication. Here are some strate-gies that you can use—andsome you shouldn’t—to getthe best value for the moneyyou spend on medication.

Do consider

Non-drug therapy. Ask yourdoctor if you can treat yourmedical condition by usingnon-drug approaches. Suchapproaches could includechanging diet, changing exer-cise habits, changing sleepinghabits, using ice to relievepain, or quitting smoking. Asan added bonus, non-drugtreatments likely cause fewerside effects than medications.

Older medication. Letyour doctor know if the costof medication is a financialconcern. Many communitypharmacists have stories

about patients who must decide between filling a prescription for aneeded medication and having enough money to pay for rent, utili-ties, or even food. Your doctor might be able to prescribe an older,less expensive medication. Although not the “latest and greatest,”many older medications still will meet a patient’s treatment needs.

Compare prices. Consult the Consumer Reports’ Best Buy Drugswebsite to compare prices of prescription medication: www.consumerreports.org/health/best-buy-drugs/index.htm Searches can be made by medical condition or by drug name.

Store-sponsored generics. Utilize store-sponsored low-cost genericmedication programs; some pharmacies offer generic drugs for only afew dollars. Stop by your local pharmacy or check the pharmacy’swebsite to find out if it has a low-cost generic drug program. Then,ask the pharmacist if generic versions of the medications you use areincluded in the pharmacy’s low-cost program. When price-checking,keep in mind that it is always best to get all medications from thesame pharmacy since that allows the pharmacist to have a completerecord of the medications someone takes. This is important because ithelps the pharmacist check for potential adverse interactions betweenthe multiple medicines someone uses.

Medication therapy management. Sit down with your pharmacistfor a comprehensive review of your medications. Patients with highblood pressure, high cholesterol, or diabetes, for example, have beenfound to be more likely to achieve their treatment goals if they haveperiodic comprehensive medication reviews with a pharmacist.

Increasingly, community pharmacies, chain store pharmacies, andpharmacies located in clinics offer Medication Therapy Management,or MTM, services. These patient-pharmacist meetings typically last

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If so…the TED Programprovides assistive telephoneequipment at NO COST to those who qualify.

Please contact us, or have your patients call directly, for more information.

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P H A R M A C Y

Stretch your medication dollars

Save money safely By Timothy Stratton, PhD, BCPS, FAPhA

between 30 minutes and an hour, but may last longerdepending upon the number of medications you takeand the number of medical conditions you have.

Because of the length of a typical MTM meeting,pharmacists usually ask patients to make an appoint-ment for the visit. For people who use Medicare PartD to help pay for prescription drugs, Medicare willpay for several MTM visits each year. Many otherhealth insurance policies that cover prescription drugsalso pay for these visits. Anyone can have a compre-hensive medication review with a pharmacist, but ifyour insurance does not cover MTM services, youwill need to pay for these visits on your own.

Before you go to your MTM visit, gather up allof the prescription medications, nonprescription medications (alsoknown as over-the-counter medications, or OTCs), vitamins, andnutritional supplements you currently use. Take them, in their origi-nal containers, to your MTM meeting with the pharmacist. The phar-macist will discuss each medication, vitamin, or nutritional supple-ment with you to ensure you are getting the best possible benefitfrom these products. The pharmacist will then work with you to cre-ate a medication treatment plan that meets your specific needs. You’llreceive a copy of this treatment plan and an up-to-date list of yourmedications, vitamins, and nutritional supplements.

With your permission, the pharmacist will share a summary ofyour visit, and his or her recommendations, with your doctor orother primary health care provider. This can alert different medicalspecialists who unknowingly are treating the same patient to a poten-tial adverse interaction between their respective prescriptions.

Patient assistance programs. Many drug manufacturers are will-ing to provide assistance to people who use that company’s products.To learn if programs are available for the medication you need, look

for a toll-free phone number for themanufacturer of your medication. Thenumber may be on the Internet andshould be available from your phar-macist.

Use caution

Some people try to save money onmedication by doing things that actu-ally can put their health at risk.

Online pharmacies. The Internethas given rise to a proliferation ofonline pharmacies. Many of these

sites promise low prices on brand-name, expensive prescription med-ications. The U.S. Food and Drug Administration (FDA), the govern-ment agency charged with protecting the American public when itcomes to the safety of medications, offers a free brochure outliningthe risks of obtaining medication from online pharmacies:www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM204943.pdf

Certainly, not all online pharmacies are suspect. Many U.S.national chain pharmacies and many local community pharmaciesalso have Internet sites through which a patient can get prescriptionsfilled and mailed to the patient’s home. These are known as “clickand brick” pharmacies because the patient can obtain a prescription

either via mail order online or by picking up a pre-scription in person.

An Internet-only pharmacy that displays the“VIPPS” seal has met state licensure standardsrequired of all pharmacies. (VIPPS stands for VerifiedInternet Pharmacy Practice Sites.) The NationalAssociation of Boards of Pharmacy maintains a web-site which lists legitimate pharmacies that carry thisseal: www.vipps.info

Samples. If your doctor offers you a sample ofbrand-name medication in the office, be sure to askthese questions: • Will I need to take this medication for a long time? • Is the medication covered by my health insurance?

• How much will I need to pay for the medication, either as a copayor in full?

• Are there effective, but less expensive, options?

Maximize benefit

Most people would rather not take medication. But for those us whodo need to take it on a regular basis, several steps can help reduce theamount we spend while getting the best possible benefit from themedications we do need to use. Talk to your doctor. Talk to yourpharmacist.

Timothy Stratton, PhD, BCPS, FAPhA, is a board-certified pharmacotherapyspecialist and a professor of pharmacy practice at the University ofMinnesota College of Pharmacy, Duluth, where he teaches ethics and super-vises medical and pharmacy students at the HOPE free clinic.


© 2012 Minnesota Diabetes & Heart Health CollaborativeMinnesota Diabetes &

Heart Health Collaborative

Eat more fruits, vegetables, whole grains and less fat

Be physically active every day

Do not smoke

Eat smaller portions and lose 10 pounds if you are overweight

Know your ABCs: A1C, Blood pressure and Cholesterol

Take your medicines as directed

Talk to your doctor

Let your doctorknow if the

cost of medication is

a financial concern.

It is best to getall medicationsfrom the same

pharmacy.


G E R I A T R I C S

MaturedriversIncreasing safety behindthe wheelBy Catherine N. Sullivan, PhD, OTR

“Driving allowed me to go wherever I wanted, whenever I wanted.”

This was the consistent answer my graduate students heardwhen aging Minnesotans who had recently given up their carkeys were asked what they valued most about driving. Becausedriving is linked to autonomy and the ability to participate fullyin community, it can be tempting for an aging driver to ignorenear misses and other warning signs of diminishing driving skill.However, promising findings from recent aging research indi-cate that many skills needed for safe driving can, with practice,be preserved and that failing driving skills can be remedied.

Crashes

The rate of fatal crashes per mile driven, the best measure ofrisk for a mature driver taking the wheel, increases sharplybetween the ages of 70 and 75, according to the InsuranceInstitute for Highway Safety (IIHS). The rate shows an evensteeper increase above age 85, especially for men, where itbecomes equal to that of teens. However, in contrast to teens,

Call to get help with: Planning for long-term care Remaining independent in your community Arranging for in-home services Getting help from state agencies Becoming involved in your community

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older drivers’ risk of fatal injuries ismuch greater to themselves than toothers, often because of seniors’greater physical frailty. These IIHS statistics highlight the need for maturedrivers to learn how to assess theirrisk level and how to remedy or compensate for specific problems.

Self-assessment

Because age-related changes are sogradual, they are difficult to recognizewithout the help of assessments.Driving requires many skills, includinggood vision, sharp hearing, focusedattention, and quick reactions, all ofwhich tend to decline with normalaging. Medical conditions such asarthritis, eye diseases, and neurologicalconditions can also affect the ability todrive safely, as do many medications.

Many helpful self-assessments areavailable (see Resources, above). The website of the AutomobileAssociation of America (AAA) offers a paper-and-pencil self-ratingchecklist, as well as an interactive tool called Roadwise Review. TheUniversity of Michigan Transportation Research Center has devel-oped an interactive online self-assessment tool called SAFERDriving, available in downloadable paper-pencil format as theDriving Decision Workbook. Research has found SAFER facilitatesdecision-making and that it matches the results of on-road drivingevaluation. All of these tools recommend what someone should doif problems are identified.

After self-assessment, what next?

Self-assessments are a good first step, but their drawback is thatthey rely largely on self-report. If several issues have been flagged, itis a good idea to request the opinions of trusted friends or familyabout an elder’s driving skills. Being open to family conversationsallows potential problems to be addressed early enough that theycan be handled before a preventable traffic accident occurs.Websites of Hartford Insurance and the Alzheimer’s Associationprovide online resources to help guide such conversations.

