4 • NOVEMBER 2013 TRINITY HEALTH HEALTHTALKNurse Practitioners“What’s the differencebetween you and adoctor?” It’s a questionthat nurse practitionershear every now and thenfrom their patients.For more than 45 years,nurse practitioners(NPs) have providedpatient-centeredhealthcare to people ofall ages in all parts ofthe globe. Yet it’s notsurprising that manypatients who benefitfrom that care aren’tquite clear on whatdistinguishes a nursepractitioner from adoctor or a nurse.“NPs have a graduate,advanced education withmost having a master’sdegree and an increasingnumber havedoctorates”, said PamPearson, FNP-C, a familynurse practitioner at theCancerCare Center.November 10-16 isNational NursePractitioner Week, anopportunity to celebratethe nurse practitionerand the role they play inhealthcare.“As NPs, we haveacquired formaleducation to practice inan advanced role asdirect healthcareproviders,” said HeatherBoyko, FNP-C, a nursepractitioner in <strong>Trinity</strong>’sInterventional Radiologyservice. “We providecomplete history andphysical examinations,diagnose and treat manycommon acute andchronic conditions,interpret lab results andx-rays, prescribe andmanage medications andother therapies.”Sally Eberle, FNP-C, afamily nurse practitionerat Convenient Care, sayspatients typically wantto know if NPs canwrite prescriptions. “Wecan and do,” Eberle said.“We need to obtain aDEA license like anyother provider, but yes,we write prescriptions.”What is a nursepractitioner?According to theAmerican Association ofNurse Practitioners(AANP), a nursepractitioner is anadvanced practice nursewho has receivedmaster’s or doctoratelevel training andextensive clinicalpreparation to provideprimary, acute andspecialty healthcareservices. Their servicesinclude, but are notlimited to: evaluatingpatients’ health status,ordering andinterpreting diagnostictests, and prescribingtreatment regimens,such as medications.Just as importantly, theywork as partners withtheir patients, guidingthem to make educatedhealthcare decisions andhealthy lifestyle choices.Not all NPs practice in aprimary care or familypractice setting. <strong>Trinity</strong><strong>Health</strong> relies on NPs ofall specialties to enhancethe practice in areassuch as Cardiology,Orthopedics, andOncology. Theconfidence that patientshave in NP-deliveredhealthcare is evidencedby the more than 916million visits made toNPs each year, AANPnotes.“Our training is based onthe nursing model thatemphasizes healthpromotion, wellness andprevention,” Pearsonexplained. “We maywork in independentpractice or collaboratewith other healthcareprofessionals.”As the U.S. faces thechallenges of an agingpopulation, risinghealthcare costs and thegrowing burden ofchronic disease, NPs dobring strength to thehealthcare workforceand maximize theresources available toaddress these challenges.“We can providehigh-quality, cost-effectivehealthcare,” Boykoadded. “With our blendof nursing preparationand experience, NPs arequalified to provide thepatient-centered carethat is central tomeeting the existing andfuture healthcare needs.”<strong>Trinity</strong> <strong>Health</strong>’s providernetwork includesapproximatelythirty-one nurseNovember 10-16National NursePractitioner Weekpractitioners, as well asother mid-levelproviders.TETWP Nets Record Fundraising<strong>This</strong> year, 2013 was arecord year forfundraising for ToughEnough to Wear Pink.Near the rodeo’s end onOctober 11, the largenovelty check associatedwith fundraisers wasunveiled, announcingthat $101,675 had beenraised.“I thought it was a greatsuccess,” said Jodi Smith,director of the <strong>Trinity</strong><strong>Health</strong> Foundation. Incomparison with lastyear, this year’s TETWPfundraising nettedalmost 100 percentmore; in 2012, $53,208was raised.A new addition to thisyear’s fundraising wasthe live auction of aHarley Davidsonmotorcycle –embellished,appropriately for theoccasion, with pink – atthe end of the rodeo onFriday. Originally, themotorcycle had beenraffled off during arecent fundraiserorganized by Kickstandsfor Cancer. However,when Magic City-HarleyDavidson discovered thewinner of the raffle wasnot a bike rider, theypurchased themotorcycle back fromhim and donated it toTETWP, Smith noted.The bike fetched$19,500 at the auctionheld October 11.