What to Know About Mammograms

What to Know About Mammograms

By Stephanie Frye - Family Nurse Practitioner

May 9 starts National Women's Health Week and with that in mind, let’s talk about the health of our breasts. 

Breast Cancer: Rates and Risk Factors

First the numbers: in 2017 among the top 10 cancers for females, breast cancer leads in the list of the new cancer cases and is the second on the list by rates of cancer deaths. In the U.S., about one in eight women will develop invasive breast cancer over the course of her lifetime, with an estimated 281,550 new cases of invasive breast cancer and 49,290 new cases of non-invasive (in situ) breast cancer expected to be diagnosed in women in 2021.

You can divide the risk factors for breast cancer into groups: those you can control and those you can’t. The first group includes smoking, drinking alcohol, being obese and being physical inactive. Also, if you’ve had radiation therapy to your chest or breasts, have taken the drug diethylstilbestrol (DES) or used specific forms of hormone replacement therapy during menopause, or certain types of oral contraceptives, your risk also increases. 

As for factors outside your control, these include being 50 years old or older, having dense breast tissue, your reproductive history (when you started and stopped having periods), a family history of breast or ovarian cancer and genetic mutations such as BRCA1 and BRCA2. Certain races and ethnicities also face an increased risk. This could be due to various lifestyle patterns, reduced access to mammography or lower quality medical care.

Tip: Want to know more about what you can do? Download the Think Pink, Live Green: A Step-by-Step Guide to Reducing Your Risk of Breast Cancer for 31 risk-reducing steps you can take today.

 

Breast Cancer Screening: Breast Self Exams (BSEs) and Mammograms 

Now that you know your risk, what else can you do besides making changes to reduce your controllable factors? Follow these two steps: know what’s normal for your breasts and undergo mammograms according to the schedule advised by your health care practitioner. 

What are some breast changes that you should bring to your doctor’s attention? Komen.org lists the following:

  • A lump, hard knot or thickening inside the breast or underarm area
  • A swelling, warmth, redness or darkening of the breast or a new pain in one area
  • A change in the size or shape of the breast
  • Dimpling or puckering of the skin
  • Itchy, scaly sore or rash on the nipple or sudden nipple discharge 
  • Pulling in or dimpling of the skin of your nipple or other parts of the breast

A breast self-exam (BSE) involves both looking at your breasts in a mirror and using your fingers to touch all the areas of both breasts while lying down and sitting. If you’re still having periods, do the physical exam a few days after your period starts, since your breasts are less lumpy and painful. (Follow the detailed instructions here.)

While a BSE shouldn’t replace mammograms, it could increase the odds of early detection as well as help you learn what’s normal for your breasts.

When you have an annual healthcare visit, you can ask for a clinical breast exam. It’s performed by a healthcare professional who is trained to know the various breast abnormalities and warning signs that could indicate a need for a more thorough screening. 

Next on the list is a mammogram. This is a low-dose x-ray exam that gives doctors a closer look at your breast tissue to identify changes that can’t be felt during a breast exam. It can take about 20 minutes from start to finish, since each breast is done separately, with two pictures taken of each: one from the side and one from above. While it’s true that having your breast compressed between the machine’s two plates can be uncomfortable, remember it only lasts a few seconds. 

There are two kinds of mammograms: screening and diagnostic. Screening mammograms are for those women with no symptoms of breast cancer, while diagnostic mammograms are used when a lump or other symptom or sign of breast cancer has been found. (Women with dense breast may benefit from having a digital screening mammogram rather than a film one since it may provide a better image.)

A three-dimensional (3-D) mammogram, also called breast tomosynthesis and digital breast tomosynthesis (DBT), takes multiple images of the breast from different angles, then reconstructs the images to give a three-dimensional image set. Studies have shown that this form of screening provides improved breast cancer detection rates and fewer "call-backs" for additional testing because of a potentially abnormal finding. It can also be more gentle on the breast than the conventional mammogram. 

If your screening mammogram shows test result that suggest an abnormality, the next step may be any or all of the following: 

  • An ultrasound—an imaging test that uses sound waves to create a picture of your breast
  • A magnetic resonance imaging (MRI)—an imaging test that uses a powerful magnet linked to a computer to provide an image
  • A biopsy—a test that removes fluid or tissue from your breast to examine for cancer cells

The schedule for screening mammograms can vary. According to the United States Preventive Services Task Force (USPSTF), women ages 50 to 74 years should get a mammogram every two years. The American Cancer Society says women age 40 to 44 should have the choice to start annual breast cancer screening with mammograms, while those age 45 to 54 should get mammograms every year, and after that switching either to mammograms every two years, or continuing with yearly screening. In general, it’s a good idea to discuss the best frequency and your risk factors with their health care providers.

For more about mammograms, download this fact sheet from the Office on Women's Health. You can also watch this video from Cedars-Sinai on the breast cancer screening process. 


