MyNorth Medical Insider 2015

MI 1 MyNorth.comMI 1 MyNorth.com

2015-2016

Professionals • Hospitals • Practices • Technology

MedicalInsider Lowest readmission rate

in nation for congestive heart failure

Lowest readmission rate MUNSON RANKED

Inside Are you at riskfor breast cancer? Advanced screening available.

Adult orthodontics: what you need to know

How McLaren achieves top rank in heart bypass

McLaren doc leads team for stroke response standards

Munson Medical Center’s Heart Failure Clinic team include from left: Nancy Harris, Rhonda Purchase, Sheila Falk, Dr. Dino Recchia, Dr. Heather Tolfree & Mary McManemy

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Our Experience Improves Yours.

We know our way around hearts. The Munson heart team

has provided advanced heart care longer than any other

team in northern Michigan. We do more heart procedures

than anyone else – and our experience improves yours.

Our heart team has the lowest 30-day heart failure

readmission rates in the nation at 16.6 percent. The

national average is 22.7 percent.

Great care and great outcomes make us the regional

leader in cardiac care. Ask your physician to refer you

to the Munson team – the most experienced and

advanced heart team in northern Michigan. We’ll feel

better when you do.

1-800-637-4033 | myheartexperts.org


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Hospitals across the nation are keenly focused on reducing the rate of hospi-tal readmission for congestive heart fail-ure, and in that pursuit, Munson Medical Center’s cardiac team recently achieved a remarkable result. In a study of 4,778 hos-pitals, the Munson team tied with three other hospitals for the lowest readmission rate in the nation.

The number one cause of hospital admissions for people over 65 is conges-tive heart failure. In the United States, of the people admitted to a hospital for con-gestive heart failure, nearly 25 percent of them will be back in the hospital within 30 days. That average is unfortunate both for the patients, who’d prefer not to be in the hospital, and for the medical system at large, which has to pay for that frequent, high-level care.

The number of people who die from congestive heart failure has doubled since the 1980s. Ironically, the increase is in part the result of success in another area of heart treatment. Medical teams have become so adept at saving people from heart attacks that many are now living with damaged and weakened hearts that have compromised pumping ability—which is what congestive heart failure is.

Five years ago, when, thanks to phil-anthropic support, Munson was able to build its Heart Failure Clinic Program the hospital’s readmittance rate nearly matched the national average. Central to lowering that rate to 16.6 percent was identifying the sickest patients—people who had the highest chance for not doing well and being readmitted and closely monitoring their condition of health at home, explains Dr. Dino Recchia, cardiologist. “We made the patient and the family part of the team,” he says.

The importance of self-care is essential for patients to understand when manag-ing congestive heart failure. “When heart failure tips over, it’s because patients are retaining water, and one of the best ways to monitor that is daily weight, so we have them weigh themselves every day,” Recchia says. The patient sends his or her weight information to a nurse, and the team adjusts medications daily in response. “It’s the same way a diabetic might adjust insulin day by day,” he says.

Taking the fluid monitoring a step fur-ther, the team can implant a tiny device in the blood vessel of a patient’s lung that measures the blood pressure in the artery, which is a reflection of the pressure in the

heart and can detect fluid retention very early on. The device detects increased flui even before it shows up as weight gain, so medications can be adjusted at the earliest possible time. The patient lies down on a small pillow that has electronics inside that read the monitoring device and send the results to Dr. Recchia’s iPhone.

When treatments involving phar-maceuticals are no longer enough, the Munson team works with teams in other hospitals on such solutions as implantable heart pumps or even heart transplants. Working closely with those physicians, Munson’s team can assist with follow-up locally, helping the patient reduce the need to travel downstate for checkups.

Given Munson’s “best in the U.S.” results, it’s little surprise that hospitals have been calling Recchia and his team to learn how they achieved such low readmission rates. “We’ve been open to helping,” he says. “This is another great example of this community working to solve a problem—donors giving financia support, the administration saying, ‘Can you make this better?’ and implementing the right expertise at the right time.”—J.S.

Congestive Heart Failure

Munson Ranked Top in Nation for Low Readmission Rate

231.935.5000 munsonhealthcare.org

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Stroke

The Urgent Goal: Shorten Time to Treatment

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You see it in print, you see it on TV, you hear it on radio, you see it on billboards: Time is of the essence when responding to stroke. Yet shortening the time between stroke and treatment remains a major hurdle in minimizing the effects of this, the No. 1 cause of adult disability in the United States. Today, less than fi ve percent of stroke victims arrive at the hospital within the 3-to-4.5 hours needed to be eligible for treatment by the most effective drug, a powerful thrombolytic agent (dissolves blood clots) com-monly called TPA (tissue plasminogen activator).

Reducing that time to treatment is a central goal of Michigan’s Ongoing Stroke Registry to Accelerate Improvement in Care (MOSAIC), a statewide stroke response and care initiative, explains Dr. Robert Levy, M.D., of McLaren Northern Michigan. MOSAIC is a multi-center initiative led by the Michigan Department of Health and Human Services and funded by the CDC as part of the Paul Coverdell National Acute Stroke Registry. Levy will be serving as clinical consultant for MOSAIC throughout Michigan as the program launches its second stage, a fi ve-year effort.

The program’s fi rst three-year stage focused extensively on in-hospital procedures and especially reducing what medical teams called “door to needle” time—the time between hospital admit-tance and when the patient begins receiving TPA. “The goal was 60 minutes. The new goal is 45 minutes,” Levy says.

In MOSAIC’s stage two, one of the main goals is reducing the time from onset of stroke to hospital admission. “We want to streamline the preadmission process, and that will involve educa-tion of EMS [emergency medical service] teams in how to rec-ognize a stroke and transport to the nearest hospital that has the ability to give TPA,” Levy says. EMS should also notify the hospital

that a stroke patient is on the way, so they are already prepared when the patient arrives.

Adding another layer of complexity to response time, hospitals have recently begun to perform clot removal from major arteries of the brain using catheter technology. Levy and his colleagues will be strategizing about how to make sure eligible patients can reach those downstate hospitals within the six-hour time frame needed for effective treatment.

McLaren Northern Michigan and Munson Medical Center have collaborated to create a single stroke critical pathway that will allow all hospitals in Northern Michigan to standardize EMS and in-hospital stroke care. Collaboration between McLaren Northern Michigan, Munson, and all the hospitals in Northern Michigan has been a pillar of developing the response systems. “We want to provide a single template for evaluation and treatment of stroke to improve patient care and outcomes,” Levy says.

MOSAIC is a multi-faceted initiative, and in addition to focusing on the pre-admittance phase, Phase Two will also be working to improve post-discharge care including smoking cessation, adher-ence to medications, and medical follow-up.

MOSAIC will also be working hard to educate the public about signs of stroke, because failure to identify stroke by the patient and family is the key reason why less than 5 percent of patients nation-ally receive TPA.

“People need to educate themselves about the signs,” Levy says. “Get a list and put it on the refrigerator.”—J.S.

ANOTHER WAY TO REMEMBER STROKE SYMPTOMS-Sudden weakness on one side of the body-Sudden confusion, trouble speaking or understanding-Sudden trouble seeing-Sudden trouble walking or loss of balance-Sudden severe headache with no known cause

THE FAST TESTFACE: Does the face look uneven? Ask them to smile.ARMS: Does one arm drift down? Ask them to raise both arms.SPEECH: Does their speech sound strange? Ask them to repeat a phrase.TIME: Every second, brain cells die. Call 911 at any sign of stroke.

source: www.michigan.gov.cvh

800.248.6777 northernhealth.org

Dr. Robert Levy


(231) 547-4024 www.cah.org14700 Lake Shore Drive Charlevoix, MI 49720

YOU HAVE A CHOICE.

Cancer touches an increasing number of people every year and treatments can require traveling long distances, sometimes to an unfamiliar area. Being away from home frequently adds stress to an already stressful situation.

Now you have a choice.

We’ve responded to the need for cancer care close to home by adding the Sarah M. Foster, MD Chemotherapy-Infusion Center, offering treatment in a calming, comfortable environment, overlooking the healing waters of Lake Michigan. Ask your health care provider for a referral.

Your treatment close to home. Your choice.

WORLD-CLASS HEALTH CARE HOMETOWN CARING



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Breast Cancer

Screening for At-Risk Women

Hilary Tarsney

Women who are diagnosed at breast cancer’s earli-est stage have a 95 percent survival rate at 10 years. That powerful statistic explains why early diagnosis has become one of the most fervently pursued strategies in the war against cancer.

Doing its part, Munson Medical Center has launched a new breast cancer-screening program designed to iden-tify women who have an elevated risk. Women who have a 20 percent or higher risk of developing breast cancer in their lifetimes will be more closely monitored, so if they do develop breast cancer, intervention can happen as quickly as possible.

