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Now Accepting CareCredit, Sound Choice1030588.MED09.cnr 1030588.MED09.cnr2009|MEDICAL DIRECTORY 3KITTITAS VALLEY HEALTH & REHABILITATIONThe Rehab CenterShort Term Rehabilitation Experts Long Term Care ProfessionalsEXPERT NURSING & THERAPY SERVICES24/7 Admissions1050 East Mountain View Avenue Ellensburg509-925-4171 Convenient Bathrooms in all Resident Rooms Hip Surgery & Orthopedic Surgery Recovery CVA & TIA Treatment All IV Therapies including TPN Negative Pressure Wound Therapy Full Time Speech Language Pathologist - Monday through Friday3,000 Square Feet Therapy Gym Occupational Therapy Kitchen1033360.MED09.cnr4MEDICAL DIRECTORY|2009Table ofContentsYOUTHFULNESS AN AMERICAN OBSESSION AT WHAT COST?PAGES 5-6METAL BONE CALLED 1ST STEP IN BETTER LIFEPAGE 7FOOD ALLERGIES ON RISE IN CHILDRENPAGE 8STUDY ON AGING STILL GOING STRONG SOME50 YEARS LATERPAGES 10-11ELECTRICAL STIMULATION OF THE BRAIN ABREAKTHROUGH IN TREATING DEPRESSIONPAGES 13-14FOR DIABETICS, PREVENTING RENAL FAILURE ISHARD WORK BUT ESSENTIALPAGES 15-16TECHNOLOGICAL ADVANCES IMPROVE SOUND OFMUSIC FOR HEARING-IMPAIRED CHILDRENPAGES 17-182009|MEDICAL DIRECTORY 5DAN L. HIERSCHE, M.D.Board Certied Orthopedic Surgeonzz vrzns rxvrnrrwcr rwErrrwsnunoLatest tecbniques 8 most recent advances in Total Joint Replacements Hip - Metal vs. Ceramic Knee - Navigation, MISArtbroscopic Surgery Knees Shoulders - Bone Spurs, Rotator cu repair, Ligament repair Endoscopic Carpal Tunnel Release Sports Medicine, work related injuries700 East Manitoba, Suite 106Ellensburg, WA98926509-962-6727No Referral Required by Family Pbysician 1033346.MED09.cnrCuet Areu - us 1runsportuton lrovded bv Hope SourceCose to Shoppng - Spucous & Modern ApurtmentSocu Actvtes - lrendv Stul00l South Chestnut - 933-l888vvv.brurvoodcommons.comncome restrctons uppv - 55 or oderBy MARTHA IRVINE and LINDSEY TANNERAssociated Press WritersLAS VEGAS(AP)Itsoneof those photos that make you do adouble-take.Dr. Jeffry Life stands injeans, hisshirt off. His faceis that of adistinguished-looking grandpa; his headis balding, andwhat hair there is is white.But his 69-year-old body lookslikeitbelongstoamuscle-bound30-year-old.The photo regularly runs in adsfor the Cenegenics Medical Institute, aLasVegas-basedclinic that specializes inage management, a growing field in asociety obsessedwithstaying young. Life,who swears thats his real last name, alsokeeps a framed copy of the photo on hisoffice wall at Cenegenics.Hestheman! patientEdDetwiler says teasingly, pointing to thephoto of the doctor who, in many ways,has become his role model.Detwiler, 47, has been Lifespatient for more than three years. Inthat time, he has adopted the regimenthat his doctor also follows drasticallychanging his exercise and eating habitsand injecting himself each day withhumangrowthhormone. Healsoreceivesweekly testosterone injections.He does it because it makeshimfeel better, moreenergetic,clear-minded.He does it because he wants tolive a long, healthy life.If I were stooped over andbedridden, what kind of quality of lifeis that? asks Detwiler, a real estatedeveloper in suburban Las Vegas whoand your brain regularly are consideredtried-and-true tactics for staying young.Protecting yourself from harmful sunrays is another. Even flossing teeth isa habit that, according to research onpeople who live to 100, might extendlife.But thats generally where theconsensus ends.Many in mainstream medicineandelsewhere worry that were becomingtoo focused on treatments with short-term benefits that have potentiallydangerous side effects and scant, if any,evidence that theyll helpinthe long run.Indoing so, they wonder if some peopleare actually jeopardizing their chance ata long, healthy life, both physically andemotionally.The quest tolive forever andthedesire to avoid diseases and not sufferis understandable, says S. Jay Olshansky,a public health professor and longevityresearcher at the University of Illinois atChicago.But it canmakepeoplevulnerableto far-fetchedandpotentially dangerousscams, he said, with some of the morebizarre including fetal cell injections,inhaling radon gas, even cutting offtesticles, an ancient practice meant toreduce overexposure to reproductivehormones.Theresalargeindustryof peopletrying to sell to people what doesnt yetexist and theyre making gobs of moneydoing it much to the dismay of thoseof us who are vigilant about protectingpublic health, he says.There also are concerns that thisobsessionis sending the wrong messageto younger generations.Surveys from cosmetic surgerytradegroupssuggest that sizablenumbers of people, even in their 20s,are getting cosmetic procedures.And a fall 2007 survey fromTRU, a research firm that specializes inthe teenage demographic, found that asays hes doing this, in part, for his wife,who is nine years younger. If I can getout and be active and travel and see theworld and be able to make a differencein other peoples lives, then yes, I wouldwant to have as long an existence aspossible.It is a common sentiment in asociety where many of us strive to lookand feel decades younger to proveto ourselves and the world that we arehealthier andmore vital thanour parentswere at our age. Weve all heard it: 60 isthe new 50, the new 40 and so on.But often, we need a little help.Sometimes, a lot of help.As the baby boomers marchtoward retirement, Botox, wrinkle fillersand hormones of various kinds havebecome big business. Medcos latestdrug trend report shows, for instance,that human growth hormone use grewalmost 6 percent in 2007.The list for age-defying tacticsis endless. Want six-pack abs? Theres asurgical procedure to create fake ones.How about drastically cutting yourcalorie intake to slowthe aging process?Theres a group of die-hards that swearsby it.Thi s search f or et er nalyouthfulness certainly isnt new. In1,500B.C. peoplewereingestingtiger gonads torejuvenate them, says Dr. Gene Cohen,a George Washington University experton aging.But for a generation of adultswhove been weaned on the modernmarketing message that for a price,you can have it all the quest is takingon a new urgency.There is, of course, much to besaid for taking good care of yourself.Eating healthy and exercising your bodyquarter of young people, 12 to 19 anda third of girls in that age group areinterested inhaving cosmetic surgery toimprove their appearance.Michael Wood, vice presidentand director of syndicated research atTRU, was a bit startled by the results.Theresnodoubtthatthecelebrationof youthandlooking youngerhas certainly accelerated in the last 10years, five years even, Wood says. Andthis is a generationthats growing upwiththat at a very young age.The effect has been palpable,says Neil Howe, a respectedgenerationalexpert whohas writtenextensively aboutmillennials, young people who arecoming of age in this century.I guess evenyoung isnt enoughanymore, Howe says. Its got to beperfect young.AlexSabbag, a23-year-oldChicagoan, has felt the pressure, bothself-imposed and societal.Ill age until Im 25. Then Imover it, she said to co-workers during alunchroom conversation that turned tothe topic of Botox.She was only partly serious. Butshe says shes also accepted that welive in a society where being well put-together and youthful gives you status.We all buy into it, Sabbag says.And plastic surgery and other cosmeticprocedures are part of it.Shes never had anything done,thoughwouldnt rule it out inthe future.She also vividly recalls how her motherleft home for several days, whenSabbagwas in elementary school, and returnedafter having a facelift.I think it gives womenandmenalike worlds of confidence that ultimatelymakes thembetter people, Sabbag says.Yes, it is a vain