If issues are identified, many sources offer solutions. Taking amature driver refresher course from AARP is a sensible place tostart. There is also a wealth of free online resources. The NationalHighway Traffic Safety Administration (NHTSA) website has adownloadable booklet titled “Safe Driving for Older Adults.”NHTSA also has a series of brochures on how to continue drivingsafely with certain medical conditions. The American OccupationalTherapy Association (AOTA) website provides documents and rec-ommendations aimed at helping older drivers and their families.

Does your car fit?

A senior’s driving safety is partly determined by how well his or hercar fits an aging body structure. CarFit is a program that checkshow well a car fits its driver and educates drivers about adaptationsto improve safety. Jointly sponsored by AARP, AOTA, and AAA,CarFit makes recommendations that include how to adjust mirrors

to eliminate the blind spot when making lane changes, a maneuverthat becomes more difficult with age. There are also new technolo-gies available that can dramatically improve driving safety for olderdrivers and that should be considered when purchasing a new car.You’ll find them listed on the AARP website.


Mature drivers to page 34

1. AAA assessments:www.seniordriving.aaa.com/evaluate-your-driving-ability

2. University of Michigan SAFER self-assessment:www.elderlydrivingassessments.com/safer.php

3. AARP Older driver refresher course:www.aarp.org/home-garden/transportation/driver_safety/

4. Hartford Insurance:www.hartfordauto.thehartford.com/UI/Downloads/FamConHtd.pdf

5. Alzheimer’s Association Dementia & Driving Resource Center:www.alz.org/care/alzheimers-demen tia-and-driving.asp

6. National Highway Traffic SafetyAdministration, “Safe Driving for OlderAdults”: www.nhtsa.gov/people/injury/olddrive/OlderAdultswebsite/index.html

7. NHTSA website with brochures abouthow various conditions affect driving: www.nhtsa.gov/people/injury/olddrive/index.html

8. American Occupational TherapyAssociation:www.aota.org/Older-Driver/

9. CarFit: www.Car-Fit.org

10. DriveSharp: www.drivesharp.com/aaa-sne/index

11. MMAP (Minnesota Mobility for AgingPersons, a consortium promoting lifelong safe community mobility):www.minnesotatzd.org/topics/older/

12. “Love of Car:Transportation as we age”:www.mngero.org/academics/loveofcar.html

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Hearing loss is grim, especially for people who love music.But few people realize that the worst-case scenario maynot be hearing loss, but rather, devastating hearing injury.

Prelude

During a 31-year career as associate principal cello of theMinnesota Orchestra I saw many colleagues struggle with physicalailments caused by awkward posture and repetitive motion. It

never dawned on me that one day my own career would be curtailed by injury.

The injury

While playing with the orchestra in 2006, I wasseated with my left ear within two feet of huge

audio speakers. Despite wearing hearing protec-tion, I sustained an acoustic shock injury: Noise from the speakerscaused intense pain in that ear and a vibrating/gyrating sensationinside it, with pain radiating into my neck, face, teeth, tongue, jaw,and head. After the concert, the least little sound caused painfulspasms, even my own voice.

For three months I was forced to isolate myself totally fromsound—no music, no TV, no telephone. My family tiptoed aroundme. I wore headphones and earplugs if I had to leave the house, but any excursion had to be brief.

P A T I E N T T O P A T I E N T

Protectyour

hearingNoise-induced damageand one musician’ssearch for a remedy

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Eventually, symptoms improved enough for me to return to theorchestra, but from that day onward I wore an earplug in my leftear, onstage and off.

The problem worsens

However, over the course of several years my right ear started tohurt, despite the fact that I avoided loud sounds and never watchedTV or listened to music except when I was at work. By 2010, mycondition was deteriorating rapidly.

The orchestra’s repertoire that year included enormously loudmusic. To make matters worse, my position onstage was in the cen-ter of that huge orchestral sound and immediately in front of theconductor, who often shouted instructions during rehearsal.

By that point I couldn’t enter Orchestra Hall without an earplugin each ear. Most days, pain brought me to tears. I couldn’t talkwith anyone because conversation hurt my ears. Normal soundswere painful; loud sounds, intolerable. It was as if the whole worldhad been turned on “high.”

In August 2010, the orchestra toured Europe and performed inLondon before an audience of nearly 4,000 people. Their cheeringand clapping was the end for me; I could no longer tolerate thatmuch noise.

My career as an orchestral musician was over.

Emotional, physical fallout

After the tour I was diagnosed with hyperacusis, an auditory disor-der arising from a problem in the way the brain perceives noise.Simply put, it is extreme sensitivity to sounds, especially high-frequency ones. Few statistics exist on hyperacusis, although theAmerican Academy of Otolaryngology estimates that approximatelyone in 50,000 people in this country suffer from this condition,which can affect people of all ages in one or both ears.

In my case, it developed from continued exposure to noise afterthe acoustic shock injury in 2006. I was advised to resign my posi-tion with the orchestra immediately and to avoid all exposure tonoise or else jeopardize my hearing and any chance of living a nor-mal life.

This condition made me become totally isolated because loudnoise permeates our society—who knew when I might encounter aleaf blower, snow blower, or construction? I could not attend orplay in a concert, nor participate in normal activities like going to arestaurant or small social gathering.

All sounds were intolerable, including everyday ones like run-ning water. High-frequency sounds were especially disturbing, evenif they weren’t loud. I felt assaulted by the high-pitched beeps ofgrocery scanners, ATMs, gas pumps, and digital appliances.

The situation seemed hopeless.

Finding help

Searching for help spanned five years and included consulting manyspecialists and getting every test in the book. It took two years tofind an otolaryngologist who correctly diagnosed the acoustic shockinjury and subsequent hyperacusis. Although I had stopped playingwith the orchestra before any measurable hearing loss was detected,my acoustic shock injury and hyperacusis are permanent.

In 2011, searching for solutions led me to Oregon Health andScience University (OHSU) in Portland, which has a clinic specializ-ing in both hyperacusis and tinnitus, or ringing in the ears. (In addi-

tion to hyperacusis, I also have low-grade tinnitus.People with one of these conditions often have theother one too. Both conditions are usually causedby acoustic shock injury and worsen from contin-ued exposure to noise.) The OHSU team fitted mewith attenuators, devices that provide five differentlevels of sound reduction and have given back mylife to me.

Another aspectof reclaiming partici-pation in our every-day world involvesdealing with thehypervigilance andfear of sound I’ddeveloped as self-protective copingmechanisms. Likeother people learning to live with hyperacusis, I amretraining my brain to tolerate sound by listeningto recordings of pleasant sounds like rainfall andwind. Training starts by listening to the recordingsat a very low volume and gradually increases thevolume and the amount of time spent listening.

Coda

Today, more than six years after the acoustic shock


Protect your hearing to page 19

Audiologists recommendthe “60/60” guideline for earbud use: Don’t listen for more than 60minutes/day, and keep volume under 60 percent of maximum volume.

Editor’s note

9 Family and Caregiver Classes forAlzheimer’sHome Instead Senior Care presents a fam -ily Alzheimer’s training class and care giversupport group. Free. Call Erica at (763)544-5988 for more information.Saturday, March 9, 9–11 a.m., WayzataLibrary, 620 Rice St. E., Wayzata

13 Pain Management ClassAllina Health presents Tilok Ghose, MD,and Scott Anseth, MD, discussing hip/kneepain and how to get the correct diagnosisfor it. Refreshments. Free. Call (651) 644-4108 for more information.Wednesday, March 13, 1–3 p.m., The Commons at Midtown Exchange,2925 Chicago Ave., Minneapolis

19 Alzheimer’s EducationAlzheimer’s Association presents occupa-tional therapist Susan Ryan, OTR/L, dis-cussing practical suggestions for living withthis disease. Light dinner provided by TheAlton Memory Care. Free. Call Mike at(952) 857-0546 for more information.Tuesday, March 19, 6:30–8 p.m., MountZion Temple, 1300 Summit Ave., St. Paul

20 Food Allergy SupportFood Allergy Support Group of MN presents a support group for those withfood allergies. Free. For more information,email [email protected] Wednesday, March 20, 7–8:30 p.m.,Crystal Community Ctr., Game Rm., 4800 Douglas Dr., Crystal

22 Mental Health Activism DiscussionThe University of St. Thomas presentsDavid Wellstone addressing politicalactivism and legislation in mental healthand substance abuse treatment. Free. Call David Hamm at (612) 962-4441 for more infor m ation.Friday, March 22, 11:30 a.m.–1 p.m.,Opus Hall, 1000 LaSalle Ave.,Minneapolis

25 Health Policy Lunch and LearnUniversity of Minnesota Medical IndustryLeadership Institute invites you to bringlunch and learn about health policy andregulatory affairs. Free. Call Monica at(612) 624-1532 for more information.Monday, March 25, 12–1 p.m., CarlsonSchool of Management, Rm. 1-135, 321 19th Ave S., Minneapolis