The program begins this fall, when the mammogram patients in for regular checkups at the hospital or the Smith Family Breast Health Center at Copper Ridge will be asked to fi ll out a risk assessment form. The question-naire runs two pages and asks for information about per-sonal health and lifestyle habits and family history. “We encourage people to take the form home, so they can talk to relatives, like their mom or an aunt, to get a more com-plete story,” says Hilary Tarsney, Comprehensive Breast Program Coordinator at Munson Medical Center.

The information is fed into a computer, which deter-mines a risk percentage based on two nationally recognized risk models. Of course the fi ndings are especially impor-tant to women with elevated risk, but the information is important for all women, in Tarsney’s view.

“Many people tell us they are at higher risk, but their information shows they are not, so that is a relief for them,” Tarsney says. “On the fl ip side, we fi nd people who did not know they were higher risk, but are, so we can advise.”

A nurse practitioner will contact women with elevated risk and have them come in for a consultation. “They will go over the results, ask about possibly doing other tests and discuss changes to their lifestyle that can reduce risk—dietary changes, exercise, less alco-hol,” Tarsney says. Some people are eligible for medications that can reduce risk. Some women might alternate every six months with a mammogram and an MRI. Some of the higher risk patients may be

eligible for full genetics testing. “Most insurance companies will pay for blood tests that will test for genetic mutations in DNA that would elevate their risk of breast cancer,” Tarsney says.

Between the hospital and Copper Ridge, 25,000 women a year have mammograms in Traverse City, and of those in 2014, 285 women were diagnosed with some type of breast cancer. “Even if half the women fi lled out the form, that would be fantastic,” Tarsney says. “They would know what their risk is.”

In Michigan, women must have a physician order to schedule a mammogram. (The health department can issue mammogram orders for women who are uninsured or under-insured.) —J.S.



We Are Munson Healthcare.We are the people who care for the people of northern Michigan. We believe the best health

care is delivered as close to home as possible by people who live and work in your community.

Our nine community hospitals are committed to the well-being of each patient. We collaborate

in a regional system of care, knowing that working together and sharing our strengths allows us

to serve our communities better.

Our eight supporting partners contribute to regional health care through coordinated services

that result in quality, convenient, easy to use care for patients and their families.

Together, we’re stronger. Together, we are Munson Healthcare.

Munson Healthcare Hospitals

Cadillac Hospital Munson Medical Center

Charlevoix Area Hospital Otsego Memorial Hospital

Grayling Hospital Paul Oliver Memorial Hospital

Kalkaska Memorial Health Center West Shore Medical Center

Mackinac Straits Health System

Partners

Kalkaska and Munson Dialysis Centers Munson Mobile Imaging

Munson Home Health Northern Michigan Supply Alliance

Munson Hospice Great Lakes Mobile PET

North Flight EMS Northwest Michigan Surgery Center

To find a physician in your area, call Munson HealthLink at 1-800-533-5520

or visit munsonhealthcare.org.



We Are Munson Healthcare.We are the people who care for the people of northern Michigan. We believe the best health

care is delivered as close to home as possible by people who live and work in your community.

Our nine community hospitals are committed to the well-being of each patient. We collaborate

in a regional system of care, knowing that working together and sharing our strengths allows us

to serve our communities better.

Our eight supporting partners contribute to regional health care through coordinated services

that result in quality, convenient, easy to use care for patients and their families.

Together, we’re stronger. Together, we are Munson Healthcare.

Munson Healthcare Hospitals

Cadillac Hospital Munson Medical Center

Charlevoix Area Hospital Otsego Memorial Hospital

Grayling Hospital Paul Oliver Memorial Hospital

Kalkaska Memorial Health Center West Shore Medical Center

Mackinac Straits Health System

Partners

Kalkaska and Munson Dialysis Centers Munson Mobile Imaging

Munson Home Health Northern Michigan Supply Alliance

Munson Hospice Great Lakes Mobile PET

North Flight EMS Northwest Michigan Surgery Center

To find a physician in your area, call Munson HealthLink at 1-800-533-5520

or visit munsonhealthcare.org.

4033 Eastern Sky DriveTraverse City, Michigan 49684

(231) 932-9000

Northern Vision Eye Care delivers state-of-the-art

medical, surgical and optical eye care with a passion for excellence,

individuality and community service.

A wise man (or woman!) once said, “The only constant is change.” Evidence of this can be seen all around us, from the newest features on the latest iPhone to the wonders of 3-D printing. A new technology as recent as the iPod is already obsolete. These same trends exist in medicine, and in no field more so than ophthalmology. In fact, the vast array of cutting-edge technology within ophthalmol-ogy was one of the many things that attracted me to the field. The diagnosis and treatment of ubiquitous eye diseases such as macular degeneration and diabetic retinopathy have been revolutionized in the last decade with incredible breakthroughs in both diagnosis and treatment.

Amidst all of this progress, eyecare provid-ers are still treating glaucoma in essentially the same way they were thirty years ago! Lowering the pressure inside the eye is currently the only proven way to treat glaucoma. Once a patient is diagnosed with glaucoma, they are usu-ally started on eyedrops to lower the pressure inside the eye; laser therapy can also be used to achieve this goal, although the effects of laser eventually wear off. While the use of eyedrops seems simple enough, time and again studies have shown that less than 50% of patients use their eyedrops as prescribed, and this doesn’t even take into account the difficulty of actually getting the drops in the eye! Not to mention that these drops can have their own side effects, both short-term and long-term.

If a patient’s eye pressure is deemed to be too high despite the use of multiple eye drops

and laser therapy, then incisional surgery is the last line of defense to lower the eye pressure and preserve the patient’s vision. However, eye surgeons typically think of traditional glaucoma surgery as the last resort because, while effec-tive, it is wrought with potential complications. Multiple large studies have repeatedly demon-strated that the best surgeons in the world still experience vision-threatening complications in upwards of 20% of cases.

This is all changing. Recent technological advances in biomedical device manufactur-ing have finally allowed engineers to precisely manufacture devices on an extremely small scale, small enough to fit inside the micro-scopic fluid outflow pathway in the eye. This has given rise to the field of MIGS, short for “micro-invasive glaucoma surgery”. The first such FDA-approved device, the iStent, is 1 mm in length (Figure 1). This device is approved for sur-gical implantation into the trabecular meshwork, the drainage tissue in the front of the eye that is most often malfunctioning in glaucoma. The iStent serves to bypass this diseased tissue, thus lowering the pressure inside the eye and helping to save vision from being lost to glau-coma. While the degree of pressure-lowering is typically more modest compared with tra-ditional glaucoma surgery, the most exciting benefit of the iStent is that it is much safer than traditional surgery. This gives surgeons the ability to surgically intervene at an earlier stage, thus serving to preserve more vision and hopefully spare patients the difficulty of being on multiple eyedrops.

The iStent is only one such MIGS device, there are multiple other devices that have dem-onstrated even better efficacy and safety across the world and are on the verge of gaining final FDA approval in the next year or two. The field of glaucoma is set to undergo a major paradigm shift, and the surgeons at Northern Vision Eye Care are excited to be able to offer this exciting technology to the community. Call 231.932.9000 to schedule a consultation or attend a free seminar to the public discussing MIGS lead by Dr. Potthoff on Wednesday, November 11th at 6:30pm at Northern Vision Eye Care (in the Copper Ridge marketplace).Seating is limited, so please call to reserve a seat.

www.northernvisioneyecare.com

MYNORTH MEDICAL INSIDER

Exciting Advances in GlaucomaBy William P. Potthoff Jr, MD

Robert K. Butryn, MD, Amy S. Ranger, MD, William P. Potthoff Jr, MD

Figure 1. Size of the iStent as compared to a penny.


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We know taking the step to get help for you, a loved one or your relationship can be a difficult one. That’s why we are committed to treating you with compassion from your first call through your last appointment.

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Hope Starts Here



ChristianMental Health Services

We know taking the step to get help for you, a loved one or your relationship can be a difficult one. That’s why we are committed to treating you with compassion from your first call through your last appointment.

· Child, family and couples counseling· Therapy for depression, anxiety, stress, grief, addiction and much more· Testing for ADHD, concussions, dementia

Professional. Confidential. Compassionate.

866.852.4001pinerest.org/traversecity

Hope Starts Here

The human anatomy has not changed, but the instruments used by physicians have, and it is this evolution of technology and training that is changing how patients experience their hip replacement. Residents of Gaylord and the surrounding communities are benefiting from these advancements, and the surgeons who use them.