practice ... but I thinkthere comes a point for people whenhardwork isnt enoughto kick the last bitof belly fat or gravity has become entirelytoo unbeatable, and so a little nip-tuckYOUTHFULNESS AN AMERICANOBSESSION AT WHAT COST?6MEDICAL DIRECTORY|2009of the forehead needs to happen.Detwiler, Lifes patient atCenegenics, isnotlookingfortheappearance of youth. Hes looking toextend his youthfulness, and his life.He knows about human growthhormone andits controversies insports.But this, he and his doctor insist, isdifferent. While it is illegal for thesekinds of hormones to be dispensed foranti-aging purposes, he takes relativelylow doses prescribed for hormonedeficiency. The idea is to bring his levelsback up to those of a young manin his 20s.Myfriendssay, Oh, Edson steroids, says Detwiler, who haswatched as muscle has replaced fat onhis belly and elsewhere. No, Im not.Look at me. Do I look likeIm on steroids?He holds out his arms toindicatethat his body is fit-looking, but notmonstrous. Im not. Im on hormonetherapy, he says of a regimen that costshim more than $1,000 a month.Besi des human gr owt hhormone, testosterone, and an adrenalhormone known as DHEA, his diet nowlargely consists of things like hard-boiled eggs, fruits, nuts, Greek yogurt,salads and palm-sized pieces of fish,chickenor low-fat beef. He also exercisesregularly, alternating between intensecardio workouts and weight-resistancetraining.I cant tell you in words howgreat I feel, says the man who used tocrack open a Pepsi to get him throughthe day.For a groupknownas the CalorieRestriction Society, youthfulness isntfound in hormones. Its reducing foodintake to, in some cases, near-starvation levels.But the claims are much thesame lots of energy and feelingsharp, says Brian Delaney, a 45-year-old California-born writer now livingin Sweden. Hes the president of thegroupthat claims about 2,000 membersworldwide andmany more followers whouse the method in hopes of markedlyincreasing their longevity.By cutting daily calories to about1,900, roughly half the recommendedamount for someone his height andage,and exercising every day, Delaney hasshrunk himself to about 140 pounds.He says his blood pressure, cholesteroland blood sugar levels have improveddramatically.At5foot11,headmitshesscrawny, which he calls themain drawback.say the least, says Dr. Jonathan Lippitz.Hes an emergency room physician insuburban Chicago who does cosmeticprocedures, such as Botox and skinfillers, in a separate practice.But its also a very slipperyslope, with patients sometimes willingto take more risk than they should andsome doctors wholl accommodate.Theyll always find somebodywilling to do it, he says.In his own practice, he says hefinds himself continually walking a fineline in deciding which procedures helldo and which ones he wont.We all say, I want my hairdifferent. I want my eyes different,Lippitz says. This idea of being perfectis a problem, though, because its notreality.I have people coming in andsaying I want these lips. I say, Youcanthave these lips.I say, Well work withwhat youhave.But what if what they have is justfine? These are the sorts of questions thattrouble Dr. Michael Morgan, a dentistwho does cosmetic work in anotherChicago suburb.Hes been seeing more young,female clients walking throughhis doors.And even his own 13-year-old daughterasked if he would whiten her teeth,something he didnt think she needed.Nor did he consider it safe for her youngteeth or age appropriate.Theres a consciousness aboutit. They are much more concerned withthe appearance of their face. But theresalso a social pressure, he says of theyounger generation for whom hell dothe most conservative procedures, butno more.He sounds a little sad when hetalks about it.Theres nothing wrong withwanting to look better. We want to lookyoung. We want to look great, he says.But part of that feeling has tocome fromwithin.For those going to even greaterlengths to try to keep aging andultimately death at bay, there alsoare no guarantees.Calorie restriction guru Dr. RoyWalford succumbed to complicationsfromLouGehrigs diseaseat age79, closerto the average than the extraordinarilylong life his followers talk about ontheirWeb site.Meanwhile,Dr. AlanMintz,founderofCenegenics,diedattherelativelyyoungageof 69duetocomplications during a brain biopsy.Hunger andwearingextraclothesto stay warmbecause of little body fator, he claims, an effect of slowed aging are barely annoyances for Delaney.Hesays heeats sensibly,replacing junk food with lots of fruitsand vegetables, no meat, and two mealsdaily no lunch. Breakfast is often ahearty bowl of granola, with fruit, nutsandsoy milk; while dinner couldbe fish,rice, beans, a large salad and red wine.Other thantons of fine wrinkleshe blames on too much sun as a kid,Delaney says in most respects, I lookmuch younger than 45.It is a bragging right manystrive for. Whenwewereyounger,wed talk about someone who was 60and that was old. And now my gym isfull of women over 60 and they lookphenomenal, says Renee Young, a48-year-old businesswoman in NewRochelle, N.Y. They dont want to becategorized as old.But theres more to it than that.Youthfulness, she says frankly, is also ameans of survival inthe business world,including in her line of work, publicrelations.It feels like youre put out topasture. No one wants to feel that howthey look means that their ability todo anything is decreased, Young says.If you have a younger look, you feelhealthier. You feel that youre still inthe game.Inthe back of her mindis the factthat her ownmother died whenshe wasonly 56.So five or six mornings a week,even when shed rather pull the coversover her head, Young gets up and putsin two hours at the gym.Thats more than double thehour or so a day generally recommendedfor optimal health. And still, for her, thatwasnt enough. She recently spent nearly$20,000 on a tummy tuck because, asshe puts it, no number of abdominalcrunches was going to make her as trimas she wanted to be.The result has been a makeoverfor her entire sense of self, she says.I made a commitment thissummer. If I was going to go through allthis surgery, then it was going to haveto be part of a complete program, saysYoung, whos also getting more rest andeating healthier.I can definitely see the result.She, too, says she has not felt this goodin years.Using a cosmetic procedure as amotivator is worthwhile, andlucrative, toSomeresearchhas suggestedthathuman growth hormone injections cancause cancer. Theyve also been linkedwithnerve pain, elevatedcholesterol andincreased risks for diabetes.Even so, Life, now the chiefmedical officer at Cenegenics, remainssteadfast. Among other things, he pointstostudies that suggest that humangrowthhormone in low doses poses no cancerrisk if there is no preexisting cancer.Withinthe next 10 years, maybeless, this is going to be thought of asmainstream medicine preventingdisease, slowing the aging process down,preventing people from losing theirability to take care of themselves whenthey get older and ending up in nursinghomes, Life says. This is really thecutting edge of medicine.Detwiler is betting on that.Therearethosewhomight thinkImcheating Gods way. I dont know, hesays. But I dont want to regress. Whyshould I?He says his overall body fat hasdropped from nearly 17 percent to lessthan 10 percent. He cant remember thelast time he had a cold or the flu. And hesays hes had the stamina to work longhours, putting himonpace to earnmorethan a million dollars this year.Thats what he knows now. Thefuture, he says, will be anyones guess.People might ask, Hey, whatshappenedto these people?Was it cuttingedge? Or did it cut it short? he says, ashe walks into a gym foranother workout.I think only