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2016: The Year in Review

Nov 29, 2016 09:15AM ● By MED Magazine
2016 was a year of growth and expansion for the South Dakota regional medical community. Healthcare institutions across the region not only built new facilities and added new staff, but also began offering cutting-edge new services and technologies.

Pediatric Dysphagia: More Than Just “Picky”

Feeding and swallowing problems are a daily reality and a source of anxiety for as many as 25 to 50 percent of babies or young children and their families. For these children, mealtimes are often fraught with emotion and marred by coughing, choking, gagging, retching and crying. And yet, pediatric dysphagia, especially in its less severe forms, is often dismissed as “picky” eating by both parents and medical professionals, many of whom believe that a child will grow out of it.

“We start to get concerned if a child is eliminating an entire food group, such as no fruits or no 
 vegetables,” says LifeScape Speech-Language Pathologist Heather Hewitt, who works closely with kids with various types of dysphagia. “Or they may be eliminating a particular texture such as any food that is crunchy or wet. Sometimes the problem is that they are not really able to manipulate it around in their mouth.”

Because feeding challenges are unique to each child, there is no one-size-fits-all therapeutic solution. In recognition of this, the feeding and swallowing program at LifeScape, is multidisciplinary, involving the skills and expertise of speech-language pathologists, occupational therapists, and child psychologists to address individual problems from every angle. In some cases, a dietitian may even be called in to help.

“No one approach is the right way to manage feeding and swallowing issues. I think we do a good job of finding what works,” says LifeScape Therapy Manager Melissa Carrier-Damon, a Speech-Language Pathologist.

Although most of these issues occur in babies and toddlers, the LifeScape team also works with older children and even young adults using a range of cutting edge techniques such as VitalStim, Beckman Oral Motor, and Sensory Oral Sequential (SOS). Often, therapists use a combination of these approaches and others, along with plenty of positive reinforcement and parental support, to encourage children to try new things, push themselves, and learn to embrace and even enjoy their mealtimes.

“It is so important for the child emotionally, socially, and nutritionally and it’s really important for the family,” says says LifeScape Speech-Language Pathologist Heather Hewitt. “This is important for development in general. We want eating to be a happy and fun time.”

For many children and their families, therapy means that mealtimes are no longer frustrating and tear-filled. Picky eaters have broadened their diets and become healthier and parents have learned how to more effectively reinforce better eating habits. Even children who were never expected to eat orally are eating and drinking regular diets after spending time in therapy for their dysphagia at LifeScape.

News Flash: Paulette Davidson, FACHE, CMPE, MBA, is selected as Regional Health’s new Chief Operating Officer and Ronald Amodeo becomes the new Innovation and Growth Officer.

News Flash: Dr. John (Jack) Wempe, a 30 year Army veteran, becomes the new Chief of Staff for the Sioux Falls VA Health Care System.

Clinical Trials: The Lifesaving Power of Increased Treatment Options

Biomedical research studies conducted on human participants are universally known in the profession as “clinical trials”. But for the President of Research at Sanford Health, the term is just too limited.

“I prefer the phrase ‘increased treatment options’, because that’s what clinical trials really are,” says David Pearce, PhD, Senior Scientist with Sanford Children’s Health Research Center and director of the Pearce Lab.

“Biomedical science and medicine are always advancing. When you are treating a patient, you 
 have the standard of care. But [through clinical trials]  you also have the ability to offer them the most up-to-date technology or intervention for their malady that may eventually become the standard of care.”

While bench research can take place almost anywhere innovative thinkers and a well-equipped laboratory exist, clinical trials require a sufficient number of eligible human participants and, often, significantly more funding. Less than a decade ago, there were few of these “increased treatment options” available in the South Dakota region. But as the area’s population has grown and the number of qualified physician scientists and researchers has increased, institutions like Sanford have committed more resources to clinical trials and have been rewarded for their efforts.

“Sanford has expanded Sanford Research because there was a feeling that our research needs to impact patients,” says Dr. Pearce whose own research has focused on the molecular basis of inherited pediatric neurodegenerative diseases. “We have basic and translational research, but we have also invested in advancing our clinical research.”

The effort got a major boost when Sanford was admitted into an elite group of 34 healthcare institutions that are part of the National Cancer Institute’s Community Oncology Research Program. NCORP sites participate in NCI cancer prevention, control, screening and post-treatment surveillance clinical trials. Sanford Health’s large footprint means that many of the region’s cancer patients are able to take part in large-scale national trials they might never have been able to access just a few years ago .