In July 2015, Otsego Memorial Hospital welcomed orthopedic surgeon, Ryan Shephard, DO. Dr. Shephard completed his residency at McLaren-Macomb Hospital in Mount Clemens, Michigan and utilizes the anterior approach to total hip replacements. “Essentially, the anterior approach has rev-olutionized the hip replacement,” said Dr. Shephard, “Surgical technology has evolved, creating instruments that allow the surgeon to move around the muscle instead of cut-ting through it.” The procedure calls for the surgeon to enter through the front (anterior) of the hip, instead of the back (posterior) or the side (lateral) approach.

According to Dr. Shephard, because the surgery is performed without cutting through the muscle, the patient can expect increased stability, with a lower dislocation rate. A sig-nificant improvement when compared to the older hip replacement procedures. The improved stability also leads to less activity limitations and lifelong restrictions. “Patients who actively participated in high level, non-impact sports, such as skiing or tennis, should not expect to have the same lifelong restric-

tions imposed on them as can be expected with the posterior or lateral approaches.” said Dr. Shephard.

The advanced technology includes more than simply newer instruments, and incorpo-rates a surgical table that works in conjunc-tion with an x-ray component, allowing for the highest level of accuracy when replacing the affected joint. OMH purchased the Hana Orthopedic Table in the spring of 2015, and is one of only two facilities in northern Michigan with the equipment and expertise to offer the anterior hip replacement.

Talent, training, and technology are changing the hip replacement surgery, and patients cannot speak more highly of the ben-efits. Although everyone will recover at their own pace, patients of the anterior approach frequently experience a faster recovery as their muscle tissue has not been cut. One of Dr. Shephard’s most recent hip procedures per-formed at OMH was completed on 70 year old Nancy, she was thrilled with the results especially as she is still in the workforce. “My husband and I were amazed,” said Nancy, “Even the nurses and physical therapists were surprised that I was walking within 30 min-utes of waking up from the procedure. The greatest pain I experienced was the discom-fort in my throat from the breathing tube.”

To find out more about the anterior approach, or to schedule an appointment with Dr. Shephard please call 989-732-1753 or 800-524-5181.

Transforming Hip Replacement Surgery

OMH Medical Group-N’Orthopedics2147 Professional Drive,

Gaylord MI 49735989-732-1753 • MyOMH.org


“My husband and Iwere amazed, even the nursesand physical therapists were

surprised that I was walking within 30 minutes of waking

up from the procedure.”


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Neurosurgery

Munson neurosurgeon Dr. Thomas Schermerhorn understand-ably felt a measure of pride when the University of Michigan medical school asked Munson Hospital to offer a one-month resident program for the neurosurgery school’s fi fth- and sixth-year students (neurosur-gery requires seven years past medical school). Schermerhorn saw the resident program as a vote of confi dence, a collaboration that showed the university respected Munson’s neurosurgeon team enough to know they could serve as valuable mentors. Schermerhorn—who has taught part time at U of M for the past three years—looked forward to playing that teaching role in his home hospital, too.

But Schermerhorn concedes he did not fully anticipate all the ben-efi ts to staff, patients and students that would result from the resident program. For one, having some of America’s best and brightest neu-rosurgery students asking smart questions helps keep Munson’s team sharp, Schermerhorn says. “They want to learn and know why we chose this particular treatment option instead of another one; it keeps us up to date on treatment advances and techniques,” he says. “We have to be able to articulate our reasoning and decision-making.”

Patients have also benefi ted because the resident program has strengthened relationships with the U of M neurosurgery team, which has led to greater collaboration, particularly on complex cases. In some emergency situations, where the Munson team has provided life-saving and stabilizing treatment and then transported the patient to U of M, the whole process happens more smoothly because of deeper relationships that now exist. “In other cases, because we have more close relation-

ships, we can provide local follow up in collaboration with their U of M physicians, so a patient may end up being able to stay here, not have to go to U of M or not go as frequently,” Schermerhorn says.

For the students, the main purpose of the Munson resident program is to see up close what it’s like to practice in a community hospital ver-sus a large medical research institution like U of M. The students see what a real community neurosurgical caseload is like, they see what resources are at their disposal. “Many students will go to practice in smaller settings than university hospitals, and there can be a certain naïveté about what to expect,” Schermerhorn says.

During their month at Munson, the residents will work with each of the four neurosurgeons on the team in a mix of observing and hands- on roles. “In the operating room, typically the resident would serve as the surgeon’s fi rst assistant,” Schermerhorn says.

The program’s fi rst resident recently gave a presentation about his month at Munson. “He felt it was very benefi cial to see the challenging cases we take care of and gained an appreciation for the breadth of neu-rosurgery practiced at Munson Medical Center,” Schermerhorn says.

The resident program also gives students a sense of the business side of medicine. “Most neurosurgeons here are also small business owner/operators, whereas in a university the physicians are typically employees, and residents have less exposure to setting up and running a practice or business,” Schermerhorn says.—J.S.

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U of M Teams with Munson for Residency Program


Dr. Thomas Schermerhorn


ANDREW S. BOYCE DO

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CHRISTOPHER R. CHUINARD MD, MPH

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THOMAS V. O’HAGAN MD, MED

MICHAEL J. PETERS II DO

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If you’ve been to the doctor lately, you have probably heard the phrase Patient Centered Care, because the philosophy behind it is shaping the doctor-patient relationship today. But what does Patient Centered Care mean exactly, and what are the ben-efi ts to the patient? We asked Dr. Melanie Manary, M.D., of Internal Medicine of Northern Michigan, to explain the approach, because she and her partners have woven the Patient Centered Care ethos into their practice for a number of years now.

First, we are hearing a lot about Patient Centered Care and Patient Centered Medical Home (PCMH), can you clarify their rela-tionship?

Patient Centered Care means you have a primary physician, somebody who takes the lead in coordinating the team of people who are involved in your care. A Patient Centered Medical Home is an insurance term—insur-ance companies evaluate physician practice services to be sure that care quality and standards qualify as a PCMH for that particular insurance company.

What are the key pieces of the Patient Centered Care philoso-phy and process?

Well, as I say, fi rst, you have a pri-mary physician who coordinates the team. That team consists of every person involved in your health care, like the medical assistant, the person tracking your immunizations, a nutri-tionist, your cardiologist ... could be a lot of different people on the team. Also, we are looking at the whole per-son, taking into account all

that’s going on with them. So maybe I notice that their blood pressure is high, but then I learn their house burned down a month ago, and now they can’t afford the blood pressure medicine. We try to help address the entire situation.

Explain how the coordina-tion—the quarterbacking that the primary physician does—results in better care.

Let’s say you go to the physical therapist and the physical therapist feels you need more leg strength. The physical therapist then sends to the primary physician. And you also see a visiting nurse who explains that you need to get out of the house more. We look at those recommendations and suggest you join a group that goes on walks. So all the elements of your care feed back to your primary phy-sician, and we can coordinate it all, determine what else might be

needed, and also eliminate duplicate care. Health care used to be very frag-mented. Patient Centered Care hopes to solve that problem.

We hear that over-prescribing medications is a problem these days. Does it help with that?

One of the best things is that our electronic medication records are always up to date. If any provider related to my patient’s care pre-scribes a medication, I get a list. When a patients comes in and says, ‘that blue pill ...’ and I don’t know which blue pill they mean, but now I refer to the electronic medication list. This way, we avoid patients being double-dosed. That has helped out hugely. The pharmacies are involved too. If a patient hasn’t fi lled a prescription they need, I get a note.

How have the patients reacted to the Patient Centered Care approach?

We’d hope our holistic approach encourages the patient to look at themselves more holistically as well.

Any piece of advice for peo-ple just getting used to Patient Centered Care?

Don’t pooh-pooh the portal! The web portal [online access to your medical records] makes it very easy to communicate with your primary physician. You can look at labs and see notes to help you remember your own care. We might talk about 18 things during an appointment, and when you get home you might think, now what did she say about aller-gies? Now, you can look on the por-tal. It helps patients stay healthy!—J.S.

Dr. Melanie Manary Explains

Patient Centered Care

231.487.2460 doctors4adults.com


Together we’re stronger.Munson Home Health professionals will be at your side to provide respectful, compassionate care. Whatever kind of help you need, we will be there to assist with expertise and a warm smile.

• Munson Home Care• Munson Private Duty• Munson Hospice• Munson Palliative Care• Munson Home Medical Equipment

• Munson Medical Alert System

To learn more, call 1-800-252-2065 or visit us at munsonhomehealth.org.