time will tell.On the Net: Cenegenics:http://www.cenegenics.com Calorie Restriction Society:http://www.calorierestriction.org Life Expectency Calculator:http://www.livingto100.com/ National Institute on Aging:http://www.nia.nih.gov/Martha Irvine is an AP nationalwriter. Lindsey Tanner is an AP medicalwriter. Theycanbereachedviamirvine(at)ap.org or http://myspace.com/irvineap2009|MEDICAL DIRECTORY 7611 South Chestnut Street, Suite B Ellensburg 509.962.5000Obstetrics & Gynecology of EllensburgJohn H. Sand, M.D. OBGYN Fellow American College of Obstetricians and GynecologistsGinger K. Longo, M.D. OBGYN American Board of Obstetrics and Gynecology Eligible Paula J. Lins, Certied Physician AssistantOffering Routine & High Risk Obstetrics ln Offce Ultrasounds GYN Surgeries (hysterectomy, prolapse,bladder incontinence, selected gyn cancers, laparoscopic tubal ligation, microsurgical tubal reversal)New Patients Welcome Hispanas son Bienvenidas1033491.MED09.cnrBy Robert S. Boyd McClatchy NewspapersWASHINGTONForyears, youvebeenable to walk into a drugstore or healthfoodoutlet andbuy a host of probiotics natural dietary supplements such asAcidophilus or Lactinex off the shelfto treat conditions such as childrenseczema or travelers diarrhea.Unlike antibiotics, these self-helpproductsdontkillgerms,buttheysupposedly confer health benefits, theway vitamins and certain minerals do.Existing probiotics havent beenapprovedHe saidhis laboratory hadengineeredanewgenerationof designer probiotics,which are tailored to target certaindisease-causing microbes or toxins. Hisgoodbugs mimic receptor proteins onthe surface of harmful bacteria andblocktheir ability to infect healthy cells.Desi gner probi oti cs bi nd tobacterial toxins in the gut ... therebypreventing disease, Adrienne andJamesPaton,researchers at the University ofAdelaide, Australia, reported in thejournal Nature Microbiology.In a e-mail, James Paton said his labhad designed a probiotic that worksagainst E. coli O157, a notorious microbethats caused serious, sometimes fatal,outbreaks of intestinal disease.The needfor more effective antibioticsiswidelyrecognizedbecauseofanalarmingincreaseintheabilityofbacteria to resist standard medicines.A special concern is the virulent MRSA methicillin-resistant staphylococcusaureus a bacterium that infects andsometimes kills hospital patients.It i s becomi ng i ncreasi ngl yapparent that alternative approachesto conventional antibiotic therapy arerequiredtocontrol infectious diseases inhumans andanimals inthe 21st century,Paton said.Increasing incidence of antibioticresistance ... has forced clinical researchto explore alternative therapeutic andby the Food and Drug Administrationor subjected to rigorous clinical trials.Whentested, their effectiveness has beenmixed, medical researchers say.Now, scientists are trying to designgood bugs, novel forms of bacteriacreated in the laboratory to prevent orcure specific diseases, including HIVand cancer.Perhaps the only hope of winning thewar against bad bugs will be achievedby recruiting good bugs as our allies,e-mailed Roy Sleator, a microbiologistat University College in Cork, Ireland.Sleator is the editor of a forthcomingscientific journal calledBioengineered Bugs.prophylactic avenues, Sleator wrotein a British microbiological journal.Probiotics are finally beginning torepresent aviablealternativetotraditionaldrug-based therapy.Sleator saidhislaboratoryhadgenetically engineereda harmless strainof E. coli tosecrete a substance that mightbe useful against HIV. Hes also workingon probiotics that may assist in theprevention and decreased recurrence ofcertain cancers.Researchers caution that designerprobiotics are still under development,need further testing and governmentapproval, andsufferanumberofshortcomings.The good bugs are fragile and short-lived, Sleator said, and scientists dontunderstand very well howthey work.Paton said there was also substantialpublic mistrust of genetically modifiedorganisms, such as good bugs, whichmay leadtomarketplace resistance evento potentially lifesaving products.Nevertheless, scientists have faiththat designer probiotics eventually willoutperformnatures products.SCIENTISTS CREATE GOODBUGS TO FIGHT BAD BUGS8MEDICAL DIRECTORY|2009By Robert MitchumChicago Tribunewonder: a titanium femur.The metal bone wont give Johnson,a salesman from Princeton in north-central Illinois, the ability to kick downsteel doors or leap buildings in a singlebound. But his doctors said total femur-replacementsurgery, aprocedureperformed less than 100 times a yearin the United States, should keep himfromhaving to use a wheelchair for therest of his life or potentially having hisleg amputated.Twenty days after Johnsons surgeonsperformedthereplacement, theyshowedtheirtiredbutoptimisticpatient the kind of shiny device thathas replaced the longest bone in hisbody, as well as his hip and knee.No wonder I gained weight, Johnsonsaid with a laugh as he marveled atthe construction of the artificial bone,which actually weighs about the sameas the femurdoctorsremoved thismonth.The total femur replacement wasa last resort for Johnson, said hissurgeons, Dr. Henry Finn and Dr. KrisAlden of the University of ChicagoBone and Joint Replacement Centerat Weiss.Johnsons femur was broken duringsurgerytorepair his10-year-oldartificial hip this year, leading to a longseries of painful surgeries and difficultrehabilitation to repair the frail bone. Asmany as 20 screws and two metal plateswere implanted to support it.In September, Johnsons leg gave wayyet again in aWal-Mart parking lot, and(MCT)Shuffling through his physical therapyexercises at Weiss Memorial Hospitallast week, 81-year-old Gene Johnsondid not appear particularly bionic tothe casual observer. But beneath thecomplicated brace on his right leg wasa newly implanted device that soundsmore like science fiction than medicalsurgeons said further reconstructivesurgery likely would be futile.If nothing were done, this man wouldhave to drag a painful leg around that hecould not walk on, Finn said.Though the replacement procedurehas been around for more than 40 years,it is more typically used in patients whosuffer from rare bone cancers, saidDr. Santiago Toledo, medical directoroforthopedicrehabilitationattheRehabilitation Institute of Chicago.The surgery is rare in part becauseits demands are so complex. Johnsonsprocedure took Finn and Alden morethan five hours because of the delicatearchitecture of muscles, blood vesselsand nerves surrounding the femur.Artificial femurs also can bring concernsover durability and infection, doctorssaid.A titanium femur costs more than$20,000 in surgery, hospital care andphysical therapy. But Finn said thecost is minuscule given the potentialbenefits to patients like Johnson inquality of life.You pay $80,000 for a Lexus, so whatsa leg worth? Finn said.AldenandFinnpredictedaslowincreaseinthenumberof femurreplacements as lifeexpectancyincreases.People are living longer and theyhave more expectations on what theirgolden years are going to be like, Aldensaid.Testing out his new femur by huffingand puffing up and down three stairs,Johnson said he had a humble goalfor his restored mobility: returning toPrinceton and walkingslowlytothe bleachers of Bureau Valley HighSchool to watch volleyball and footballgames.Its an unknown; there arent a lot ofpeople around to talk to about this,Johnson said of the titaniumbone. Buthopefully itll let me live longer and domore things.1030598.MED09.cnrMAN, HIS DOCTORSSAY TITANIUMFEMURIS SPACE-AGE FIXFORDEBILITATING PAINMETAL BONE CALLED1ST STEP IN BETTER LIFE2009|MEDICAL DIRECTORY 9CZbW[ObS3gSQO`S;ORSW\9WbbWbOa1]c\bge-:ccc e-e::cc~=Lee ~e c=e e=tcee e~ LccL ~e c=e =ectLtee: Treatment of Cataracts, Glaucoma, & Eye Infections Local Eye M.D. Oering Exams & Surgeries Largest Selection of Eyewear in Central WA Complete Contact Lens Services=c`DWaW]\3f^S`baDr. Abel W. Li M.D., Dr. William R. Meyer, O.D.Leo Oltman, L.D.O., Dr. Scott Oltman, O.D.Dr. Bob Davis, O.D., F.A.A.O.c: w. ccL=v~ =c. Lte LLemeeL=c, weeedOZZSgdWaW]\Oaa]QWObSaQ][1030590.MED09.cnrBy Erin Richards Milwaukee Journal Sentinel(MCT)One M&M, swallowedwhole, andlittleNoelles skin turned as red as a Cortlandapple.A month later, after eating soy icecream, the 2-year-old turned colorsagain and started drooling, promptingher mother to inject a syringe full ofepinephrine into the childs leg.KarenTylicki of Mukwonagohas noideawhy her daughters body treats certainfoods as if they were poison. Tylicki, likeparents of a growing number of food-allergic kids inMilwaukee andelsewherearound the country, is familiar with thefear, uncertainty, grief and sorrow thatfrequently accompany the condition.Add hope to that list. Thanks to aLaCrosse clinic thats gaining attentionfor its work desensitizing patients withfood allergies, Noelle, now 6, can ingestalmost2ouncesofmilkwithoutareaction.Thespikeinthenumberofkidswith food allergies - an 18% increasenationwideoverthepast decade,according toa newly releasedstudy fromthe U.S. Centers for Disease Control andPrevention- has promptedmany schoolsand day-care facilities to develop newsafety measures.At the Childrens Community Center,a day care facility in Menomonee Falls,director Nancy Larson said the jars ofpeanut butter that were once standardin every classroom have been removedTaraWilliams, of the village of BelgiuminOzaukee County, saidher family wentthrough a period of mourning whenherthen11-month-oldson, Brett,was diagnosed with allergies to eggs,dairy, peanuts, tree nuts, sunflower andcoconut.Youstart thinking of all the kidthingsyou envisioned doing as they grew up- going out for pizza, ice cream on a hotsummer night, even just having themleave your eyesight without worrying,Williams said. You go through angerandsadness. Everything will be fine for awhile, and then hell have a reaction outof the blue, and youre all upset about itagain.Theories abound about why morechildren are suddenly allergic to morefoods. Michael Zacharisen, a physicianinthe Allergy/Asthma/Immunology Clinicat Childrens Hospital of Wisconsin inWauwatosa, saidnoneof them- theweretoo sanitized theory, the antibioticsleaching in the gut theory, for example- has been proved.Food allergy has lagged a bit behindother research because it doesnt havepharmaceutical funding, Zacharisensaid.Research on potential treatments isbecauseoftheincreaseinpeanutallergies.If someone forgot their lunch, wealways used to give them peanut butterand crackers, Larson said. Now wepurchase soy butter.In Waukesha Public Schools, DistrictNurse Twyla Lato said schools arentpeanut-free because that gives childrena false sense of security. Nevertheless, thenumber of kids in the district with foodallergies is startling: 545 students lastyear, compared with 481 in 2003-04.At GraftonElementarySchool,Principal Jeff Martyka said that fiveyears ago he didnt have any studentson epinephrine, the adrenaline-likedrug that severely allergic children aresupposedtocarry withthemat all times.Nowhe has seven.Jamie Dempsey, 6, is one of them.Although he brings his lunch to school,his allergies to milk, eggs, peanuts andsesame are so severe that he eats ona sanitized lunch tray to avoid gettingany of the offending substances on hisskin. In the classroom, Dempsey andhis classmates have hand sanitizers ontheir desks.Its hard - trying to strike a balancebetween providing awareness and notprovoking anxiety in people or comingacross as a high-maintenance mom, saidMonica Dempsey, Jamies mother.Food, emotions linkedFoodandemotions are sointrinsicallylinked that dealing with the pitfalls offood allergies can seem like a disabilityat times, parents say.more promising. At Duke University,subjects in a study are being given tinyamounts of liquid or powder peanutprotein to see if they can build up atolerance over time.Allergy Associates of LaCrosse has alsochampionedthe practice. The clinic seesmore than 10,000 patients a year whocome for sublingual immunotherapy -or the placing of tiny drops of the allergenunder the tongue to stimulate the oralmucosa. According tothe clinic, 43 statesare using the LaCrosse method to treatpatients with food and other allergies.Mary Morris, the clinics lead allergist,saidthe goal is tominimize the effects ofan accidental exposure.Patient Noelle Tylicki, who startedkindergartenthis year inGenesee Depot,will increase her dosage of milk one lasttime in January. She has completed thedesensitizing programfor eggs.I have togive her wings at some point,her mother said. She has tobe able toflyby herself.FOOD ALLERGIES ON RISE INCHILDREN10MEDICAL DIRECTORY|2009AFFORDABLEFUNERAL CARE(509) 925-2902101 East 2nd Ave.Ellensburg, WA 9892Complete funeral and cremation services available at need or by prearrangement.Locally owned and independently operated.Bonnie Marsh(509) 962-2925 A Tradition of CaringWe Honor All Existing Burial Plans1033342.MED09.cnrWI LLI AMPHI LLI P, D. D. S.107 East Mt. View Avenue Ellensburg, WA509.962.8299 www.pankeydentist.org Prevention Restoration EnhancementCaring hands, hearts and minds.Creating dentistry that ts you.1031698.MED09.cnrBy Richard SevenThe Seattle Times(MCT)SEATTLE - The Uni versi ty ofWashington has been awarded a five-Medicine and will focus on multiplesclerosis, spinal cord injury, musculardystrophy and post-polio syndrome.Although much research has beendone on these disabling conditions,very little has been done on the effectof aging in compounding the functionalproblems of persons with these fourdisabilities, says Dr. George Kraft, aUniversity of Washingtonphysiatrist andAlvord Professor of MS Research. Thiscenter will be the first to explore theseimportant research questions.The grant was awarded by the NationalInstitute onDisability and RehabilitationResearch.K. Warner Schaie agreed to presentfindings from his exhaustive study onaging at last years Washington StatePsychology Association conference, butonly if he could bring 26 guests. Theyranged from74 to 101 years old and hadstuck with him for a half-century.They were a handful of the 500 subjectswho enrolled in the first year of theSeattle Longitudinal Study in 1956. Stillgoing, it is considered by many to be themost extensive and lasting psychologicalresearch study on how people developand change cognitively as they age.Information from it has helped changemandatory-retirement lawand combatphrases like having a senior momentyear, $4.5 million grant to researchspecific challenges related to aging witha disability.The Aging Rehabilitation Researchand Training Center will be based inthe University of Washington MedicalCenters Department of Rehabilitationand other examples of ageism.Schaie, whois 80, has publishedbooks,monographs, chaptersandpapersand testified before Congress aboutage discrimination in the workplace.Butrecallingthedayhepresentedhis information alongside the peopleinstrumental in building the databasemakes him smile.Oneofmysubjects,a101-year-old woman, sat in the front row, hesays. And she was scribbling all thesenotes.A LONGTERM STUDYEvery sevenyears, Schaie and his teamhave tested and added people to thestudy. About 6,000 people, insome casesrepresenting three generations of thesame family, have been tested at leastonce.The st udy exami nes heal t h,demographi c, personal i t y andenvironmental factors that influenceindividual differences. Subjects takecognitive tests and answer psychologicalquestions while researchers