<strong>Trinity</strong> <strong>Health</strong>’s CancerExercise RehabProgram is fundedprimarily from theproceeds of the ToughEnough to Wear Pinkcampaign. The programhelps fight againstradiation- orchemotherapy-relatedfatigue by offeringYMCA memberships tocancer patients; it isfunded from eventssuch as the ToughEnough to Wear Pinkfundraising, as well asother fundraising eventsheld throughout theyear, in addition todonations receiveddirectly from the publicand other organizations.Currently, there are 13patients participating inthe program, saidRussell Gust, an exercisephysiologist with <strong>Trinity</strong><strong>Health</strong>, who managesthe program. Patientscan participate in theprogram for threemonths before they‘graduate,’ Gust said,<strong>This</strong> year’s Tough Enough to Wear Pink campaign raised more than $101,000 to help cancer patientsparticipate in <strong>Trinity</strong> <strong>Health</strong>’s Cancer Exercise Rehab program. Pictured are, from left, Anne Thordahl,WGO and The Zoo; Russell Gust, <strong>Trinity</strong> <strong>Health</strong> Exercise Physiology Coordinator; Kim Whittemore,Minot Bands Together; Cassidy Kersten, SRT; and Cory Schmaltz, Kickstands for Cancer. MinotBands Together and Kickstands for Cancer donate proceeds from their respective events to TETWP.adding that “I had alarge group graduate thismonth. The programaverages about 16patients a month, withthe record being 21, andthis month we had our300th patient graduatefrom the program.”Gust noted that throughsponsorships with MinotBands Together,Kickstands for Cancer,Magic City-HarleyDavidson, SRT, as wellas WGO and The Zoo,the fundraising effortsare successful. “Theresponse of thecommunity to this effortcontinues to be beyondbelief,” he added. “Onbehalf of all of ourpatients, I would like tothank the people in andaround the communityof Minot. It is onlythrough their generositythat we are able to helppeople feel better.”Donations can be sentdirectly to the <strong>Trinity</strong><strong>Health</strong> Foundation, P.O.Box 5020, Minot, ND58702. Additionalinformation about the<strong>Trinity</strong> <strong>Health</strong>Foundation can befound at:http://www.trinityhealthfoundationnd.org/.Join us at facebook.com/<strong>Trinity</strong><strong>Health</strong>.ND<strong>Trinity</strong> <strong>Health</strong>’s Speaker’s BureauCall our Community Education Department at 857-5099 to check for available dates and topics.
HEALTHTALK TRINITY HEALTH 5 • NOVEMBER 2013Bladder “Pacemaker” Solves a Sensitive ProblemA woman’s lifecan becomplicatedenough. Addoveractivebladder to themix, and it canbe downrightunmanageable.Overactivebladder(OAB) – also known asurge incontinence – isthe strong, sudden needto urinate even whenthe bladder isn’t full.OAB can severely limitone’s ability to engage ineveryday pursuits suchas social situations andeven running routineerrands.“These are women whoknow where everybathroom in Minot is,”says Timothy Bedell,MD, an obstetrician andgynecologist with <strong>Trinity</strong><strong>Health</strong>. “The problem isthat the nerve thataffects the bladdersuddenly creates aspasm, telling thebladder that it needs tovoid. <strong>This</strong> can happenas many as two to threetimes per hour.”The good news istreatments are available,including exercises andmedications. And now,with Dr. Bedell’s arrivalTimothy Bedell, MDin Minot a fewyears ago,women alsohave access toa unique OABtreatmentcalledInterStim. It’sa device thatcorrects overactivebladderwith animplantable regulator –a pacemaker for thebladder.“InterStim is not the firstline of treatment forurge incontinence,” Dr.Bedell explains. “But if awoman has triedmedications or othertreatments and is stillnot getting good resultsor is unhappy with sideeffects, InterStim is agood option.”InterStim Thearpy uses asmall device that isimplanted under theskin, similar to apacemaker. The devicesends mild electricalpulses to the nervelocated in the lowerback, just above thetailbone. <strong>This</strong> nerve,called the sacral nerve,influences the bladderand surrounding musclesthat regulate urinaryfunction. The electricalstimulation may reduceoveractive bladdersymptoms and eveneliminate the suddenurge to go. It may alsobe used to treat peoplewho have difficultyemptying their bladder.(It’s not designed forwomen with stressincontinence – leakingthat can occur whensomeone coughs orsneezes.)One of the nice featuresof InterStim, accordingto Dr. Bedell, is that awoman can take it on a“test run.”“We’re able to testwhether a patient willbenefit from the devicebefore we proceed toimplantation,” Dr. Bedellsays. “We place leads fora limited time, and anelectrical unit is wornexternally for 2-3 days. Ifthe result is positive – ifthe patient notices a significantchange in herbladder symptoms, wecan talk about going tothe next step of longtermtherapy.”Another neatcharacteristic is that awoman can adjust thedevice herself toachieve the level ofcontrol she wants.The implantabledevice is very smalland is inserted intothe fatty tissue of thebuttocks. “Onceimplanted most womencan’t even feel it,” Dr.Bedell adds. The devicecan be removed at anytime.Dr. Bedell wasintroduced to InterStimduring his Ob/Gynresidency. He’s used thedevice in his practice at<strong>Trinity</strong> with good results.A potential source ofembarrassment, OAB isa condition that peoplemay be reluctant todiscuss or seek help for.It affects one is sixadults in the U.S. andcan happen at any age.