Weeks patients can now see medical specialists 'On TV'

By Bonnie Barber

In early May, 83-year-old Pauline Labrecque had a consult with Dartmouth-Hitchcock Medical Center (DHMC) nephrologist Thomas Kaneko, MD. A diabetic, the Groveton, resident had been experiencing kidney problems. But instead of traveling 100 miles from her home to DHMC in Lebanon, Labrecque's daughter Rose McGlone drove her ten miles to Weeks Medical Center in Lancaster, where she had a telehealth appointment with Dr. Kaneko.

"I really enjoyed talking face-to-face with the doctor on the TV," says Labrecque, who worked for 41 years at the Groveton Paper Mill before retiring. "It was just like he was there sitting in front of me. And it saved quite a trip for us. It is two hours down to Dartmouth and two hours back, so this was nice."

She talked to Dr. Kaneko via the built-in camera and monitor on a telemedicine cart while sitting in an examination room with Weeks registered nurse Maureen Eaton at Weeks' Lancaster Physicians Office. Labrecque is one of more than 20 patients Dr. Kaneko has seen since March, when DHMC's Nephrology and Hypertension section and the D-H Center for Telehealth launched a chronic kidney disease program with Weeks. Care Coordinator Lisa Wheelock, RN, who runs Weeks' telehealth program, says patients have been "thoroughly impressed" with the telehealth consults. "Our list continues to grow, with new patient referrals every month," she says.

Help Managing Patients with Chronic Disease

Weeks had earlier partnered with DHMC on a telehealth kidney dialysis clinic in 2014, in which patients consulted with DHMC nephrologists during dialysis, using an iPad with secure video software to talk to them. With no nephrologist on staff, Weeks needed additional help managing its large volume of chronic kidney disease patients whose conditions had not yet reached the dialysis stage.

According to Brian Remillard, MD, section chief of nephrology and hypertension, Weeks has about 100 primary care patients with glomerular filtration rates of less than 30, who have never been seen by a nephrologist. GFR is a measure of how well your kidneys filter blood and a number below 60 may indicate kidney disease. While several Weeks patients had been receiving care at DHMC, Dr. Remillard says many patients were finding it increasingly difficult to travel to Lebanon.

"We've seen patients not coming to DHMC for appointments because of cost, distance, and economics," says Dr. Remillard, who notes that patients whose kidney conditions are not managed by a nephrologist may ultimately wind up in the intensive care unit. "So we started to pick out patients from the North Country and asked them if they wanted to try the telehealth solution."

"We had a willing partner in Weeks Medical Center," adds DHMC continuing care manager Judy Dixon, RN, CNN. "And we knew we had patients in need because we had more than a handful who said they just couldn't get down here any more."

DHMC's chronic kidney disease team then worked with the D-H Center for Telehealth to set up the new telehealth program. Jamie Carmichael, the Center for Telehealth's ambulatory care service project coordinator, says the project launch was seamless since Weeks already had two telemedicine carts in place. They are being used for Weeks' telehealth programs with DHMC's rheumatology and dermatology sections, and by an ALS patient who consults with his DHMC neurologist via telehealth. The telemedicine carts were distributed to Weeks thanks to a nearly $1 million United States Department of Agriculture grant awarded to the Center for Telehealth in 2014 to help fund the deployment of telemedicine equipment and services across six counties in rural New Hampshire and seven counties in rural Vermont.

Telehealth Consultation

During Labrecque's telehealth consult she spoke first via live video with D-H continuing care manager Patricia Borden, RN, CNN, just as she would have done during an in-person consult. After answering questions such as whether she learns best through reading, videos, or one-on-one sessions so that Borden could provide her with the appropriate educational materials, Dr. Kaneko then appeared on Labrecque's monitor. Dr. Kaneko asked questions about her health and was also able to perform a physical examination thanks to two electronic stethoscopes—one at Weeks and the other in Dr. Kaneko's office—that communicate with each other.

"The fact that I can listen to someone's heart from 100 miles away just fascinates me," says Dr. Kaneko, who explains that the nurse places the stethoscope on the patient's chest and the sound is transmitted directly to his stethoscope, enabling him to listen to their heart and lungs. "I can really do a fairly thorough assessment of patients. There are certain very sick, very complex patients that you have to see in person and certain procedures that you have to be physically present for. But so far, with select cases, we've been able to take care of patients. And they seem to really like the telehealth option."

