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HFL2SEL11008_FallPrint_HeatherAdams.indd 12/29/2012 1:09:05 PMselectsecurity“When my daughter was three, she developed a chronic illness. After ayear of tears every month, when we were covered by a different insurancecompany, it really taught me how great SelectHealth is. I was so delighted tochange back. At SelectHealth, they do what they say they’re going to do.”Heather Adams, American Forkselecthealth.org© 2011 SelectHealth. All rights reserved. 1661 10/112 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 3

CombiningPhysical + behavioralHealthcare for ChildrenBudge Pediatrics: A pioneer for preventative pediatric careBy Clint Field, PhDA critical and much valued aspect of pediatric medicine isthe emphasis placed on prevention. Prevention servicesbenefit children and families immediately as well as acrosstheir lifetime. However, the scope of prevention servicesneed not be limited to a child’s physical health. Recentchanges at Intermountain Healthcare have created theopportunity for preventative behavioral health services tobe made available to families. As an organization, Intermountainhas made a commitment to the integration ofphysical and behavioral health services for patients withinprimary care clinics.Accordingly, the pediatric department at the BudgeClinic in Logan has adopted a cutting-edge model ofcare integrating physical and behavioral health servicesfor children. Pediatricians and behavioral-pediatricpsychologists are now a fully integrated team located inthe same clinic space, with adjoining offices, and consultwith each other in person, multiple times daily. This is amodel of care that cannot be found elsewhere in CacheValley; only a few other such places around the countryare known to exist!Budge Pediatrics has taken the model a step further bybecoming the first pediatric clinic in the country to offerpatients the opportunity to participate in a behavioralhealth universal prevention program for children. Thisservice is being offered without charge to interestedparents of 2-year old children. It has been designed toprovide every parent with the critical skills for managingthe negative behaviors children display during thedevelopmental period, often referred to as the “terribletwos.” This is significant for a few reasons. First, researchhas suggested this period should possibly be renamed “theterrible one-and-a-halves to threes.” Experienced parentsknow the challenging behaviors encountered can endurefor two to three years and are a significant source of stressfor families and negative strain on the parent-child relationship.Second, surveys of pediatricians have indicatedthat problems with tantrums and disobedience are someof the most frequent concerns shared by parents duringcheck-ups, suggesting that almost all parents encounterthese challenges and many are not sure how to respond.The origins of this novel and effective approach to preventioncan be traced to the behavioral pediatric researchgroup at Utah State University. Doctoral students fromthe University have partnered with pediatricians indelivering the service at the Budge Clinic. The preventionprogram is designed to keep typical problems fromgrowing out of parental control. Negative behaviors leftunaddressed during early childhood can translate intoa unnecessary risk that children will become aggressive,defiant, or experience academic problems. These behaviorsmay endure through middle school, even becoming asource of trouble during the teen years.Clint Field, PhDPediatric PsychologistBudge Clinic Pediatrics435.792.19406 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 7

Statistically speaking,heart disease is the most common cause of death among both men and women,claiming the lives of more than a half million Americans each year.Coronary artery disease results from the buildup of fat and cholesterolin the arteries that supply blood to the heart. These cholesterol ladendeposits are called atherosclerotic plaques. Atherosclerosis is the medicalterm for “hardening of the arteries.” Current research shows that thiscondition can begin as early as adolescence.Statistically speaking, heart disease is the most common cause of deathamong both men and women, claiming the lives of more than a halfmillion Americans each year.As atherosclerotic plaques grow, portions of the artery become cloggedand narrowed. If an artery is severely obstructed, it reduces blood flowto the heart causing chest pain due to lack of oxygen and nutrientdelivery to the pumping heart muscle. The heart beats all day, everyday, and requires tremendous blood supply. A heart attack (myocardialinfarction or MI) occurs when a coronary artery plaque ruptures andcompletely