Munson Home Health is the largest, most comprehensive provider of home health services in northern Michigan. With offices throughout our communities, we provide:

Manistee

Traverse City

Gaylord

Munson Home Health Service Area and Office Locations

Cadillac

Grayling

Houghton Lake

Reed City

How does FAMILY define our business? Communication is the key to any relationship, and FAMILY relationships suffer when hearing loss interferes. There’s a difference between hear-ing, listening, and understanding. Knowing those differences is important. This is why we include your significant others during your appointments (spouse, child, sibling, or friend). Any hearing aid can increase volume, but at FAMILY HEARING CARE it’s the counseling, experience, and expertise that will guarantee your satisfaction. Listening to your needs, forming a lasting part-nership, and earning your trust through true caring and concern means we’ll do whatever we can to help. The process of pur-chasing hearing aids can be confusing and frustrating. Our Flex:

Try Before You Buy program lets you experience the benefit of hearing aids in your own home with no cost or obligation.

Call, stop in, or find us on the web. We are FAMILY HEARING CARE with “Decades of experience bringing you sound advice for a better future”….. Homemade cookies? Cup of coffee? Relax, you’re FAMILY coming by for a visit, located next to Sleder’s Family Restaurant.

Family Hearing Care315 N. Division, STE 120 • Traverse City, MI 49684

(231)946-2200 • [email protected]

Dr. Paul Hanrahan AuD, CCC-A, Ed Smith M.A., CCC-A


Growing our practice into the future…Surgical Associates has been caring for Northern Michigan

for more than 35 years. Comprised of board certified specialists in general and colorectal surgery, we provide the highest qual-ity of care and the latest innovations in surgery. During the past several years, the growth of our practice has continued.

New to the group this summer is Christopher LaFond, MD, MPH, who joins the group following completion of his surgical residency at St. Joseph Hospital in Ann Arbor. Dr. LaFond is also a graduate of

The University of Michigan, as well as the Medical School

for International Health at Ben Gurion University. His surgical interests include treatment of thyroid and parathyroid disease, as well as surgical management of breast cancer. In addition to comprehensive diagnos-tic and therapeutic endos-copy, he is providing open/laparoscopic procedures for abdominal hernias, biliary or gastrointestinal surgery. Dr. LaFond is accepting new patients.

Also relatively new to the group is Adrian Seah, MD, who joined the practice in the summer of 2013, following his surgical residency at the University of Vermont/Fletcher Allen Healthcare. Dr. Seah is also a graduate of both The University of Michigan and Michigan State University. His special interests include esophageal reflux, abdominal hernias, and endocrine pathology. Dr. Seah is accepting new patients.

Drs. VanderKolk, Tooley and Potthoff, continue to offer expert care in all areas of general surgery, including breast, endocrine, and colorectal surgery. All providers also offer routine EGD and colonoscopy screenings.

Dr. LaFond Dr. Seah

1221 Sixth Street, Suite 306 • Traverse City, MI 49684231-935-2400 • www.surgicalassociatestc.com




McLaren Receives Top Cardiothoracic Rating

Heart Surgery

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When a person is suddenly told he or she needs heart bypass surgery, a common reaction is to consider large, high-profil research hospitals for the procedure. But in some cases, the close attention and intimate care patients receive at a regional hospital can actually offer better outcomes. That idea is supported by the top performance ranking that McLaren Northern Michigan’s heart team receives from the Society of Thoracic Surgeons. Known as STS, the organization gathers information on hundreds of data points related to heart surgery and assigns participating hospitals a ranking based on performance. The highest ranking is three stars, and McLaren Northern Michigan consistently achieves that ranking.

“When I came here five years ago, our number one focus was quality in every aspect of care—from the time the patient is admitted right through their time returning home,” says Dr. Christopher Akins M.D., cardiothoracic surgeon. The McLaren Northern Michigan team performs about 300 heart operations a year, and 40 percent of them are bypass surgeries.

For each heart patient, STS asks if the surgery prep started on time, how long the procedure took, how long the patient was in intensive care, how long they were on the ventilator, if there were any complications, if there was any infection, if the

patient came back for repeat surgeries, if the patient is readmit-ted within 30 days … There are nearly 500 data points to report on for each patient, according to Nausherwan “Nash” Ansari, perfusionist, who works closely with Akins and who is also involved in providing the data to STS.

The cardiac team is especially proud that McLaren Northern Michigan performed so well on several of the key points of measure. “Last year, compared to STS data, we had the low-est blood transfusion rate, we had zero infection, we had the shortest ventilator intubation time, and we had no renal failure,” Ansari says.

The takeaway for patients, in Ansari’s view, is you don’t have to go to a big hospital downstate. “Quantity doesn’t mean quality; quality means quality,” he says.

The STS database and reports are designed to promote best practices, based on a data-driven model. In theory, the best practices will also lower costs by achieving improved, more long-lasting outcomes. Is the project working that way, saving money too? “The STS data saved Michigan $54 million in health care costs just last year,” Ansari says. —J.S.

From left:Nausherwan Ansari, Dr. Christopher Akins

800.248.6777 northernhealth.org



When McLaren Northern Michigan patients face the need for com-plicated reconstructive surgery for conditions such as breast cancer, skin cancer or physical injury, they learn that an entire multi-faceted team will be deployed to take them through the process from start to finish. Called “continuum of care,” the multi-disciplinary approach is essential to achieving the best possible outcome, says Dr. Christopher Jeffries M.D., a plastic and reconstructive surgeon at McLaren Northern Michigan. Jeffries and his colleagues on the McLaren plastic and reconstructive surgery team began working in Petoskey a couple of years ago to complete that continuum in this essential area of care at regional hospitals.

“Breast cancer exemplifies the continuum of care well because it relies on so many specialties,” Jeffries says. The breast cancer sur-gery and post-surgical follow-up can involve general surgery, plastic surgery, oncology, internal medicine, primary care, navigators, social workers, Pilates, yoga and more.

“There’s a sense that you have to travel elsewhere for world class reconstructive surgery care,” Jeffries says. “But at McLaren we now offer everything that is modern and popular in the country today.” Jeffries and his team also consult regularly with McLaren’s Karmanos Cancer Institute for broad and deep perspective on individual cases. —J.S

Dialing Down a Child’s Hospital Anxiety

Pediatrics

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Hospitals can be scary places even for grown-ups, so imagine being a child and having to take in that busy and complex scene of a giant building, bustling hallways, machines, tubes, wires, doctors and nurses in various colors of uniforms, and even people wearing masks. “It can be challenging for the kids ... and the parents, too,” says Lisa Gates, Munson Medical Center’s new child life specialist—it’s her job to dial down that anxiety. The new position is also part of Munson’s expansion of pediatric services and is another expression of Munson’s mission of “top quality care close to home.”

Props and play are key to Gates’s strategy with the children. “I use therapeutic play, medical play, toys, things they can manipulate, all so they can better understand what to expect in the hospital,” she says. “The activities work because by taking away fear and misconceptions and allevi-ating the children’s stress, they feel more empowered,” she says. They feel more control in a setting that can easily make children think they have no control. “I’ve seen cases where a parent says, ‘we’ve been through this before and it didn’t go well, you might need multiple people to hold down my child.’ But with some talking, letting the child know what to expect, giving him a job to do during the procedure, I’ve seen drastic change,” Gates says. Thus far, Gates has focused her work on children who are spending the night in the hospital, but she will eventually be deployed in the emergency room and out-patient settings, as well.

The pediatric unit admits from two to eight patients a day, and the emergency rooms see about 8,000 pediatric patients a year.

Her advice to parents of children who will be having a hospital pro-cedure:

“Always engage children and educate them about what’s coming up. As much as you can, teach them about what to expect at the hospital. You want to be honest and have fun.”—J.S.

McLaren’s Team Approach to Reconstructive Surgery

Continuum of Care

Lisa Gates

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MI 20 MyNorth.com

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The Region’s Most Expert Shoulder Surgeons Work HereNorthern Michigan’s only fellowship-trained shoulder reconstructive surgeons practice in Traverse City.

Orthopedic Surgeons Christopher Chuinard, MD, and John Reineck, MD, have been trained by the top experts in their field. They use their additional education and training to diagnose and treat complicated shoulder and elbow disorders.

Drs. Chuinard and Reineck also specialize in reverse total shoulder replacement for people with a severely damaged rotator cuff, arthritis, or complex fractures. Together, they have performed more than 1,000 shoulder replacements and 1,500 rotator cuff procedures for people in northern Michigan.

If you have debilitating shoulder pain, you can get expert help right here. For more information about orthopedic services in northern Michigan, call 1-800-533-5520.

Christopher Chuinard, MD

John Reineck, MD



HIV Innovation

Mobile Treatment Team for Rural Patients

In the drive to stop the spread of HIV, a primary goal is reducing the patient’s virus count to a non-detectable level. “Research shows that the chances of passing on the disease dramatically decreases if we can achieve that degree of viral suppression,” says Nick Erber, manager of the Thomas Judd Care Center, an HIV/AIDS clinic within Munson Medical Center.