Clinical trials lead to more clinical trials in a sort of snowball effect. An institution’s involvement in NCORP-style community based clinical trials can, as they have in Sanford’s case, open the door to what Dr. Pearce calls commercial trials. A growing number of pharmaceutical companies and device manufacturers now look to South Dakota as a good place to run an FDA trial. “Reputation is everything in research,” says Dr. Pearce.

News Flash: South Dakota Lions Eye and TIssue Bank joins forces with North Dakota eye bank and becomes Dakota Lions Sight and Health
News Flash: Cornelius Boerkoel, MD, PhD, joins Sanford Health as the executive director of the Sanford Imagenetics Research Center on Genomic and Molecular Medicine.
News Flash: Sioux Falls-based medical supply distributor Kreisers, Inc. is one of a trio of companies joining forces to form one large distribution company known as Concordance Healthcare Solutions.
News Flash: Avera officially opens the new Avera Medical Group Family Health Center on the Grassland Health Campus in Mitchell this month.

When Providers Are Patients: Insights from The Other Side

Many healthcare providers believe they know what it is like to be a patient. For some, experiencing a life-altering medical condition can show them how much they really do not know. In this story, we meet providers who were changed by their experiences as patients.

Orthopedic surgeon Steven Meyer, MD, with the CNOS Clinic in Dakota Dunes, South Dakota, ad lived with pain in his shoulders for more than 10 years. Over the last three years, he had both shoulder joints replaced.

“The greatest thing about it is that I’m re-enthused about what I do for a living,” says Meyer. “It makes me feel incredibly blessed to be able to be an orthopedic surgeon – I know the impact I have on people’s lives.”

And Dr. Meyer says his experience has been as good for his patients as it has been for himself. “Now, I can look at people and say I know exactly what that’s like. It’s given me a greater sense of empathy, and enhanced my understanding. It helps me relate to patients, and helps my patients relate to me.”

Stephanie Broderson, MD, with Sanford Family Medicine in Sioux Falls, was 28 weeks pregnant
  when she learned that her kidneys were failing. After a decade of declining kidney function, she received a donor kidney from her stepdaughter.Today, the healthy and pragmatic Iowa native says she has little patience for patients who neglect their health and offers tough love, born of experience, for the rest.

“My motto is ‘no whining’,” she says. “I had to do chemo. I had to do a kidney biopsy and a bone marrow biopsy. I was chronically ill and had to take medication. And I underwent a major surgery.  So I understand how tough it can be.”
Sioux Falls Audiologist Robert Froke, MA, CCC-A, was left with moderate hearing loss after a bout of a flu-like illness. Like his patients, Froke says he “played the denial game”, telling himself that everyone around him was mumbling. “Then suddenly I caught myself. I thought ‘You hear this all the time from your patients!’ So I decided I had better get real about it.”

After an MRI ruled out a tumor, Froke began using a set of RIC (receiver in canal) digital hearing aids. “This has really helped me help my patients,” he says. “Now, I can be one step ahead of people in terms of my counseling and tell them, yeah that’s normal. That is to be expected as far as your adjustment to your hearing aids or to hearing the world again.”

News Flash: Avera Cancer Institute’s new Navigation Center makes cancer navigation services available system-wide.

News Flash: Marian Petrasko, MD., PhD, an interventional cardiologist with Sanford Heart Hospital in Sioux Falls, recently  performed his 100th robotic-assisted angioplasty.


Regenerative Medicine: Stem Therapy in Spinal Surgery at Orthopedic Institute

Stem cells, undifferentiated biological cells with the power to differentiate into specialized cells,
  are a key component of regenerative medicine. These cells, which in developing embryos become all the tissues of the body, can also be found in the bone marrow, adipose tissue, and blood of adults. Globally, scientists are hard at work on the development of techniques that will utilize these powerful cells to heal injuries, regenerate damaged tissues or even produce entirely new organs.

“Regenerative medicine might be the biggest advance in healthcare I’ve seen in my thirty years as a physician,” says Walter Carlson, MD, MBA, a surgeon with Orthopedic Institute in Sioux Falls and a Clinical Professor with Sanford USD Medical School. Carlson has been incorporating stem cell therapy into select spinal fusion surgeries for the past two years.

Many musculoskeletal conditions have few therapeutic options beyond the conventional approaches, but stem cell therapy - especially when it utilizes the patient’s own cells - offers the promise of less invasive tissue repair, faster healing, and, in some cases, the ability to delay or even avoid joint replacement surgery.

“I was looking for ways to improve the quality of the fusions I do in the lower back,” says Carlson, who recently performed his 100th successful, stem cell-augmented spinal fusion.