occludes blood flow to the working heart muscle. Withoutoxygen and nutrients, heart tissue is damaged or even dies. If you survivethe attack, your heart can sustain damage that puts you at greaterrisk for future cardiac events and may limit your heart’s ability to supportyour former level of activity.Although many patients with severe coronary artery disease have noclear identifiable risk factors, the major obvious factors of the diseaseare: age, family history of heart disease, diabetes, tobacco, and elevatedcholesterol or blood pressure.Following a heart healthy lifestyle, risk factor modification, and earlydisease recognition are the key to preventing coronary artery disease.To determine if you have coronary artery disease and, if so, how severeit may be, visit your healthcare provider. Your clinician will assess yourlikelihood of coronary artery disease based upon your risk profile,examination, or possibly diagnostic testing.Gerald I. Polukoff, MDInterventional CardiologyCache Valley Heart Clinic435.716.2200By Gerald I. Polukoff, MDCommonWarning Signsof aHeart AttackChest DiscomfortFrequently, chest discomfort is located in the centerof the chest, lasts more than a few minutes, and maycome and go. It can present as uncomfortable pressure,squeezing, fullness, or pain. The discomfort is oftenassociated with sweating, nausea, shortness of breath,and a sense of panic.Not all peoplewithHeart Attackshave Chest Pain:Discomfort can occur in other areas of the upperbody including pain or an ache in one or both arms,back, neck, jaw, or stomach. You could also experienceunexplained shortness of breath with or without chestdiscomfort and/or light-headedness, fainting,or palpitations.Don’t Delay. Take action by calling 911and getting to the hospital as soon as possible.In a Heart Attack,every second counts.10 10 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 11

Hospitals are Helping MomsTake an Active Rolein theirChildbirth DecisionsAbout 4 million women in the United States,if recent trends hold true, will give birth this year.As her relationship begins with her new baby, eachwoman will have fun, exciting, and important decisionsto make: choosing her baby’s nursery accessories, herbaby’s name, and where to deliver her baby.Women have more birthing options now than ever before.Hospitals are still the number one choice for the vastmajority of women in the U.S., but the ageless motive tochoose a hospital birth over another option simply becausethe hospital can “take care of me and my baby in an emergency”is not the only reason women are choosing hospitalbirths these days.Hospitals are implementing patient-centered care approachesto more actively involve patients in their health care decisions.Patient-centered care is based upon open communicationbetween the provider, patient, and their familymembers. The approach involves the patient in all aspects oftheir care and empowers them to seek the best solution formanagement or treatment of their health care need.Nationally, Intermountain Logan Regional Hospital isahead of the curve in the implementation of patientcenteredcare at its Women and Newborn Center. A newmom works with physicians as a team to have the birthingexperience she desires by:Taking an active role in making decisions about herchildbirth optionsHaving educated choices which may include medicatedor non-medicated birthing optionsCarrying out the instruction she learned in childbirtheducation classesWorking to progress labor with techniques thatfacilitate her comfort, relaxation, and the naturalphysiological changes to help her give birthTechniques can include: position changes and movement,massaging, hypnobirthing, hydrotherapy, andaromatherapyConsulting with the well-trained nursing staff whoprovide her both instruction and emotional supportAt Logan Regional Hospital’s Women and Newborn Center,the execution of patient-centered care results in betteroutcomes for moms and babies, a lower risk of intervention,and ultimately, a unique and memorable childbirthexperience for every woman.14 14 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 15 15

Logan Regional is theFamily Behind Your FamilyFinding qualityhome care doesn’thave to be diffi cult.We make home care easy.“ A fter my son Walker was born six weeks early,I stayed at Logan Regional Hospital for 20 days. The nurses and the staff tooksuch good care of us. I’ve had all five of my boys at Logan Regional.It’s our family hospital — the only place I’d ever want to go.”Erica Low, ProvidenceHOSPICEHOME HEALTHINFUSION THERAPY &SPECIALTY PHARMACYHOME MEDICAL EQUIPMENTCACHE VALLEYHome Health & Hospice(435) 716-5477Home Medical Equipment(435) 716-5396full service ad logan.indd 18/24/2011 4:15:45 PMVisit loganregional.org16 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 17