McGlone was certainly impressed by the high-tech care her mother received at Weeks. "I was amazed that the nurse here could put certain instruments on her (a detachable camera) and the doctor could see if she had swelling in her feet," McGlone says. "We don't have many healthcare options here in North Country, so this is very helpful for people up here. It eases the mind, body, and spirit knowing that we can get this kind of care."

Convenience and Effectiveness of Telehealth

"For a patient who is doing very well and managing his or her medical issues okay, this is a fantastic way to see them," Dr. Kaneko says. "We'll be monitoring her blood pressure, because keeping that under control is key to avoiding dialysis, and also monitoring her potassium and vitamin D levels, among other things. But the nurse at Weeks or her primary care physician can do this testing and then provide me with the results. She just needs a nephrologist to oversee everything."

Weeks' director of physician services Rona Glines says that patient feedback has been extremely positive, and that patients appreciate the convenience of telehealth and the access it gives them to specialists.

"Having the telehealth clinics in our Lancaster office allows patients to receive services closer to home, often in the same office where they see their primary care provider," says Glines. "Traveling to DHMC is time-consuming and can be a real hardship for some of our patients. By partnering with specialty practices at Dartmouth-Hitchcock, we have increased our knowledge in those areas, which has been helpful in caring for our patients."

md kaneko thomas 073115 oname mDr. Thomas Kaneko, nephrologist at Dartmouth-Hitchcock Medical Center, consults with and examines patient Pauline Labrecque at Weeks Medical Center via telemedicine technology. (MARK WASHBURN PHOTO)

Serenity Steps open house Oct. 9

BERLIN — Serenity Steps, a peer support center located at 567 Main St. in Berlin is hosting an Open House on Friday, Oct. 9. This is open to the public, and will be from 11 a.m. to 4 p.m. Light refreshments will be served all day. The members of Serenity Steps have invited the community to come to their center, enjoy a nibble or two, and learn what a peer support looks like and what it has to offer. For more information, call (603) 752-8111
A peer support center, like Serenity Steps, is a place for people who have, or had mental health challenges will find a safe place to learn and grow together. The mission of Serenity steps is “to provide a sanctuary where people 18 years old and older learn to create a personal vision leading to their own recovery. This journey toward recovery occurs in a compassionate atmosphere through education, peer support, sharing of common experiences and utilizing individual as well as community resources".
“The center is sort of like a plant pot,” states Ellen Tavino, the Team Leader, “we provide a protected place for their plants to grow.” This means the person is allowed to decide what their recovery—or journey to wellness—will look like. No one at Serenity Steps is an expert on another’s experience, nor does anyone there dictate what another’s life should be.
Approximately one in five families is impacted by some form of mental illness. But, there is hope. People can, and do move forward from such challenges. Serenity Steps is a place where that can happen.

Cutline: Children at the Gorham Learning Center learn Tai Chi

kandsSue Martin from K & S Fitness came to the Gorham Community Learning Center to teach the children Tai Chi. She incorporated animals into the session to go along with the GCLC’s newly adopted Zoo Phonics curriculum. The GCLC serves children from ages 18 months to 12 years old with high quality childcare and education. If you would like any information or would like to inquire about enrollment please call, (603) 466-5766, or stop by 123 Main Street, Gorham.

Veteran stories to become part of medical record at White River Junction VA hospital