Free Mammograms
Patoka Family Health Care in November, 2021 - Call ahead to schedule your preventative screening.


 

Posted by koch in Obstetrics, Womens Health
What You Should Know About HPV

What You Should Know About HPV

By Stephanie Frye - Family Nurse Practitioner

There are more than 150 different types of HPV. They can range in appearance from small, painless, rough-surfaced warts to larger, more painful and flatter plantar warts. According to the CDC, 85% of people will get HPV infections in their lifetime

And while being called a “wart” doesn’t sound all that serious, it can be if your body doesn’t clear out the virus on its own. HPV causes about 44,000 cancers in men and women each year in the US, from cervical cancer (the leading cause) to cancers of the vagina, vulva, penis, anus, and mouth, according to Harvard Health. According to the CDC, more women (about 25,400) than men (about 19,900) develop HPV-associated cancers in the United States each year. 

Here’s what else you should know about HPV

HPV is the most common sexually transmitted infection. While using condoms consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases, it’s not a fool-proof strategy, according to the CDC, because the virus can also infect areas that aren’t covered. Limiting the number of sex partners can reduce the risk, although even if you have only one lifetime sex partner, you can still get HPV. The only reliable method for preventing genital HPV infection is abstaining from sexual activity. 

The FDA has only approved tests to find HPV in individuals with a cervix. Positive results can be then managed with extra testing and prompt treatment if the infection causes abnormal cell growth. (Note: There is no approved HPV test to find HPV in the mouth or throat.)

The HPV vaccine has a 15-year track record of success. Since the HPV vaccination was first recommended in 2006, there has been a significant reduction in HPV infections, with fewer teens and young adults getting genital warts. The HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers and has also reduced the number of cases of precancers of the cervix in young women. The HPV vaccine offers long-lasting protection against HPV infection and HPV disease—even against new HPV infections. This makes the vaccine a valuable weapon against causal HPV infection for cancers since it can take decades after the infection for the cancer to be diagnosed.

HPV is thought to cause 70% of oropharyngeal cancers in the United States – cancer in the back of the throat, tongue or tonsils. The vaccine protects against the types of HPV that can cause this cancer and can prevent this cancer from developing. 

The HPV vaccine is safe and effective for children ages 9-12. Why start that early? According to Claire McCarthy, MD, Senior Faculty Editor at Harvard Health Publishing, the HPV vaccine is most effective if it’s done before your teen becomes sexually active. Those who haven’t been vaccinated at an early age can have a catch-up vaccination—recommended for females and certain special populations through age 26, and for males through age 21, according to the CDC. The Cervarix and Gardasil vaccines protect against most cases of cervical cancer; Gardasil also protects against most genital warts. Both vaccines are recommended for girls and women, while only the Gardasil is recommended for boys and men. Recently the HPV vaccine eligible age has been increased to 45. People aged 27 to 45 should discuss HPV vaccination with their doctor and their decisions on an individual basis.

The more you know about HPV, the better you can protect yourself and your children. While the Healthy People 2020 goal was to reach 80% in terms of HPV vaccination coverage, a study in JAMA Pediatrics showed that the U.S. was far below that number. Part of the reason may be that most adults, men and women, weren’t well informed about HPV, HPV vaccination, and the relationship between HPV and cancer. For example, more than 70% of adults didn’t realize that HPV causes oral, anal, and penile cancers. Since parents make HPV vaccination decisions for their children, it’s important to discuss the need for this vaccine with your doctor or your child’s pediatrician. 

Posted by koch in Obstetrics, Womens Health
What to Know About Endometriosis

What to Know About Endometriosis

by Missy Ray, MSN Family Nurse Practitioner

 

What is endometriosis?

Endometriosis, also called “endo,” occurs when tissue similar to the lining of the uterus (called the endometrium) is found in other areas in the body. These areas or patches of endometriosis can also be called implants, nodules or lesions.

Most often, endometriosis occurs in the peritoneum, the ovaries, the fallopian tubes, on the outer surfaces of the uterus, bladder, ureters, intestines, and rectum or in the space behind the uterus called the “cul-de-sac.” In rare instances, endometriosis may grow on the lungs or in other parts of the body. Endometriosis causes a chronic inflammatory reaction that may result in scar tissue.

What causes endometriosis? 

While no one knows for sure what causes this disease, researchers are looking at several possibilities. These include problems with menstrual period flow, immune system problems, hormones or errors made during other surgery when endometrial tissue is moved by mistake. 

You also may be more likely to develop endometriosis if you never had children, had menstrual periods lasting longer then seven days, had shorter menstrual cycles, or have a health problem that interferes with the normal flow of menstrual blood. If a family member had endometriosis, you are most likely at greater risk since there is a genetic component.

While you can’t prevent endometriosis, you can reduce the risk by lowering your estrogen levels, since that hormone is responsible for helping to thicken your uterine lining during your menstrual cycle.

