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.

We have two new family practice physicians starting at Saltzer in August

John Freeman, MD will begin seeing patients August 7. Dr. Freeman is a pediatrics, internal medicine physician who will be working in our family practice department at 215 E. Hawaii Ave in Nampa. To schedule an appointment with Dr. Freeman call 468-5910

Mark Clinger, MD, family practice, will begin seeing patients at 745 S. Progress Ave in Meridian on August 20. To make an appointment with Dr. Clinger, please call 884-2920

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.

What a way to loose weight, and quick! Dr. Rick Roberts an Internal Medicine Physican at Saltzer’s main clinic is helping people lose weight quickly with diet and exercise, all physician supervised. The Dr. Ted Weight Loss program is designed to help people lose weight rapidly, and it works! Dr. Roberts should know, he lost 40 pounds using the program himself! He also has one patient that was non-ambulatory who is now out of her wheel chair. How can you top that testimonial? If you are interested in rapid weight loss, supervised by a physician, this may be the right program for you. To learn more go to www.drteddiet.com, or call Dr. Roberts at 463-3031

Dr. Howard Shoemaker is Saltzer Medical Group’s newest expert in the field of Occupational Health. He is Board Certified with 30 years of Occupational / Preventative Medicine.

Dr. Shoemaker obtained his Doctor of Medicine at the University of Miami School of Medicine followed by his Masters of Health Sciences at the University of Colorado. Additionally, Dr. Shoemaker is a Medical Review Officer.

Dr. Shoemaker has extensive experience in all forms of Occupational Medicine which includes 14 years in Hospital based Medical Programs, 15 years as the in-house Medical Director of a major telecommunications company in Colorado and 4 years in Idaho / Oregon with Medical groups. Dr. Shoemaker has extensive experience as a consultant to all types of industries ranging from Preventative to Injury treatment perspectives.

Satzer Medical Group has invited Dr. Shoemaker to start on April 15, 2008. I’ve spoken with Dr. Shoemaker and he’s really excited to start servicing the community.