Apr. 1–5 National Public Heath FilmFestival University of Minnesota School of PublicHealth presents its National Public HealthWeek Film Festival. Films shown on varioushealth-related topics; Q & A with expertsafter each night’s film. Free. Call Nicholeat (612) 626-9303 for more information.Monday–Friday, April 1–5, 5–9 p.m.,Mayo Memorial Auditorium, 4th Flr., 425 Delaware St. S.E., Minneapolis

Apr. 6 Cancer Survivor Series University of Minnesota presents the 8thAnnual Survivorship Series. This confer-ence addresses questions cancer and stemcell treatment survivors and their familiesmay face after treatment. Free. Call (612) 624-2620 to register. Saturday, April 6, 8 a.m.–1:30 p.m.,McNamara Alumni Ctr., 200 Oak St. S.E.,Minneapolis

July 14-19 Gluten-Free Fun CampR.O.C.K.-Twin Cities Chapter offers campfor kids 8–17 with celiac disease. Registernow at: www.twincitiesrock.org/campSunday–Friday, July 14–19, Camp Courage, 8046 83rd St. NW,Maple Lake

Send us your news:We welcome your input. If you have an event youwould like to submit for our calendar, please sendyour submission to MPP/Calendar, 2812 E. 26thSt., Minne apolis, MN 55406. Fax submissions to(612) 728-8601 or email them to [email protected]. Please note: We cannot guaranteethat all submissions will be used. CME, CE, andsymposium listings will not be published.

America's leading source of health

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Did you know that one in 88 Americanchildren is identified as being on theautism spectrum? That is a tenfold in -crease in prevalence in 40 years, accordingto the Centers for Disease Control andPrevention. An estimated one in 54 boysand one in 252 girls are diagnosed withautism in the United States, with preva-lence rates growing 10 percent to 17 per-cent annually in recent years. To raiseawareness, April 2 has been designatedWorld Autism Awareness Day.Autism cannot be definitively diagnoseduntil 18–24 months, but early signs canshow in babies as young as 8–12 monthsof age. Look for no sharing of sounds,smiling, or other facial expressions bynine months, and no babbling or pointingby 12 months.There is no single cause of autism, butgenetic and environmental factors arethought to be at work. Expectant motherscan lessen their chances of having a childwith autism by taking prenatal vitamins,especially folic acid. Other risks to avoidinclude advanced parental age and mater-nal illness during pregnancy. For more information on autism:www.autismspeaks.org

Apr. 3 ASD TreatmentsSkillshopAutism Society of Minnesotapresents Amy Esler, PhD, LP, asshe discusses commonly used treatments forAutism Spectrum Disorder (ASD) and evi-dence supporting these treatments. Cost is$10 for AuSM member with ASD. Call(651) 647-1083 for more information.Wednesday, Apr. 3, 7–9 p.m., 2380 Wycliff St., Ste. 102, St. Paul

World Autism Awareness Day


March Calendar

injury, my ability to manage hyperacusis has improvedto the point that I can play cello in small groups ofmusicians. The injury to my ears is permanent and Iwill always need to avoid noisy situations, but at leastI can tolerate being outside my home, thanks to theattenuators.

Reinventing myself after losing my professionalidentity as an orchestral musician has not been easy. I feel fortunate to have had the support of medical

personnel, friends,and family, andhave worked hardnot to let myinjury keep mefrom continuing ameaningful life.

Noise pollution

Part of what makes my life meaningful is alerting peo-ple to noise pollution: traffic and construction noise,music blasting in retail establishments, and young peo-ple listening to loud music for hours. This results in ahigh proportion of people with hearing problems.

According to research published in the Journal ofthe American Medical Association in 2010, 20 percentof U.S. adolescents aged 12 to 19 are losing their hear-

ing, a significant increase from the 15 percent of adolescents in1988–1994 who had hearing loss. Currently, one in five teens cannot hear correctly. Even mild hearing impairment during youthcan lead to decreased educational achievement and impaired social-emotional development.

Another study revealed that the common denominator amongstudents with hearing damage at a school in Ohio was that they lis-tened to MP3-type portable music players. According to the MayoClinic, most personal listening devices can produce sounds up to120 decibels, which is equivalent to an ambulance siren.

Protect yourself

The problem with noise-induced hearing loss is that you don’t feel itwhile it’s happening; it may take years before you realize that someof your hearing was permanently destroyed.

How can you protect your hearing? Ask retail establishments toturn down the volume. Carefully consider the volume at which youplay personal listening devices and the length of time earbuds are inyour ears. Wear earplugs around lawn mowers, at rock concerts,and in other noisy settings. Get a hearing test to see if you havealready sustained damage.

Protect your ears before it’s too late.

Janet Horvath is a cellist and a soloist, chamber musician, writer, and advo-cate for injury prevention. She writes about injury prevention for manypublications, writes about music for www.interlude.hk, and has written aninjury-prevention book for musicians (www.playinglesshurt.com).

Protect your hearing from page 17

The problem withnoise-induced hearingloss is that you don’t feel it while it’s happening.


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Every hour, one American dies ofmelanoma, the most deadly form of skincancer. There were 123,590 new cases ofmelanoma in 2011 and 8,790 deathsfrom it. Unfortunately, the incidence ofmelanoma continues to increase by 4 per-cent to 10 percent annually. One in 55

women and one in 36 men will develop melanoma during their lifetimes.If a melanoma is detected early in its development, it can be treated easily.However, if detected in later stages, survival rates are low. Thus, early

diagnosis is paramount.

Symptoms

Typically, melanoma appears as a new mole or as one whoseappearance is changing; 30 percent of these cancers arise inan existing mole. Melanoma can look like a multicoloredmole, including one that’s brown and black, but it also can

be a pink or red lesion. Often, this cancer appears on theback in men and on the legs in women, although it can develop

anywhere on the body, including the eye or inside the mouth.

Risk factors: Ban the tan

Caucasian men over 50 are at highest risk for melanoma, but it is themost common cancer in people 25–29 years of age, and the second most

common among those 15–29. Melanoma occurs less frequently in non-Caucasians, but having dark skin does not mean a person is risk-free. Bob

Marley, of Jamaican reggae fame, died of a melanoma under his toenail. Risk factors include fair skin, blue or green eyes, red or blond hair, and the pres-

ence of multiple atypical moles and freckles. A personal or family history of melanomaincreases susceptibility.

All these factors are beyond a person’s control. The only preventa-ble risk factor is exposure to ultraviolet (UV) radiation, which the U.S.Department of Health and Human Services and the World HealthOrganization have declared a cancer-causing substance.

UV radiation causes cancer because it damages genetic material inskin cells. This leads to aging of the skin, immune suppression, eyedamage (including cataracts and ocular melanoma, or eye cancer), andskin cancer. Intense, intermittent sun exposure such as blistering sun-burns promotes the development ofmelanoma. The risk for melanoma dou-bles for people who have had more thanfive sunburns at any age or one or moreblistering sunburns in childhood.

Increasing incidence

The rising incidence of melanoma in the U.S. is due primarily tobehaviors promoting recreational UV exposure. Sunburn before age21, outdoor summer jobs as a teen, and the use of tanning beds arerecognized risk factors. Indoor tanning increases the risk ofmelanoma by 75 percent overall and by 87 percent for those whostart before age 35. Just one indoor tanning session increases theuser’s chance of developing melanoma by 20 percent.

Despite this risk, 28 million Americans visit tanning salons annu-ally, nearly 70 percent of whom are Caucasian women ages 16 to 29.Despite compelling evidence that tanning beds cause skin cancer,including melanoma, the use of indoor tanning continues to rise.Legislation banning indoor tanning and prohibiting its advertising isurgently needed. Although the majority of states have laws limitinguse of tanning beds by minors, these laws usually are not enforced.

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MelanomaPrevention and

early detection are key to survival

By Pierre George, MD, and Juan Jaimes, MD

Prevention: Slip, slap, slop

Melanoma is largely a preventablelifestyle disease. The cornerstone ofprevention involves minimizing UVexposure. Rules of smart sun expo-sure are simple and well known,but often ignored. Only one-thirdof adults and even fewer teens rou-tinely practice these sun-protectivebehaviors:

• Ban the tan. Tanning promotesskin cancer, regardless of whetherthe tan comes from a tanning salon or outdoors.

• Wear a broad-brimmed hat.

• Wear long-sleeved shirts and long pants. These are available inlightweight, SPF-impregnated fabric.

• Apply broad-spectrum sunscreen that blocks both UVA and UVBrays and has an SPF of 30+.

• Use sunscreen daily, even on cloudy days. (Ultraviolet rays penetrateclouds.)

• UVA rays penetrate most window glass; use sunscreen when drivingor sitting next to a window.

• Seek shade, especially between 10 a.m. and 4 p.m. If your shadowis shorter than you are, stay in the shade.

In Australia, these guidelines are called Slip, Slap, Slop (slip on ashirt, slap on a hat, slop on sunscreen). Sunscreen’s effectiveness inpreventing melanoma is well documented: A recent Australian studyshowed that the risk of developing melanoma was reduced by 50 percent for daily users of sunscreen, compared with people whodidn’t use sunscreen regularly.

