Archive - March 2018

1
Protecting Your Smile
2
DULCE – An Innovation in Health Care Delivery
3
Stress and Your Health
4
Pain Management from a Physician’s Perspective
5
Get Outside and Get Moving!

Protecting Your Smile

By: Wendy S. Hubbard, RN, MCHC and Linda Greaves, Dental Hygienist, Vermont Department of Health, Morrisville Office

Pregnancy is a busy time for a woman. Remembering to take time for yourself is important. One item that is easy to overlook during the excitement is maintaining your oral health. Going to the dentist during your pregnancy is safe and one of the first things you can do to provide for the health of your baby.

In a recent Pregnancy Risk Assessment Monitoring System (PRAMS) report, only 63% of women had their teeth cleaned in the year prior to their pregnancy and only 62% of women had their teeth cleaned during pregnancy.

Dental care is so important during pregnancy that in Vermont if you are insured by Medicaid there is an expanded dental benefit through pregnancy and continues for 60 days after the baby is born. The PRAMS report stated 28% of women with Medicaid that had a dental problem did not think they could afford to go to the dentist. The Medicaid expanded dental coverage has no required co-pay or cap on services. You are fully covered!

Twenty-eight percent of women enrolled in Medicaid that needed a dentist according to the PRAMS report could not find a dentist who accepted Medicaid. Women can call the Vermont Department of Health (VDH) at 800-464-4343 for assistance in finding a local dental provider.

This website http://www.healthvermont.gov/local/morrisville has links to the twelve local health offices for the phone number to the office closest to you.

For further information on oral health resources for the whole family please visit the VDH website: http://www.healthvermont.gov/wellness/oral-health/resources-health-professionals.

DULCE – An Innovation in Health Care Delivery

By: Scott Johnson

The healthcare sector is experiencing rapid changes. Vermont is on the cutting edge of reform – leading the country in exploring alternative payment systems and finding better ways to measure success for patients and quality of care.

These reform efforts are also impacted by the fast-growing science related to how adversity in childhood impacts health care. Research at Harvard’s Center on the Developing Child reveals the significant impact of early life experiences on the growing brain and other biological, physiological, and neurological systems. According to the Center, in the first few years of life, more than one million new neural connections form every second. This critical developmental stage creates the architectural foundation for the rest of the infant’s life. Chronic stressors on the developing brain impact the quality and quantity of those neural connections.

Activation of the stress response produces a wide range of physiological reactions that prepare the body to deal with threat. However, when these responses remain activated at high levels for significant periods of time, without supportive relationships to help calm them, toxic stress results. This can impair the development of neural connections, especially in the areas of the brain dedicated to higher-order skills. (https://developingchild.harvard.edu/science/key-concepts/brain-architecture/)

Our earliest life experiences can impact how we respond to circumstances and challenges for the rest of our lives. In our region there is an innovative program to assure infants and their families have what they need to get off to a strong start. Appleseed Pediatrics, the Lamoille Family Center, and Vermont Legal Aid are working as a team to support Lamoille area families with newborns. The program is called DULCE (Developmental Understanding and Legal Collaborations for Everyone) and is about to enter its third year of operation.

The DULCE model embeds a family specialist from the Lamoille Family Center into the pediatric practice. The family specialist works with every family who wants her support to assure children in Lamoille get off to the best start possible; reducing the likelihood infants’ fast-growing brains and bodies are exposed to toxic stress and its lingering impact on the child.

Carol Lang Godin – LFC Program Director
and supervisor to DULCE family specialist –
with two DULCE graduates

Lamoille’s DULCE site is the only Vermont site and the only rural model in this national research project (six other sites are in Florida and California). While it’s a free and voluntary program, 98% of families have accepted the offer for support, and since inception in March 2016, DULCE has worked with almost 240 Lamoille families. A detailed and comprehensive evaluation process will begin in the coming months, and early indicators from family surveys tell us that families are benefiting from the support and information they receive from the program. The team, including the family specialist and the attorney help families with a range of issues parents of newborns may face that can impact the family’s health and well-being, including: child development, landlord-tenant challenges, child custody, family court issues, mental health, substance use, housing, economic well-being, safety, food security, and transportation.

The Lamoille Family Center is working with its local and state partners to expand DULCE in other practices in Vermont. This promising innovation that links health care, community services, and legal supports started here in Lamoille and could be a core component of all pediatric practices in Vermont within a few years. Giving children their best chance for a healthy and prosperous future starts with a family-centered approach like DULCE.For more information, contact Scott Johnson at sjohnson@lamoillefamilycenter.org, or Carol Lang-Godin at clang-godin@lamoillefamilycenter.org.


Scott Johnson is Executive Director of the Lamoille Family Center and has worked in Lamoille Valley in human services and education for nearly his entire career. The Family Center has served our community by encouraging, educating and celebrating children, youth and families for forty years.

Scott writes about early care and education, adolescent development and strengthening families that improve conditions of well-being.

Stress and Your Health

By: Rorie Dunphey

I’m sure you have heard how chronic stress can be bad for your health and maybe you have thought to yourself, “I really need to reduce my stress, but how?”

