SAWTOOTH MOUNTAIN CLINIC news

The Daily AppleJuly 2015 Issue 4

Sawtooth Mountain Clinic

Clinic hours:Mon - Fri 8 AM to 5 PMSaturday 8 AM to 12 Noon513 5th Ave WestGrand Marais, MN 55604For appointments call 218-387-2330

Fax: 218-387-1278

In addition to Sawtooth Mountain Clinic, physicians provide services at these two sites:

Birch Grove Clinic

9 Good Neighbor Hill RdTofte, MN 55615For appointments andhours of operation call:218-387-2330

Grand Portage Health Services

Clinic Hours:Mon - Fri, 8 AM to 4:30 PM62 Upper Road, PO Box 428Grand Portage, MN 55605For appointments call:218-475-2235

Sawtooth Mountain Clinic513 5th Ave WestGrand Marais, MN 55604www.sawtoothmountainclinic.org

MISSION: to provide access to high quality, comprehensive, primary and preventative health care in Cook County to all users, regardless of financial ability to pay for service.

a 501(c)(3) not-for-profit organization

IN THE news

SENATOR AL FRANKEN VISITS SAWTOOTH MOUNTAIN CLINIC

Those of us who live in Cook County know how crucial it is to have good health care close to home. We also know how important it is to have that good health care be affordable and easy to access. We are well aware of how different life in Cook County would be if the nearest health care facility was 100 miles away.

Senator Al Franken knows all of these things too, which is why he is dedicated to the continuation of our government’s funding for the quality, affordable, accessible health care offered by Federally Funded Health Care Centers like Sawtooth Mountain Clinic.

On January 17th, Senator Franken, who cochairs the Bipartisan Senate Rural Health Care Caucus, visited Sawtooth Mountain Clinic as part of the Rural Health Initiative he is spear-heading. Senator Franken toured the facility, met with doctors and administrative staff and heard questions and comments from the public.

Franken showed particular interest in how rural communities are addressing the dental and mental health care needs of its patients. He was pleased to hear of the partnership between Sawtooth

www.sawtoothmountainclinic.org513 5th Ave. W., Grand Marais, MN 55604 Ph: 218-387-2330 Fax: 218-387-1278

Sawtooth Mountain ClinicTogether Through Lifea 501(c)(3) not-for-profit organization

Sandy L. Stover, MD; Paul E. Terrill, MD; Jennifer L. Delfs, MD; Michael R. Sampson, MD; Milan C. Schmidt, MD; Lisa M. Zallar, CNP; Rita M. Plourde, CEO

SENATOR AL FRANKEN VISITS THE CLINIC..........................1DIETARY SUPPLEMENTS...............................................................2, 7SMC HAS A NEW TAG LINE............................................................3BREAKING BAD HABITS...............................................................4, 5PATIENT PORTAL.....................................................................................5GREAT PLACE PROJECT......................................................................6FISH PROJECT............................................................................................7BOARD OF DIRECTORS......................................................................7

Mountain Clinic and Grand Marais Family Dentistry, as well as the recent Behavioral Health Grant received by the clinic that will offer enhanced mental health services for our patients at point of care.

Senator Franken applauded the work being done at Sawtooth Mountain Clinic and stated he would do everything in his power to ensure clinics like ours maintain the federal funding needed to continue offering exceptional care close to home.

Carol DeSain, President carol@thetamarackgroup.netNancy Burns, Vice President nburns@lutsenresort.com Jeff Stoddard, Treasurer jeff@lutsenresort.comEddie Hertzberg, Secretary erhertz@boreal.org

Rick Anderson ricka@boreal.orgWayne Anderson oboephil@gmail.comDeb Benedict radiodiva@boreal.org Penny Bradovich tbrado@msn.com Matthew Brown gilly1214@gmail.comBob Carter drydoc@boreal.orgJoAnn Krause jkrause@boreal.org Bob Hanle rvhanle@msn.comBev Johnson sonjohn@boreal.orgJenny Kartes jkartes@aecimn.comJack McDonnell jack@boreal.org

Dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods, not as drugs. The label may claim certain health benefits. But unlike medicines, supplements can’t claim to cure, treat or prevent a disease.