Spot it, stop it

If you can spot melanoma, you can stop it. There is no effectivecure for this disease once it’s in the advanced stage, so early detec-tion is the best method to save lives. If a melanoma is found early inits development and before it spreads to the lymph nodes, it can eas-ily be treated with a surgical procedure that results in a 98 percentsurvival rate over a five-year period. (This means that 98 percent ofthe people who were treated had not died from melanoma five yearsafter treatment.) Survival falls to 62 percent if the disease reachesthe lymph nodes, and 15 percent once it metastasizes (spreads) to

distant organs. Early diagnosisis critical.

Check your skin every oneto two months using two mir-rors or the help of a partner;

80 percent of melanomas are detected by the patient or a spouse. Ifyou can’t do it that, at the very least check your birthday suit on yourbirthday and report any suspicious lesions to your dermatologist.Look for any mole that has changed color, size, or shape, using“ABCDE” to remember what to look for.

A) Asymmetry. Most melanomas are asymmetrical; a line through themiddle of the mole or lesion does not create matching halves.

B) Border irregularity. Borders of a melanoma are uneven. Edges maybe scalloped or notched.

C) Color variability. A melanoma may have varied shades of brown,tan, black, red, white, or blue.

D) Diameter. Melanomas are usually largerthan a pencil eraser although smallermelanomas are not rare.

E) Evolution. Any change in color, size,shape, height, or other characteristic, orany new symptom such as bleeding, itch-ing, or crusting, indicates danger andshould be evaluated by a doctor.

Periodically taking photos of your moles is agood way to detect changes over time.

Treatment

The treatment for melanoma is surgery. Whena lesion is detected early, removing it and a margin of normal skinaround it is usually a cure and can be done in the doctor’s office. Inmore advanced cases, when melanoma cells may have spread beyondthe borders of the tumor, removing nearby lymph nodes and addingchemotherapy may be helpful.

Early detection

Melanoma is one of the fastest-growing cancers. However, it’s alsoone of the most preventable and curable, if caught early. Recommen-dations for prevention are simple: Seek shade, cover up, wear sun-screen, and wear sunglasses, especially wraparounds, which protectthe sides of the eyes.

Early detection is critical. Examine your skin routinely, and see adermatologist if you find anything changing, growing, or new.

Pierre George, MD, and Juan Jaimes, MD, are board-certified dermatologistswho practice with Dermatology Consultants in St. Paul and Woodbury.


For more informationwww.aad.orgwww.skincancer.org

MDH reminds winter vacationers about sun protection

The Minnesota Department of Health (MDH) reportsthat melanoma is one of the most rapidly increasingcancers in Minnesota. The number of Minnesotansdiagnosed with invasive melanoma of the skin nearlytripled between 1988 and 2009.

“If not found early, melanomas can spread toother parts of the body and can be deadly,” saysCommissioner of Health Ed Ehlinger, MD. “… we alsowant to remind people taking winter vacations thatthey risk serious health consequences if they don’tprotect their skin from ultraviolet light,” he adds.“The idea that it is a good health move to get a ‘basetan’ before going on vacation is a myth.”

Gout is the most common form of inflammatory arthritis in men and affects millions of Americans. In people with gout, uric acid levels build up in the blood and can lead to an attack, which some have described as feeling like a severe

burn. Once you have had one attack, you may be at risk for another. Learn more about managing this chronic illness at www.goutliving.org

Living with gout? Keep enjoying life’s

simple pleasures.


E N V I R O N M E N T A L H E A L T H

Spring: Trees are budding, cro-cuses are blooming, windowsare open. Who wouldn’t wantto go outside?

Twenty percent of the population, that’s who. Forthese hayfever sufferers, itchy,swollen eyes and sneezing signalthe onset of spring allergies trig-gered by pollen. Pollen is

a fine powder produced by certain plants when they repro-duce, which occurs from spring through fall in Minnesota.Trees pollinate in spring, grass in summer, and weeds, fromAugust to frost. Symptoms of pollen allergies can begin inearly childhood or as late as middle age, but usually show upbetween childhood and a person’s 20s.

Symptoms Symptoms include a stuffy and/or runny nose, postnasal drip (drainage down the back of the throat), sneezing, anditching. Dark circles around the eyes may indicate congestion,as can breathing exclusively by mouth, which can producebad breath. Poor sleep caused by severe stuffiness may indi-cate hayfever; sinus and ear infections and allergic asthmamay be associated. Skin may feel itchy, particularly aroundthe eyes. It’s important to address itching because repetitiveskin scratching can trigger eczema. Eczema is characterizedby redness, bumps, and patches of scaly, thickened skin.

HayfeverHow to copeBy Nancy Ott, MD

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In addition, certain fresh fruitsand vegetables can cause mild itchingin the mouth and throat because theycontain proteins similar to pollen.Cooking the produce prevents thisreaction. This phenomenon, known asoral allergy syndrome, suggests thepresence of hayfever. It can precede eye and nose symptoms.

DiagnosisDiagnosis often is made initially by a primary care provider, basedon patient symptoms. Determining what, exactly, is causing thehayfever is done by testing sensitivity to pollen from trees, grasses,and weeds. Tree pollen in the Upper Midwest involves six pollens:oak, elm, maple, birch, cottonwood, and ash. These tree pollenscross-react with other tree pollens, so testing for them will detectallergies to all regional trees. Minnesota’s Junegrass and timothygrass cross-react with all grasses in this region; testing for those twograsses will detect allergies to regional grasses. Since ragweed is thedominant weed in Minnesota and other weeds are less likely to be amajor allergy trigger, testing for ragweed is all that is necessary todetect weed allergies.

Hayfever sufferers who spend a lot of time in different areas ofthe country, such as those who winter in Texas, should be tested forpollen found in those areas too. Texas, for instance, has mountaincedar tree pollen and grasses that do not grow in Minnesota.

Mold spore allergy or hayfever? Mold spore allergy can causecongestion but is unlikely to cause the itching and sneezing causedby pollen. The highest level of mold spores outdoors occurs duringlate fall, when leaves are being raked after the frost. Reaction to thespores isn’t considered classic hayfever. However, because it canoccur in the late summer and early fall at the same time as weedallergies, mold spore allergy can complicate the process of determin-ing the cause of congestion.

Self-treatmentAvoidance strategies. Shower immediately after being outside andplace in the laundry any clothing worn outside. Leave shoes at thedoor. Nasal rinses with neti pots or squeeze bottles of sterile saltwater can flush allergens and mucus. Eye rinses help relieve eye

symptoms. Keep windows closed to keeppollen outside the home. Go outdoors laterin the day, when pollen counts are typicallylower, or immediately after it has rained.

Over-the-counter (OTC) medicine suchas nonsedating antihistamines can help con-trol itchy, runny eyes and/or noses. Deter -mine what works for you via trial and error;loratadine (Claritin), cetirizine (Zyrtec), andfexofenadine (Allegra) are options. Adver -tising claims that one antihistamine is betterthan another for “outside” or “inside” useare unfounded. Each person responds differ-ently to each antihistamine regardless of

whether an allergen is outside or inside the house.

OTC decongestants can alleviate congestion but may cause sideeffects. Nasal spray decongestants such as Afrin or Neo-synephrine

can be used safely for three to five days. Using OTC nasal deconges-tant sprays longer than one or two weeks can cause worsening con-gestion as the spray wears off. If the spray is then used repeatedly inan attempt to keep nasal passages open, it creates a “rebound” cyclethat is hard to break.

Oral decongestants such as pseudoephedrine or phenylephrinecan be used daily with less chance of rebound, but may lead tosleeplessness and high blood pressure. Antihistamines available incombination with decongestants are sold as Claritin-D, Allegra-D,and Zyrtec-D. The decongestants in these products often last 12 to24 hours. Generic medications are less expensive than brand-namedrugs and work just as well.

Eye drops. Just as nasal decongestants can lead to rebound, socan eye drops such as Visine. Eye drops claiming to “get the red out”are vasoconstrictors, meaning they constrict blood vessels. Theyshould be used short term, similar to decongestant nasal sprays.Nonvasoconstrictor eye drops, such as ketotifen eye drops, can beused safely every day. Ketotifen is an anti-inflammatory OTC non-steroidal eye drop available as Zatidor, Alaway, and other names.


Hayfever to page 27

Claims that one antihistamine is better than

another for “outside” or“inside” use are unfounded.

Shots maydecrease allergy

symptomsover time.


More than half of adult cancer patients andsurvivors report experiencing significant distress during treatment, recovery, or

survivorship, according to the 2007 Institute ofMedicine (IOM) groundbreaking report, “Cancer Carefor the Whole Patient: Meeting Psychosocial HealthNeeds.” In fact, cancer patients and parents of youngchildren with cancer sometimes meet the criteria forpost-traumatic stress disorder (PTSD), reports the IOM.

