Snake River Osteoporosis Support Group will be meeting regularly over the next 10 months at the Nampa Senior Center, 207 Constitution Way, Nampa

The following are the topics covered, and all events are FREE to anyone who would like to attend

September 8, 2008 - “Taking Steps for Strong Bones” - A slide show by Casey Sanchez, RMA
October 6, 2008 - “Exercise for Bone Health” - Kathy Dufer, PT
November 3, 2008 - “No Bones without it, Find Calcium” - Kate Hohenbrink, RD
Dec, Jan - No Meeting
February 2, 2009 - “Posture, Standing tall against Osteoporosis” - Daranee Hatch, PT
March 2, 2009 - “What’s new in treating Osteoporosis” - Kelly Timmons, MD, PhD
April 6, 2009 - “Balance and Fall Prevention” - Deanna Kinsman, PT
May 4, 2009 - “living with Osteoporosis” - Greta Leonard, RN
June 1, 2009 - Potluck Picnic 1:00 PM at Liberty Park, behind Mercy Medical Center

For more information call Greta with the Idaho Osteoporosis Center at 288-4971

Vaccine preventable disease rates are at all time lows due to diligent research, effective immunization systems, and outreach. This success has come from a collaboration of private and public sectors. Nonetheless, there are still barriers to optimizing immunization protection from vaccine preventable diseases. Prior to modern day immunizations, many diseases impacted countless numbers of children with disability and, unfortunately, mortality. In recent decades, there have been advances in vaccines broadening the protection net for children and adults. As vaccine preventable illnesses diminish, such as polio, measles, pertussis and even now haemophilus, pneumococcus, rotavirus and varicella, the public loses valuable memory of the devastation of these diseases. Yet outside of the United States one million deaths occur annually from measles alone. Complacency sets in from a lack of knowledge of natural diseases and fears of adverse events, including autism, further add to the barriers to protecting our children and adults. Idaho continues to struggle to obtain higher immunization coverage rates.
The Idaho Immunization Program, funded jointly by the State of Idaho and the Centers for Disease Control, has grown in the past decade improving our rates considerably. The Idaho Immunization Program hosted an Immunization Summit in the fall of 2007 inviting public and private health sectors to formulate the problems facing our State and potential solutions. The group discussed the successes of the Canyon Area Immunization Coalition and proposed a Statewide Coalition. Idaho is the only state in the Nation without a widespread or statewide Immunization Coalition.

This brings us to May of 2008. The AAP Idaho Chapter held an Immunization Congress, funded by a grant from AAP National. The congress succeeded in bringing public and private sectors together to launch what is now the Idaho Immunization Coalition. The coalition is a 501 c3 non profit organization to enhance the existing immunization system in Idaho. The goal is to protect adults and children from vaccine preventable disease in an efficient, safe and enlightened manner and to maintain the statewide immunization registry. The Coalition will have an Executive Committee with Keith Davis, MD, President of the Idaho Academy of Family Physicians and Tom Patterson, MD, President Elect of the Idaho American Academy of Pediatrics as co-chairmen. Subcommittees consisting of Education, Legislation and Vaccine Outreach will address specific issues. The state Immunization Program, the AAP, and AAFP Idaho Chapters are all on board to see the coalition to fruition. We have succeeded in many ways, though there is much work to be done to reach our goal of maximum immunization coverage in all populations.

“Ok, you have some varicose veins, but… Do you have venous reflux?”

This question is more important that many people realize. Venous reflux is a common medical problem where the blood traveling in the leg veins “refluxes” or, slides back down the leg veins instead of going upwards, back to the heart. This condition is a result of the ever present force of gravity while we are standing and the fact that age, previous blood clots, pregnancy, and other conditions cause the small valves in the vein to malfunction and allow the blood to slip back downwards, towards the feet. This de-oxygenated blood then pools in the lower leg veins and creates several problems over time. One of the earliest manifestations is varicose veins, which sometimes may be noted as a painful throbbing sensation, because of the pressure of the “old” blood which is pooling in them. Other problems then result over time, such as discoloration of the skin, increased swelling of the surrounding tissue (edema), and ultimately, skin breakdown and chronic sores called venous stasis ulcers. The goal is to prevent these later changes from occurring and treat the reflux early, since it only worsens over time.