There’s little evidence that any supplement can reverse the course of any chronic disease,” says Hopp. “Don’t take supplements with that expectation.”

Evidence does suggest that some supplements can enhance health in different ways. The most popular nutrient supplements are multivitamins, calcium and vitamins B, C and D. Calcium supports bone health, and vitamin D helps the body absorb calcium. Vitamins C and E are antioxidants—molecules that prevent cell damage and help to maintain health.

Women need iron during pregnancy, and breast-fed infants need vitamin D. Folic acid—400 micrograms daily, whether from supplements or fortified food—is important for all women of childbearing age.

Vitamin B12 keeps nerve and blood cells healthy. “Vitamin B12 mostly comes from meat, fish and dairy foods, so vegans may consider taking a supplement to be sure to get enough of it,” Haggans says.

Research suggests that fish oil can promote heart health. Of the supplements not derived from vitamins and minerals, Hopp says, “fish oil probably has the most scientific evidence to support its use.”

The health effects of some other common supplements need more study. These include glucosamine (for joint pain) and herbal supplements such as echinacea (immune health) and flaxseed oil (digestion).

Many supplements have mild effects with few risks. But use caution. Vitamin K, for example, will reduce the ability of blood thinners to work. Ginkgo can increase blood thinning. The herb St. John’s wort is sometimes used to ease depression, anxiety or nerve pain, but it can also speed the breakdown of many drugs—such as antidepressants and birth control pills—and make them less effective.

Just because a supplement is promoted as “natural” doesn’t necessarily mean it’s safe. The herbs comfrey and kava, for example, can seriously damage the liver.

“It’s important to know the chemical makeup, how it’s prepared, and how it works in the body—especially for herbs, but also for nutrients,” says Haggans. “Talk to a health care provider for advice on whether you need a supplement in the first place, the dose and possible interactions with medicine you’re already taking.”

For vitamins and minerals, check the % Daily Value (DV) for each nutrient to make sure you’re not getting too much. “It’s important to consider the DV and upper limit,” says Haggans. Too much of certain supplements can be harmful.

Scientists still have much to learn even about common vitamins. One recent study found unexpected evidence about vitamin E. Earlier research suggested that men who took vitamin E supplements might have a lower risk of developing prostate cancer. “But much to our surprise, a large NIH-funded clinical trial of more than 29,000 men

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SAWTOOTH MOUNTAIN CLINIC

BOARD MEMBERS

SHOULD YOU TAKE DIETARY SUPPLEMENTS? A look at Vitamins, Minerals, Botanicals and More...

When you reach for that bottle of vitamin C or fish oil pills, you might wonder how well they’ll work and if they’re safe. The first thing to ask yourself is whether you need them in the first place. Read more about dietary supplements.

More than half of all Americans take one or more dietary supplements daily or on occasion. Supplements are available without a prescription and usually come in pill, powder or liquid form. Common supplements include vitamins, minerals and herbal products, also known as botanicals.

People take these supplements to make sure they get enough essential nutrients and to maintain or improve their health. But not everyone needs to take supplements.

“It’s possible to get all of the nutrients you need by eating a variety of healthy foods, so you don’t have to take one,” says Carol Haggans, a registered dietitian and consultant to National Institutes of Health. “But supplements can be useful for filling in gaps in your diet.”

Some supplements may have side effects, especially if taken before surgery or with other medicines. Supplements can also cause problems if you have certain health conditions. And the effects of many supplements haven’t been tested in children, pregnant women and other groups. So talk with your health care provider if you’re thinking about taking dietary supplements.

“You should discuss with your doctor what supplements you’re taking so your care can be integrated and managed,” advises Dr. Craig Hopp, an expert in botanicals research at NIH.

FISH PROJECT:Fish are Importantfor Superior Health

Call and ask for your FISH appointment:

Looking for 500 women age 16 to 50 for FISH visits

Do not need to eat fishCan be pregnantNeed to be available for a possible follow-up visit in 6 months

FISH visits:Are free and confidentialTake around 45 minutes.Include a blood draw (small amount)$50 VISA cards if complete entire visit

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Sawtooth Mountain Clinic 218-387-2330

Grand Portage Health Service

218-475-2235

SHOULD YOU TAKE DIETARY SUPPLEMENTS ?A look at Vitamins, Minerals, Botanicals and More...Continued from page 2

found that taking supplements of vitamin E actually raised—not reduced—their risk of this disease,” says Dr. Paul M. Coates, director of NIH’s Office of Dietary Supplements. That’s why it’s important to conduct clinical studies of supplements to confirm their effects.