To help reach that goal, the clinic recently launched a mobile care program in which a nurse with state-of-the-art mobile diagnostic tools will visit patients in rural areas and small towns across 25 Northern Michigan counties. Munson designed the program after receiving a grant from the state that is intended to spur innovative methods for reducing rates of HIV.

The program is needed because in rural areas, HIV patients can still have problems establishing a relationship with a primary care doc-tor. The issues might be related to insurance or transportation or even social stigma associated with the disease—will word spread in a small town? Adding to the need for regular nursing visits, viral suppression demands never-ending attention. “Once you achieve viral suppres-sion, you have to stay on the meds, and if somebody starts missing doses or missing doctor appointments, that’s a problem,” Erber says.

In designing the program, Munson’s medical staff turned to telemedi-cine—tools that allow a patient to be diagnosed in real time by a medical expert far away. In Munson’s HIV program, a nurse will be able to trans-mit medical information about a patient in, say, Alpena, to a nurse prac-titioner stationed at a computer monitor 125 miles away in Traverse City.

Among the more advanced diagnostic tools is an EKG glove, which looks like an oven mitt, and when the patient wears the mitt and places it over his or her heart, it gives an EKG reading. Another tool is a high-magnification camera that enables the nurse practitioner to take close-up photos for the patient’s medical record.

At last official count, there were 810 people with HIV living in Northern Michigan, but not all of them would need the program or qualify for its income requirements. Patients must make less than about $40,000 a year. To enter the program, an initial face-to-face meeting is also required.

Erber hopes to have the program operating about November 1.On a related note, Munson plans to offer rapid-read HIV tests, which

give results in 15 minutes. The Centers for Disease Control now recom-mends that everybody from 13 to 65 be tested at least once.—J.S.

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From left:Nanette Peters, Shawn Kintigh,Nick Erber


MI 22 MyNorth.com

Transforming CareMulti-million dollar renovation beginning soon

VILLA HEALTHCARE is an innovator with a unique vision and singular focus. We are

changing the landscape of post-hospital care by transforming nursing facilities into modern,

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A Leader in Non-EmergencyMedical Transport

When it comes to non-emergency medical transportation, one Michigan company that has made this service a priority focus comes to mind . . . Coastline Transportation.

Through their nine years of specializing in non-emer-gency medical transportation services over local & long distances, Coastline Transportation has partnered with many medical facilities to offer much needed transporta-

tion for Michigan’s elderly and disabled persons to appointments, treatments, outpatient services and more.

Coastline’s NEMT services are a cost effective transportation option when a patient, (i.e. worker’s comp or auto accident survivor), needs to get to and from these types of medical services, where ambulance services usually would be cost prohibitive.

You can rely on Coastline Transportation to help you or your patients arrive in a safe and timely manner in one of their modern, clean & handicapped accessible vans. If a non-emergency transport becomes an emergency, Coast-line Transportation’s personnel are prepared to handle it.

(231) 398-0360 • CoastlineTransportation.comSTATE LICENSED • FULLY INSURED

Several of Coastline’s drivers have a medical license either EMT-B or MFR. All drivers are certified in CPR and AED.

Coastline Transportation offers reasonably priced rates for both their local and long distance services and are avail-able 24 hours a day 7 days a week with advance notice.

Call Coastline Transportation at 231-398-0360 to discuss how their services can help you or your patients!

When life changes, we help.

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Artist’s Depression-Era Letter to Physician: ‘Let’s Make a Deal’

History Munson Letter

As the rate of Gastroesophageal Reflu Disease (GERD) has increased in America, one of the unfortunate side effects has been a dra-matic increase in a deadly form of cancer that can occur in the esophagus. Called esophageal adenocarcinoma, the cancer is often triggered by acid reflux. Reflux allows stomach acids to flow up into the esophagus and damage cells there, in some cases changing the cell type to a pre-cancerous condition known as Barrett’s esophagus. The incidence of esopha-geal adenocarcinoma has increased by 500 to 600 percent since 1970, and it remains one of the fastest growing cancers in the United States.

Medical researchers have found, however, that if the disease can be identified and treatedduring a precancerous stage, patients can have remarkable success in staving off esopha-geal adenocarcinoma. Adding to the good news, the state-of-the-art treatment for the pre-cancerous cells is now performed as an outpatient procedure that most patients tolerate very well and has been available at Munson since 2013, according to Dr. Mark Galan, of Digestive Health Associates, who performs the procedure there.

“The procedure is done under anesthesia and generally requires two or three treatments before the Barrett’s is completely eradicated,” Galan says. “In 92 percent of the patients, the

esophagus is free of Barrett’s five years later,” he says.

The treatment, called radio frequency abla-tion, involves passing a scope into a person’s mouth and down his or her esophagus. At the tip of the scope are paddles or a balloon wired to deliver electricity to the problem cells. When in place, the physician puts the device in contact with the targeted cells and activates high-intensity radiofrequency energy, precisely burning off a superficial layer of esophageal lining, which contains the malformed cells. When the cells grow back, they typically grow back as normal cells.

An important thing to know about Barrett’s esophagus is that even if a person with acid reflux is keeping the condition in control with over-the-counter drugs, he or she might be at risk. “The damage might have occurred early on in the course of GERD, and Barrett’s produces no symptoms until it progresses to cancer,” Galan says.

Considered a deadly cancer, esophageal adenocarcinoma has a five-year survival rate of about 20 percent. Risk factors in addition to chronic GERD include age greater than 50, male sex, white race, obesity and the presence of a hiatal hernia. —J.S.TO

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Radiofrequency Ablation Treatment for Pre-Cancerous Cells

Esophageal Cancer

Munson Medical Center celebrates its 100th anniversary this year, a natural moment to reflect upon medical care, both past and future. A letter from the Munson archive offers fodder for such reflection. The letter to Edwin L. Thirlby, M.D., dated February 26, 1931, illustrates the impact of the Great Depression on medical care and payments in Traverse City. The letter was written by Maud Miller Hoffmaster, who became an internationally renowned landscape artist and who organized the Art Department at Interlochen Center for the Arts.

Dr. Thirlby,If I need your help, will you please trade work with

me? I am interested in a girl, 18 years old, who tells me that she has a small hernia which troubles her. She wants to have it sewed up, but she hasn’t any money; neither has her father who is a farmer with four children. I would like to help her with this matter, but these aren’t such good times for an artist, either. I am considered just as expert in my line of work as you are in yours, and I will give you a painting that took weeks and months to finish if you will do this work for me. This painting has been appraised at $1,000; I am asking $250 for it.

This painting is a big wave just at the point of breaking as it appears from the side of a ship out in the middle of the Atlantic. I thought it would make a nice gift for your wife, as she could show her friends how the Atlantic looks when it gets restless.

Of course, your diagnosis of this case may be dif-ferent than the one the girl gave me and you may not consider an operation necessary, but I know I can trust you to do whatever is right, and I’d rather have you do it. I put this girl through high school and now I would like to see to it that she isn’t handicapped with ill health or a big debt hanging over her head. A girl has it hard enough when she has to earn her own living and this is a good little girl and deserving of your and my help.

Please telephone me as soon as you read this letter and if you will cooperate with me, and if the girl will accept, I will send her to you for an examination. I want this attended to right away, so she will be ready for the summer work, whatever she does.

Very sincerely yours,Maud Miller Hoffmaster

Dr. Mark Galan



MI 26 MyNorth.com

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We offer 1 & 2 bedroom assisted & independent living apartments in an intimate lakeside setting.

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We offer 1 & 2 bedroom assisted & independent living apartments in an intimate lakeside setting.

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In today’s world, patients should have options. At Chronic, LLC, Certification and Pain Management Center, we offer both traditional pain management and holistic approaches with the goal of improv-ing the quality of life for our patients. Empowering patients to take charge of their own health is one of the most satisfying experiences of our professional work. We want our patients to have a meaning-ful experience when they walk through the door. Our mission and goal is to provide patient-centered education and assistance with both medical marijuana certifications and traditional pain manage-ment. We are the only center in the region that takes the time to comprehensively evaluate each patient, looking at all aspects of care, mind, body spirit and emotional needs. Your concerns, goals and needs are important to us, and your privacy is guaranteed. Our doc-tors and staff maintain their position at the forefront of the ever-expanding scientific research on the medical use of marijuana and

pain management by actively studying the latest developments in these highly specialized fields. Chronic, LLC, Certification and Pain Management Center is now accepting new patients and would like to invite you for a personalized assessment with our staff. Please call us for an appointment or find us on our Facebook page.