try to learnwhy some people stay sharp well intoold age while others falter.In recent years, investigators havedrawn blood samples and administeredbrainscans to add neurological evidenceto the database, some of which mightone day be relevant to the early detectionSTUDY ON AGING STILLGOING STRONG SOME 50 YEARS LATER2009|MEDICAL DIRECTORY 11EarNose & ThroatC L I N I CE L L E N S B U R G2205 W. Dolarway, Suite 3 Ellensburg509-962-5111J. Harden Howell, MD & Cheryl L. Varner, MDAlso oering cosmetic procedures1033329.MED09.cnrOrthodontics for Children & AdultsMichael L. George, DDS, MSDUniversity of Washington Dental School and Orthodontic Program Graduate315 N. Sprague|Ellensburg, WA|509.962.6902|877.416.6902Free Consultations|Flexible Payment Options|Insurance AcceptedBRING IN THIS AD AND RECEIVE $100 OFF SERVICES.1033394.MED09.cnrof dementia.Psychologist Alejandra Suarez, whoteaches at Seattles Antioch University,says following the progress of the sameset of subjects for so long has madeSchaies study especially valuable.Many studies about how peoplechange cognitively are done by askingpeople of different ages to participatein the studies - which is like taking asnapshot of how different generationsfunctionintellectuallyat asinglemoment in time. But those results aremisleading because the differencescan be due to changes in education,nutrition and diversity of opportunitiesover generations.What Dr. Schaie has done isinvite people to participate and theninterviewed and assessed them everyseven years, to see how a particularperson changes and evolves, comparedto his or her original abilities. This meansthat he can rule out that the changes aredue to generational opportunities andchallenges.Continued on the next page.INTHE FAMILYWhileanundergraduateat theUniversity of California in 1951, Schaieworkedinthecomposingroomofthe San Francisco Chronicle. Becausethe newspaper was published in themorning, he worked late into the night,shrinking the range of classes he couldtake and leading him to conduct anadult development study as a way to getcredits.His family doctor happened to have ageriatric practice, too, andallowedSchaieto survey willing patients. To Schaiessurprise,hewasinvitedtopresentfindings fromhis studyat aninternationalgeriatrics conference inSt. Louis. He gotthere by Greyhoundbus andmet some ofthe leaders inthe small but growing field.When he was accepted into graduateschool at the University of Washington,he chose, as his niche, gerontology.People would say who is this crazyyoung guy interested in old people,hesays,laughing. Whydoesnthedo something mainstream? It wasntmainstreamback then.He got his initial sample (and everysubject since) for the Seattle LongitudinalStudy from Group Health Cooperative.He left Seattle upon graduation butcontinued to return to retest and addmore tothe study. Eventually he openedapermanent office here andbegantestinghis subjects offspring. The work is fundedby the National Institute on Aging.80 ANDSTILL GOINGHaving just retired from Penn StateUniversity, Schaie and his wife, fellowscientist Sherry Willis, moved back toSeattle. Willis has been co-investigatoron the study since 1983.The subjects alsohave helpedscientistslearn about whether people can recovermentalfunctionthroughintensivetrainingsessions. That sort of workhelpedinspire the brain fitness software andbooks that flood the market today eventhoughSchaiebelieves someof theclaimsbehindthose products have not yet beenfully validated through research.Along the way, he has studied howlifeevents, fromlosing a spouse torecoveringfrom cancer, affect a persons cognitiveability and has searched the data fornuances. There are all sorts of factors thatcan hasten decline, but Schaie has alsoseen cases where scores improve, suchas when a cancer treatment has beensuccessfully completed or someone hascome to terms with a spouses death.Howyouliveyourlifemakesadifference as to how you will move intoold age, he says. You dont suddenlybecome a member of a difference specieswhenyougrowold. Its clear that a personwho is quick-minded and not rigid inhis thinking has an advantage. Thingschange, but if youre a good problemsolver or successfully handleda personalcrisis when you were younger you willlikely continue to do so.He also believes that education andcontinuingcuriosity may protect apersonfrom rapid decline. Why does he, at 80,still collect and interpret the data?I really dont have any compellinghobbies that challenge me, Schaie says.I findthis stimulating, my work is still indemand to a degree and I get to remainintouchwithmy colleagues, whoare alsomy friends - and thats important, too.12MEDICAL DIRECTORY|2009Dr. Julie A. Grebb, ND, LMPLicensed Naturopathic Physician& Massage Practitionerww.ndaccess.com/vnhealthRand Gillen, NA, LMPLicensed Massage TherapistEnergy Work& Medical Massage TherapyMost Insurance Accepted509.925.1525 507 North Pine, Suite EVALLEY NATURALHEALTHFamily owned since 1977111 West 6th Avenue Ellensburg509-925-2505- Bulk Foods, Herbs 8 Spices- Nutritional 8 Fitness Supplements- Nutrition for your skin- Expanded Gluten-Free SelectionYour Complete Whole Foods Narket509.929.3838Jane McClenney, Move LightlyCertied Feldenkrais Practitioner Decrease Pain Increase Flexibility Movement Education Classes Functional Integration CraniosacralDAVID L. WRIGHTD.D.S, P.SGeneral DentistryNEW PATIENTS WELCOME962-6172Preferred ProviderWa. Dental Service309 E. 2nd, EIIensburg 24 Hour Access to Nationwide Clubs State-of-the-Art Equipment Secure Comfortable Clean509-925-5445www.anytimetness.com2305 Dolarway Rd.Ellensburg, WADON A. CHILDRESS, D.C.Health Through Chiropractic502 N. Ruby Ellensburg, WA 98926(509) 962-9796Fax (509) 962-9019KITTITAS VALLEYCHIROPRACTICNorIbwesI Audloloqy& Hearlnq AldCenIer1rust Cnv un Audoogst or SOUND ADVICE!962-9575603 N. Mun Sute 2Lensburg, \A 98926MikeHeadley R.Ph.IndependentHerbalifeDistributorGuaranteedWeight Loss,Gain or Maintenancewith Cellular Nutrition509 or 866-962-61052009|MEDICAL DIRECTORY 13By Don SapatkinThe Philadelphia Inquirer(MCT)PHILADELPHIA - In the late 1700s,Italian anatomist Luigi Galvani made adead frogs muscles twitch when struckby a spark, a discovery that paved theway for the modern understanding ofelectricitys role in living things. It is thebasis for countless medical technologieslike the pacemaker.But electricity does not travel easilythrough the skull to the brain, the organresponsible for every purposeful twitchand altered mood. So when a group ofBritish scientists in 1985 used magneticpulses from outside the head to inducean electrical field inside the brain - andgot a subjects hands to move - theircolleagues clamored for a chance to zapthemselves.That breakthrough, knownastranscranial magneticstimulation(TMS),ledtotheFoodandDrugAdministrationsapproval last monthof thefirstnoninvasive, non-pharmacologicaltreatment for depression.As a practical matter, approval ofthe device made by Neuronetics Inc.,a five-year-old Malvern, Pa., company,is intended for patients with majorErnie Mercer in the late 1980s, Prozachad just come on the market, and itworked. When depression struck againfive years ago, it didnt. Neither didEffexor or a third drug. Worse, they madehim nervous and constipated.For Mercer, a retired engineer wholives near Atlantic City, depression waswithdrawal from life. Nothing was funanymore, he said.He answered an ad seeking researchvolunteers for anexperimental treatmentin 2005.Theclinical trial oftranscranialmagnetic stimulationwent like this: Hedshowup at a University of Pennsylvaniaclinic five times a week, answer the sameset of questions about his mood, andthen sit in what resembled a dentistschair for 40 minutes with earplugs inhis ears and