Because supplements are regulated as foods, not as drugs, the FDA doesn’t evaluate the quality of supplements or assess their effects on the body. If a product is found to be unsafe after it reaches the market, the FDA can restrict or ban its use.

Manufacturers are also responsible for the product’s purity, and they must accurately list ingredients and their amounts. But there’s no regulatory agency that makes sure that labels match what’s in the bottles. You risk getting less, or sometimes more, of the listed ingredients. All of the ingredients may not even be listed.

A few independent organizations conduct quality tests of supplements and offer seals of approval. This doesn’t guarantee the product works or is safe; it just assures the product was properly made and contains the listed ingredients.

“Products sold nationally in the stores and online where you usually shop should be fine,” Coates says. “According to the FDA, supplement products most likely to be contaminated with pharmaceutical ingredients are herbal remedies promoted for weight loss and for sexual or athletic performance enhancement.”

To make it easy to find reliable information, NIH has fact sheets on dietary supplements at http://ods.od.nih.gov/factsheets/list-all/. NIH also recently launched an online Dietary Supplement Label Database at www.dsld.nlm.nih.gov. This free database lets you look up the ingredients of thousands of dietary supplements. It includes information from the label on dosage, health claims and cautions.

For more personalized, on-the-go information about dietary supplements, check out NIH’s free updated app for your smart phone or tablet: My Dietary Supplements (MyDS). You can access it at http://myds.nih.gov.

The MyDS app provides the latest supplement information and lets you keep track of the vitamins, minerals, herbs and other products you take. You can even keep track of supplements taken by your parents, spouse or children.

“Deciding whether to take dietary supplements and which ones to take

is a serious matter,”

Article from the National Institutes of Health - News in Health / August 2013

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SMC’S Endowment Fund

HELP GROW OUR ENDOWMENT – Your generous donation to the Sawtooth Mountain Clinic Endowment fund is

vital to ensure the mission of our Community Health Center…to continue providing access to high quality health care to

all users, regardless of financial ability to pay, and to ensure continued recruiting and retention of all Providers.

In 2014, a unique partnership formed between the Moving Matters project of the Sawtooth Mountain Clinic and the Cook County Chamber of Commerce: the Great Place Project. Now in its second year, the Great Place Project is funding 13 mini-grants for place making projects across Cook County and Grand Portage. The Sawtooth Mountain Clinic is helping lead this initiative with support from the Center for Prevention at Blue Cross and Blue Shield of Minnesota.

PLACE MAKING FOR COMMUNITY HEALTH

Physical activity is an important part of health and people are more active where they have pleasant and safe places to do so. Place making capitalizes on a local community’s assets, inspiration, and potential, with the intention of creating public spaces that promote people’s health, happiness, and well-being. Place making helps transform locations into great places, where people want to be.

2015 MINI -GRANTS

Thirteen local businesses and non profits, of twenty seven applicants, have been chosen for 2015 Great Place Project mini-grants totaling $10,000. “It’s both gratifying and exciting to see so many creative applications in the second year of the Great Place Project,” said Jim Boyd, Executive Director of the Cook County Chamber of Commerce. “Our county already is a Great Place; these projects make it a bit greater, and we all get to enjoy the results.”

The Great Place Project is a friendly, local competition for mini-grants to use high impact, low cost ideas to create great places in our communities. A great place is inviting, beautiful, and catches the eye. It reflects the unique character and identity of the community. And a great place encourages people to slow down and spend time there. “The Great Place Project has been an incredible opportunity to invest in community spaces and the health of our community” said Moving Matters Coordinator, Kristin DeArruda Wharton.

The Great Place Project is sponsored by the Moving Matters project of the Sawtooth Mountain Clinic and the Cook County Chamber of Commerce. The Moving Matters project, with funding from the Center for Prevention at Blue Cross and Blue Shield of Minnesota, is working to create safer and more accessible places to walk and bike in Cook County and Grand Portage.