What are the symptoms? 

Common symptoms of endometriosis include very heavy periods and chronic pain in the abdomen, lower back, or pelvic areas, especially before and during menstruation or during sexual intercourse. Researchers have discovered that the severity or the location of the pain is not related to the size and location of the lesions, nor is it associated with a woman’s ability to get pregnant. 

However, some women with endometriosis may have no symptoms at all, with the condition identified only when they have difficulty conceiving. 

How is it diagnosed? 

There is no simple test that can be used to diagnose endometriosis. If your SICHC family provider suspects you may have endometriosis, then the first step is usually a physical exam, including a pelvic exam, where your doctor will feel for large cysts or scars behind your uterus.

You may undergo an imaging test—either an ultrasound or a magnetic resonance imaging (MRI)—that will provide pictures of your reproductive organs. However, undergoing a surgical procedure called a laparoscopy is the only way to definitively identify that you have endometriosis. During the procedure, a small amount of tissue may be removed (biopsied) to be tested (diagnostic evaluation).

Download the First Consultation pdf from Endometriosis.org to help you prepare for your visit.

What are the treatment options? 

While there is currently no cure for endometriosis, there are treatment options to help deal with the pain and any infertility issues it may have caused. Treatment choices will be based on the severity of your symptoms and the disease itself, your age and your desire to have children. 

Treatment options for endometriosis-associated pain include hormone therapy, over-the-counter or prescription pain relievers, and surgical procedures (laparoscopy or laparotomy) to identify and possibly remove endometriosis patches. Hormone therapy may also keep new lesions from forming but generally don’t get rid of any endometriosis tissue already present. 

However, not all treatments work well, and the symptoms may occur after medication is stopped or when a period of time has passed after surgery. 

Does endometriosis cause infertility? 

According to the American College of Obstetricians and Gynecologists, it’s estimated that close to four in 10 women with infertility have endometriosis, either due to inflammation from endometriosis inhibiting the movement of the sperm or egg through the fallopian tubes and uterus or because that inflammation has damaged the sperm or egg.

If the endometriosis is severe, it may have resulted in scar tissue or adhesions blocking the fallopian tubes. Removing endometriosis tissue through surgery may improve fertility.

 

For more information, visit these websites: Endometriosis Association, Endometriosis Foundation of America and Endometriosis Research Center, download this fact sheet from Office on Women's Health, or schedule an appointment with SICHC’s Woman’s Health team, or if you prefer, we can recommend you to an OBGYN specialist.

 

Resources

American College of Obstetricians and Gynecologists

CDC-Women's Reproductive Health 

Endometriosis.org

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Office on Women's Health

World Endometriosis Society

Posted by koch in Womens Health
SICHC’s “Thrive” initiative: helping overcome ACE trauma

SICHC’s “Thrive” initiative: helping overcome ACE trauma

As a parent, you want your children to develop resilience and be able to handle whatever setbacks and challenges they face. But it isn’t as simple as telling them to have a “stiff upper lip” or “learn how to take it” or “quit being a crybaby” when bad things happen.

While not every unfortunate event that children experience can be considered major, there are a significant number that fall under the ACE (Adverse Childhood Experience) umbrella—serious childhood traumas that result in toxic stress that can change brain development and affect such things as attention, decision-making, learning, and response to stress. (Learn more by watching the ACES Primer HD video.) 

 

What are the types of ACEs?

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study categorized Adverse Childhood Experiences (ACEs) into three groups, the most common of which are: 

  • abuse: emotional, physical and/or sexual
  • neglect: emotional and/or physical
  • household challenges: experiencing the divorce of parents, or having a family member who is in jail, has a mental illness or substance abuse problem, or is a victim of domestic violence. 

But there are other types of toxic stress as well, notes the ACE and Resilience survey, including the loss of a loved one, homelessness and involvement with the foster care or juvenile justice systems. And it’s also important to know that, according to research results, childhood trauma is very common and can occur in all families, regardless of race, employment status, and income, insurance and education level. (You can view the 10-point ACEs quiz here.)

 

What are the effects of ACEs?

If an ACE is unidentified, untreated and unresolved, it can have lasting, negative effects on a child’s health, well-being, and opportunity, from increasing the risks of unhealthy lifestyle choices such as alcoholism, drug abuse, violence and other behaviors to a wide range of chronic diseases. Problems can continue into adulthood, making it difficult for the person to form healthy and stable relationships, hold down a job or manage finances.

 

What treatment and resources are available to treat ACEs?

That’s the bad news. The good news is that ACEs are preventable and if they occur, they are treatable. The sooner a child and the family as a whole receive help, the better the long-term outcome will be for everyone.

Here at SICHC, we are focused on helping our community understand the impact of ACEs and provide parents with the necessary resources and help. In 2019, we sponsored Thrive Orange County, working together with other local stakeholders to improve our community’s health and well-being.