an apparatus strapped tothe top left of his head. He heard loudclicking sounds but felt nothing.After four weeks, a sensationsuddenlymatched the clicking - kind of likesomebody tapping on your scalp like10 times a second, he said - and hisdepression began to lift. He had beeninitially assigned to the sham(placebo)group; now he was getting TMS. Afterseveral weeks of the real thing, he feltfine. He still does.Mercer, 65, paid nothing for eithertreatment-resistant depression whodo not respond to any one medication.Millions of Americans fail to benefit fromantidepressants, and millions more quitbecause of side effects.Symbolically, the federal action is abig deal - another advance in a groupof emerging fields that involve electricalstimulation of the brain.Our view of the brain is changing,said Mark S. George, a professor ofpsychiatry, radiology and neuroscienceattheMedicalUniversityofSouthCarolina.Just 10 or 15 years ago, scientiststhought of the brain as a single entity- what he called the brain-as-soupmodel. But really you want to treatspecific regions in the brain.George is editor in chief of a year-oldjournal named Brain Stimulation, andhe is a champion for the cause. Afterdecades of success with psychiatricdrugs, he said, we had forgottenthat thebrain is really an electrical organ.Researchers worldwide are testingtherapies ranging from highly invasiveelectrical implants to hardly noticeablemagnetic fields ondozens of psychiatricand neurological disorders. Successhas been limited - but so are currenttreatment options.When a major depression envelopedthe treatment series or twice-monthlymaintenance sessions ever since. Theresearchgrant ends this month, however,and the clinic will charge him$150 onitssliding scale if health insurance doesntcover it; most of the clinics patients arelikely to pay at least $200. Insurers arejust now beginning a review.The new treatment is not a panacea.An unrelated study two years ago foundthat, of patients who failed to benefitfrom one antidepressant medication,just one-third responded adequatelyto a second. TMS produced a similarresponse rate (as does talk therapy,according to other studies), althoughthe effect was described as greater.The biggest difference is side effects,which cause many patients to stoptakingantidepressants. Themostcommonly reported side effects to thebrain stimulation were headaches andscalp irritation, both temporary.TMS poses a slight risk of seizure.No incidents were reported in data on10,000 sessions submitted to the FDA.Neuroneticsdidntseekapprovalto treat all major depression; whenantidepressants work well, they arehard to beat. Still, the FDA rejected theinitial application last year to use theNeuroStar TMS device for treatment-resistant cases generally.Areanalysisof dataonthe301patients in the multicenter trial foundthe strongest response among thosewhohadtriedandfailedwithjustone drug, and thats what the agencyapproved. Patients like Mercer, who gaveup on three, can be treated off label,which may be less likely to qualify forreimbursement.Oddlyenough, TuftsUniversitypsychiatrist Daniel Carlat said he wouldbe more likely to steer those patients -the ones least likely to respond - towardTMS because theyve run out of easyalternatives.Carlat, who has no connection withthe manufacturer or drugmakers, haswritten skeptically about TMS in pastissues of his Carlat Psychiatry Report.He said the latest findings changed hismind.Psychiatrist John OReardon, whoran the Neuronetics-funded trial atPenn and is beginning to study TMSforAttentionDeficitHyperactivityDisorderinadolescents, believesthat many people who cant tolerateantidepressants will find this easierdespite the inconvenience of 20 to 30daily sessions.They come in and sit in the chair,we slap a magnet on their head for 30ELECTRICAL STIMULATION OF THE BRAIN ABREAKTHROUGH IN TREATING DEPRESSION14MEDICAL DIRECTORY|2009Dr. Donald W. Orminski307 S. 12th Ave, Suite 9Yakima, WA 98902509.248.4900 800.676.46751033390.MED09.cnrminutes, and afterward they can gohome, said OReardon, director ofPenns Treatment Resistant DepressionClinic.static magnets. The electromagnet inthe new device is thousands of timesmore powerful, similar to that of anMRI,said Neuronetics chief executive officerBruce Shook.In repetitive transcranial magneticstimulation(rTMS), rapid series ofpulses pass through the skull and inducean electrical field on the surface of thebrain, exciting the neurons below.For depression, the target is a postagestamp-size part of the left prefrontalcortex that is less active in depressedpeople. Scans confirm more activityafter successful treatment of any kind,although the exact mechanism is notknown.The therapy is being studied for post-traumatic stress; obsessive-compulsiveand panic disorders; fibromyalgia; andother conditions.The most promising results are fordampening the auditory hallucinationsthat schizophrenics describe as hearingvoices. Ralph Hoffman, aYale psychiatryprofessorwhobeganstudyingthetreatment 10 years ago, said the latestdatashowed asignificanteffect,although years away from clinical use.ItistherepetitioninrTMSthatseems to retrain the neurons and bringenduring change. Single-pulses, calledsTMS, have a short-term effect.Neuralieve Inc., of Sunnyvale, Calif.,has applied for FDA approval of itsportable, handheld sTMS device forthe one-third of migraines that arepreceded by recognizable visual orsensory symptoms known as auras.The battery-operated device is aboutthe size of a hair dryer. At the onset ofsymptoms, you place it against the backof your head and press a button. After30 seconds to recharge the batteries,you deliver a second pulse. The short-termstimulation disrupts the spread ofabnormal brain waves.It left nearly 40 percent of participantsin a recent clinical trial pain-free aftertwo hours, said Terese M. Baker, thecompanys vice president of marketing.You can stop the migraine progressionbefore it takes root, she said.The oldest form of brain stimulation,dating to the 1930s, is electroconvulsivetherapy. It is the most effective treatmentfor major depression. Once stigmatizedas electroshock, ECT has been refinedin recent years. But it works by causingseizures, and the risk of serious sideeffects, especially memory loss, stilllimits its use to the most serious cases.A kinder, gentler version may be inthe works. Sarah H. Lisanby, a professorofclinical psychiatryatColumbiaMagnet t herapi es have beenadvertised for years, usually to relievepain, but have not been proved to workin rigorous trials. Most rely on simple,University, developed magnetic seizuretherapy (MST), which uses magneticpulses to induce seizures.With magnetic fields, we have bettercontrol, she said. The seizures are morefocused and less robust.Lisanby, who is researching severaltypes of brain stimulation, thinks thatpart of the potential of these fields liesin the ability to tailor treatments for anindividual. Magnetic and electrical fieldscanbe aimed at a variable target. Todaysdrugs cannot be.Anthony T. Barker has been followingall these developments with interestfrom afar. Barker led the team thatzapped a mans brain with a magneticpulse in 1985 and got his hand to move.And while none of the newtherapies wason his radar screen at the time, so manycolleagues wanted tohave a go that heknew something would come of it.Itisarguablyoneofthecoolestdemonstrations of physics effect on thehuman body, said Barker, a professor inmedical physics and clinical engineeringat Royal Hal l amshi re Hospi tal ,Sheffield.If you were here, I would zap yourbrain and make your hand move, andyou would think it was cool, too.