Such stress puts cancer patients and their families at increased risk for anxiety, depression, and other mental health problems. Depression alone costs an estimated $8,400 annually for the cancer patient whoexperiences it, reports Cancer Support Community, an international nonprofit organization that providessupport and education to people affected by cancer.

P A L L I A T I V E C A R E

Easing thejourneyAddressing cancer’s psychosocial impact

By Michelle Silverman

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In addition to economic cost, patients suffering fromdepression, anxiety, or excessive stress can have difficultyremembering, concentrating, and making decisions. Theseproblems can compound the challenges of cancer treatmentand decrease a patient’s motivation to complete treatment,resulting in a debilitating, downward spiral.

Support eases stress

But it doesn’t have to be that way. A Stanford University clinical trial found that women who participated in supportgroups while undergoing cancer treatment demonstrated significant improvement in making necessary life changes, a positive attitude toward their illness, better interpersonalcommunication, and a significant decrease in PTSD symptoms:

• 87 percent of the women experienced reduced stress

• 86 percent of the women felt less fearful

• 85 percent of the women felt they could face the futuremore positively

• 83 percent of the women felt more in control of their lives

Increasingly, cancer treatment experts advocate collaborationbetween a patient’s medical team and community resources thataddress the psychosocial impact of cancer. Although managing stressis recognized by the medical community as an important factor inthe cancer journey, only 14 percent of the oncologists surveyed bythe IOM in 2007 screened patients for stress. However, that willchange in 2015 when the American College of Surgeons Commiss-ion on Cancer, which accredits cancer treatment centers, beginsrequiring centers to screen patients for stress as a prerequisite for

accreditation. Those screenings and any

needed services provided inresponse will benefit both thepatient and the health care systemas a whole. According to an articlein Progressive Brain Research enti-tled The Cost-Effectiveness ofMind-Body Medicine Interventions(2000), evidence supports the effec-tiveness of services aimed at reliev-ing the emotional distress thataccompanies cancer. This occurseven if patients are experiencing

debilitating depression, anxiety, or both. Early identification andtreatment of psychosocial distress through counseling and supportservices pays off: Patients experience decreases in average length ofhospital stays, hospitalization frequency, physician office visits,emergency room visits, and the number of prescriptions received.

Patient support

Health care systems provide some help, such as support groups forpeople with certain cancer diagnoses. However, they cannot provideall the services needed by cancer patients and their families due toconfidentiality laws and constrained resources, says Brenda Weigel,MD, division director of pediatric hematology/oncology at theUniversity of Minnesota and medical director of the clinical trialsoffice at the university’s Masonic Cancer Center.

In addition, many individuals do not want to receive supportservices at the same place where they are treated for cancer. That’swhy offering psychosocial support services outside a hospital orclinic setting is necessary to attract the very people who need them.

Caregiver support

A need for support includes not only a person living with cancer buthis or her family members and friends. For example, when parents


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www.mppub.com

Easing the journey to page 26

Gilda’s Club Twin Cities Gilda’s Club Twin Cities (GCTC), an affiliate of theCancer Support Community, is scheduled to open in2013 as a place where men, women, teens, and children living with cancer, along with their familiesand friends, can join with others to receive social,emo tional, and psychological support. GCTC expectsas many as 17,000 annual visits based on the experi-ence of Gilda’s Clubs located nationwide in similarmetropolitan communities.

Named for comedienne Gilda Radner, who died of cancer in 1989, this organization’s nationallyacclaimed program includes support groups, educa-tion, healthy lifestyle programs, social opportunities,and information and referral services. All services arefacilitated by licensed professionals and are free.

Many caregiversreported that they

needed help dealing with

their loved one’s emotional distress.

learn their child has cancer, it is notunusual for them to want to reach outto other parents going through thesame trauma and associated stress.However, points out Dr. Weigel,“Because of confidentiality, we can’tintroduce families to each other.Instead, they meet in hospital hallwaysand cafeterias. These aren’t the idealsettings. Other organizations can facilitate those connections inways we cannot.”

An American Cancer Society survey of caregivers found that a significant percentage of people caring for someone with breastcancer experienced the same level of distress as the patient. Manycaregivers reported that they needed help dealing with their lovedone’s emotional distress, especially at thetwo- and five-year anniversaries of the diag-nosis. Caregivers also reported needing helpdealing with their own emotional distress atthose times.

Not surprisingly, the survey found that“[o]ne of the most stressful events in thecourse of the cancer experience is being told that the cancer hascome back. Some of them were faced with that awful news, andothers had to prepare for the loss of their loved one. During thosetimes, especially, if the caregivers had a strong support system in

place, they were able to adjust better.” According to research published in

an article in the Journal of ClinicalGeropsychology (Impact of psycho- educational interventions on distressedcaregivers, 2000), fatigue can exhaust acaregiver’s physical and mental reservesand make caregiving a difficult, if notimpossible, task. Providing early andfrequent support for the caregiver helps

to mitigate these effects and ensures a healthier environment for allthose involved.

Reducing cancer’s burden

The American Cancer Society estimates that more than 13 millioncancer survivors live in the U.S. Given the size of this population

and the fact that survivors now live longerafter diagnosis than in the past, treating theemotional and psychological distress that often accompanies cancer is a necessity.Early intervention and consistently avail-able support services have been proven topromote healthier, less stressed patients and caregivers, thus reducing cancer’s

burden on both the individual and the community.

Michelle Silverman is executive director of Gilda’s Club Twin Cities,Minnetonka.

Easing the journey from page 25


Early identification and treatment of psychosocial

distress through counselingand support services pays off.

Additional Resources • www.cancersupportcommunity.org

• www.gildasclubtwincities.org

• www.cancer.org

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Medical treatmentPrescription nonsteroidal eye drops or antihistamine eye drops similar to ketotifen can help prevent itching, tearing, and swelling. It is best to use these eye drops before allergen exposure, if possible,as this gives the best chance of preventing symptoms. If you use thedrops after symptoms begin, it may seem as though it takes thedrops longer to be effective. This is because the previous inflamma-tion that caused symptoms needs to diminish before improvementcan be detected.

Prescription nasal sprays can contain antihistamine, corticos-teroid (alone or combined), and anticholinergics. Antihistaminesprays can relieve itching and drainage and need to be used dailybecause their effects last only 12 hours. Inhaled nasal corticosteroids(INS) are miniscule amounts of cortisone-like sprays that coat nasalpassages and decrease swelling of the nasal tissue, mucus produc-tion, and response to pollen.

INS is the most effective type of medicated nasal spray for controlling symptoms. Because the dose is so small, INS needs to be used daily to control symptoms and may take up to four to sixweeks to alleviate symptoms. The OTC anti-inflammatory nasalspray Nasalcrom can be used as a mild symptom preventer/controller similar to INS. Anticholinergic sprays such as ipratropium

decrease thin, watery nasal discharge but do not significantlydecrease congestion or itching.

Oral corticosteroids. For people with unbearable symptoms thatmake it impossible to go to work or school, sleep, or perform nor-mal activities, a short course of oral corticosteroids lasting five toseven days can bring acute symptoms under control enough to allowtopical (applied to the surface of the body) prescription or othertreatments to be implemented to control symptoms.

Allergy shots. If medication and avoidance strategies do notcontrol symptoms, consider consulting an allergy specialist for skintests to pinpoint allergens (substances causing an allergic reaction).Once allergens are confirmed, an allergist may prescribe allergyshots. Shots may decrease allergy symptoms over time becauseinjecting small amounts of an allergen can teach a person’s body to tolerate it.

It’s manageableDon’t let hayfever sidetrack you. For more information, visit:www.aaaai.org and www.acaai.org

Nancy Ott, MD, is a board-certified allergy/immunology specialist withSouthdale Pediatrics, where she treats adults and children.

Hayfever from page 23

Keep windows closed to keeppollen outside the home.


Elizabeth Klodas, M.D.,F.A.S.C.C is a preventive

cardiologist. She isthe founding Editor inChief of CardioSmartfor the American

College of Cardiologywww.cardiosmart.org,a published author

and medical editor forwebMD. She is a member

of several nationalcommittees on improving

cardiac health and afrequent lecturer on

the topic.

Preventive Cardiology Consultants isfounded on the fundamental belief thatmuch of heart disease can be avoidedin the vast majority of patients, andsignificantly delayed in the rest, by prudentmodification of risk factors and attainablelifestyle measures.

We are dedicated to creating a true part-nership between doctor and patient workingtogether to maximize heart health. Wespend time getting to know each patientindividually, learning about their lives andlifestyles before customizing treatmentprograms to maximize their health.

Whether you have experienced any typeof cardiac event, are at risk for one, or

are interested in learning how to preventone, we can design a set of just-for-yousolutions.