SustainableWeight LossBy Patrick Shepherd, R.D.Exercise and weight lossare often explained asfitting together as a hand and glove model; in that,one without the other is thought to be ineffective.While this idea sounds credible, many who engagein consistent and aggressive physical activity oftenreport the opposite: weight gain. Such weight gainis frequently explained away as simply the neteffects of increasing muscle mass (a more densetissue) concurrent with their fat loss. This may notalways be the case.The body provides energy to sustain itself (breathing,pumping blood, repair, and activity) fromthree main sources: carbohydrates, fats, andproteins. While all three can be used as an energysource, not all energy pathways operate at the samespeed. In high intensity activity, the majority ofenergy is derived from carbohydrates with smallerquantities coming from fat and protein. Such activitydoes burn calories, but simply burning caloriesmay not ensure weight loss. Weight loss comesfrom sustaining a calorie deficit over time.It is common that when people begin a weight lossregimen they may aggressively restrict their calorieintake via counting calories or simply reducing portionsizes. Initial days of restriction are overshadowedby the idea that “if moderation leaves me alittle hungry and only causes moderate weight loss,I might as well get it over with by being really hungry,and see faster weight loss.” This type of restrictionalone is enough to be NON-SUSTAINABLEin the long term.Compounding thisproblem is that many alsobegin an intense regimenof physical activity. At highintensities the calories beingburned come from thebody’s reserve of carbohydrates,of which verylittle is stored, 1500-2500calories at all times. Thisintense burst of activityleaves the person carbohydratedepleted and feelingVERY HUNGRY, whichcauses the hunger response to prod them towardsreplacing the carbohydrate calories expended.This may result in the person returning fromtheir workout, consuming a small meal, and stillfinding themselves starving afterwards. The bodycontinues to express its frustration until its lack ofcarbohydrate stores is replenished. Eventually aperson yields to their hunger with compensatoryeating which counterbalances or overbalances thecalories they burned during their workout, resultingin weight gain.A person desiring to lose weight and be physicallyactive should therefore engage in an exercise planthat is of a sustainable and of a moderate intensity.Even though moderate activity will not burn nearlyas many calories as intense activity, it can derivethe majority of its energy from fat stores, (which iswhat most of us want to reduce in the first place)and leave the majority of the carbohydrate storesintact. This can allow a person to pursue physicalactivity without engendering a large spike in hungerlevels. Such a moderate attack combined with awell-constructed meal plan can allow the person toachieve meaningful weight loss and actuallyENJOY physical activity for the rest of their lives.Patrick Shepherd, RDDieticianBudge Clinic435.792.171020 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 21 21

understands healingisn’t always about giving you more time.Sometimes it’s about helping make themost out of the time you have left.Hospice can help.• Pain & Symptom Management• End-of-life planning• Nursing & Aide Services• Social Work & Spiritual Support• Caregiver Respite• Bereavement ServicesIntermountain Homecare is a full service home careprovider offering: Hospice, Home Health,Home Medical Equipment, andHome Infusion Therapy.For more information, call435-716-5477.hospice ad logan.indd 18/24/2011 4:17:50 PM22 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 23

HOW DO I CHOOSE ACOSMETICS U R G E O N ?By Casey N. Isom, MDIn today’s world we are barraged with advertisementspromising quick fixes to look and feel better.Patients are sometimes confused when it comes to choosinga qualified physician to provide cosmetic services.Many offer amazing results with little risk. It can be difficultto distinguish who is a legitimate surgeon and whois not, especially when you see an MD behind the person’sname. I would like to recommend ways to maximize yourchances of success with a cosmetic procedure and minimizeyour risk of complications and disappointment.There is an alarming trend where healthcare workers andeven doctors are practicing medicine far beyond their scopeof training. Examples of this are medical spas and so calledmedical institutes that are operated by nurses or familydoctors who have no formal training in plastic or any kindof surgery. Some limit themselves to Botox, filler injectionsand spa type