3291 Racquet Club Dr., Suite C • Traverse City, MI 49684 231-421-8000 • chroniccertcenter.com.




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In today’s world, patients should have options. At Chronic, LLC, Certification and Pain Management Center, we offer both traditional pain management and holistic approaches with the goal of improv-ing the quality of life for our patients. Empowering patients to take charge of their own health is one of the most satisfying experiences of our professional work. We want our patients to have a meaning-ful experience when they walk through the door. Our mission and goal is to provide patient-centered education and assistance with both medical marijuana certifications and traditional pain manage-ment. We are the only center in the region that takes the time to comprehensively evaluate each patient, looking at all aspects of care, mind, body spirit and emotional needs. Your concerns, goals and needs are important to us, and your privacy is guaranteed. Our doc-tors and staff maintain their position at the forefront of the ever-expanding scientific research on the medical use of marijuana and

pain management by actively studying the latest developments in these highly specialized fields. Chronic, LLC, Certification and Pain Management Center is now accepting new patients and would like to invite you for a personalized assessment with our staff. Please call us for an appointment or find us on our Facebook page.

3291 Racquet Club Dr., Suite C • Traverse City, MI 49684 231-421-8000 • chroniccertcenter.com.



MI 28 MyNorth.com

Your Next Opportunity is HereIf you want to be a part of a compassionate, collaborative, sophisticated team that makes a real difference in people’s lives, Munson Medical Center is looking for you.

A Magnet-designated facility and leading employer in Traverse City, we have immediate opportunities for physicians, nursing staff, and entry level/support services including medical assistants, housekeeping, clerical, security, maintenance, and billing staff.

As a 391-bed regional referral center and one of nine hospitals in the Munson Healthcare system, our hospital has been providing outstanding patient-centered care to the region for 100 years and currently employs more than 4,000 people. Each person in our organization – from top-notch physicians and nurses to our strong support teams – helps make Munson Medical Center a great place to work.

If you’re not familiar with northern Michigan, here’s what it means to live and work in Traverse City. Our bayside town is listed as one of America’s “must see” places for family vacations, fine arts, craft beer and wine, farm-to-table food, fun festivals, romance, golf, and miles of beautiful beaches. As a resident, you’ll enjoy having this spectacular four-season playground right outside your door.

Are you ready to learn more? Visit munsonhealthcare.org/dreamjob to see what we’re all about.

We’re the best at what we do. Now all we need is you.

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MI 30 MyNorth.com

Osteoporosis, rheumatoid arthritis, chronic obstructive pulmonary disease, sleep apnea, obesity, diabetes, cardio-vascular disease and Alzheimers; it is a formidable list that all share specific oral bacteria as contributory factors. 8-12 spe-cific oral bacteria have been implicated in oral inflammation (i.e., periodontal dis-ease) and systemic disease. It is shocking that 40% of people under the age of 30 have significant elevations of these bac-teria, which increases as the person ages. Eighty-three percent of people over 80 have elevated levels. A simple salivary test can identify an individual’s oral bacterial profile. Dr. Makowski employ’s this analy-sis to aid patients in discovering how their oral environment may be impacting their overall health. “The Mouth-Body con-nection is well established”, Dr. Makowski states, “and our patients need to be aware of how we can help them achieve better overall health by improving dental health.”

Did you know that people with seri-ous gum disease were 40% more likely to have a chronic medical condition? Dr. Makowski says, “The Mouth-Body con-nection has led dentistry to the forefront of prevention with addressing the many medical problems that could stem from dental disease. There are specific oral bacteria that’ve been linked to cardiovas-cular disease, Alzheimer’s, diabetes, and premature births.”

Did you know that 91% of patients with heart disease have periodontitis?Dr. Makowski reported that “Risk fac-tors such as smoking, poor diet, obesity, and periodontal disease increase heart dis-ease in people. Inflammation in the gums causes inflammation in the blood vessels, linking it to hypertension. Plaque buildup in the vessels leads to an increased risk of stroke and heart attack.”

Did you know that oral infections could lead to premature births and low

birth rates? Dr. Makowski said, “The cause may be linked to direct consequenc-es of the infections as well as hormon-al changes.” She promotes maintaining recommended scheduled dental visits and daily oral hygiene. By doing so, patients will reduce risk of infection that could interfere with prenatal health for you and the baby. Dr. Makowski recommends that expecting or soon-to-be mothers complete a thorough periodontal exam to evaluate if you are at risk.

Dr. Melissa Makowski is one of the only laser dentists in northern Michigan with a Mastership in Laser Dentistry. Besides laser dentistry, her practice focus is on the complex relationship between oral and physical health. Prevention. Conservation. Education.

Mouth-Body ConnectionBY DR. MELISSA MAKOWSKI OF LAKEVIEW DENTISTRY

Dr. Makowski has completed and satisfi ed all the requirements to acquire her Fellowship in the Academy of General Dentistry, which has spear-headed the focus on educating patients and the public on the multiple links between the Mouth and Body. Lakeview Dentistry of Charlevoix’s team is committed to providing exceptional care by utilizing the most advanced dental technol-ogy for patients. Dr. Makowski has undergone extensive laser training with a Mastership in the World Clinical Laser Institute and is a member of the Academy of Laser Dentistry. She has also received training in Botox use specifi c for dentistry in the treatment of disorders such as temporal mandibular joint disorder. Dr. Makowski is a member of the dental honor society Omicron Kappa Upsilon, the Academy of General Dentistry, American Academy of Cos-metic Dentistry, American Dental Association, Michigan Dental Association and the Vaca-tionland District Dental Society. Dr. Makowski dedicates herself and her team to continuing education to bring the most advanced dental care to her patients.

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We all know young people who have shining, perfect smiles after realigning their teeth with orthodontics, and many adults are now inspired to fix teeth irregularities that they are tired of living with. But the teeth and bones of adults differ markedly from those of young people, and other issues need to be considered when mapping out an orthodontic plan for a grown-up. We asked Dr. David Swan, a family dentist who often serves as a point person for patients undergoing orthodontics, to share things patients need to know when contemplating measures like braces.

It seems like we are seeing more adults with braces. What typically compels an adult to pursue orthodontics?

Well, yes, we do have a lot more adults wanting orthodontics. Sometimes it’s restorative, sometimes it’s cosmetic, sometimes the patient is suffering pain from TMJ (Temporomandibular joint syndrome) pain.

Briefly, why are orthodontics different for young people

and adults?Adolescent mouths are still growing—the bones are soft and

malleable. So when you move teeth, the mouth adapts, and the teeth settle into their new positions nicely. But with adults, the bone is resistant to tooth movement, and the settling in is not as predictable. Also, the teeth are worn, and they won’t necessarily mesh when aligned. Sometimes, the teeth could even look worse because the wear becomes more apparent.

So how do dentists and orthodontists compensate for that, for what time has done to our teeth?

It’s a process called “occlusal equilibration,” and what that means essentially is detailing to get the bite to align more perfectly. It involves reshaping the teeth with procedures like selective grind-ing and polishing, replacing fillings or doing crowns, all so the teeth can mesh better. If the gums require plastic surgery, we might enlist the help of a periodontist.

How should adults approach this procedure?It requires a team approach, bringing in various experts who

have the specific skills needed. Typically your family dentist would quarterback the process. That person has the global understanding of your dental situation and the ability to coordinate the vari-ous specialists. Also the patient should make sure to get a very comprehensive evaluation. We make a model of the patient’s existing teeth and then a second model that shows what the finished product will be. This not only lays the groundwork for all the orthodontic and restorative work to come, but it also makes sure the full scope of the project is understood and all costs are accounted for.

Cases involving adult orthodontics can require a significant investment of the patient’s time and financial resources. Much of this care is far beyond the scope of what traditional dental insurance plans might cover, and we owe it to our patients to avoid any unpleasant surprises.—J.S.

WhatGrown-upsNeed to Know About Braces

Adult Orthodontics

231.947.0210 dr. david swan, d.d.s

Osteoporosis, rheumatoid arthritis, chronic obstructive pulmonary disease, sleep apnea, obesity, diabetes, cardio-vascular disease and Alzheimers; it is a formidable list that all share specific oral bacteria as contributory factors. 8-12 spe-cific oral bacteria have been implicated in oral inflammation (i.e., periodontal dis-ease) and systemic disease. It is shocking that 40% of people under the age of 30 have significant elevations of these bac-teria, which increases as the person ages. Eighty-three percent of people over 80 have elevated levels. A simple salivary test can identify an individual’s oral bacterial profile. Dr. Makowski employ’s this analy-sis to aid patients in discovering how their oral environment may be impacting their overall health. “The Mouth-Body con-nection is well established”, Dr. Makowski states, “and our patients need to be aware of how we can help them achieve better overall health by improving dental health.”