Some of the initiatives that Thrive OC has developed include: 

  • Handle with Care, a county-wide collaboration between school districts, the sheriff’s department, and town police departments to help students deal with trauma resulting from a family member’s involvement with law enforcement.  
  • Mindful Schools at Paoli and Orleans schools to help students learn to self-regulate their stress response systems.
  • Project Unite Teen Pregnancy Prevention, funded by IU CRE, to reduce the high rate of teen pregnancy in Orange County using community input from parents, the faith-based community, and schools.
  • Healthy Relationships and Social Media pilot programs at Orleans Elementary and Mt. Lebanon United Methodist Church.

Thrive OC has brought the Miss Kendra Programs to Springs Valley Elementary Schools in 2020, with funding provided by Springs Valley United Methodist Parish, HealthLinc, and The Tony Bennett Foundation. Two advisory councils have also been established: the Mentoring Advisory Council with a focus on creating a county-wide mentoring program, and the Early Childhood Advisory Council, which will be involved in improving access to quality early childhood education.

Finally, Thrive OC has collected student ACE scores from Orleans, Springs Valley and Paoli students in various grade levels as well as community survey data—all to identify community norms and measure barriers and stigma associated with seeking care or treatment for a substance use disorder, or a mental health condition.

 

For more information about the Thrive Orange County initiative or to discuss any mental health needs, reach out to our office using our Contact page or by calling one of our office locations.

 

Posted by koch in Mental Health
Covid-19 mass vaccination clinic in Crawford County Saturday, March 27

Covid-19 mass vaccination clinic in Crawford County Saturday, March 27

MARENGO, Indiana – Southern Indiana Community Health Care (SICHC) will offer up to 90 administrations of the Johnson & Johnson one shot COVID-19 vaccine this Saturday, March 27. The Crawford County administration will take place in the 4-H Building. The address (for GPS location) is 1095 S State Road 66, Marengo, IN 47140.

People who wish to receive the free Johnson & Johnson vaccine must sign up in advance.

SICHC expresses its thanks for the free use of the 4-H Building, which is located across from the Crawford County High School.

“People coming for the vaccine need to remember that they will remain onsite for a 15-minute monitoring period after they receive the vaccine, which is standard procedure,” said Dr. Yolanda Yoder, SICHC Medical Director. “We will adhere to CDC guidelines for social distancing 6 feet apart and wearing masks".

If you haven't pre-registered for Saturday, please sign up for a Moderna vaccine at our Paoli vaccine clinic open Monday-Thursday 9am-5pm by signing up on the state’s website at ourshot.in.gov or call 2-1-1.

Posted by koch in Covid-19, NEWS
SICHC clinics to distribute free digital blood pressure cuffs, grant funding to enable widespread monitoring, improved access

SICHC clinics to distribute free digital blood pressure cuffs, grant funding to enable widespread monitoring, improved access

 

PAOLI, Indiana – Patients with high blood pressure (hypertension) served by Southern Indiana Community Health Care (SICHC) clinics will soon be able to receive a free digital blood pressure cuff monitor, according to Yolanda Yoder, MD, SICHC Medical Director.  SICHC secured a $159,000 grant from the federal Health Resources and Services Administration (HRSA) to initiate the four-county program. 

The grant funds will be used to purchase and distribute the specialty blood pressure cuffs, which can securely transmit health care data through a cellular enabled device, and to purchase the healthcare software required to receive, process and secure the confidential data. The data will help SICHC medical professionals treat high blood pressure remotely.

Eligible SICHC patients receiving treatment for both “controlled” hypertension (blood pressure maintained at 120/80) and “uncontrolled” high blood pressure (blood pressure typically appearing at 140/90 or above) will receive the free digital units. 

“With SICHC receiving the HRSA hypertension initiative grant, we will be able to support our patients who have high blood pressure by also offering learning opportunities, heart health education, and provide routine follow-up phone calls between patient visits,” said Cynthia Gillespie, a Certified Community Health Worker (CCHW) with SICHC. “We are working to provide cellular-enabled blood pressure monitors to the majority of our hypertension patients who do not currently have access to in-home self-monitoring devices.” 

Once the secure remote cloud software is in place, several blood pressure cuff monitors will initially be distributed. The goal is to create access of blood pressure cuffs for up to 2,600 patients in four counties.  Hypertension patients served by six SICHC clinics in Crawford, Martin, Orange, and Washington counties will be eligible to receive the free digital devices.

As Mrs. Gillespie explained, the remote monitoring access will be coupled with patient and community outreach to help people practice sound nutrition that can promote heart health (including cooking classes). SICHC will also provide instruction and information for area residents to learn to practice stress reduction techniques (including mindfulness) to lower stress-induced elevated blood pressure.

Given transportation issues faced by some SICHC patients and the inability for many people to leave their homes due to COVID-19, this remote patient monitoring (RPM) technology will enable doctors and other medical professionals to make a closer and timely review of patient health in the time between scheduled visits. Patients will be able to digitally record blood pressure, which the monitor will then automatically send to a cloud-based platform. The information will then be accessible for providers in the secure Electronic Medical Record (EMR) system. 