treatments that are relatively benign. Others,however, perform invasive procedures such as laser peels, fatgrafting and liposuction in an office setting with no formaltraining. Unfortunately, a surgical instrument in the handsof an untrained physician can become a deadly weapon.These doctors typically do not have privileges at their localhospital which requires that they practice within the limitsof their training. If the patient ends up with a complication,they are told to make their way to the nearest emergencyroom because the doctor is unable to take care of the complication.Dissatisfaction and complication rates are usuallyhigh when untrained doctors dabble outside of their medicalspecialty in search of higher income. It is interesting tonote these clinics advertise more than reputable surgeonsbecause they cannot rely on referrals from satisfied patients.They offer bargain prices, but in reality their fees are notmuch less than those done by a qualified board certifiedplastic surgeon. The old adage that you get what you payfor is true in this case. Besides, the cost of a complicationor disfiguring result can be very high indeed. I feel stronglythat if a family physician desires to practice plastic surgery,they should complete a residency in plastic surgery, ratherthan attend a weekend course and think they can do whattypically takes six years to master.Medical training in the United States begins with fouryears of medical school where students learn a little bitabout all the major medical specialties. After which the titleof medical doctor is bestowed: if the licensing exams arepassed. The next step is to apply for residency training inthe budding doctor’s chosen field. Some specialties are particularlycompetitive and require excellent exam scores andclinical performance in order to be accepted. An exceptionallyqualified new doctor will likely be accepted into theirchosen specialty. If not, they may end up training in a lesscompetitive specialty. After residency training, the new physiciancan legally practice any type of medicine they desirewithin their private clinic. However just because somethingis legal doesn’t mean it is ethical or safe, nor covered by theirmalpractice liability insurance. In order to work withinthe hospital system one must be credentialed by a panelof physicians and hospital representatives who ensure theclinician has been properly trained and is practicing withinthe limits of their training. Be wary of surgeons without ahospital affiliation.Many surgeons claim board certification. The question hasto be asked, “Board certified in what and by whom?” Inthe United States the American Board of medical specialties(ABMS) is a not-for-profit body which oversees 24approved medical specialty boards. They are instrumentalin the development and use of standards in the ongoingevaluation and certification of physicians. ABMS isrecognized as the gold standard in physician certification.The American Board of Plastic Surgery is the only plasticsurgery board recognized by the ABMS. Certification bythe American Board of Plastic Surgery guarantees that yoursurgeon has completed an accredited residency program inplastic surgery. Vigorous testing by leaders in the field ofplastic surgery assures the individual has been recognized asa safe, ethical, and competent surgeon. This is an ongoingprocess requiring periodic recertification exams, continuingmedical education and review of surgical results. Certainspecialties cross-over into the realm of plastic, reconstructiveand even cosmetic surgery depending on their area of expertise.Examples of these are ear, nose and throat surgeons,dermatologic surgeons, and oculoplastic surgeons who dealwith surgery of the eye.A news report was recently broadcast by KSLnews on this very issue. It can be found athttp://www.ksl.com/?nid=148&sid=155703496.Some important questions to askany healthcare provider beforeallowing them to perform an invasivecosmetic procedure would be:What and where was your specialty training?What is your board certification specialty?Do you have hospital privileges and where?What are the possible complications and how wouldthese be dealt with?Are you operating in a certified operating room, andwhich organization has provided the certification?(A certified operating room is has met standards ofsafety and is equipped to handle life-threateningcomplications a patient may experience during asurgical procedure)Can you show me examples of average results?Can I speak with some of your previous patients?If the answers to these questions are not satisfactory or ifyou feel uncomfortable, I would recommend seeking asecond opinion by a surgeon certified by the AmericanBoard of Plastic Surgery. Every doctor in this countrytook an oath to do no harm. Practicing medicine beyondthe limits of their specialty violates this oath.Casey N. Isom, MDIsom Plastic Surgery435.792.176024 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 25