Did you know that people with seri-ous gum disease were 40% more likely to have a chronic medical condition? Dr. Makowski says, “The Mouth-Body con-nection has led dentistry to the forefront of prevention with addressing the many medical problems that could stem from dental disease. There are specific oral bacteria that’ve been linked to cardiovas-cular disease, Alzheimer’s, diabetes, and premature births.”

Did you know that 91% of patients with heart disease have periodontitis?Dr. Makowski reported that “Risk fac-tors such as smoking, poor diet, obesity, and periodontal disease increase heart dis-ease in people. Inflammation in the gums causes inflammation in the blood vessels, linking it to hypertension. Plaque buildup in the vessels leads to an increased risk of stroke and heart attack.”

Did you know that oral infections could lead to premature births and low

birth rates? Dr. Makowski said, “The cause may be linked to direct consequenc-es of the infections as well as hormon-al changes.” She promotes maintaining recommended scheduled dental visits and daily oral hygiene. By doing so, patients will reduce risk of infection that could interfere with prenatal health for you and the baby. Dr. Makowski recommends that expecting or soon-to-be mothers complete a thorough periodontal exam to evaluate if you are at risk.

Dr. Melissa Makowski is one of the only laser dentists in northern Michigan with a Mastership in Laser Dentistry. Besides laser dentistry, her practice focus is on the complex relationship between oral and physical health. Prevention. Conservation. Education.

Mouth-Body ConnectionBY DR. MELISSA MAKOWSKI OF LAKEVIEW DENTISTRY

Dr. Makowski has completed and satisfi ed all the requirements to acquire her Fellowship in the Academy of General Dentistry, which has spear-headed the focus on educating patients and the public on the multiple links between the Mouth and Body. Lakeview Dentistry of Charlevoix’s team is committed to providing exceptional care by utilizing the most advanced dental technol-ogy for patients. Dr. Makowski has undergone extensive laser training with a Mastership in the World Clinical Laser Institute and is a member of the Academy of Laser Dentistry. She has also received training in Botox use specifi c for dentistry in the treatment of disorders such as temporal mandibular joint disorder. Dr. Makowski is a member of the dental honor society Omicron Kappa Upsilon, the Academy of General Dentistry, American Academy of Cos-metic Dentistry, American Dental Association, Michigan Dental Association and the Vaca-tionland District Dental Society. Dr. Makowski dedicates herself and her team to continuing education to bring the most advanced dental care to her patients.

109 West HurlbutCharlevoix, Michigan 49720

(231) 547-4347www.charlevoixdentist.com

FAMILY AND LASER DENTISTRY

LakeviewD E N T I S T RY O F C H A R L E V O I X

Conservation. Education. Prevention.



MI 32 MyNorth.com

Situated in the heart of Antrim County is Bellaire, a quaint town known for its striking landscape and charm. Here is where you will find two Irish brothers with traditional, old school values and a vision of providing quality, caring, conservative dentistry that is affordable to patients. Bellaire Dental Health Care opened its doors in June of 2014, and while the building may be new and the equipment cutting edge, improving dental health and pro-viding interactive care to patients is nothing new at all for Drs. Dennis and Shawn Spillane, who have been making the Torch Lake area their home for over 15 years now. Each of the brothers has over 30 years experience. After attending Catholic Central in Metro Detroit, the brothers graduated from top Dental Schools in Michigan; Dennis attended the University of Detroit and Shawn the University of Michigan, giving patients the best of both worlds when it comes to dental treatment and options. Working closely together, they are both committed to providing you and your fam-

ily with excellent dental care in a professional and friendly man-ner. Dennis, Shawn and the staff at Bellaire Dental Health Care pride themselves on providing compassionate care to patients of all ages, including children. We offer a wide range of dental ser-vices, from preventative care such as cleanings, exams, and X-rays to major dental procedures such as extractions, root canal therapy, implants, crowns, dentures and partials.

For a complete list of what we have to offer and to learn more about our office, we encourage you to call us at 231-533-5001, visit www.bellairedentalhealthcaremi.com or email [email protected]. Free second opinion consultations are always welcome.

Bellaire Dental Health CareDennis Spillane, DDS & Shawn Spillane, DDS 638 Willow Drive • Bellaire, MI 49615 • 231-533-5001

638 WILLOW DR. 231-533-5001 BELLAIRE, MI 49615 231-544-8115

DENTAL HEALTH CAREBELLAIRE

FAMILY DENTISTRY

Dr. Dennis SpillaneDr. Shawn SpillaneDr. David Dibble

& Associates

Drs. Dennis and Shawn Spillane on Torch Lake with the boat named after their father’s disparagement of choice and hometown.

• Most Major Insurances Accepted• Delta Dental PPO Provider• Reduced No Insurance Fees• Healthy Michigan Plan, Healthy Kids & MiChild Accepted




Oral Cancer

Saliva Screening Test: Detects Cancer

231.947.2716 dr. peter w. piché

For years, dentists have been screening patients for oral cancers during their regular checkups, but the screening process has been less than perfect. The dentist can feel a lesion only when it’s already well advanced, and attempts at early screening tests thus far—like flourescence rinse applied to the inside of the mouth—result in a high rate of false positive findings and unnecessary biopsies. But the need to have a good early screen-ing test for oral cancer is undeniable: oral cancer has one of the highest mortality rates of all cancers, and part of the reason is the difficulty of detecting it early.

Coming soon, however, is a test that promises to make earlier and more accurate screening a reality. Bonus: the test is easy for both patient and dentist, because the patient just spits into a test tube.

“There are a number of different oral cancers,” says Dr. Peter Piché, a family dentist in Traverse City, “but the big one is squamous cell carcinoma, because of the one in 98 people who get oral cancer, 90 percent of them will have squamous cell carcinoma.” As with other cancers, the earlier the cancer can be detected, the less invasive the treatment can be and the less expensive it is to treat; and of course, earlier detection means fewer people will succumb to oral cancer.

The saliva analysis involves looking for messenger RNA and proteins—called “biomarkers”—that are associated with squamous cell carcinoma. If those markers appear, further investigation would ensue. The dentist might recommend seeing another specialist or might take a tissue sample for testing. If no lesions are found, a dentist might suggest testing a patient’s saliva on a regular basis. “The saliva test proved more accurate than blood testing and has 10 years of research behind it,” Piché says. Saliva appears to be such a good cancer screening medium that researchers are now looking to see if other cancers reveal themselves there.

The saliva test for squamous cell carcinoma is not yet widely available, but Piché expects dentists will begin folding it into their service offerings over the next year or two.—J.S.


MI 34 MyNorth.com

Dr. John Holcombe and Dr. Steve Hall are proud to provide high quality dental care to their patients. Established in 1977, the Suttons Bay Dental Center has been providing Leelanau County with conservative esthetic and family dentistry for over 30 years. A dedication to personalized, comprehensive dental care with a special focus on each patient’s comfort helps to define their team’s mission.

Now on their second decade of offering computerized CAD CAM dentistry, the office is often described by patients as high tech and cutting edge. Dr Holcombe remarks, “Many of our new patients are retired to the area and often are surprised that our

Leelanau County office is more advanced than their ‘big city’ office back home.” Digital x-rays, one visit CAD CAM designed crowns, and paperless records all contribute to the office’s advanc-es in technologies.

Although technology is important, the biggest point of pride for the doctors is the experienced, caring staff. Seeing a famil-iar face at appointments helps to establish relationships with the patients thus making visits enjoyable and relaxing.

The most rewarding part of their day is helping patients change their smiles. Drs. Holcombe and Hall have emphasized this in their practice and are thrilled to see a new smile change a patient’s life.

1299 South West Bayshore Drive • Suttons Bay, MI 49682 231-271-6700 • suttonsbaydental.com

Dr. John HolcombeDr. Steve Hall


Mason Periodontics provides personalized dental care to patients all over Northern Michigan. When you visit our office you can be confident that you are receiving the finest and most advanced dental care available. Our office uses state-of-the-art technology and materials to allow us to detect dental concerns at the earliest stages, treat your dental issues with precision, and provide stunning results. Our practice also employs a premium dental software system to maximize our efficiency and reduce the time of your office visit. We pride ourselves on the warm, indi-vidualized care we offer to our patients, as well as, utilizing the most modern equipment and methods available.