WHITE RIVER JUNCTION, Vt. — The White River Junction VA Medical Center has joined six other VA hospitals in a program that interviews veterans about their life stories and makes the transcribed oral histories part of the patients’ medical record.
The program, called My Life, My Story, was started by the VA Hospital in Madison, Wis., in 2013 and is expanding to six other VA hospitals around the country beginning in March. The new sites, in addition to White River Junction, are Asheville, N.C.; Bronx, N.Y.; Iowa City, Iowa; Reno, Nev.; and Topeka, Kan. Initial funding for the White River Junction VA program was through the VHA Office of Patient-Centered Care and Cultural Transformation and ran through the end of FY2015. The Veterans Education and Research Association of Northern New England Recently received a $75K grant from The Byrne Foundation that will allow WRJ VA to extend the program for at least a full year.
Madison VA therapist and My Life, My Story coordinator Thor Ringler has been with the project since it began.
“I think it’s about people having a voice,” Ringler said. “The story is really a way to connect providers with Veterans and have them connect over something that’s real and meaningful. I think there’s something missing in health care and this project is just one way to bring the spark back and remind us why we’re here — who we’re here for.”
Marine Corps veteran Michael Gundlach was recently interviewed at the Madison VA.
“Being able to talk about my experience was a morale builder, first of all, for the acknowledgement of [my] service,” Gundlach said. “And second of all — and more long-term — it gave me the chance to review my life. The way the interview was conducted felt very stress-free. I think the program is absolutely something that should be expanded.”
After conducting an interview, which typically takes about one hour, project staff and volunteers write up a story about the veteran’s life. They then review it with the veteran and, with veteran approval, add the story to the veteran’s medical record. They also alert the veteran’s primary care and inpatient care providers when the story is added.
Polly Boynton is a nurse practitioner at the Madison VA who consults the stories frequently.
“I have taken the time to read each “My Story” I have encountered in my patients’ charts and am grateful to have the additional dimension and background,” Boynton said. “It is a true pleasure to read these stories; I feel I gain such valuable insight into the humanity of my patients.”
Until recently, the Madison VA was the only facility offering this service to veterans. A grant from the VA Office of Patient Centered Care allowed the project to expand to the six new sites.
Gundlach knows that for many veterans, it is not an easy thing to tell your story, but he encourages their participation.
“I would highly recommend this to any veteran who is at a point in his emotional status where he can talk about it,” Gundlach said. “If you think that you don’t want to talk to people — say your friends and family — this is another way to release and talk about something that is so important. There’s absolutely no downside to participating in this.”
The program in Wisconsin has interviewed more than 500 veterans and trained more than 25 community and student volunteers to gather their stories since it began in 2013. White River Junction VA has launched the My Life My Story program and has begun collecting veterans’ stories to be included in their patient records. As the program grows it will be a great resource for providers and veterans alike.

Women’s Health at Memorial Hospital celebrates National Midwifery Week

NORTH CONWAY — During the week of Oct. 4 through 10, the American College for Nurse-Midwives is seeking a greater understanding by the public of the role midwives can play in women’s healthcare. Their theme, “With women, for a lifetime,” reinforces the fact that midwifery services offer more than just prenatal and childbirth care – they apply their philosophy of care in all settings and with women across their lifespan.

“Most people connect the idea of a midwife with birth,” says Julie Bosak, CNM MSN, one of three certified nurse midwives at Memorial Hospital’s Women’s Health practice. “It’s a national misconception because we do provide care to women throughout their life cycle, from puberty to pregnancy, birth through menopause.”

Bosak, along with midwives Erin Tullock, CNM MSN and Kathleen Mulkern, CNM MPH, work together with OB/Gyn physicians Marni Madnick, MD and Lauren Frye, DO. Together, they offer a wide range of well-woman care for all ages at one of the largest onsite all-female women’s health practices in New Hampshire.

It’s true that many women do make their first connection with a midwife during pregnancy. The ACNM points out that the growing number of births attended by certified nurse midwives has helped to reduce the rate of Cesarean sections across the country. At Memorial’s Family Birthing Center, the majority of births are attended by the midwives.

“A midwifery approach can offer the best of both worlds,” Bosak explained. “We focus on education and support, but we also partner with you to give you the birth experience you want. That might include your choice of an epidural or use of nitrous oxide. We also work in close collaboration with Dr. Madnick and Dr. Frye if their services become necessary.”

While many of the country’s midwives provide prenatal care, about a third of them work in primary care settings. According to the ACNM, 95% of nurse midwives are working in hospital settings today.

“We see a number of teenage girls in our practice,” Bosak said. “It’s an important time for us to develop a partnership with these young women, providing education on a variety of subjects. We’re there for them to talk about birth control, STD screenings, and how to take care of their overall health.”

The Memorial Hospital Women’s Health midwives offer well-woman health care, annual gynecologic exams and screenings, and birth control counseling. Along with the physicians in the practice, they also provide specialized services for menopause, infertility counseling, and VBACs (vaginal birth after cesarean).

For more information about their services or to make an appointment, call (603) 356-4949, Ext. 2167.

memorialmidwivesMemorial Hospital's nurse midwives (from left to right) Julie Bosak, CNM, BS, MSN, APRN, Erin Tullock, CNM, MSN, APRN and Kathleen Mulkern, CNM, MPH.