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TrampolineIncontinence... What is it?So why is it that many moms refuseto jump on trampolines? Really, it is a child’sdream to have mom share in the excitement, right? Althoughthis could be due to many reasons, we tend to believe lotsof women hesitate due to urinary incontinence. It is a verycommon ailment we see on a daily basis in our community aswell as world-wide. Leaking while on the trampoline is no real“accident.” Rather, it is a combination of several important andundeniable factors all present in our society today.The first factor is the physical position of the female bladderwithin the pelvis with a very short urethra as well as the externalforces present with weight gain. Second, the incrediblegravitational forces present when decelerating so quickly whilejumping. And third, it deals with the laxity of the pelvic floorthat comes from childbearing and age. Although a very commonailment world-wide, this seems to be even more so locally due tothe prevalence of each of these factors present in our communitytoday. One has to believe that we are contenders for trampolinesper capita, as well as a leader when it comes to size of family, asincreased vaginal birth certainly has great potential to weakenthe pelvic floor which contributes to the leaking.By Teryl Hunsaker, PA-C and Kristin Craig, MDWhat is urinary incontinence (UI)?Urinary incontinence is the loss of urine control, or the inabilityto hold your urine until you can reach a restroom. Accordingto the National Association for Continence, approximately25 million adult Americans experience temporary or chronicurinary incontinence. UI can strike at any age. Women overage 50 are the most likely to develop UI and typically increasesin prevalence as one ages. Urinary incontinence may be a temporarycondition resulting from an underlying medical condition.It can range from the discomfort of slight losses of urineto severe, frequent wetting.What causes urinary incontinence?Incontinence is not an inevitable result of aging, but is particularlycommon in older people. It is often caused by specificchanges in body function that may result from diseases, use ofmedications, and/or the onset of an illness. Sometimes it is thefirst and only symptom of a urinary tract infection. Women aremost likely to develop incontinence either during pregnancyand childbirth, or after the hormonal changes of menopause,because of weakened pelvic muscles.What are some of the different types ofurinary incontinence?The following are the most common forms of urinary incontinence:• Urge incontinence — the inability to hold urine long enoughto reach a restroom. This is often accompanied by urinary frequency.It is common in people who have conditions such asdiabetes, stroke, dementia, Parkinson’s disease, and multiplesclerosis, but may be an indication of other diseases or conditionsthat would also warrant medical attention.• Stress incontinence — the most common type of incontinencethat involves the leakage of urine during exercise,coughing, sneezing, laughing, lifting heavy objects, or otherbody movements that put pressure on the bladder. (i.e.jumping on trampolines)What are the symptoms of urinaryincontinence that indicate that youshould get treatment?The following are the most common indications of urinary incontinence.However, each individual may experience symptomsdifferently:• Progressive weakness of the urinary stream with or without afeeling of incomplete bladder emptying• An increased rate of urination (frequency) without a provenbladder infection• Needing to rush to the restroom and/or losing urine if youdo not get there in time• Leakage of urine that prevents activities• Leakage of urine that began or continued after surgery• Leakage of urine that causes embarrassment• Frequent bladder infectionsThe symptoms of urinary incontinence may resemble otherconditions or medical problems. Always consult your physicianfor a diagnosis.How is urinary incontinence diagnosed?For people with urinary incontinence, it is important to consulta physician for a complete physical examination that focuses onthe urinary and nervous systems, reproductive organs, and urinesamples. In many cases, patients will then be referred to a urologist,gynecologist, or a urogynecologist. All are physicians whospecialize in diseases of the urinary tract.Teryl Hunsaker, PA-CBudge Urology Specialists435.792.1950Kristin Craig, MDBudge OB/GYN Specialists435.716.1920Treatment for urinary incontinence:Only