During the spinal fusion procedure, while the patient is under general anesthesia, Dr. Carlson
aspirates about 100 cc of the liquid bone marrow (more for a multi-level fusion) and passes the syringe to a technician who performs the centrifugation. Preparation requires only about 20 minutes, after which a concentrated dose of about 15 cc is applied to a scaffolding product at the graft site, enhancing the environment to encourage consolidation of the bone.

“This is not the fountain of youth or the Holy Grail,” cautions Dr. Carlson. “But even at three to six months, I’m seeing a nice development of bone where I want it to be to help to stabilize and fuse the spine. This has been the experience of others around the country, as well, and the literature now supports the idea that stem cell supplementation in lumbar fusion is equal to or better than other techniques.”

Eventually, many of these patients do end up needing surgery. Although stem cell therapy has not been proven to be more effective in the short run than other nonsurgical approaches, it does offer one very distinct advantage.

“In addition to reducing inflammation and pain and improving function, there is also the hope that stem cells might actually help restore some of the patient’s tissues back to a more normal state,” says Dr. Carlson.

News Flash: Avera Cancer Institute Sioux Falls is now offering treatment for brain tumors with the a precision radiation therapy tool called the Elekta Gamma Knife Perfexion
News Flash: The South Dakota Department of Health asks healthcare professionals to support a new Breastfeeding Friendly Business Initiative.
News Flash: Applications for the University of South Dakota Sanford School of Medicine reach a ten-year high.
News Flash: Rapid City Regional Hospital’s Cancer Care Institute upgrades its radiation treatment technology to include one of the newest TomoTherapy treatment systems in the world.   
News Flash: Sanford Health’s work in cellular therapy and regenerative medicine earned a team of its top researchers and administrators a trip to the Vatican as part of an international conference.


Virtually Ideal: Avera’s Expanding eCare Empire

A 42 year old Parkston, South Dakota area man is having dinner with friends when he suddenly develops the classic signs of a stroke. He becomes week, half of his face droops, and he loses the ability to talk. His wife rushes him to the nearest hospital, Avera St. Benedict Health Center in Parkston, where his friend, family physician Jason Wickersham, MD, is waiting.

Dr. Wickersham, who has worked in Parkston for 12 years, is not unfamiliar with stroke and has 
had experience using clot-busting drugs in the treatment of elderly heart attack patients, but this is a different scenario. In a larger health center, he and his patient would likely be surrounded by colleagues who could weigh in on the situation. Here, he is on his own.

Until, he presses a button on the wall of one of the two ER rooms.

Within seconds, the high-definition screen on the wall fills with the image of an ER physician at
  Avera’s eCare hub in Sioux Falls and he and Dr. Wickersham are collaborating on the case, working in tandem as physicians are trained to do. Within a short time, the two are joined by a neurologist, who helps walk Dr. Wickersham through a series of tests with the patient to confirm the diagnosis they all suspect: acute ischemic stroke.

Through eCare, even the most geographically remote or understaffed facilities can connect with an ER physician 24/7, for everything from a quick second opinion to assistance with a complex procedure. At 120 sites and counting, eEmergency is second only to eConsult as the most popular eCare service.

“It is truly amazing,” says Sioux Falls emergency medicine specialist Brian Skow, MD, medical director of both eEmergency and eCare. Skow has logged more than 8,000 hours in front of a camera and a 50-inch high definition monitor, working alongside rural doctors like Wickersham from a distance.

What began in the early 1990s as an outreach service heavily funded by the Helmsley Charitable Trust has evolved into a self-sustaining business with new sites coming on board every few months. More than two-thirds of these sites are non-Avera facilities.

More than 100 types of Avera specialists in areas such as critical care, infectious disease, pulmonology, cardiology, neurology and others now provide care in ten percent of the nation’s critical access hospitals across ten states in the Midwest and the Northeast through Avera eCare.

News Flash: Avera and the Avera Institute for Human Genetics established the first and only twin register in South Dakota.



Family Bonds, Healthcare Benefits
Conversations About Growing Up in Medicine on the Northern Plains
From family farms to small-town hardware stores and diners, to banks, there is a long tradition
  across the Northern Plains of passing on passion for a special line of work from one generation to the next. It turns out that the passion for the medical profession is no exception. While national surveys find fewer than half of today’s doctors would recommend the same path to a young person, we found many notable exceptions - and their physician offspring - in our region. In this article, we explore these medical family bonds and the ways in which the profession is changing with several pairs of parent/child physicians.

Eldon Becker, MD, General Surgeon and his son, General Surgeon Brandt Becker, MD,
Avera Medical Group Pierre

Dr. Eldon: Brandt has worked at the hospital and the clinic nearly as long as I have. If he wasn’t outside, he was at my office or a partner’s office. He got to see what life was like as a surgeon.