So, whenever a provider is examining a patient who has complained of varicose veins, the most important question is whether those veins are the result of venous reflux (bad vein valves). The reason this is so important, is that if the reflux, which is the actual cause of the problem, is not treated, then treated problem veins will recur. We encounter many patients who have previously been treated in a med spa or shopping mall facility where laser or sclerotherapy treatment was performed, but the patients find that their problem veins recur in a few years time. Many of these patients are found to have venous reflux on a comprehensive ultrasound evaluation. Here, at Saltzer vein clinic, patients who are suspected of having venous reflux are screened by a Registered Vascular Ultrasound Technician to find whether or not they have venous reflux. If they do, the underlying reflux is treated with a catheter inserted into the vein using laser or radiofrequency energy. If they do not have reflux, they are usually treated by injecting a sclerosant chemical into the veins or by use of a cutaneous laser for these veins.

As mentioned above, if the patient does have venous reflux, almost all insurers and medicare programs consider this a medical problem and it is covered as such. The patient who chooses Saltzer Vein Clinic benefits from our expertise in treating all sizes of varicose veins as well as the causes of venous reflux and late effects of reflux, such as venous ulcers. Not only do patients benefit from our high tech, comfortable, American College of Radiology approved imaging facility, they also receive care from a board certified surgeon and phycisian assistant. We have invested much more into these resources than most of our competitors. We have multiple options for treatment, all the way from ultrasound guided injection, different laser treatments, radiofrequency treatment, to actual surgery. As you can imagine, having all of these options available means we can tailor the best treatment for each individual patient, instead of “pushing” our patients to be treated with limited options. Just like home or car repair, having the right tool for the job at hand makes all the difference. Now that you know how much we have invested into these resources, you would likely conclude that we charge more than some of the smaller shops in the area. Our costs are cheaper than any of the area vein treatment facilities and I encourage patients to call around and prove this for themselves.

Please visit our website, www.saltzervein.com for more detailed information. Thank you.

Steven W. Williams, M.D., F.A.C.S.

Sometimes, a medical study challenges our presumptions. For instance, a recent report suggested that maybe fitness is more important than weight. A study published in the Archives of Internal Medicine in August 2008 looked at risk factors based on the body weights of 5,440 people age 20 and over. The results suggest that just looking at body weight alone can be misleading since almost 25% of normal weight adults had 2 or more risk factors that are often associated with being overweight and obese. Within the normal weight adults who had 2 or more risk factors, the study showed that older age, physical inactivity and a larger waist size were associated with increased risk.

Approximately 50% of overweight adults and 30% of obese adults had normal or only one risk factor. Of these adults, the study showed that younger age, higher physical activity and a smaller waist size were associated with decreased risk.

This study emphasizes the importance that everyone, of all ages and body sizes, should see their primary care provider to help determine the need for screening for cardiovascular risks. Some of the risk factors in this study included elevated blood pressure, low high density lipoprotein (the “good” cholesterol), elevated triglycerides and blood sugar levels.

RICE = Rest, Ice, Compression, Elevate

The RICE method often helps with many types of joint and muscle injuries. The method will ease pain and help speed recovery. The RICE method is very helpfully if you use it right away after an injury.

REST - For most injuries, rest the area until the pain decreases. However, For simple sore muscles gentle stretching will reduce stiffness more quickly.

ICE - Ice is the most effective treatment for reducing inflammation, pain and swelling of injured muscles, joints and connective tissue. The cold helps keep blood and fluid from building up in the injured area, reducing pain and swelling. For the first 48 hours post-injury, ice for 20 to 30 minutes every 2 hours. More than 30 minutes doesn’t help heal the injury any faster, you can cause damage to the tissue.