in cases of frequent bladder infections would UI causeother medical problems. The decision for treatment, therefore,is based on how the symptoms affect your lifestyle. If you aregiving up activities, travel etc., or if you are wearing a pad daily,it is worth it to consider treatment.Specific treatment for urinary incontinence will be determinedby your physician based on:• The type of incontinence you have• Your age, overall health, and medical history• Extent of the problem• Your tolerance for specific medications, procedures, or therapies• Urodynamic studies performed in a special bladder lab toproperly assess the cause of incontinence and to determinethe best treatment options.In general, stress incontinence is treated with anatomic changessuch as exercises and surgery. Urge incontinence is treated withphysiologic changes such as behavior modification and medications.Treatment may include:Behavioral therapies (to help people regain control of their bladder),including the following:• Bladder training teaches people to resist the urge to void andgradually expand the intervals between voiding.• Toileting assistance uses routine or scheduled toileting,habit training schedules, and prompted voiding toempty the bladder regularly to prevent leaking.• Dietary Modifications avoidance of caffeine, citrus,chocolate, coffee, carbonation, or spicy foods. Thesefoods provide a significant irritation to the bladder.• Pelvic muscle rehabilitation (to improve pelvic muscle toneand prevent leakage), including the following:• Kegel exercises/Biofeedback/Pelvic Floor Stimulation• Regular, daily exercising of pelvic muscles can improve,and even prevent, urinary incontinence. This is particularlyhelpful for younger women. Should be performed30-80 times daily for at least eight weeks. Awareness ofthese muscles and specific intervention is carried out bya physical therapist who specializes in this.• Medication (including specific drugs for incontinence aswell as estrogen therapy, which may be helpful in conjunctionwith other treatments for postmenopausal women withUI). The popular anticholinergics medications are oftenprescribed and include medications like Detrol, Vesicare,Toviaz, Ditropan.• Surgery (if the incontinence is related to structural problemssuch as an abnormally positioned bladder or a blockage).this includes bladder suspensions and sling procedures. Thefemale mid urethral sling has truly revolutionized the treatment—minimallyinvasive with great success rates in a wellselected population.32 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 33 33

Treat it!Gout:By Corey W. Walker, MDWhat is Gout?Gout is a type of inflammatoryarthritis caused by the deposition of uric acid crystalsin the joints and other tissues. Excess uric acid occursbecause of overproduction in some individuals or aninability to excrete it out of the body through thekidneys. It affects approximately three percent of thepopulation and men more than women.Gout generally starts withintermittentattacks of inflammation in the toes causing severe pain,swelling, and usually redness to the joint involved. Theattacks usually come and go for awhile, the personbeing asymptomatic between flare ups. Over time andwithout treatment the gout attacks start increasing inseverity and frequency. Eventually it can start attackingother joints like the ankles, knees, wrists, elbows, andsometimes fingers. Left untreated it can cause persistentinflammation in the joints and, more importantly,permanent damage to the joints involved.Factors that increasea person’s chances ofhaving a gout attack include certain medications (diureticsand low dose aspirin) and foods that are highin purines (red meats, shell fish, alcohol, soft drinks,and fructose). Foods that can decrease gout attacks aredairy products and vitamin C.Gout is diagnosedby finding evidence of toomuch uric acid in the body, usually through a bloodtest and identifying uric acid crystals in the joint fluid.Treatment of gout is broken down into two differentgoals: treatment of the inflamed, painful, and swollenjoint(s), and second, treatment of the underlyingproblem which is high uric acid in the body.Acute AttacksThe goal of treatment here is to startmedication as soon as symptoms appear tocontrol pain and minimize the severity ofthe attack. Nonsteroidal anti-inflammatorydrugs (NSAIDs) are typically first linetherapy. Ibuprofen 800mg three times dailyor indomethacin 50mg three times daily arecommonly used. Colchicine (Colcrys) hasbeen around since the beginning of timeand also is commonly used to control anacute flare of the disease. Glucocorticoids, aclass of medications known as steroids, likeprednisone and joint injection of cortisone,are also used in more severe or difficult tocontrol flares of gout.Uric Acid LoweringTherapyThe most critical part of treating gout is gettingthe uric acid level down in the body toprevent recurrences of gout attacks and jointdamage. Medications used for this includeallopurinol, febuxostat (Uloric), probenacid,and pegloticase (Krystexxa). Also, changingones diet to take in less red meats, shellfish,and alcohol is important. This typically involveslong term commitment to treatmentbut is well worth it in the end.Corey Walker, MDRheumatologyBudge Clinic435.792.151834 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.orgIntermountainMedicalGroup.org 35 35

