May 14, 2017

Street Medicine

Heritage Health serves homeless with mobile clinic and community outreach program

CDA Press Staff Writer

Homeless people get sick or become injured like everybody else — only they don’t have health insurance to pay for a doctor’s visit or to have their prescriptions filled.

 The lack of insurance or money to pay for basic health care services can have life-altering consequences. A bad cut can easily become a raging infection, a nagging cough develops into pneumonia, or unchecked high blood pressure leads to a fatal heart attack.

 Heritage Health is addressing the problem with its street medicine and community outreach program, providing medical, dental and mental health services to the homeless and underserved individuals. The program also is able to help people and families connect with nonprofits, churches and other groups dedicated to serving the homeless population in Kootenai County.

 “We go out into the community to where we know we can make contact with the underserved of our community,” said T.J. Byrne, Heritage Health’s Homeless Outreach Director.  “One of the biggest issues for our patients is transportation. It can be next to impossible for them to be able to get to us.”

 Which is why Heritage Health began using a converted RV in 2009 to deliver basic healthcare to people who could not otherwise get to the doctor. The mobile clinic operates weekly Monday through Thursday from 1 p.m. to 5 p.m. with a four-person medical team.

 “It’s like urgent care on wheels,” said Byrne. “We’re able to make diagnosis and provide needed medications.”

 The mobile clinic serves between 80 and 100 people per week, delivering a wide array of care and services, and many more for social service needs, and referral to other agencies for basic needs, safety, shelter, food and transportation.

 “We can help people who have been assaulted or injured,” he said. “We have splints and sutures. If somebody has diabetes or high blood pressure, we have medicines for them.”

 The Street Medicine team also makes individual visits to people who are not able to get to local shelters and churches, providing care, food, clothing, and other essentials.

 Heritage Health’s Street Medicine program collaborates with a wide spectrum of partners, including local churches, area food banks, law enforcement, St. Vincent de Paul of North Idaho, private businesses like Medicine Man Pharmacy and other health care providers.

 “Any organization that is helping the underserved is someone we’re looking to work with,” said Byrne. “We’re able to help each other and better serve our patients.”


April 23, 2017

The Fight Against Hepatitis C

New therapy options help patients live longer

CDA Press Staff Writer


Twenty years ago a Hepatitis C diagnosis was viewed as a death sentence because there was no cure.

 While a complete cure remains elusive, advances in medicine can make the virus virtually undetectable in the blood, said Natalie Brulotte, a nurse practitioner at Heritage Health.

 “There is a functional cure today,” said Brulotte, FNP-BC. “We treat the viral load with vastly improved drug therapies. Scarring of the liver goes from bad to moderate or mild with treatment.”

 That stigma of the virus lingers to this day. Health care professionals are hoping to change perceptions and help people with the disease.

 “We’re opening up a treatment plan for Hepatitis C for people who are not able to see a specialist due to financial barriers,” Brulotte said. “There have been so many significant improvements in treatment over the last five years. Patients can live longer, healthier lives...”

 The virus is spread by contact with contaminated blood, for example, from sharing needles or from unsterile tattoo equipment.

 The first step is testing, as most people don’t display symptoms, said Brulotte.

 “Between 45 percent and 85 percent of those patients with hepatitis C have it and don’t know it,” said Brulotte. “If you were born between 1945 and 1965, you are five times more likely to have the disease than any other demographic group.”

 Half of that group has no risk factors, either, said Brulotte. “If you had blood transfusions before 1992, any homemade tattoos or any IV drug use, you should get tested.”

 Individuals who do develop symptoms may suffer from fatigue, nausea, loss of appetite, and yellowing of the eyes and skin. The virus can ravage the liver.

 Getting tested is the first step in Heritage Health’s new treatment strategy it is unveiling this spring. A simple Hepatitis C antibody blood test can show if a person has the virus.

 Once a person has been diagnosed, they typically are put on medications that fight the virus. The drug treatments improve quality of life while reducing long term health care issues and costs, said Brulotte.

 “The drug therapies are 90 percent effective and they’re easier to tolerate,” she said. “You take oral medication instead of a shot. That is a big improvement for people.”


April 9, 2017

Big Changes for Life

Heritage Health’s dietitians help people achieve wellness goals


CDA Press Staff Writer


Bill Mitten weighed 390 pounds about eight months ago. He had suffered four heart attacks and was taking a bevy of heart medications. In addition, he took 300 units of Insulin daily to treat diabetes.