___Brain Stimulation TherapiesAtleastninemethodsarebeingstudied.The most common:_Transcranial magnetic stimulation(TMS)With the patient awake in the office,external magnetic pulses induce anelectrical field on the surface of thebrain, activatingneuronsbelow.Noninvasive._Electroconvulsive therapy (ECT)Electrical stimulation of the scalpunder anesthesia induces a wave ofactivity across the brain - a seizure. Agentler, magnetically triggered versionis being tested._Vegus nerve stimulation (VNS)Apacemakerinthechestsendselectrical impulses to electrodes incontact with the vagus nerve in theneck, and then up to the brain._Deep brain stimulation (DBS)This is similar to VNS, but electrodesare surgically implanted in the brainto stimulate precise regions in variousdisorders. Highly invasive.2009|MEDICAL DIRECTORY 15 24 hour specially trained sta Life enhancing activities Transportation Paid utilities, except phone And much more818 East Mountain View EllensburgCall today for a complimentary tour and lunch509-925-12201033392.MED09.cnrBy Josh GoldsteinThe Philadelphia Inquirer(MCT)PHILADELPHIA - Diabetes has costRobert Heard dearly. His left leg wasamputated below the knee two yearsago. Kidney failure - with its specialdiets, thrice-weekly dialysis, and ever-present threats of infection - is worse.It breaks you down mentally, saysHeard, 32, who has been waiting fora second kidney transplant since thefirst, donated by his uncle, failed fourproblems or heart disease often come tomind. Thats a correct association, but sois kidney failure.The number of Americans diagnosedwith the condition increased five timesover the past three decades, a period thatalso sawa staggering rise in the numberof Americans with diabetes.Nearly half of all kidney failures in thiscountry are now caused primarily bydiabetes, according to a leading federalhealth agency.The link is incredibly powerful,says Richard C. Wender, professor ofyears ago.Heard was diagnosed with Type 1diabetes at age 10, and said he managedit well for 15 years until, as an adult,he changed jobs and lost his healthinsurance. Unable to get the medicineshe needed, the Logan resident lostcontrol of his blood sugar levels.Likemany peoplewithanuncontrolledchronic illness, Heard regularly endedup in the emergency room. And likemore and more diabetics, his kidneysfinally gave up.Ask someone about diabetes, and eyemedicine at Jefferson Medical Collegein Philadelphia. Diabetes is the leadingcause of kidney failure in the U.S.The United States spends $34 billiona year on kidney failure. And the bulk,more than $20 billion a year, is coveredby taxpayers through Medicare.About 24 million people nationwidehave diabetes, federal authorities say,and 57 million more are prediabetic -with elevated blood sugar levels that putthem at high risk for the illness.That means 81 million people, aboutoneinfourAmericans, areeitherdiabetics or potential ones.For doctors, patients andpolicymakers,the health-care systems inability tostop preventable kidney damage fromdiabetesisfrustrating. Withgoodprimary care, diabetes can usually bemanaged, or even spotted and stoppedbefore it fully develops.But the system doesnt pay well forpreventive care. Many patients arenteducatedonhowtomanagetheirconditions. Drugs canbe expensive, andmany people lack good access to care.Even those who see their doctorsregularly could get in trouble becausegooddiabetescaretakestime, acommodity that few caregivers haveto spare.Kidney failure can be caused by eithermajor form of diabetes: Type 1, onceknown as juvenile onset, arises fromthe bodys inability to make insulin, akey hormone that regulates the bodysblood sugar levels.Type2, themorecommon, candevelop at any age, and is caused bythe bodys failure to use insulin. Bothcandamage the kidneys and cause death ifleft untreated.Each kidney is essentially a giant filtermade up of roughly 1 million smallerLOU SAVIDGE INSURANCE AGENCYGet health carecoveragefor less than the cost ofa latt per dayLou Savidge - Agent(509) 962-57931-800-829-5793Authorized Agent for:1030596.MED09.cnrFOR DIABETICS, PREVENTING RENAL FAILURE ISHARD WORK BUT ESSENTIAL16MEDICAL DIRECTORY|2009Ellensburg PediatricsComplete Healthcare for Infants, Children & AdolescentsElise J. Herman, MD Victoria A. Perkis, ARNP Janet A. Penny, MD611 South Chestnut Street, Suite E509.962.KIDS (5437)Open to New Patients!1031105.MED09.cnrfilters known as glomeruli. These tuftsof tiny vessels remove waste, but notnutrients, from blood.Over many years, the excess sugar ofdiabetes harms the membranes of thosevessels. An early sign of kidney diseaseis the appearance of tiny amounts of theprotein albumin in the urine.If the filter is not working, you canlose a lot of the good stuff into yoururine, says Mitchell A. Lazar, director ofthe University of Pennsylvanias Institutefor Diabetes, Obesity and Metabolism.At the same time, waste products andexcess fluids buildupinthe bloodstream.So patients must get their blood cleanedartificially.One way to accomplish this is to pluginto a mechanical kidney.Catheters are placed into vessels inthe arm, enabling large amounts ofthe patients blood to pass throughthe machines filter and back into thebody.Patients must undergo this treatment,called hemodialysis, for at least severalhours three times a week.The treatment can cause many sideeffects, ranging fromnausea and anemiato infections and sudden drops in bloodpressure. Catheters also can becomeclogged, requiring multiple procedurestoclear or make newopeningselsewhere.How can you avoid all this?Thebeststrategyistopreventdiabetes - and the most effective way inthe majority of patients, said JeffersonsWender, is to maintain a normal weightand exercise regularly.A better diet may help, including lotsof fruits and vegetables.Socancontrollinghighbloodpressure, a commonprecursor to kidneyproblems.Nearly everyone should get routineblood tests to catch diabetes before itdamages the kidneys, said Jeffersonendocrinologist Serge Jabbour.It is not uncommon for people withType 2 diabetes to live with the diseasefor five or 10 years before developingsymptoms that cause them to seektreatment, Jabbour said. During thattime, high blood sugar levels could bedamaging the kidneys.If the worst happens and your kidneysfail, a good attitude can still help.You need to stay happy, because themore upbeat you are, the better thingsgo, said Heard, who has gotten care atAlbert Einstein Medical Center in NorthPhiladelphia. The challenges of livingwith the condition are an everydaything, he said.Another patient, Ben Walters, 48, hasbeen controlling his blood sugar to keepthe disease from progressing.Diagnosed with diabetes in 1990, theCenter City resident has since developeddiabetes-related nerve damage in hisrightknee-aconditionknownasCharcots joint - that severely limitshis ability to walk, forcing him to use awheelchair.Despite that and everything else -getting dialysis three times a week thatoften leaves himweary, and giving up ajob he loved as deputy inspector generalfor the City of Philadelphia - Walters triesto remain focused.I think I have extended my life,he said last month after four hours ofdialysis.Trusted Medical Care PlanningMedicare SupplementsGroup Medical Insurance PlansIndividual Medical Insurance PlansDental & Vision CoverageCall 925-1811 or Toll Free1-800-258-4294205 S. Main St., EllensburgVirginia Gayken InsuranceLisa Cruse, AgentChristi McCune, Agent1030593.MED09.cnr2009|MEDICAL DIRECTORY 17Royal Vista Care Center offers manybenets to our residents Medicare Certied Speech Therapy 24-Hour Skilled Nursing Care Restorative Care Diverse Activity Program Nutritious Meals Individual Care Plans Special Diets Physical Therapy Secured Exits Occupational Therapy Three Enclosed Patios Community InvolvementA Prestige Facility Quality Care at