Great Place Project – PARTNERSHIP BETWEEN THE CLINIC AND CHAMBER

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“TOGETHER THROUGH LIFE”

If you see Sawtooth Mountain Clinic’s name, you’re also going to see our new

tag line: Together Through Life. It was not an easy process, trying to come up with

a few short words that we felt spoke to who Sawtooth Mountain Clinic is, what we

stand for and who we strive to be as a Community Health Center. But, after many

good ideas, some good laughs and a whole slew of scratched phrases, we feel

confident that we’ve stumbled on to something that really speaks to the spirit of

Sawtooth Mountain Clinic. As a Community Health Center, we consider it a

charge and a privilege to walk with our patients from birth to death,

coming alongside in support of every aspect of life.

“Together Through Life” are three small words with a BIG meaning.

It is a mantra for us and a statement of commitment to our patients.

Arrowhead Pharmacy—Mural paintings by local artist Betsy Bowen, complemented by seating and landscaping. Birchbark Books and Gifts—Locally themed mural paintings with hidden books by local artist Tim Young.Border Designs—Rustic park bench and plantings by walking path in Lutsen. Cook County Higher Education—Welcoming entrance with plantings, enhanced walking path, and picnic table.Cook County Historical Society—Gathering place with plantings, seating, and enhanced bike parking at museum.Grand Portage Wellness Committee—Community Park gathering table and grill in Grand Portage. Java Moose—Chair seating by the Grand Marais Harbor, at both café locations. Kah-Nee-Tah Gallery—Log bench seating area with plantings. Last Chance Studio—Moose sculpture created by local artist Tom Christianson. Oddz and Endz—Resting spot with benches, tables, and planters using repurposed and recycled materials. Schroeder Area Historical Society—ADA accessible viewfinder at Taconite Harbor.Tofte Historical Society—Planters to enhance the plaza at the North Shore Commercial Fishing Museum. Visit Cook County—Enhancement of Grand Marais Visitor Center common area with benches and planters.

2015 GRANT RECIP IENTS

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BREAKING BAD HABITS Why It’s So Hard to ChangeArticle from the National Institutes of Health - News in Health / January 2012 If you know something’s bad for you, why can’t you just stop? About 70% of smokers say they would like to quit. Drug and alcohol abusers struggle to give up addictions that hurt their bodies and tear apart families and friendships. And many of us have unhealthy excess weight that we could lose if only we would eat right and exercise more. So why don’t we do it?

National Institutes of Health-funded scientists have been searching for answers. They’ve studied what happens in our brains as habits form. They’ve found clues to why bad habits, once established, are so difficult to kick. And they’re developing strategies to help us make the changes we’d like to make.

“Habits play an important role in our health,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “Understanding the biology of how we develop routines that may be harmful to us, and how to break those routines and embrace new ones, could help us change our lifestyles and adopt healthier behaviors.”

Habits can arise through repetition. They are a normal part of life, and are often helpful. “We wake up every morning, shower, comb our hair or brush our teeth without being aware of it,” Volkow says. We can drive along familiar routes on mental auto-pilot without really thinking about the directions. “When behaviors become automatic, it gives us an advantage, because the brain does not have to use conscious thought to perform the activity,” Volkow says. This frees up our brains to focus on different things.

Habits can also develop when good or enjoyable events trigger the brain’s “reward” centers. This can set up potentially harmful routines, such as overeating, smoking, drug or alcohol abuse, gambling and even compulsive use of computers and social media.

“The general machinery by which we build both kinds of habits are the same, whether it’s a habit for overeating or a habit for getting to work without really thinking about the details,” says Dr. Russell Poldrack, a neurobiologist at the University of Texas at Austin. Both types of habits are based on the same types of brain mechanisms.

“But there’s one important difference,” Poldrack says. And this difference makes the pleasure-based habits so much harder to break. Enjoyable behaviors can prompt your brain to release a chemical called dopamine. “If you do something over and over, and dopamine is there when you’re doing it, that strengthens the habit even more. When you’re not doing those things, dopamine creates the craving to do it again,” Poldrack says. “This explains why some people crave drugs, even if the drug no longer makes them feel particularly good once they take it.”