There is solid evidence that chronic stress has a detrimental effect on both our physical and mental health, making stress management a vital to good health. With the frantic pace of our hyper-connected lives and the steady flow of information barraging us, it is easy to feel swept along as if someone else is in charge of your life. In addition, our culture feeds us messages that encourage constant stimulation and busyness, with leisure and relaxation judged as ‘lazy’. It may just seem easier to keep tumbling forward, never really taking the time to slow down and de-stress. We adapt by simply resetting to this low level of anxiety, which becomes our ‘new normal’.

Here are some examples of how stress affects the body;

  • Brain: Difficulty concentrating, anxiety, depression, irritability, mood, mind fog.
  • Heart and lungs: Higher cholesterol, higher blood pressure, increased risk of heart attack and stroke.
  • Joints and muscles: Increased inflammation, tension, aches and pains, muscle tightness.
  • Immune system: Decreased immune function, lowered immune defenses, increased risk of becoming ill, increase in recovery time.
  • Skin: Hair loss, dull or brittle hair, brittle nails, dry skin, acne, delayed tissue repair.
  • Stomach: Decreased nutrient absorption, diarrhea, constipation, indigestion, bloating, pain and discomfort.
  • Reproductive system: Decreased libido, increase in PMS symptoms.

This is certainly not a very pleasant list of symptoms. Managing stress does not mean eliminating all the causes of the stress in our lives, which is usually impossible. What it does mean is that we can learn to better respond to stress and establish healthy practices to better manage our day to day responsibilities.

Here are some simple practices that you can try:

  • Get moving: Get some exercise and fresh air daily. Take a walk, swim, dance, do yoga…Regular exercise helps us manage our mood, weight & energy level. Even a 10-minute stroll can help us feel less stressed and more grounded.
  • Spend quiet time in nature: Go to a park, the beach or into the woods; or if you can’t get there put some pictures of nature where you will see them daily.
  • Plan a weekly ‘fun’ activity: Invite a friend or family member to share in the fun and find free fun things to do around town. Host a game night!
  • Practice gratitude: Think of 3 things that you feel grateful for every day upon waking or before bed. Notice how you feel when you appreciate the good things you already have.
  • Body care: Try massage, acupuncture or a warm bath for relaxation.
  • Pray: When you feel tempted to worry about a person or situation in your life, prayer may be helpful. This does not need to be ‘religious’ prayer, but rather a way of letting go and accepting what we cannot change. Focus on having compassion for the person or problem that is the focus of our stress, rather than building up difficult emotions like anger or fear.
  • Help someone else: Volunteer, help a friend, show kindness to a stranger. Often the simple act of recognizing what we have to offer can help us feel more appreciative of what we do have.
  • Ask for help and graciously receive it: This takes courage! We all sometimes have a hard time accepting help or recognizing when we need it.  Give someone the gift of being able to help you. It usually feels good to the other person, gives us a boost and brings us a closer personal connection.
  • Do something you love that makes you happy every day: It could be something different and simple every day; read a book, talk with a good friend, cook a meal you enjoy, buy a fancy coffee, work in your garden, play a game, listen to favorite music, take a nap.
  • Honor yourself: We all have limitations and strengths. Notice what you are good at and what you like about yourself and focus on it a few minutes daily. Smile at yourself in the mirror!
  • Express yourself: Write in a journal, draw, paint, sing, or do something creative to express your feelings and get the yucky stuff out of your system.
  • Build community: Consider participating in a group that is meaningful to you, such as a church, support group, or a sports team. Spending time with people you enjoy and with whom you share values and interests helps us feel more connected and supported as we face life stressors.

While we often cannot change the cause of our stress, we can always change our reaction to it.  Managing our stress is a commitment and a choice, and is central to good health.


Rorie Dunphey works under Vermont’s Blueprint for Health as the RN Chronic Care Coordinator at Family Practice Associates in Cambridge. She works one-on-one with people and also leads classes to promote health and help people better manage their chronic diseases. She also assists patients in accessing community and state resources to better coordinate their health and wellness needs. Rorie has a particular passion for promoting a healthy diet and exercise routine to inspire people to live their best life.

Pain Management from a Physician’s Perspective

Nicholas Antell, MD, one of Copley Hospital’s orthopaedic specialists, recently testified in front of the Vermont Senate Health and Welfare Committee. Dr. Antell was invited as part of the Committee’s request for feedback from providers on legislation that went into effect last year. The Vermont legislation limited prescribing and increased required education and communication in a statewide effort to address opioid addiction. Below is a transcription of Dr. Antell’s testimony. 

Over the past several days I’ve talked to most of the prescribers in our practice, Mansfield Orthopaedics, including physicians, but more importantly our Physician Assistants (PAs) and Nurse Practitioners (NPs) who do most of the prescribing and fielding of patient phone calls. The overwhelming consensus is that we are able to control our patient’s pain under these rules and that we were likely prescribing more opioids than necessary prior to their implementation. My subspecialty training is in orthopaedic trauma, taking care of patients that have complex fractures. I started with Mansfield Orthopaedics in August of 2016, and the NP I work with and I adopted these rules well ahead of the go-live date to see how it went. There were, of course, a few exceptions, but we were pleasantly surprised with how few patients were calling back requesting more pain medications. Now, I had the benefit of a developing practice, with a little more time to talk to our patients and manage expectations, which I feel was a huge benefit.