 The retired steamfitter with bad knees decided to do something about his situation and got moving — one step at a time.

 “I was doing nothing,” said the Post Falls resident. “My doctor first asked me why I wasn’t dead already? I said, ‘Nobody told me I was supposed to be.’”

 Mitten’s life changed when his doctor recommended he enroll in Heritage Health’s Kroc RX program and a diabetes class.

 “It probably saved my life,” said Mitten. “Since I started, I’ve lost 57 pounds and I am still losing weight. I am in water aerobics twice a week and I walk a mile on Fridays.”

 Kroc Rx participants exercise at a level they can handle while receiving nutritional and emotional support services from Heritage Health. To date, more than 1,000 patients have successfully completed the program at the Kroc Center, Peak Fitness in Post Falls and Rathdrum Fitness.

 Dr. Joseph Abate, Heritage Health’s medical director, said participants in the eight-week program lost an average of 5 ½ pounds and dropped their A1C scores, a test to measure blood sugar, by .6. They also improved mental health, reducing test scores for symptoms of depression by 42 percent.

 “The demand for our programs is increasing because of the success we’re experiencing,” said Abate, who launched Kroc RX in 2015.  “These are lifestyle changes for our patients.”

Proper nutrition is an essential component to a healthy life,  said Heritage Health Dietitian Jennifer Ramsrud. Heritage Health added nutrition education to the Kroc RX program about a year ago.

 “We teach them how food works with their bodies,” said Ramsrud. “Many of the people in the program come in with preconceived ideas about what they can or can not eat. It’s not about extremes. This is about lifestyle changes that give them the ability to be healthy.”

 Mitten said Ramsrud’s approach to nutrition “clicked” with him after years of trying diets and other weight loss strategies.

 Heritage Health uses shared medical appointments to deliver important information to patients via a group setting. The health care provider offers a wide array of shared medical appointments, including chronic care management, emotional wellness, and aging gracefully.

 “It’s great because you’re able to develop relationships with people and the patients help hold each other accountable,” said Ramsrud. “Hopefully, we inspire people to achieve their goals.”


March 26, 2017

Baby On Board

Heritage Health helps educate young parents


CDA Press Staff Writer


Teenage mothers are often woefully unprepared for the realities of having a baby.

They lack critical knowledge about nutrition, safe sleep practices, vaccinations and infant development, says Dr. Nikki Odom, a Heritage Health pediatrician.

“Young mothers are overwhelmed and they don’t realize the enormity of the situation,” said Dr. Odom. “Often they’re coming from inconsistent and chaotic households. Pregnancy is a very frightening proposition.”

Thankfully, agencies like Heritage Health are here to help mothers better understand all that goes into caring for a newborn baby and what resources are available to them.

The regional provider will introduce shared medical appointments for teenage mothers this spring.

“We are reaching out to expecting parents and those with young children to provide a safe, fun, non-judgmental space where important topics and issues about parenting can be taught and discussed,” said Dr. Odom.  “We are going to be covering maternal and child nutrition, maternal mental health, infant and child development, safe sleep practices, questions about vaccines and the role of your baby's primary care provider, connection to community resources, etc.”

Heritage Health uses shared medical appointments to deliver important information to patients via a group setting. The health care provider offers a wide array of shared medical appointments, including chronic care management, emotional wellness, and aging gracefully.

Shared medical appointments for young mothers and young fathers will be offered free or almost free weeknights at Heritage Health’s main campus, 1090 W. Parkplace in Coeur d’Alene.

“The costs are nominal, like $2,” said Dr. Odom. “We have scholarships available for young parents who can’t afford it. We believe this information is critical for parents to have.”


March 12, 2017

Sometimes, Love Isn’t Enough

Heritage Health offers individual and family counseling services


CDA Press Staff Writer


Roughly half of all marriages in the United States end in divorce, but many are saved from dissolution thanks to individual counseling, commitment and communication.

 However, there are no quick fixes.

 “Relationships take a lot of work to sustain,” said Jodi Smith, Heritage Health Clinic’s Director of Family Support Services. “We’ve all heard, and many have said, ‘Love will carry us through.’ While having love for one another is a key element to the survival of a relationship, communication is every bit as key.”