Dr. Brandt: I mowed the lawn at the clinic when I was 8 years old. So it made me comfortable with medicine and with the other docs. It’s always been there as part of my life. I think it’s really not that different from passing on the family farm or local hardware store. That whole gerations thing.

Dermatologists Roger Knutsen, MD, and his daughter Siri Knutsen-Larson, MD
West River Dermatology, Rapid City

Dr. Roger: She is definitely going to have to deal with managed care more often than I have. But on the other hand she has been trained in different treatment modalities and with different drugs than I have.

Dr. Siri: There are a lot more hoops to jump through now. It is no longer that the doctor just does what best. Now we have so many other things we have to take into consideration.

Ronald Anderson, MD, ObGyn, and his daughter Breanne Anderson Mueller, MD, ObGyn
Sanford Health, Mitchell and Sanford Aberdeen Medical Center

Dr. Anderson: She picked up the joy I had in my job. She also understood the lifestyle. You miss some christmases and birthdays, but it’s also a rewarding practice. I let her decision unfold naturally.

Dr. Mueller: When I went college, I found that, of all the things I tried, I liked medicine the most. This was the only specialty that really made me happy. As my dad says, this was the specialty where people are usually happy to be coming to the hospital

News Flash: Avera Health announces plans to build a new Avera Cancer Institute in Pierre.
News Flash: Brookings Health System opened the newly constructed Medical Plaza building, completing the first leg of the health system’s hospital expansion and renovation project.
News Flash: Siouxland Physician Dr. Gerald McGowan is the recipient of Mercy Medical Center’s Dr. George G. Spellman Annual Service Award.



Healing Hearts in the Hills
Regional Heart Doctors Achieve Important “Firsts” in Cardiac Care

As the Black Hills regions’ largest group of cardiovascular specialists, Regional Heart Doctors, a department of Regional Health’s Rapid City Regional Hospital, continues to push the envelope to advance comprehensive cardiac care for the communities they serve. In recent months, several RHD physicians have performed notable “firsts”, bringing world-class new techniques and technology to heart patients in Western South Dakota.

When cardiologist Bhaskar Purushottam, MD, was completing his fellowship training in Endovascular & Structural Interventional Cardiology at Mount Sinai Medical Center in New York in 2015, he never imagined that, less than a year later, he would be the first physician in the Dakotas to implant the world’s smallest heart pump, Abiomed’s Impella RP, into the right ventricle of a Rapid City patient. Even the Mayo Clinic had not yet offered this procedure when Dr. Purushottam performed it at RCRH in May.

“We were able to take him off the blood pressure medicine and he is doing phenomenally well,” says Dr. Purushottam. “To put it in layman’s terms, he kissed death and came back.”

Just three months after Dr. Purushottam implanted the region’s first Impella RP in his patient’s
right ventricle, his colleague, cardiologist/electrophysiologist Kelly Airey, MD, who joined the practice in April of 2014, performed a first of her own. On August 23rd, Dr. Airey became the first in the Dakota’s to implant the world’s smallest minimally invasive pacemaker, the Micra Transcatheter Pacing System from Medtronic, which was FDA-approved last April.

Dr. Airey, who estimates that she sees one or two patients a month in her practice who could benefit from the Micra, worked closely with Medtronic to help bring the procedure to RCRH.

Cardiothoracic surgeon Zahir Rashid, MD, has been a part of Regional Heart Doctors for just seven months but, by October, he had already introduced several new approaches to the surgical treatment of heart patients at RCRH.

Dr. Rashid was the first to perform a minimally invasive procedure to replace a patient’s diseased aortic valve through the right chest at RCRH. Another first for Dr. Rashid at RCRH was  minimally invasive coronary artery bypass from the left side of the chest, a procedure that may be recommended when there are blockages in one or two coronary arteries, usually in the front of the heart.

“The biggest benefit is for people at highest risk such as those with multiple comorbidities,
people who have had a previous sternotomy, or elderly people with a condition like COPD or emphysema,” says Dr. Rashid. “With a minimally invasive approach, we don’t compromise lung function with a big incision.”

News Flash: Prairie Lakes Healthcare System breaks ground on a new specialty clinic set to open in two years.

News Flash: Regional Health announces a multi-year, phased project to expand and renovate Rapid City Regional Hospital and construct an Advanced Orthopedic and Sports Medicine Institute in Rapid City.

News Flash: Six children’s hospitals sign an agreement to form the Sanford Children’s Genomic Medicine Consortium,