“Again, it’s not the firstline of treatment,” Dr.Bedell adds. “But forpeople with urgeincontinency whereother treatments havefailed, InterStim is a niceoption because we havethe ability to test aheadof time whether they’llhave a good response.People who arecandidates who’vereceived the devicelove it.”About Dr. Bedell:Timothy Bedell providesindividualized care thatmeets a woman’schanging needsthroughout her lifetime,with subspecialtyinterests that includegynecologic surgery,urogynecology, and thetreatment ofincontinence and pelvicprolapse. The Dallasnative graduated fromthe University of Texasand earned his medicaldegree from theUniversity of NorthDakota School ofMedicine in GrandForks. He completed hisOb/Gyn residency atGrand Rapids MedicalEducation and ResearchCenter in Michigan.He’s a member of theAmerican College ofObstetricians &Gynecologists. He’slocated at <strong>Health</strong>Center – Medical Arts,with appointmentsavailable at 857-7397.North Dakota’s Drug Take Back ProgramHave you ever wondered what optionsthere are for disposal of unused andunwanted medications? In NorthDakota there is a free program thatallows you to dispose of unwanted orunused medications in a secure andenvironmentally friendly way. <strong>This</strong>program, called the Drug Take BackProgram, is sponsored by the AttorneyGeneral Wayne Stenjhem and theNorth Dakota Board of Pharmacy.Medications that are non-controlledsubstances, including unused or expiredprescriptions and over-the-countermedicines that are left in their originalpackaging, can be safely deposited in drop box containersat participating pharmacies for disposal. Controlled substanceproducts such as Hydrocodone (Vicodin), Oxycodone(Oxycontin), Fentanyl, Meperidine(Demerol), Diazepam (Valium),Zolpidem (Ambien) and others shouldbe taken to the secure container atparticipating law enforcement agencies.Sharps (such as syringes, lancets),thermometers, glass, home based care(HBC) or durable medical equipmentsupplies are not accepted by thisprogram. If you have any questionsplease check with your pharmacist, yourlocal law enforcement agency or contactthe Attorney General’s office at701-328-2210 or go to www.ag.nd.gov.The Role of Physician AssistantsPhysician assistants playan important part in thehealthcare dynamic.Physician assistants, orPAs, are healthcareprofessionals authorizedto practice medicine aspart of a team with aphysician. Nationwide,more than 90,000certified PAs providecare each day. Whiletheir practice can vary,PAs can examine, test,diagnose and treatpatients; prescribemedication; and providepreventive carecounseling as part of thehealthcare team.“We work incollaborationwith oursupervisingphysician,”explained LoriDockter, PA-C,Obstetrics andGynecologywith <strong>Trinity</strong><strong>Health</strong>. “PAsare allowed toact as first assists withsurgical procedures.”PAs also perform minorprocedures in the clinic,Dockter said. “We donot take care of patientsin the hospital setting.Our clinical skills areLori Dockter, PA-Cgeared towardsour specialty,and each hastheir ownscope ofpractice.”For Dockterspecifically,she seespatients fortheir wellnessexams and does a lot ofpreventative healthscreening andcounseling, as well ascontraceptive care, STDscreenings andcounseling, IUDinsertions, andmenopause issues.“I feel as part of thehealthcare team, we canhelp facilitate patients’access to care, by freeingup the physicians forpatients that need to beseen for more serioushealth concerns,”Dockter added.To practice, PAs mustgradate from anaccredited PA programand pass the nationalcertifying examination,administered by theNational Commission onCertification ofPhysician Assistants. Tomaintain certification,PAs must complete arecertification examevery ten years (as of2014; previously, theexam was needed everysix years). More than6,000 individualsgraduate fromaccredited PA programsin universities andacademic health centerseach year. PAs areentering the medicalworkforce at a faster ratethan physicians and arehelping to bridge thegap caused by thegrowing physicianshortage.Need a health care provider?A trained professional will assist you in selecting a health careprovider right for you. Please feel free to leave a message afterhours, and your call will be returned the next regular business day,or email us anytime at DR4U@trinityhealth.org.