The grant is being administered as part of SICHC’s goal by providing health care services focused on the entire person. Mrs. Gillespie explained that her role as a community health worker (CCHW) “is to help improve access to quality health care, along with improving health outcomes.” She added: “I will follow up with patients who have hypertension between office visits to support them with their health plans, medication management, and be able to connect them to other community recourses - anything from food, housing issues, financial and employment assistance, transportation arrangements to and from doctor appointments, and other health or social services.”

SICHC’s grant for its southern Indiana operations was part of HRSA funding that was also provided to health care institutions in Elkhart, Indianapolis, Jeffersonville, Portage, Richmond and Valparaiso. 

 

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About the Southern Indiana Community Health Care (SICHC) nonprofit organization – Well-known as a high-impact health care provider committed to continuity of care, the nonprofit Southern Indiana Community Health Care (SICHC) organization is committed to providing high-quality, comprehensive, community-sensitive health care utilizing Christ-centered principles to medically underserved, rural communities.  As a Federally Qualified Health Center (FQHC), SICHC serves as a “safety net” provider for vulnerable populations and focuses on increasing access to primary care services for Medicaid and Medicare patients in rural communities. SICHC offers medical care in medically underserved areas of Crawford, Martin, Orange, and Washington counties. SICHC is a member of the National Health Services Corps and receives program funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. SICHC offers services to all persons, regardless of the person’s ability to pay. For more information, please visit https://sichc.org/

Posted by koch in Grants, Hypertension, NEWS, Rural Healthcare
Telehealth Checklist: Preparing for Your Virtual Doctor Visit

Telehealth Checklist: Preparing for Your Virtual Doctor Visit

By Krisendra Markham – Quality and Data Manager, FMH Coordinator

While telemedicine (delivering medical care at a distance) and telehealth (the electronic and telecommunications technologies and services used to provide telemedicine) have been around for decades, COVID-19 has made remote care a more popular option to help reduce exposure for patients and healthcare staff. 

Having a Telehealth Virtual Visit at SICHC

Your Southern Indiana Community Health Care (SICHC) telehealth appointment can take place on your landline phone or with your computer, laptop, smartphone or tablet.

SICHC offers video and smartphone visits through FollowMyHealth, a secure message and video platform available through the FollowMyHealth App on your smartphone (Apple or Android), or through your computer’s web browser. 

Although having a FollowMyHealth account isn’t required. Just call any of our four offices and a staff member will help schedule you for the type of appointment that best fits your needs. (If you have a FollowMyHealth account, you can schedule your appointment through that portal.) 

Once your appointment is scheduled, a staff member will call you before your appointment begins to ask some routine questions, and, if needed, give you additional instructions. Your care provider will then start the visit (phone call or video).

TIP: If you’re using the FollowMyHealth App, you can supply much of this information prior to the virtual appointment. For example, you can upload a close up photo of a skin rash. Here is a link to the FollowMyHealth YouTube channel to get familiar with the platform.

What to Do Before Your Visit

• Find a quiet space. You want to be able to focus on your appointment without interruptions from children, pets or roommates. A separate room, going to a friend’s house or even sitting in your car (while it’s parked!) can give you the privacy you need. 

• Prepare your device (for video). Close other applications to prevent distractions and keep your internet speed from slowing down. Then position your device so you are visible on the screen and the lighting in the room doesn’t shadow your face. 

• Review any instructions or emails from your provider. These can include how to log on to the FollowMyHealth app or gather specific health information such as your temperature, blood pressure, blood sugar, or weight. 

TIP: If you need to download an app, do it well before your visit so you can road-test it and address any problems. 

• Compile your concerns. Make a list of any symptoms, questions or worries you want to discuss during the appointment. Has anything changed since your last appointment? Are your vaccines up to date? 

• Collect your meds. Make a list of prescription medications as well as any OTC (over-the-counter) medications or supplements you take on a regular basis. Do you need refills for any prescriptions? Have the bottle available and double-check the dosage instructions.

• Have a notepad handy. During the visit, you’ll want to take notes so have pen and paper at hand. If you prefer to use a device, don’t try to take notes on the same one you’re using for the telehealth appointment, but have a second one ready.

• Gather your health data. This includes your health history, recent vaccines, other healthcare providers and the phone number and location of your local pharmacy. 

What to Do During Your Visit

• Stay focused. Don’t eat or drink, take calls or check your email during your visit. Your full attention should be on the visit, just as though you were in the examination room.

• Ask questions. If you aren’t sure what the doctor said (sometimes there can be a problem with the audio) or you need additional details, don’t hesitate to ask for clarification. If the doctor orders bloodwork or other tests, confirm where they are to take place and when you can expect results.