Dr. Suzanne Mason grew up spending summers in Omena,

Michigan with her family and working at a local restaurant in Northport. She received her B.S. in physiology, DDS from the University of Detroit Mercy School of Dentistry, and a M.S. in Periodontics from the University of Michigan, Ann Arbor. She was elected as American Academy of Periodontology Student Ambassador and is a member of the Michigan Dental Association, the American Dental Association, American Academy of Periodontology, the American Academy of Dental Research and the Midwest Society of Periodontology. Dr. Mason is a Michigan Board certified periodontist and a diplomat of the American Board of Periodontology.

Mason Periodontics& Dental Implants

541 South Garfield • Traverse City, MI 49686231-932-4223 • www.masonperiodontics.com




Dr. John Holcombe and Dr. Steve Hall are proud to provide high quality dental care to their patients. Established in 1977, the Suttons Bay Dental Center has been providing Leelanau County with conservative esthetic and family dentistry for over 30 years. A dedication to personalized, comprehensive dental care with a special focus on each patient’s comfort helps to define their team’s mission.

Now on their second decade of offering computerized CAD CAM dentistry, the office is often described by patients as high tech and cutting edge. Dr Holcombe remarks, “Many of our new patients are retired to the area and often are surprised that our

Leelanau County office is more advanced than their ‘big city’ office back home.” Digital x-rays, one visit CAD CAM designed crowns, and paperless records all contribute to the office’s advanc-es in technologies.

Although technology is important, the biggest point of pride for the doctors is the experienced, caring staff. Seeing a famil-iar face at appointments helps to establish relationships with the patients thus making visits enjoyable and relaxing.

The most rewarding part of their day is helping patients change their smiles. Drs. Holcombe and Hall have emphasized this in their practice and are thrilled to see a new smile change a patient’s life.

1299 South West Bayshore Drive • Suttons Bay, MI 49682 231-271-6700 • suttonsbaydental.com

Dr. John HolcombeDr. Steve Hall


MAGNIFICATION LOUPES That which you cannot see, you cannot find nor fix. 2.5X or greater loupes opens up a new world to your dentist.

RUBBER DAMIt makes the job of doing a filling or crown much easier for a dentist, and leads to improved quality.

BUFFERED ANESTHETIC/ONSET FROM ONPHARMA This new technology makes it painless to get an injection. onpharma.com.

MODERN FACILITY THAT IS CLEAN AND NEAT The great dental leader Dr. Pete Dawson said, and I paraphrase, “A sloppy, unkempt and disorderly appearance to the office or team is not suggestive of sloppy quality, it is proof of it.”

ONE DAY PERMANENT CROWN (CEREC) CEREC crowns are digitally made, fit extremely well and have no need for a second visit or second numbing. Additionally, patients have less post-operative discomfort and the crowns fit as well or better than a laboratory-fabricated crown. cerecon-line.com or onevisitdentist.net.

DIAGNODENT LASER DECAY DETECTION This laser detects tooth decay long before your dentist would be able to otherwise. A dentist can find only 60 percent of tooth decay in a visual inspection. With a laser he or she can find 90 percent or more. A smaller, earlier-detected filling means less cost, less tooth destruction, and a longer lasting filling! kavousa.com/US/DIAGNOdent/DIAGNOdent-Dentists.aspx.

DIGITAL RADIOGRAPH Emitting up to 80 percent less radiation than traditional X-ray systems, digital radiographs are safer and are as good or better than traditional film systems.

SALIVA TESTING/ULTRASONIC CLEANING This is DNA diagnostic testing of your saliva for periodontal (gum) pathogens. Your saliva can tell your dentist about your risk for developing severe periodontitis, and reveal if you require antibiotics as an adjunct in treatment. Ultrasonic scalers are proven to destroy the biofilm that causes periodon-titis, and will give you a better outcome from your gum treatments and cleanings. myoraldna.com.

CARIES STAIN This dye sticks only to decayed areas of your tooth. The dentist knows when to stop drilling when the stain no longer sticks to the tooth, helping preserve as much “good” tooth as possible.

TOP QUALITY MATERIALS/LAB Does your dentist buy the cheapest materials from China, or does he or she research the products available and only buy the best? The dental lab makes a difference too. Ask to see sample photographs of the work done, and have the dentist show you what a great-fitting crown looks like on a radiograph. dhbaker.com.—Dr. Philip Yancho

When looking for a dental home, what would a practicing dentist look for if he or she needed dental care in this age of high technology? Here is a 10-point checklist—technologies and practices that I would require of my dentist for me to be confident that he or she was offering state-of-the-art care.

As a first step, ask for a meet-and-greet with your dentist and go over this list. The meeting should be offered at no charge. That meeting will also give you a chance to see if you feel the personalities of the dentist and staff and general phi-losophy are a good fit for you and your family.

A Dental Home

Things to Consider When Shopping for a Dentist

231.941.2201 dr. philip yancho


MI 36 MyNorth.com

A Team Approach to Dentistry Drs. David Swan, Macare Lumbrezer, Chris Mazzola, Josh Van

Horn, and Christina Mazzola are all graduates of the University of Michigan School of Dentistry. The greatest advantage of work-ing in a practice with five doctors is the ability to collaborate on patient care. This team approach gives patients the benefit of all of their advanced training and collective skills. They meet regularly to discuss cases and share techniques they’ve learned at continuing education courses.

Patients appreciate that we can perform most services right in our office including dental implants, sedation dentistry, and wisdom teeth extraction. Whether you are a new patient or one

of the many patients that have been in our office for decades, our goal is to exceed your expectations at every visit.

Our team approach is successful due to the efforts of our hygienists, dental assistants, and business staff. Every day we hear patients comment on the care they receive; complementing our team as happy, eager to help, and, of course, smiling.

Learn more about our office at: www.traversedental.com or call us at 231.947.0210.

Traverse DentalAssociates

555 S Garfield Ave • Traverse City, MI 49686231-947-0210 • traversedental.com

Dr. Van Horn, Dr. Lumbrezer, Dr. Swan, Dr. Mazzola, Dr. Mazzola


I am living with diabetes.Northern Michigan Diabetes Initiative connects you to classes, seminars, and other resources to help you live life to the fullest while managing your diabetes.

To learn more about how to thrive with diabetes, call (231) 935-9227 or visit nmdi.org.


10 Munson Outpatient Services - Manton*** Lab 115 E. 7th St., Manton | (231) 824-9414

11 Munson Outpatient Services - West Front* Lab | Physical Therapy 3643 W. Front St., Ste. B, Traverse City | (231) 935-0590

12 Paul Oliver Memorial Hospital - Frankfort** CT Scan | Hand Therapy | Hearing Clinic | Lab MRI | Occupational Therapy | Physical Therapy Speech Therapy | X-ray 224 Park Ave., Frankfort | (231) 352-2204

Munson Hearing Services are also available in the Munson Professional Building 1221 Sixth St., Traverse City | (231) 935-6455

* A Service of Munson Medical Center ** A Service of Paul Oliver Memorial Hospital *** A Service of Munson Healthcare Cadillac Hospital

Munson Healthcare Cadillac Hospital, Munson Medical Center, and Paul Oliver Memorial Hospital bring expertise and quality services to clinics near you. Less travel, more convenience, same great care.

Our services. Your neighborhood.

1 Munson Community Health Center - Traverse City*Driver Assessment | Hand Therapy | Healthy Weight Center Lab | Pain Management Program | Pediatric Therapy | Pharmacy

Physical and Aqua Therapy | Sleep Center | Speech Therapy Urgent Care | X-ray 550 Munson Ave., Traverse City | (231) 935-5000

2 Munson Laboratories at Grand Traverse Commerce Centre* Lab (across from Grand Traverse Mall) 3287 South Airport Rd., Traverse City | (231) 392-0380

3 Munson Outpatient Services - Benzonia** Lab | Physical and Aqua Therapy | X-ray 6277 Frankfort Hwy., Benzonia | (231) 882-1062

4 Munson Outpatient Services - Chums Corner* Lab 4025 Chums Village Dr., Ste. C, Traverse City | (231) 943-0637

5 Munson Outpatient Services - Elk Rapids* Lab | X-ray 119 Bridge St., Elk Rapids | (231) 264-0024

6 Munson Outpatient Services - Empire** Lab | Physical Therapy 9973 Ottawa Ave., Empire | (231) 326-2053

7 Munson Outpatient Services - Frankfort** Lab 826 Forest Ave., Frankfort | (231) 352-5271

8 Munson Outpatient Services - Interlochen** Hand Therapy | Lab | Occupational Therapy

Physical Therapy | X-ray 1975 Stirling Dr., Interlochen | (231) 275-6980

9 Munson Outpatient Services - Kingsley* Hearing Clinic | Lab | Physical Therapy | X-ray 2291 M-113 East, Kingsley | (231) 392-7890

For more information or services in your area, visit munsonhealthcare.org/outpatient

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