COMPRESSION – Between icings, wrap the injured area with an elastic bandage to help control swelling and provide support. Begin wrapping at the farthest point away from the body and wrap towards the heart. The wrap should be snug, but not cutting off circulation to the extremity. So, if the extremity becomes cold, blue, or tingle, re-wrap!

ELEVATE – Raising the injured area for the first 24hours above your heart will allow gravity to help reduce swelling and draining excess fluid. The less swelling present, the faster an injury will heal.

Dr. Shoemaker, an Occupational Medicine Physician, has been at Saltzer Medical Group for over 2 months now. He is very happy to be back in the Treasure Valley working with his “Team”. His “Team” consists of 3 key people.

The Director of Occ Med, Tom, who he met while working in Oregon, chose to move to Idaho to continue working for Dr. Shoemaker. Tom has 20 years experience in various Health Care related positions.
His assistant, Lynn, who had previously worked with Dr. Shoemaker, was delighted to come back to work for him. Lynn has worked in Occupational Medicine for 4 1/2 years and is currently working towards an Associate degree in Health Sciences.
And last but not least, me, Lynda. I also had previously worked with Dr. Shoemaker. I returned to nursing to work for Dr. Shoemaker at Saltzer Medical Group after a short hiatus. I have 20 years of nursing experience and 5 of those years were spent in Occupational Medicine.

Dr. Shoemaker and his “Team” come together with many years of experience. With the combined knowledge of the “Team”, it’s by far one of the best in the Valley.
If you or anyone you know could benefit from a Board Certified Occupational Medicine Physician, get on the phone and call us at 884-2965.

Dr. Howard Shoemaker is now with Saltzer Medical Group in both Meridain and Nampa, Idaho! I can’t tell you what a relief this is for me personnally as well as professionally.

I first started working with Dr. Shoemaker and his nurse Lynda some four years ago. That was when I discovered that I had a passion for this line of work. Through Dr. Shoemakers indirect influence and Lynda’s direct influence, I made the decision to go back to school (after 20+ years) to obtain an Associates Degree in Health Sciences. I felt that through this degree and a certification as a Medical Assistant I would be able to give more of myself to the area of work comp and the injured worker. I can’t begin to tell you how they both have influenced me; both professionally and spiritually and how good it is to be a part of his Occupational Medicine team again.

Dr. Shoemaker has over thrity years of experience in the world of Occupational Medicine. His willingness to treat injured workers and to assist them in their rehabilitation process is commendable. Dr. Shoemaker prides himself on his specific protocols which help him to return the injured worker back to a full duty status sooner.

I value Dr. Shoemakers’ experience and the knowlege that both he and Lynda posses and am truely blessed to be a part of the Occupational Medicine team here at Saltzer Medical Group. If you have experienced a work related injury, I would not hesitate to recommend Dr. Shoemaker and his staff to you. So if the occasion should arise, we would be glad to see you and to help serve your needs as a work comp patient.

Beginning in May, 2008, Saltzer Medical Group rededicated itself to developing a quality Occupational Medicine program in the greater Boise area. With clinics in both Meridian and Nampa, their hope is to offer quality care and service to both the employers and employees of the Treasure Valley. The first move was to find a board certified and residency trained Occupational Medicine physician. This was accomplished when Dr. Howard Shoemaker took the position with Saltzer Medical Group. Doctor Shoemaker, who had been a part of the Primary Health Occupational Medicine group, left for the rains of Oregon in 2005. During his time in Oregon his wife had continued to operate as a real-estate agent with the Tamarack development in Donnelly, Idaho. Because of this business interest, when Saltzer Medical Group offered Dr. Shoemaker the opportunity to return to Boise he decided that it was time to return to Idaho.

For the past thirty years, Dr. Shoemaker has practiced exclusively occupational medicine. Why is this important to area employers? The reasons are way too numerous for one short blog. However, some of the primary reasons include an aging workforce, getting your workers back to work as quickly as possible, and finally to provide the highest quality of care for the injured worker.