Among the services we provide

• One-on-one consultations withcardiologists

• In-depth evaluation of nutrition andlifestyle factors

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• Vascular screening

• Dietary counseling/Exercise prescriptions

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A unique perspective on cardiac care

To schedule an appointment or to learn more about becominga patient, please contact:

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Since 1965, newborn screening hasidentified nearly 5,000 Minnesotainfants who, because screening

detected rare medical disorders, wereable to receive early treatment that prevented serious complications. The Centers for Disease Control andPrevention calls newborn screening oneof the great public health accomplish-ments of the 21st century.

How it beganIn 1965, when newborn screening be -came available statewide in Minnesota,infants were screened for only one dis-order, phenylketonuria (PKU). Withoutearly treatment, children with this dis-order suffer significant, permanentdevelopmental delay. In those days,most children with PKU lived in institu-tions.

Thanks to the development of newborn screening tests, PKU-affectedchildren are now identified at birth,which allows them to immediately starta special diet. This diet protects chil-dren with PKU from developmentaldelay and gives them the chance to livehealthy lives and to grow up with their

families. To give all children an equal chance of a healthy life, legis-lation was passed that requires newborn screening be offered to par-ents of all newborns and makes it a public health program adminis-tered by the Minnesota Department of Health (MDH). Screening iscovered by insurance. Today, newborns in Minnesota are screenedfor 54 medical disorders. This includes severe combined immunedeficiency (SCID), added to the screening panel in January 2013.

The processShortly after birth, a small amount ofa newborn’s blood from his or herheel is collected on special paper.This blood spot is dried and sent tothe MDH public health laboratory,where rapid testing for 54 diseases iscompleted on 200-plus infants eachday. If test results are abnormal,genetic counselors contact the infant’sdoctor to arrange for additional diag-nostic testing. MDH staff follows upwith the doctor and family to ensurerecommendations are followed and that the infant sees a specialistfor treatment, if needed.

Leftover dried blood spotsIn addition to screening newborns, MDH staff constantly checkscreening accuracy and look for ways to improve tests. To do this,leftover dried blood spots are needed. Current Minnesota lawallows MDH to keep any leftover blood for 71 days after normal

P U B L I C H E A L T H

Newborn screeningSimple tests produce lifetime benefits

By Amy Gaviglio, MS, CGC, Beth-Ann Bloom, MS, CGC, and Sondra Rosendahl, MS, CGC

Legislation was passed

that requires newborn

screening beoffered to

parents of allnewborns.

screening results and for two years after abnormalresults in order to provide ongoing assessment andimprovement of the screening process.

Leftover dried blood spots can be used for:

• Quality assurance

• Test improvement and development

• Further testing for the child or family

• Public health studies

Quality assurance activities that monitor testingaccuracy could not be done without using leftoverdried blood spots. This is not considered research,and is mandated by federal regulations covering allclinical laboratories.

Improving existing tests and developing tests fordisorders not currently on the screening panel areintegral to the program. An individual’s blood dur-ing the newborn period is very different from bloodin adults and older children. Newborn blood contains constituentsthat disappear as a child ages, and therefore cannot be detected dur-ing childhood or adulthood. As a result, developing tests for new-born screening can only be done using blood from newborns. Ifdried blood spots had not been previously available to newbornscreening programs, Minnesota infants would be screened today foronly PKU rather than for 53 additional treatable diseases.

Families occasionally contact MDH in an effort to understandwhy their child developed a medical disorder. For example, the fam-ily of a child with hearing loss might ask for their child’s blood spotso that doctors can determine if the hearing loss was caused by aninfection at birth. In cases like this, the dried blood spot is the onlysample available that can answer this question. Dried blood spotsmay also be used to help identify a missing or deceased child.

Public health researchers sometimes contact MDH in an effortto learn more about public health. Some study environmental expo-sures; others, congenital infections not obvious at birth.

While leftover blood spots are kept for a short time and areavailable for quality assurance andprocess improvement during thattime, they are not made available fordevelopment of new testing, furtherhealth testing for the child, orresearch to benefit the public healthwithout informed consent from theparents.

Parents who want to have theirchild’s dried blood spots and screening results saved at the MDHbeyond the standard 71 days (for normal spots) or two years(abnormal spots) can sign the consent form at:www.health.state.mn.us/newbornscreening/docs/storage_use.pdf

Signing this form allows storage and use of the dried bloodspots until the child is 18; parents can revoke consent at any time.Dried blood spots are used anonymously and MDH never uses allof a child’s dried blood spot; some sample remains available shouldthe family need it.

While newborn screening has expanded beyond the days of PKUtesting, its mission remains the same: to find newborns with treat-able diseases as early as possible in order to give them the bestchance at a healthy life. Minnesota’s health care professionals and

the Newborn Screening Program cannot accomplish this missionwithout support. Parents now have an opportunity, by completingand submitting the consent form, to help improve and expand new-born screening. This will benefit not only their own children, butfuture generations of Minnesotans.

Amy Gaviglio, MS, CGC, certified genetic counselor, supervises the Short-term Follow-up unit of the MDH Newborn Screening Program. Beth-AnnBloom MS, CGC, and Sondra Rosendahl MS, CGC, are certified geneticcounselors with the MDH Newborn Screening Program.


Everett’s story

Everett Olson’s mom, Korissa, remembers looking at Everett whenhe was born and seeing an apparently healthy baby. Because heseemed healthy, Korissa declined newborn screening. Only afterhospital nurses discussed the importance of testing did she agree tohave Everett tested. Four days later, the Olsons were told by theirpediatrician that Everett’s newborn screening had detected galac-tosemia. Children with galactosemia are unable to break down nat-urally occurring sugar in milk, so dangerous levels of this sugaraccumulate in their blood. Without prompt treatment they developbrain damage, mental retardation, cataracts, liver failure, and infec-tions, and can die young.

Although Everett seemed fine during his first few days of life,he soon showed symptoms of galactosemia. Because of newbornscreening, his disease was diagnosed quickly, appropriate treatmentwas started right away, and today Everett is a happy, healthy four-year-old. View his story atwww.youtube.com/watch?v=Q7oEz6pmhPA&feature=youtube

Newborns inMinnesota arescreened for 54 medical disorders.

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Research shows there is one clear way to motivatesmokers to quit and prevent young people fromstarting: Raise the price of cigarettes. Increasingprices on cigarettes is the top driver of smokingdeclines in our state and around the country. But Minnesota has fallen behind the pace in ourcigarette taxation.

Tobacco in Minnesota: Still a problem

Today, Minnesota’s adult smoking rate is 16 percent. That number maysound low compared to 20 years ago, and it is. But 16 percent still translatesinto 625,000 addicted Minnesota adults, and our kids are still using tobaccoat alarming rates.

The results are frightening. Each year 5,100 people die in our state fromsmoking and exposure to secondhand smoke. That’s more deaths than thoseresulting from alcohol, murders, car crashes, AIDS, drugs, and suicide—combined. And it isn’t happening by accident. Far from having been neutral-ized by regulations and lawsuits, tobacco companies are still spending mil-lions targeting our kids. In Minnesota, 77,000 middle school and high schoolstudents are current tobacco users; they will buy or smoke 13.4 million packsof cigarettes this year.

Further, the simple dollars and cents are a stark reminder of tobacco’seffects on our health care system and economy. Smoking costs Minnesota $3 billion per year in excess health care costs: This equals $554 for everyman, woman, and child in the state, regardless of whether they smoke.Employers are adversely affected by smoking too. They end up paying theprice through higher health insurance premiums and lost productivity ofsmoking employees, who are more likely than nonsmokers to miss work.

P O L I C Y

TOBACCOTAX

UPDATEA high-stakes

legislative issueBy Molly

Moilanen, MPP

Every day is a reason for a person with Down

syndrome to smile. And find joy in things the rest

of us often overlook. To learn more about the rich-

ness of knowing or raising someone with such an

enthusiasm for life, call your local Down syndrome

organization. Or visit ndsccenter.org today.

It is the mission of the Down Syndrome Association of Minnesota to provide information, resources and support to individuals with Down syndrome, their families and their communities. We offer a wide range of services, programs andmaterials at no charge. If you are interested in receiving one of our information packets for new or expectant parents, please email [email protected] or

For more information please call:

(651) 603-0720 • (800) 511-3696©2007 NationalDown SyndromeCongress

WHO’S GOT BETTER MOVES ON THEDANCE FLOOR, YOU OR ME?

A clear solution

That’s the bad news. But there isgood news, too. A new researchstudy has taken the deepest-ever lookinto what tactics have successfullyreduced smoking here in Minnesota.Funded by tobacco control nonprofitClearWay Minnesota, the MinnesotaSimSmokeModel examined data tolearn what fueled the 27 percentdecrease in smoking prevalenceMinnesota experienced between1999 and today.

The results were clear. The priceof tobacco was found to be the singlemost effective tool for influencing smoking behaviors in the state,responsible for 43 percent of smoking declines during the periodstudied. (Other helpful efforts included smoke-free policies, mediacampaigns, youth access laws, and cessation programs.)