 Through the course of a marriage, couples’ communication skills can erode, and they fail to express their feelings to each other. A downward spiral ensues.

 “For some reason, we assume our significant other has become a mind reader, or that they should know what we are thinking,” Smith said. “The problem with this assumption is that it can lead to inaccurate interpretations of actions and words, which can lead to confusion, frustration, arguments, and ultimately, resentment on the part of one or both. As patterns of unhealthy communication are developed, they become more and more difficult to change.”

 According to Smith, couples tend to believe that “He always does this” or “She always says that,” assuming that what he’s done or she’s said is meant with intention to be hurtful.

 “We forget that most people do not intentionally engage in behaviors to hurt others,” Smith said. “While all behaviors do have an intent and purpose, they are usually acted upon due to an unmet need.

 “Here’s a simple and quite common example: When one partner is hungry and makes themselves a sandwich, and the other gets mad because they didn’t make them one. How would the partner making the sandwich know the other was hungry unless some communication took place?”

 Since every relationship is different and a person’s ability to function within one is based on their own experiences, such as parental role models, a  mental health professional or counselor can be a valuable asset.

 “When one partner goes to counseling, they learn new skills and strategies that should assist them to decrease the discomfort that brought them to ask for help. As this partner learns new strategies and begins to incorporate them, the other can begin to feel threatened, as the dynamics of the relationship have changed,” Smith said. “Simply put, one is changing while the other is staying the same. It’s important for both partners to learn those new skills and strategies.”

 Last year, Heritage Health had 20,000 patients go through its Family Support Service program, which includes individual and family counseling, community-based rehabilitation programs and educational classes.

 Health insurance policies vary, so individuals should check with their provider to see what’s covered before scheduling an appointment.


February 26, 2017

Winter got you down?

Seasonal Affective Disorder, lack of Vitamin D or clinical depression may be to blame


CDA Press Staff Writer


Day after day of gloomy gray skies and never-ending darkness takes its toll on people living in North Idaho.

 Depression, anxiety and not feeling right are the potentially serious mental health problems caused by our long winter months.

 “We see a lot of folks with significant mood shifts,” said Dr. David Wait, the Director of Mental and Behavioral Health at Heritage Health.  “I treat severe depression more than anything else and the majority of those patients have a seasonal component to it.”

 Many residents seek help for Seasonal Affective Disorder (SAD), a type of depression that's related to changes in seasons. Typically, symptoms start in the fall and continue into the winter months, sapping a person’s energy and causing moodiness or leading to depression.

 Between 4% and 6% of people in the United States suffer from SAD and another 10% to 20% may experience a mild form of winter-onset SAD.

 Treatment for SAD may include light therapy, psychotherapy and medications, according to the Mayo Clinic. Often the dreary weather is just part of the problem. Dr. Wait said many of his patients have a Vitamin D deficiency.

 Low Vitamin D levels have been linked to obesity, weight gain and depression, he said. Dr. Wait recommends that everyone socialize a few times a week during the winter months, exercise and eat a healthy diet.

 “If you’re feeling fatigued or anxious, it’s a good idea to get Vitamin D screening,” he said. “It’s a good idea for people living here to take 1000- 2,000 units daily during the darker months of the year.”

 What are the symptoms of depression?

 “Clear symptoms of depression are hopelessness, helplessness and worthlessness that last for more than 2 weeks.  If a person has these it’s very important for them to seek help,” Dr. Wait said. “Many other symptoms can be part of the picture such as Profound anxiety that doesn’t resolve or major sleep or apetite changes.   If you’re having suicidal thoughts, seek immediate attention.”

 Dr. Wait added that some people can be severely depressed but friends and families don’t realize it.

 “If a person is stoic or has a stiff upper lip, you might never know they’re hurting inside,” he said. “Social isolation is one of the major causes as well as symptom of depression.  It’s important for friends and family to speak up when they see a change happening, talk to them about it, and urge them to talk to their doctor or a therapist about depression if it is present. People shouldn’t suffer alone.”

 “Here at Heritage, I’m proud to be part of a full team of primary care providers, therapists, psychiatric providers who can help.  In addition, we have as educational and exercise group medical visits that can help people with anything ranging from mild seasonal mood shifts to severe depression.  I’m really pleases that we can help people with these services if they have insurance and if they do not, so anyone can get the help they need.”