There are certainly times where I prescribe less, but most of my fracture patients are prescribed an amount of opioid that falls into the “severe” pain category in addition to recommending other medications such as Tylenol and Advil. My colleagues that perform joint replacement surgeries, such as total hip and total knee replacements, prescribe an amount of opioid that falls into the “extreme” category, and this was a significant cut from what they were used to. The PAs that work closely on that service tell me less than half of patients call back asking for more pain medications, but some still do. My colleagues that specialize in hand surgery, shoulder surgery, and foot and ankle surgery also feel they are able to control their patient’s pain under the current rules.

A point that was brought up by many was that we can use these regulations to help us limit the amount of opioids given to patients we do not feel really need them but are requesting them. In essence, we can blame the rules and the burden does not fall on the provider.

There are concerns amongst physicians in my group about legislation directing medical practice.  We must be allowed to use our clinical judgment when determining how many opioids are prescribed on an individual basis. We do not feel that it is up to lawmakers to decide if our patients fall into the minor, moderate, severe, or extreme pain categories. Although good as guidelines, we should be allowed to place our patients into which category we feel will adequately, and safely, control our patient’s pain so they can successfully recover from their orthopaedic procedure.

The most common complaint I received from our practice was with the Vermont Prescription Monitoring System (VPMS). We all appreciate the need to know if other prescribers are providing our patients with regulated medications, but the prescribers and delegates that use it most find it cumbersome and time-consuming to use. One provider suggested being provided with a reference number for each query that can be placed in the patient’s chart to confirm on our end that a query had been done. Another has found the customer service hours inconvenient while trying to get a password reset. We have also talked about a requirement to check VPMS before the first prescription is given, but then the system notifies us, for example by email, when another provider prescribes a controlled substance to this patient outside of our practice. Then instead of having to spend time rechecking VPMS in the rare circumstance a patient needs a refill, we can either quickly provide a refill knowing we are the only provider prescribing for them, or be able to have a conversation with that patient about the other prescription we are aware has been filled under their name. Most of us think there is certainly room for improvement with VPMS.

The consent form does add time to our preoperative routine, but the majority of the providers in our group don’t find it to be a nuisance, and with a few exceptions, we feel patients appreciate the discussion. A few patients have even taken this opportunity to tell us they don’t want a narcotic prescription following their procedure.

In our group, we have decided to prescribe Narcan to all patients that receive a narcotic prescription. This saves the hassle of having to figure out who needs one and who doesn’t. To save time we had a stamp made for our Narcan prescriptions, which lives in our perioperative area. However, we have noticed that the majority of our patients do not fill this Narcan prescription.

Initially, the morphine milligram equivalent requirement was confusing. We worked with our pharmacy department who put together a table to help guide how much of each specific narcotic medication could be prescribed to comply with these rules. This was extremely helpful in determining our new prescribing habits. I encourage the other providers here today to do the same if they haven’t already.

In conclusion, I want to thank this committee on behalf of Mansfield Orthopaedics for being given the chance to testify today, and for your continued interest in making these rules as operational and functional as possible, while not inhibiting our ability to practice medicine in a thorough and efficient manner.


Dr. Nicholas Antell of Mansfield Orthopaedics at Copley Hospital specializes in treating acute musculoskeletal injuries and total joint replacement.

Get Outside and Get Moving!

By: Tricia Follert

Outdoor recreational activities are the talk of our town. Did you know there was a fabulous MoVolley Ball Tournament at Oxbow Park last Sunday?  It was a gorgeous sunny day and about 25 people came out to play instead of sitting around their woodstove.  The competition was fierce, fun was had by all and the A team won gift certificates to 10 Railroad Street.

Speaking of recreational activities, there are 2 sets of horseshoe pits, a volleyball net and a tetherball pole at Oxbow Park, all free for the community to use. Now that spring is just around the corner, the bike share bikes will soon be available.  Gather your friends and family and get out and enjoy the many outdoor activities this community has to offer.

Did you know there are soccer, basketball, baseball and a summer recreation program for the kids here in town?  We want to get the word out about all the great outdoor opportunities available.

Do you want more recreation in the community or just want to know what is available?  An ad hoc group of Morristown community members are interested in re-establishing a year-round recreation committee.

If you are interested in joining us, have a topic you want us to discuss, or are interested in attending future meetings, let me know.

Tricia Follert, Community Development Coordinator, Town of Morristown

tfollert@morristownvt.org

802.888.6669  x231

In the comments section below, please share 3 ideas you would like to see a recreation committee work on for our community!

 


Tricia Follert is the Community Development Coordinator for the Town of Morristown, where she coordinates and implements activities for the town. She currently sits on three local boards, River Arts, Morristown Alliance for Culture & Commerce, and the Morrisville Co-Op,  and works closely with many local nonprofits on community projects. She is also actively involved in the community gardens, the rail trail and the arts.