For example, in 2005 a health impact fee increased the cost of a pack of cigarettes in Minnesota by 75 cents, and motivated one-fourth of then-smokers to attempt to quit. In 2009, a 62-cent fed eraltax increase on cigarettes flooded cessation programs with requestsfor help. QUITPLAN Services, the free cessation program providedby ClearWay Minnesota, saw a 150 percent increase in helpline vol-umes during the first week the tax took effect. Nationwide, the 2009increase prevented 220,000 American youth from using tobacco injust the first two months after implementation.

The Minnesota SimSmoke findings reinforced previous researchfrom across the country showing that cigarette tax increases wereamong the most effective strategies for reducing smoking.

State cigarette taxes: Behind the times?

Minnesota is a leader in health care in many regards. In 2012, the state celebrated the five-year anniversary of the monumentalFreedom to Breathe Act, our strong smoke-free law. Minnesota is

healthier because of this law, and sup-port for it has grown, with an over-whelming number of Minnesotans—nearly 80 percent—now supporting the law.

Considering the strong public sup-port for health and policies that reduceyouth tobacco use, it is surprising andvery disappointing that our state has notincreased its own tax on cigarettes since2005. In fact, Minnesota’s tobacco taxnow ranks in the bottom half of statesnationally. States that have increasedtobacco taxes have seen steep declines in their smoking prevalence as a result.Minnesota should follow suit, but politi-

cal dynamics and shifts at the Capitol have presented challenges.

Benefits: Thousands of lives, millions of dollars

Research has projected many public health benefits for Minnesota ifwe succeed in increasing the cost of tobacco products. A $1.50-per-pack increase would result in 16 percent fewer kids starting to

smoke, saving 47,700 of them from alife of addiction. It could save 25,700Minnesotans from a premature death.

The health-care cost savings arealso enormous. In the next five years,fewer lung cancer cases would save thestate more than $5 million, fewersmoking-affected pregnancies andbirths could save nearly $13 million,and fewer heart attacks and strokescould save more than $12 million.

Minority populations and lower-income Minnesotans are disproportion-ately affected by smoking and smoking-related diseases. Native Americans have

the highest lung cancer rates in Minnesota, and African Americanmen and women are 30 percent to 40 percent more likely to die oflung cancer than their Caucasian counterparts. Meanwhile, for near-ly 50 years the tobacco industry has directly marketed its productsto minorities, with campaigns in recent decades targeting AfricanAmericans, Latinos, the LGBT commun ity, and other communities.Tobacco tax increases drive quitting among all smokers, but espe-cially among lower-income individuals, who are the most likely tobenefit, both economically and in terms of health improvement,from any increase in the price of tobacco. Bringing down the smok-

Tobacco tax to page 32

Facts about tobacco use in Minnesota• 5,100 Minnesotans die each year from smoking

and exposure to secondhand smoke.• Minnesota’s 77,000 kids who are current tobac-

co users will buy or smoke 13.4 million packs ofcigarettes this year.

• Smoking costs Minnesota $3 billion per year inexcess health care costs: $554 for every man,woman, and child in the state.

• The price of tobacco has been found to be thesingle most effective tool for influencing smokingbehaviors in the state.

• In 2005, when the cost of a pack of cigarettes inMinnesota rose by 75 cents, one-fourth of then-smokers attempted to quit.

The price oftobacco wasfound to be

the single mosteffective tool for

influencingsmoking behaviors

in the state.

In the next issue...

• Fish consumption

• Blood banks

• Bladder cancer


ing prevalence rate will have a particularly positiveeffect on these populations and give them a betterchance at health.

It is undeniable that quitting improves individ-uals’ quality of life and happiness. At ClearWayMinnesota, we have heard many stories from thosewho used our QUITPLAN programs and promotionsto quit. One woman wrote of the joy of running herfirst-ever 5K race after quitting. Another happy quit-ter saved the money he would have spent on cigarettesand eventually was able to buy a camper with thosesavings. And by extending life and improving its qual-ity, quitting smoking also gives individuals more andbetter time with their families and loved ones.

How can you help?

Raising the price of cigarettes seems like commonsense, but in the realm of public policy there arealways challenges. You can help. I ask you to join thegrowing effort to make a new, significant tobacco taxincrease in Minnesota a reality rather than a dream.

There are many ways to do that. Consider com-municating with your representatives at theMinnesota Legislature (to find contact informationfor your legislators, go to www.leg.state.mn.us/). AtClearWay Minnesota’s website, www.clearwaymn.org,

our Action Center provides suggestions and data foryou to use in writing letters to lawmakers and theop-ed pages of newspapers.

Raise it for Health (www.raiseitforhealth.org) isa coalition of leading health and nonprofit organiza-tions that includes ClearWay Minnesota, Blue Crossand Blue Shield of Minnesota, the MinnesotaHospital Association, the Minnesota MedicalAssociation, the Twin Cities Medical Society, theAmerican Lung Association, the American HeartAssociation, the American Cancer Society CancerAction Network and many others, who have bandedtogether to reduce tobacco use in Minnesota andadvocate for a tobacco tax increase of $1.50 perpack. The stronger these organizations are, the moreeffective they can be in this fight, so your activemembership will increase their clout on this issue.

The cost of doing nothing is too great—to oureconomy and to the health of our citizens. Pleasejoin us in asking our state leaders to support raisingthe tobacco tax.

Molly Moilanen, MPP (Master of Public Policy), is thedirector of public affairs at ClearWay Minnesota and co-chairs the Raise it for Health Coalition.

Tobacco tax from page 31


77,000 middle school

and highschool students

will buy orsmoke 13.4

million packsof cigarettes

this year.

Health Care ConsumerAssociation

Minnesota

Each month, members of the Minnesota HealthCare Consumer Association are invited to participate in a survey that measures opinionsaround topics that affect our health-care delivery system. There is no charge to join the association, and everyone is invited. For more information, please visit www.mnhcca.org. We are pleased to present the results of the February survey.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

No

opinion

Agree Disagree Strongly

disagree

0

5

10

15

20

25

30

35

40

14.71%11.76%

23.53%

14.71%

35.29%

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

No

opinion


disagree

0

10

20

30

40

50

60

52.94%

11.76%

17.65%

5.88%

11.76%

2. I believe gun control is a serious public health issue.

1. I believe that state and federal governmentcan reduce health care costs through tax and regulatory initiatives.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

No

opinion


disagree

0

10

20

30

40

50

29.41%

44.12%

2.94%

14.71%

8.82%

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

No

opinion


disagree

0

10

20

30

40

50

20.59%

41.18%

8.82%

17.65%

11.76%

5. I believe raising taxes on soda pop and energy drinkswill encourage healthier behaviors.

Pe

rce

nta

ge

of

tota

l re

spo

nse

s

Strongly

agree

No

opinion


disagree

0

5

10

15

20

25

30

35

40

35.29%

32.35%

2.94%

20.59%

8.82%

3. I believe limiting access to guns will reduce health care costs associated with gun violence.

February survey results ...

4. I believe raising taxes on cigarettes will reduce health care costs related to smoking.

“A way for you to make a diff erence”

Join now.

SM

Welcome to your opportunity to be heard in debates and discussions that shape the futureof health care policy. There is no cost to joinand all you need to become a member is access to the Internet.

Members receive a free monthly electronicnewsletter and the opportunity to participate in consumer opinion surveys.

www.mnhcca.org

Health Care ConsumerAssociation

Minnesota


If self-assessment identifies only minor issues and the driver hasno medical conditions, it can be beneficial to take several refresherlessons from a driving instructor. Research shows that driver educa-tion classes for older drivers result in reduced risk when combinedwith on-the-road refresher lessons.

However, if self-assessment revealsmore serious issues, consider a profes -sional driving evaluation. Older driverswith a medical condition should choose acertified driving rehabilitation specialist(CDRS) instead of a driving instructor.That’s because CDRSs—typically, spec -ially trained occupational therapists—can show drivers how toaddress underlying losses of body function that may be linked todriving problems, such as loss of muscular control. Older driversshould consult a physician about how any medical conditions theyhave could affect driving.

Prevention maintains safety

Stay healthy. Vision-friendly nutrition and regular eye checks helpforestall chronic eye diseases. Regular physical activity is linked to alower crash risk for older drivers. Since research has found that peo-ple who have sustained falls are at increased risk for crashes,enrolling in an exercise program and/or a fall-prevention programcan improve physical conditioning that, in turn, can help decreaseboth falls and crash risk. Engaging in physical activity that requiresfast reactions, like racquet sports, has also been found to preventthe normal, age-related decline in reaction time.

Practice visual attention. Efficient visual scanning is essential foranticipating the need to stop quickly as a child approaches a cross-walk. With age, all of us tend to have a more difficult time dividingour visual attention between various parts of the visual field. Newresearch has found that attention training can result in loweredcrash risk and may delay the need for older adults to stop driving.