Lets first address the aging workforce. As we age, there is a natural amount of deterioration which occurs within the body. Whether it is cartilage between our bones, or the natural de-calcification of our bones, it is important to have a skilled specialist who can identify between what is a work related injury and what is just a part of being a baby-boomer. As any claims adjuster, safety manager or HR manager will attest to, a miss-diagnosed injury can become a financial nightmare within the Workers Comp system. As Dr. Shoemaker frequently states, “it is 10% of the cases that creates 90% of the expenses”.

Second, getting workers back to work is extremely important to the company’s bottom line. In a study conducted by Lilly Ramphal, MD, MPH, she states that companies pay $62 billion dollars in lost productivity or “lost time”. This translates into approximately 42% of work related injuries expenses in the United States ($140 billion). Without the proper diagnosis of the work-related injury, or the granting of excessive time off due to injury, this number would escalate even further out of control. As Dr. Shoemaker has frequently stated, “you always want to do what is best for the patient, and in virtually every instance what is best for the patient is to get them back to work”. Dr. Shoemaker has told me many times, he believes that a worker is like an athlete and it is his job to get them “back in the game”. By doing so, the employee will heal faster.

Finally, everyone wants the employee to receive a high level of care. By properly identifying the injury, the employee can begin an aggressive regimen of treatment. In doing so, they can get back to work and continue to do what they were trained to do. By having a specialist monitor the worker’s progress, success is more likely to occur.
Because of the above reasons, we welcome Dr. Shoemaker back to the Treasure Valley.

As a pediatrician I am concerned about the impact Micron’s new insurance system will have on some of the Treasure Valley’s most vulnerable citizens, children.

The new insurance is structured so that only one hospital in the Boise area is covered by the premium coverage. Use of any other hospital results in higher co-pays, and deductibles, resulting in significantly increased health care costs for Micron families.

St. Luke’s Regional Medical Center is not a part of the premium network. St. Luke’s is the only children’s hospital in the area. St. Luke’s has the only pediatric ICU and is the only hospital in the area that provides coverage by all of the pediatric subspecialists such as gastroenterology, neurology, infectious disease, oncology, etc.

With Micron’s new insurance plan families can only access services at the St. Luke’s Children’s Hospital by paying a much higher deductible and receiving lower reimbursements. This results in much higher medical bills for Micron families seeking proper, high quality medical care for their children.

In addition, many physicians that were previously preferred providers are no longer part of the premium network. Imagine the emotional toll on children and their families who are forced to leave a doctor they have grown to trust.

My partners and I at Saltzer Medical Group have seen many children of Micron employees for years, several with chronic and ongoing medical conditions. The change in insurance plan structure will result in worse outcomes for these children.

I am hoping that Micron will rethink their insurance structure, and put these children before the bottom line.

Katie Copeland, MD
Chair, Department of Pediatrics
Saltzer Medical Group, P.A.

I want to highly recommend Dr. Shane Andrew, an Orthopedic Spine Surgeon at Saltzer Medical Group. In February of this year I broke my back in a horse riding accident. I was very impressed right from my first visit with Dr. Andrew. His extensive education and training on backs and spine gave me the confidence I needed to help in my recovery. He explained all of my options in a manner that was easy to understand. I thought for sure my recovery would require surgery, but Dr. Andrew instead suggested I try alternate treatment first. He recommended surgery only as a last resort if alternate treatment was not successful. After speaking with him and reviewing my options, I decided to try wearing a brace for awhile in order to avoid any surgery. While healing from my injury, I saw Dr. Andrew on a regular basis where he monitored my recovery and progress. I was afraid my accident would permanently limit my activities; however, I’m happy to report that it has been 4 months since my accident and I’m already back to riding horses and ATVs. All of this was accomplished without surgery. It was so easy to talk with Dr. Andrew…he has a kind nature and a great “bedside manner.” I am glad to see that we have doctors in our area that are more concerned about the patient’s well-being rather than “lining their pockets” through costly surgeries that are not necessary. I will definitely refer all of my family and friends to him without hesitation!