PAID ADVERTISEMENTThe Anatomyof the EyeIrisPAID ADVERTISEMENTOptic NervePupilCorneaRetinaLensG l a u c o m aT h e P r e v e n t a b l e B l i n d n e s sThe inside back of the eyeballis lined by cells that detect light(the retina cells). All these cells are associatedwith nerve fibers which coalesce and exit the backof the eye to form a cable extending from theeye to the brain. This cable is known as the opticnerve. Glaucoma refers to a group of eye conditionswhich lead to characteristic damage of theoptic nerve and is one of the leading causes ofpreventable blindness in the United States.In most cases, damage to the optic nerve comesfrom increased pressure inside the eye, alsoBy Christian D. Nilson, MDknown as intraocular pressure (IOP). If damageto the optic nerve goes undetected, it can eventuallylead to permanent blindness.There are four major types ofglaucoma:1. Open Angle (Chronic) Glaucoma2. Angle Closure (Acute) Glaucoma3. Congenital Glaucoma4. Secondary GlaucomaNormal Fundusand Optic NerveGlaucoma Damageto Optic NerveOpen Angle Glaucoma and Secondary Glaucoma patientsusually have no symptoms. Once the vision loss is apparent,the damage is very severe. In Acute Angle Closure Glaucoma,patients will have sudden severe pain in or around the eye, redness,decreased or cloudy vision, nausea, vomiting and halosaround lights. In Congenital Glaucoma, the child is usuallynoted to have cloudiness to the front of the eye, redness, enlargementof one or both eyes, tearing and sensitivity to light.A complete detailed eye exam is needed to evaluate the condition.If glaucoma is suspected, your eye doctor will do othertests to confirm the diagnosis.There is no cure for glaucoma but thereis treatment. The management depends on the type ofglaucoma. Acute Angle Closure Glaucoma usually requiresemergent treatment with medication (eye drops or oral pills)and can sometimes require urgent laser treatment. Treatmentfor more chronic glaucoma usually involves eye drops.Sometimes, patients need more than one type of drop. Othertreatments can involve laser and/or surgery. Treatment, inmost cases, can halt the progression of the disease and preventfurther optic nerve damage.Glaucoma is more common in patients over 40 years old andin patients with a family history of the disease. All adultsshould have a complete, detailed, dilated eye exam by age 40,or sooner, if you have risk factors for glaucoma or other eyeproblems.Christian D. Nilson, M.D.OphthalmologistNorthern Utah Eye Center435.752.2020www.NorthernUtahEyeCenter.com36 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 37

Introducing Three Of Our Newest PhysiciansIntermountain Medical Group of Cache ValleyDr. Steven NailLogan Regional Wound and HyperbaricCenter and the Intermountain MedicalGroup welcome Steven Nail, MD, boardcertifiedwound and hyperbaric specialist.Dr. Nail brings seven years of wound-careexperience to his new role. He comesto Logan from Austin, Texas, where heserved as Assistant Medical Director atHyperbaric Physician Consultants. Healso has more than two decades of experiencein emergency medicine.A Texas native, Dr. Nail earned his bachelor’sdegree from Texas A&M Universityand attended medical school at Universityof Texas Health Science Center atSan Antonio. He completed a familypractice residency in Fort Worth, Texas,and is board certified in family practice,emergency medicine, and hyperbaricmedicine. Dr. Nail and his wife, Tatia,have five children and three grandchildren.They are pleased to join the CacheValley Community.Dr. Nail works with podiatrist CurtisPedersen, DPM, in treating patients atthe Wound and Hyperbaric Center. Dr.Pedersen was one of the founding physicianswhen the Logan Wound Center firstopened in 2002. He is board certified infoot surgery and has 15 years of woundcareexperience.Dr. Gerald I. PolukoffDr. Gerald Polukoff joins the staff atIntermountain Healthcare’s Cache ValleyHeart Clinic from Salt Lake City,Utah, where he most recently worked ina private practice cardiology office. Hejoins Intermountain with exceptionalknowledge and experience in the field ofinterventional