While this research used DriveSharp attention-training software, any regular activity that requires fast reaction to visual input, likeracquet sports or playing ball with grandkids, can help improvevisual attention.

Decision-making. Driving safely also requires making appropri-ate decisions about when to drive and when to use other modes oftransportation. Since women typically outlive their driving era by 10 years and men by seven years, being comfortable walking orusing buses and other transportation alternatives allows seniors tocontinue participating in community life regardless of driving status.This facilitates independence and continued social engagement, bothso important to mental and physical health.

Catherine N. Sullivan, PhD, OTR (Occupational Therapist), an associateprofessor at St. Catherine University, St. Paul, teaches occupational therapyand conducts research with older drivers.

Mature drivers from page 15


Driver education classes for older drivers result in reduced risk.

When Alzheimer’s disease touches your life, turn to us.The Alzheimer's Association can help.The Alzheimer’s Association Minnesota-North Dakota Chapter is the premier source of information, support and hope for those with Alzheimer’s disease, their families and caregivers; and offers a broad range of programs and services state-wide, including:

• 24/7 Information Helpline – 1.800.272.3900

• Family and Community Education

• Support groups

• Care Consultation

• Professional Education

• Advocacy

• Research

• Medic Alert® + Safe Return®

Make the first call for help24/7 Information Helpline—1.800.272.3900

Visit us online - www.alz.org/mnnd

Important Patient Information

This is a BRIEF SUMMARY of important information about Victoza®. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about Victoza®, ask your doctor. Only your doctor can determine if Victoza® is right for you.

WARNING

During the drug testing process, the medicine in Victoza® caused rats and mice to develop tumors of the thyroid gland. Some of these tumors were cancers. It is not known if Victoza® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people. If MTC occurs, it may lead to death if not detected and treated early. Do not take Victoza® if you or any of your family members have MTC, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). This is a disease where people have tumors in more than one gland in the body.

What is Victoza® used for?

• Victoza®isaglucagon-like-peptide-1(GLP-1)receptoragonistusedtoimprovebloodsugar(glucose)controlinadultswithtype2diabetesmellitus,whenusedwithadietandexerciseprogram.

• Victoza®shouldnotbeusedasthefirstchoiceofmedicinefortreatingdiabetes.

• Victoza®hasnotbeenstudiedinenoughpeoplewithahistoryofpancreatitis(inflammationofthepancreas).Therefore,itshouldbeusedwithcareinthesepatients.

• Victoza®isnotforuseinpeoplewithtype1diabetesmellitusorpeoplewithdiabeticketoacidosis.

• ItisnotknownifVictoza®issafeandeffectivewhenusedwithinsulin.

Who should not use Victoza®?

• Victoza®shouldnotbeusedinpeoplewithapersonalorfamilyhistoryofMTCorinpatientswithMEN2.

What is the most important information I should know about Victoza®?

• Inanimalstudies,Victoza®causedthyroidtumors.Theeffectsinhumansareunknown.PeoplewhouseVictoza®shouldbecounseledontheriskofMTCandsymptomsofthyroidcancer.

• Inclinicaltrials,thereweremorecasesofpancreatitisinpeopletreatedwithVictoza®comparedtopeopletreatedwithotherdiabetesdrugs.Ifpancreatitisissuspected,Victoza®andotherpotentiallysuspectdrugsshouldbediscontinued.Victoza®shouldnotberestartedifpancreatitisisconfirmed.Victoza®shouldbeusedwithcautioninpeoplewithahistoryofpancreatitis.

• Seriouslowbloodsugar(hypoglycemia)mayoccurwhenVictoza®isusedwithotherdiabetesmedicationscalledsulfonylureas.Thisriskcanbereducedbyloweringthedoseofthesulfonylurea.

• Victoza®maycausenausea,vomiting,ordiarrhealeadingtothelossoffluids(dehydration).Dehydrationmaycausekidneyfailure.Thiscanhappeninpeoplewhomayhaveneverhadkidneyproblemsbefore.Drinkingplentyoffluidsmayreduceyourchanceofdehydration.

• Likeallotherdiabetesmedications,Victoza®hasnotbeenshowntodecreasetheriskoflargebloodvesseldisease(i.e.heartattacksandstrokes).

What are the side effects of Victoza®?

• Tellyourhealthcareproviderifyougetalumporswellinginyourneck,hoarseness,troubleswallowing,orshortnessofbreathwhiletakingVictoza®.Thesemaybesymptomsofthyroidcancer.

• Themostcommonsideeffects,reportedinatleast5%ofpeopletreatedwithVictoza®andoccurringmorecommonlythanpeopletreatedwithaplacebo(anon-activeinjectionusedtostudydrugsinclinicaltrials)areheadache,nausea,anddiarrhea.

• Immunesystemrelatedreactions,includinghives,weremorecommoninpeopletreatedwithVictoza®(0.8%)comparedtopeopletreatedwithotherdiabetesdrugs(0.4%)inclinicaltrials.

• Thislistingofsideeffectsisnotcomplete.YourhealthcareprofessionalcandiscusswithyouamorecompletelistofsideeffectsthatmayoccurwhenusingVictoza®.

What should I know about taking Victoza® with other medications?

• Victoza®slowsemptyingofyourstomach.Thismayimpacthowyourbodyabsorbsotherdrugsthataretakenbymouthatthesametime.

Can Victoza® be used in children?

• Victoza®hasnotbeenstudiedinpeoplebelow18yearsofage.

Can Victoza® be used in people with kidney or liver problems?

• Victoza®shouldbeusedwithcautioninthesetypesofpeople.

Still have questions?

Thisisonlyasummaryofimportantinformation.Askyourdoctorformorecompleteproductinformation,or

• call1-877-4VICTOZA(1-877-484-2869)

• visitvictoza.com

Victoza® is a registered trademark of Novo Nordisk A/S.

DateofIssue:May2011Version3

©2011NovoNordisk140517-R3June2011

Victoza® helped me take my blood sugar down…

Model is used for illustrative purposes only.

and changed how I manage my type 2 diabetes.Victoza® helps lower blood sugar when it is high by targeting important cells in your pancreas—called beta cells.

While not a weight-loss product, Victoza® may help you lose some weight.

And Victoza® is used once a day anytime, with or without food, along with eating right and staying active.

If you’re ready for a change, talk to your doctor about Victoza® today.

FOR TYPE 2 DIABETES

To learn more, visit victoza.com or call 1-877-4-VICTOZA (1-877-484-2869).

Non-insulin • Once-daily

Indications and Usage:Victoza® is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes when used along with diet and exercise. Victoza® is not recommended as the first medication to treat diabetes. Victoza® is not insulin and has not been studied in combination with insulin. Victoza® is not for people with type 1 diabetes or people with diabetic ketoacidosis. It is not known if Victoza® is safe and effective in children. Victoza® is not recommended for use in children.

Important Safety Information:In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice. It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early. Do not use Victoza® if you or any of your family members have a history of MTC or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). While taking Victoza®, tell your doctor if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.Inflammation of the pancreas (pancreatitis) may be severe and lead to death. Before taking Victoza®, tell your doctor if you have had pancreatitis, gallstones, a history of alcoholism,

or high blood triglyceride levels since these medical conditions make you more likely to get pancreatitis. Stop taking Victoza® and call your doctor right away if you have pain in your stomach area that is severe and will not go away, occurs with or without vomiting, or is felt going from your stomach area through to your back. These may be symptoms of pancreatitis.Before using Victoza®, tell your doctor about all the medicines you take, especially sulfonylurea medicines or insulin, as taking them with Victoza® may affect how each medicine works. Also tell your doctor if you are allergic to any of the ingredients in Victoza®; have severe stomach problems such as slowed emptying of your stomach (gastroparesis) or problems with digesting food; have or have had kidney or liver problems; have any other medical conditions; are pregnant or plan to become pregnant. Tell your doctor if you are breastfeeding or plan to breastfeed. It is unknown if Victoza® will harm your unborn baby or if Victoza® passes into your breast milk. Your risk for getting hypoglycemia, or low blood sugar, is higher if you take Victoza® with another medicine that can cause low blood sugar, such as a sulfonylurea. The dose of your sulfonylurea medicine may need to be lowered while taking Victoza®.

Victoza® may cause nausea, vomiting, or diarrhea leading to dehydration, which may cause kidney failure. This can happen in people who have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration.The most common side effects with Victoza® include headache, nausea, and diarrhea. Nausea is most common when first starting Victoza®, but decreases over time in most people. Immune system-related reactions, including hives, were more common in people treated with Victoza® compared to people treated with other diabetes drugs in medical studies.

Please see Brief Summary of Important Patient Information on next page.

If you need assistance with prescription drug costs, help may be available. Visit pparx.org or call 1-888-4PPA-NOW.You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call 1-800-FDA-1088.Victoza® is a registered trademark of Novo Nordisk A/S. © 2011 Novo Nordisk 0611-00003312-1 August 2011

Minnesota Health care News March 2013

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Transcript of Minnesota Health care News March 2013