In a sense, then, parts of our brains are working against us when we try to overcome bad habits. “These routines can become hard wired in our brains,” Volkow says. And the brain’s reward centers keep us craving the things we’re trying so hard to resist.

The good news is, humans are not simply creatures of habit. We have many more brain regions to help us do what’s best for our health.

“Humans are much better than any other animal at changing and orienting our behavior toward long-term goals, or long-term benefits,” says Dr. Roy Baumeister, a psychologist at Florida State University. His studies on decision-making and willpower have led him to conclude that “self-control is like a muscle. Once you’ve exerted some self-control, like a muscle it gets tired.”

After successfully resisting a temptation, Baumeister’s research shows, willpower can be temporarily drained, which can make it harder to stand firm the next time around. In recent years, though, he’s found evidence that regularly practicing different types of self-control—such as sitting up straight or keeping a food diary—can strengthen your resolve.

“We’ve found that you can improve your self-control by doing exercises over time,” Baumeister says. “Any regular act of self-control will gradually exercise your ‘muscle’ and make you stronger.”

Volkow notes that there’s no single effective way to break bad habits. “It’s not one size fits all,” she says.

One approach is to focus on becoming more aware of your unhealthy habits. Then develop strategies to counteract them. For example, habits can be linked in our minds to certain places and activities. You could develop a plan, say, to avoid walking down the hall where there’s a candy machine. Resolve to avoid going places where you’ve usually smoked. Stay away from friends and situations linked to problem drinking or drug use.

Another helpful technique is to visualize yourself in a tempting situation. “Mentally practice the good behavior over the bad,” Poldrack says. “If you’ll be at a party and want to eat vegetables instead of fattening foods, then mentally visualize yourself doing that. It’s not guaranteed to work, but it certainly can help.”

One way to kick bad habits is to actively replace unhealthy routines with new, healthy ones. Some people find they can replace a bad habit, even drug addiction, with another behavior, like exercising.

“It doesn’t work for everyone,” Volkow says. “But certain groups of patients who have a history of serious addictions can engage in certain behaviors that are ritualistic and in a way compulsive—such as marathon running—and it helps them stay away from drugs. These alternative behaviors can counteract the urges to repeat a behavior to take a drug.”

Another thing that makes habits especially hard to break is that replacing a first-learned habit with a new one doesn’t erase the original behavior. Rather, both remain in your brain. But you can take steps to strengthen the new one and suppress the original one. In ongoing research, Poldrack and his colleagues are using brain imaging to study the differences between first-learned and later-learned behaviors. “We’d like to find a way to train people to improve their ability to maintain these behavioral changes,” Poldrack says.

Some NIH-funded research is exploring whether certain medications can help to disrupt hard-wired automatic behaviors in the brain and make it easier to form new memories and behaviors. Other scientific teams are searching for genes that might allow some people to easily form and others to readily suppress habits.

Bad habits may be hard to change, but it can be done. Enlist the help of friends,

co-workers and family for some extra support.

Get ConnectedStop by the clinic front desk and register for

Patient Portal today!

WHAT IS A PAT IENT PORTAL?Patient Portal is a password protected web site on the internet where you can review components of your Sawtooth Mountain Clinic records.

HOW DO I ENROLL IN PAT IENT PORTAL?Visit Sawtooth Mountain Clinic and let a staff member know that you are interested in creating an account within Patient Portal. We will assist you with the registration process.

MAY I REQUEST PRESCRIPTION REFILLS?Continue to request medication refills through your Pharmacy.

WHY SHOULD I USE PAT IENT PORTAL?Sometimes it isn’t convenient to call your care team. At other times you may have a non-urgent question and think an appointment isn’t needed. With Patient Portal, you can send a message to your care team, anytime that is good for you.

WHAT IF I DON’T HAVE AN E-MAIL ACCOUNT?Sawtooth Mountain Clinic will help you establish a FREE e-mail account by going to Yahoo! Mail, Microsoft Hotmail or Google Mail. This gives us a way to let you know that there is secure information waiting for you on Patient Portal.

You can also send a non urgent message to your doctor or nurse, request an appointment, send a question to the billing office, receive your statement and pay your bill online, view your test results, view your medications and see a summary of your health.