• Review your treatment plan. Before you end the call, review the treatment plan your doctor recommended and ask what you should do if your problem persists.

What to Do After Your Visit

• Follow instructions. If you need to make another appointment (either virtual or in-person), change your current medication schedule or begin taking a new one, be sure to do so.

• Bring your notes. If your doctor advises you to see another physician or go to the ER, bring your notes from your telehealth call. 

• Track any changes. The doctor will want to know if your symptoms improve or if you notice any new changes.


Concerned About Insurance Coverage? 

Call your insurance provider beforehand to confirm coverage. Phone and video visits are billed to your insurance just like a regular office visit. If you do not have insurance, please call our Self Pay Department for more information at 812-723-7121 or visit our payment options webpage.

If you’re on Medicare or Medicaid, know that Medicare has temporarily expanded its coverage of telehealth services, but you should check with your state regarding Medicaid coverage for telehealth services. 


Other helpful information to know before your virtual doctor visit. 

This checklist with tips from Telehealth.HHS.gov and American Academy of Allergy, Asthma & Immunology will help you prepare so you can get the most from your appointment. You can also watch this video from the Hawaii State Department of Health Genomics Section to learn more about what to expect from a telehealth visit.

Posted by koch

Twelve Indiana Healthcare Providers Receive Grants to Improve Accessibility for People with Disabilities

01/28/21

Grants provided by MHS as part of Provider Accessibility Initiative

INDIANAPOLIS – (January 28, 2021) – MHS, in partnership with the National Council on Independent Living (NCIL), has awarded 12 healthcare providers across Indiana with grants to make their facilities more accessible to people with disabilities. The awardees applied for grants which are part of the health plan’s Provider Accessibility Initiative (PAI), with the full list of grantees including:

  • Porter Starke Services DBA Marram Health Center
  • Eric A Yancy, M.D.
  • Forniss Optometric P.C.
  • Walker Medical Group
  • HealthLinc, Inc.
  • Open Door Health Services
  • Edgewater Health
  • Tulip Tree Health Services of Gibson County
  • Montgomery Medical Associates LLC
  • Southern Indiana Community Health Care
  • Community HealthNet Health Centers
  • Goshen Family Physicians

The goal of the PAI is to increase the number of practitioner locations that meet minimum federal and state disability access standards. Providers in the MHS network selected to receive grant funds submitted applications to NCIL, explaining their need for more accessible facilities. MHS selected recipients based on the impact of the improvements on its disability access network adequacy, as well as the number of MHS members with disabilities impacted.

In the application process, providers proposed a list of potential improvements for each of their facilities. Upgrades like doorway and restroom modifications, more accessible exam tables and procedure chairs, and braille signage are just some of the improvement additions intended to be made with the additional funds. Some providers submitted multiple applications for several of their facility locations to make improvements.

“We are very excited to receive this funding. We will be able to serve a much larger segment of our community with dignity. I don’t want any patient, particularly kids, to feel like their care is an extra burden to staff or family. Everyone’s experience when going to the doctor should feel comfortable. A wheelchair should be able to enter a room easily. A transport chair should be able to go up a ramp easily. More importantly, a patient, should not even notice their experience is different than any other patient. I am proud to play a part in maintaining the dignity of others,” said Dr. Roland Walker, M.D. of Walker Medical Group.

For more information about the grants and the provider accessibility initiative, visit: www.ncil.org/provider-accessibility-initiative/

Posted by Tim Meyers in Disabilities Accessibility, Grants, Rural Healthcare
5 Tips for COVID Mental Health

5 Tips for COVID Mental Health

By Teresa Faulkner, Licensed Clinical Social Worker

COVID-19 affects everyone, not just those who have caught the virus. Even if you haven’t been physically infected, you most likely have been affected by it emotionally in one way or another. And the longer the pandemic lasts, the more challenging it can be to find ways to cope with the feelings it has caused.

How you deal with COVID stress depends on your background, your level of social support and many other factors. But by using these five tips, you will be better equipped to deal with the current situation as well as other stressful times in the future.

  1. Acknowledge your emotions.

It’s important to recognize and acknowledge what you’re feeling. It’s natural to feel anxious, afraid, frustrated or lonely. And don’t be surprised if your feelings change over time. One day you may feel full of energy and the next day be unable to focus. Accept how you are feeling and practice good self-care: eating healthy foods, exercising and getting enough sleep.

Feeling helpless? Remind yourself that there are steps you can take to reduce the odds that you will contract the virus, such as following the CDC guidelines: wearing a mask, practicing social distancing, avoiding crowds and washing your hands.

  1. Take a breath and a break.

Take those deep breaths. It may sound like it’s too simple to really have any impact, but deep belly breathing not only gets oxygen into your body but can also slow your heartbeat and help stabilize your blood pressure. This counteracts the negative impact of stress breathing (short, shallow breaths) that can lead to symptoms like chest tightness, heart palpitations or dizziness.