cardiology. His past workexperience includes Sorensen CardiovascularGroup (Salt Lake City), The HeartCenter (SLC), and the Heart Clinic ofCorpus Christi (Corpus Christi, Texas).He also served as an adjunct associateprofessor at the University of UtahSchool of Medicine.Dr. Polukoff specializes in interventionalcardiology. He attended the Universityof Florida for his undergraduate workand went on to the American Universityof the Caribbean where he received hismedical degree. He has completed his internshipand residency in internal medicineat the St. Louis University AffiliateTeaching Hospital in St. Louis, Missouriand has completed two fellowships – onein cardiovascular disease at the Universityof Texas Medical Branch and the other ininterventional cardiology at the Universityof Utah School of Medicine.Dr. Erica SmithJoining the Budge Clinic Obstetrics andGynecology, Erica Smith, MD, receivedher undergraduate and medical degreesfrom Marshall University in Huntington,West Virginia. Following the completionof her 48-month residency at East TennesseeState University in Johnson City,Tennessee, Dr. Smith joins IntermountainMedical Group July 2012.Dr. Smith is a member of the AmericanCollege of Obstetrics and Gynecology,the American Physicians Obstetrics andGynecology, the American Society of ReproductiveMedicine, and the AmericanMedical Woman’s Association.While she practices obstetrics and gynecologyfor all ages, she has a particularemphasis in pelvic ultrasound and adolescentgynecology.Dr. Smith was raised in rural WestVirginia. She and her husband, Matthew,enjoy fly fishing, hiking, and naturephotography. They are delighted to jointhe Cache Valley community and lookforward to taking advantage of the valleyand all it has to offer.ALLERGY1350 N. 500 E., Logan435.792.1950AUDIOLOGIST1350 N. 500 E., LoganCobabe, Andrew, AuD435.792.1950CARDIOLOGY1300 N. 500 E., Suite 320, LoganOtrusinik, Rudolf, MDSaul, William L., MD435.716-2200DERMATOLOGY1350 N. 500 E., LoganHanson, Nathan W., MD435.792.1770DIETITIAN1350 N. 500 E., LoganShepherd, Patrick, RD435.792.1710ENT/OTOLARYNGOLOGY1350 N. 500 E., LoganStahl, Kathleen M., FNP435.792-1950FAMILY MEDICINE*Includes ObstetricsAvery, D. Barton, MD*Harris, Gary L., MD*435.563.3222190 S. Hwy. 165, ProvidenceBroadhurst, Jeremy W., DO*Call, Nathan H., MDFirth, R. Mark, MD*435.755.3300412 N. 200 E., LoganCarlson, Brian W., MD*Goates, Brad M., MDHyldahl, Douglas R., MD*435.713.2800GASTROENTEROLOGY1300 N. 500 E., Ste. 340, LoganGarg, Vikram, MD435.716.5900INTERNAL MEDICINE1350 N. 500 E., LoganFaux, David S., MD435.792.1806Francis, Michael R., DO435.792.1780435.792.1810Nash, Robert M., MD435.792.1805INTERNAL MEDICINE - CONT.Stones, Michael J., MD435.792.1807Strong, Jeffrey S., MD435.792.1808Szpunar, Agnes M., MD435.792.1804NEUROLOGY1350 N. 500 E., LoganWilliams, Michael H., MD435.792.1809OBSTETRICS/GYNECOLOGY500 E. 1400 N., LoganAnderson, Jennifer, NPBenedict, James P., MDCraig, Kristin F., MDFlansburg, Deborah, CNMHorsley, E. Brett, DOMcCulloch, Kimberly D., MDMurillo, Ena, NPOlsen, Tandy G., MD435.716.1920ORTHOPEDICS1300 N. 500 E., Ste. 130, LoganHooley, Eric W., MDKing, Bryan C., MDMurray, David P., MDHunt, Scott, PAStowers, Benjamin, PA435.716.2800PEDIATRICS1350 N. 500 E., LoganBrown, Nordell T., MDClarke, Derrel W., MDField, Clint E., PhDGarg, Prafulla D., MDHorkley, Tyson S., MDO’Dell, J. Dennis, MDRoper, Sheryl, PNPSchneider, Stephen D., MDVisick, Michael K., MD435.792.1940PHARMACIES412 N. 200 E., Logan435.713.27701350 N. 500 E., Logan435.792.1521PHYSICAL MEDICINE1300 N. 500 E., Ste. 130, LoganEgbert, Jacob R., DOPeterson, Cameron G., MD435.716.2800PLASTIC SURGERY1350 N. 500 E., LoganIsom, Casey N., MD435.792.1760PODIATRY1300 N. 500 E., Ste. 130, LoganPedersen, Curtis C., DPM435.716.2800RHEUMATOLOGY1350 N. 500 E., LoganWalker, Corey W., MD435.792.1518SPORTS MEDICINE1300 N. 500 E., Ste. 130, LoganLyons, Trek D., MD435.716.2800SURGERY1350 N. 500 E., LoganAnderson, Allan D., MDHarker, David L., MDWeiss, Bartley M., MD435.792.1950UROLOGY1350 N. 500 E., LoganCallister, Michael S., MDHunsaker, Teryl, PAPitcher, Brent, PA435.792.1950WORKMED412 N. 200 E., Logan435.713.2850WOUND CARE1300 N. 500 E., Ste. 130, LoganAnderson, Allan D., MDHarker, David L., MDNail, Steven, MDPedersen, Curtis C., DPMWeiss, Bartley M., MD435.716.2850URGENT CAREIntermountain InstaCare8 am-8 pm, seven days a week412 N. 200 E., Logan435.713.2710We’ve got adocfor that.38 INTERMOUNTAIN MEDICAL GROUP IntermountainMedicalGroup.org IntermountainMedicalGroup.org 39

INSTACARE8 A.M. TO 8 P.M.SEVEN DAYS A WEEK412 N 200 E435-713-2710• Prompt physician care for illness & injury• No appointment necessary• X-ray, lab, and pharmacy on-site• Most insurance plans accepted• Open most holidays