a Reasonable Price For more information please call or visit Royal Vista Care Center. We are available to meet with you at your convenience.925-14041506 Radio Road EllensburgWe provide vision and medical eye care for patients of all ages. New patients and emergencies are welcome.Most major insurances and medicare accepted.2 Locations to Serve YouEllensburg301 E. 2nd Ave509-925-9873Cle Elum807 West DavisSuite 102A509-674-4313www.familyeyeclinicwa.comComplete Family Eye Care for Over 50 YearsOptometric PhysiciansSarah K. Storrs, ODByron E. Thomas, OD, FAAOComplete Family Eye Care for Over 50 YearsFAmzzv 2vz czzwzc1035239.MED09.cnrBy SabineVollmerMcClatchy Newspapers(MCT)RALEIGH, N.C. - WhenRachel SkerganInstead, they would rely ontechnologyto allow her to hear and talk.Rachel, now a chatty 5-year-old fromRaleigh, received a cochlear implant inher left ear when she was 10 monthsand another in her right ear when shewas 2. Weekly therapy sessions helpedher interpret and reproduce soundsthe implants generated, and her familytook extra steps to improve her listeningskills.But still missing was music.Rachel could hear melodies and beats.She could carry a tune, and she followedthe beat when she danced, her mother,Natalie Skergan, said. Still, the detailsof music were missing - the plinkingof piano keys, the rat-tat-tat of a drumbeat or the weeping of the strings in afull orchestra at play.To capture those details, Rachel hasbecome one of the first children inthis country to be fitted with the latestcochlear technical upgrade: a speechprocessor that promises to improve thehearing of music.The device was brought to market thissummer by a small Durham companycalled Med-El. The privately ownedAustrianfirm,whichputitsNorthAmerican headquarters in Durhambecause of the scientific expertise intheTriangle, is one of only three cochlearwas diagnosed with congenital deafnessshortly after she was born, her parentsmade a choice that would alter her life:She would not be taught to signwith herhands or read lips.implant manufacturers in the UnitedStates.In the more than 20 years since theFood and Drug Administrationapprovedthe first cochlear implant, microchipsinside processors have gotten smallerand more powerful. That has improvedthesoundquality, butbiomedicalengineers are still working to capturethe full range of musical sounds.Med-Els technology, like that of theothermanufacturers, digitizesthesound that is picked up and sent to theelectrodes implanted in the patientscochlea. Med-El claims its softwareallows it to better fine-tune the signalreceived by the patient.Because music is such a complexsound, research nowfocuses onsoftwarethat would allowanaudiologist to betterprogram a processor to each personshearing damage, said Charles Finley,a biomedical engineer who teaches atthe University of North Carolina-ChapelHill and North Carolina State University.Finley was part of a group of Triangleresearchers who in the mid-1980s cameup with the multiple-electrode designthat cochlear implants still follow.Every system has its limits, Finleysaid. The same implant system cando remarkably well in one person andpoorly in another.TECHNOLOGICAL ADVANCESIMPROVE SOUND OF MUSIC FORHEARING-IMPAIRED CHILDREN18MEDICAL DIRECTORY|2009Technological limitations are partlywhy only half of the children who couldbenefit from a cochlear implant haveone. Of about 38,500 Americans withcochlear implants, 15,500 received themas children, according to the most recentfigures from the National Institute onDeafness and Other CommunicationDisorders.The hearing of deaf children developsbest with cochlear implants in placeearly on. The longer the auditory nerveisnt stimulated, the more likely it is thatthe brain uses nerve cells dedicated tohearing for other purposes - a processthat is difficult or impossible to fullyreverse. The implications go beyond justbeing able to talk and listen; the abilityto fully appreciate music has beenlinkedto better math skills.Cost - an implant costs about $70,000per ear including surgery - poor access toaudiology and auditory-verbal therapydaughters first word three months afterthe first cochlear implant was activated:Rachel said, Uh-oh, whenshe droppedsomething sitting in her high-chair.Skergan doesnt expect changes thatmemorable from the newest processorupgrade. But I expect changes, she said.I hope shell say, This sounds better. Iexpect music to be even better.Thefirstsessiontoprogramthenew processor, which included settingsound levels on the 12 electrodes insideRachels ear, didnt go well. Relying onlyon the implant in her right ear, Rachelpicked up a blue crayon after beingasked to show a red one. Then HollyTeagle, an audiologist and the UNCclinics director, turned up the currenton all the electrodes simultaneously.Hey, too loud, Rachel protested.After Teagle had adjusted the currentto a more acceptable level, Rachel wasspeaking loudly. I can still hear, sheservices, and insufficient insurancereimbursements are also to blame,according to a paper published in Aprilin a peer-reviewed medical journal.TheSkergans, becauseof theirproximity to the same scientific expertisethat brought Med-El to the Triangle,were able to overcome many of thebarriers to cochlear implants. Rachelssurgeon, audiologist andauditory-verbaltherapist are all in the Triangle, as is themanufacturer of all her implants.The new Med-El processor RachelreceivedinAugustwaspartofanupgrade that the Skergans chose atthe time of Rachels surgery in 2006. Toturn on the new processor - a thumb-sizedevicethathooksontheear-Rachel sat through more than 10 hoursof programming at UNCs clinic forchildrens communicative diseases inDurham.Natalie Skergan rememberedhersaid. I can hear weird.A test in a sound booth confirmedthat more time would be needed to fine-tune the processors program. Teaglescheduled three more sessions, eachabout three hours long. Shortly after theprogramming sessions restarted threeweeks later, Rachel said she liked hernew processor better than the old one,her mother said.Shes over the hump, Teagle saidduring the final session.Like previous technological upgrades,programming Rachels new processorhad taken time and effort. But NatalieSkergan had no regrets.Wed do it again in a heartbeat,she said. The gift to have her hearingrestored is priceless.2009|MEDICAL DIRECTORY 192811 Tieton DriveYakima WA98902 509 | 575-8000 www.yakimamemorial.orgState-of-the-artSPECIALTY MEDICAL CAREright here in Central Washington.Cancer CareCardiac CareGenetic ServicesInfusion CareInterventional Pain CareNeonatal Intensive CareNeurosurgeryOrthopedicsPhysical Medicine and RehabilitationPlastic SurgerySleep MedicineVascular MedicineWound ManagementCancer Care 877.902.3324Vicky Jones, MDThomas Boyd, MDSleep Medicine 509 | 452. 5378Georey Greenberg, MD100 East Jackson, Suite 104Ellensburg, WAquality & Expertisein Kittitas County.quality & expertise20MEDICAL DIRECTORY|2009State-of-the-art-Surgical Services24-Hour Emergency CareLevel IV Trauma CenterCritical CareHome Health & HospiceFamily Birthing CenterImaging ServicesLaboratory ServicesRespiratory ServicesPulmonary Function LabEndoscopyPhysical TherapyOccupational TherapySpeech TherapyNutrition ServicesTDD 925-8472962-9841E XCE P T I ONAL COMMUNI T YHE AL T HCAR EKVCH SPECIALTY CENTERSCle Elum Medical Center & Cle Elum Urgent Care Center201 Alpha WayCle Elum, WA98922509-674-5331Kittitas Valley Internal Medicine700 East Manitoba Ave.Suite 101Ellensburg, WA98926509-925-6100Also home to the Anticoagulation ClinicKittitas Valley Orthopedics611 South Chestnut St.Suite DEllensburg, WA 98926509-933-8700Call for information about hip resurfacing603 South Chestnut Street Ellensburg, WA98926www.kvch.com1031106.MED09.cnr