Also, during the day, take periodic breaks and practice relaxation techniques. This will help generate a sense of calmness and relaxation.

  1. Connect with friends and family members.

One of the biggest challenges with the pandemic is that it has increased feelings of isolation. No longer can you meet a friend for dinner to talk over your problems, since doing so would put both of you at risk. However, there are ways you can share how you feel with those you trust. Phone calls or video chats can help replace in-person get-togethers. Even occasional walks (with masks and practicing social distancing) can make you feel less alone. Sometimes when you share your emotions, you find out others feel the same way, too.

  1. Develop a routine.

COVID-19 has undoubtedly disrupted your schedule and way of life, forcing you to try to adjust to a new “normal” that seems to change every day. When everything around you seems out of control, creating a routine can actually give you a sense of power. Make it simple and do-able—for example, eating and exercising at established times or setting small goals to work toward. While your COVID routine may bear no resemblance to the one you had pre-pandemic, the objective is to follow a schedule, which will then give you a feeling of security. An additional benefit is that by having a routine, you will also be taking better care of yourself.

  1. Shut off the info flow.

While you may think it’s a good idea to stay on top of all the latest virus developments, this can actually increase your stress level. Periodically, give yourself a mental break by shutting off the info flow. Take breaks from watching, reading, or listening to virus news stories, including those on social media. Instead, seek out pockets of calm: read a good book, go for a walk, listen to music or find activities that engage your mind and body.

And when you are ready to catch up on pandemic news, make sure that you are getting it from a reputable source like the CDC. You’ll have a better understanding of the risks and will be less likely to spread misinformation.

Let Us Help You

While COVID-19 is unlike any health crisis we have faced before, it’s important to remember that it is a temporary situation. Thanks to medical research, vaccines are now available to combat the virus and new treatments have been developed to help those who contract it.

However, if you have trouble coping with your emotions, develop physical ailments that last for several days, or turn to unhealthy coping mechanism such as drinking or drug use, then consider seeking professional help.

Here at Southern Indiana Community Health Care, our offices include a mental health counselor as part of our care team. This allows us to treat the whole individual, physically and mentally. In response to the COVID-19 pandemic, SICHC has expanded our behavioral health services to include virtual visits, offering the same high-quality care from your trusted provider. We have also added two virtual group sessions: substance use and anxiety.

For more information, contact one of our four offices, and a staff member will help schedule you for the type of appointment that best fits your needs. You can also request appointments through your FollowMyHealth account.

Trust our team to help you through the emotional challenges caused by COVID-19. Reach out to us. We’re here to help you. Remember, we are all in this together.


Posted by koch in Covid-19, Mental Health, Rural Healthcare
Pregnancy Tips During COVID

Pregnancy Tips During COVID

By Yolanda Yoder, MD, Family Practitioner and Member of the SICHC OB Team 

Pregnancy is a joyous time but pregnancy can be stressful for expectant mothers. This stress is natural. After all, during pregnancy, everything is changing: from the way you look to the way you feel physically and emotionally. And now with COVID-19 complicating nearly every aspect of your life, your stress level may be even higher if you worry about being pregnant during a pandemic.

What steps can you personally take to lower stress levels and stay healthy during your pregnancy, in spite of COVID?

Eat Healthy

Good nutrition is important for both you and your baby. That means avoiding a lot of sweets and following a well-balanced diet with fruit and vegetables, dairy, good carbs with fiber (like oats and other whole grains) and healthy protein: nuts, chicken, fish and beans. Want help planning a healthy meal? Check out the guidelines at Choose My Plate

As for the old saying “eating for two,” the American College of Obstetricians and Gynecologists (ACOG) recommends skipping that in favor of thinking of eating twice as healthy. Try practicing mindfulness in all your activities- including eating. Become aware of your habits, do your research, work with your provider, and let your focus rest on being healthy. 

Having twins? You only need about 600 extra calories extra a day to support your growing babies. Make them good calories and you won’t have to worry about overeating (and by the way empty calories tend to leave you hungry). Overeating during pregnancy means more stress on your body and more weight to lose after birth. Good meals and snacks leave you feeling satisfied and content—and healthy.

Exercise Regularly 

According to the American Pregnancy Association, just 30 minutes of mild to moderate exercise several days a week can help lower cortisol levels—the hormone that fosters anxiety. Exercise also eases constipation, reduces back pain and promotes healthy weight gain as well as improves your overall fitness, says ACOG. Even just simply taking a walk every day can make a difference, physically, mentally, and emotionally.

Get Enough Sleep

Sometimes it can be a challenge to get good quality sleep as your body adjusts to the growing baby. While in the first trimester you may feel drowsier than normal and may even have to take naps, physical changes in the second and third trimester can make it harder to get the shut-eye you need. Between the kicks and the bathroom trips, you may find you’re just as tired when you get up in the morning as when you went to bed the night before.

Tips from the Sleep Foundation include reducing your fluid intake in the evening, avoiding spicy or acidic foods if you’re prone to heartburn, using pillows to support your body in a comfortable position and trying relaxation techniques to help calm your mind. ACOG offers a simple breathing technique to try: Breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. Repeat three times. Still having trouble sleeping? Talk to your doctor if your insomnia persists.

Seek Social Support

Social support during this time is very important, but COVID-19 has conversely made it harder to spend time with friends and family members. Find ways to be with others while staying socially-distant—perhaps taking a “masked” walk together or even having virtual get-togethers, when you can talk about what is happening during your pregnancy. You can also reach out to other expecting and new mothers through online groups.

Monitor Your Stress Levels

In the same way you are watching how much you eat and exercise, you need to watch how much stress you’re exposing yourself to, and as much as possible, limit your contact to it. The March of Dimes recommends taking periodic breaks from watching or listening to the pandemic news stories or limiting your time on social media to help reduce anxiety. Experiencing extreme feelings of sadness, hopelessness or despair? Talk with your doctor or other health care professional so you can get the extra support you may need. 

For more advice, download the free fact sheet from the March of Dimes: COVID-19 Things to know if you’re pregnant—available in many languages.

Let Us Help You 

Now that you have some ideas in what you can do to stay healthy for your sake and the wellbeing of your baby, here’s what we at SICHC will be doing to make this wonderful time easier for you. 

We do everything we can to create a safe environment for our mothers and babies. We take special care to ensure that all six SICHC locations are frequently sanitized and cleaned according to CDC guidelines, and we limit the number of patients to keep interaction at a minimum. 

We’ve also temporarily opened an office on Cherry Street in Paoli for obstetrics and newborn care only, in addition to our pregnancy care services at our Shoals and Salem locations.

And when appropriate, we can schedule a virtual visit to reduce your in-office time. For more information about this option, contact one of our offices, and a staff member will help schedule you for the type of appointment that best fits your needs. You can also request appointments through your FollowMyHealth account.

We encourage you to trust our team to provide not just a safe environment, but also to walk with you through both the physical and the emotional challenges of your pregnancy.

This is a special time for you, your baby, and your family. Our experienced team stands ready to share and support your journey – contact us today.

Posted by koch in Covid-19, Obstetrics, Pregnancy

New SICHC obstetrics offering successfully providing critical services in Salem, Shoals, and other areas of southern Indiana

SHOALS and SALEM, Indiana – Southern Indiana Community Health Care (SICHC) new obstetrics services for expectant mothers and families is “being well-received and making good progress in reaching mothers, babies and women,” according to Yolanda Yoder, MD, SICHC medical director. The new services include general obstetrics, pregnancy, well-baby, and well-woman services here and in other areas of southern Indiana, including expanded services in Crawford county.

“Rural areas traditionally present a number of unique challenges that expectant mothers or women who seek OB-related services may face, including limited service” said Dr. Yoder. “We have expanded our strong OB service offerings with our physicians and Melissa Ray, a family nurse practitioner, to meet these important needs in Washington, Martin, and Crawford counties, as well as the patients we serve in Orange and elsewhere in southern Indiana.”

“Pregnancy is a very special time for expectant mothers and families, and I count it a privilege to help support them with OB, well-baby, pediatric, and well-woman services,” Ray said. “Every pregnancy is different, and our entire medical staff recognizes the uniqueness of each patient and goes beyond to ensure great care is delivered.”

Melissa Ray, MSN Family Nurse Practitioner

Ray provides OB services at the Choices Life Resource Center in Salem and at the Martin County Health Department/WIC facility in Shoals, as well as SICHC’s other locations in Orange and Crawford counties when appropriate.

In addition to being a family nurse practitioner, Ray holds a master’s degree in Nursing.

Ray directly cares for expectant mothers through in-person visits (observing COVID-19 precautions) and by telehealth connectivity. At 36 weeks into a pregnancy, Ray’s patients are transferred and then served directly by SICHC physicians, including Dr. Sean Salés, Dr. Karen Farris, and Dr. Yoder. Babies are normally delivered at the IU Hospital in Paoli by SICHC physicians with visiting privileges.

SICHC secured a grant from the Indiana State Department of Health earlier in 2020 to specifically help provide obstetrics services to counties that had been designated as medically underserved for OB.

Ray presently travels between SICHC medical offices in Shoals, Salem and elsewhere to see patients and provide general OB services. “Missy Ray offers our expectant mothers and their babies superb depth and first-hand experience,” said Dr. Yoder. “In addition to being a qualified and experienced nurse practitioner caring for OB patients and families these past four years, she served in the hospital delivery room for 16 years and as a general RN.”

“It’s very exciting to provide these services and help mothers, babies, families and women in general lead healthy lives,” said Ray. “I especially appreciate working with the OB and extended medical team at SICHC, because everyone here puts patients first, treating and supporting them as people, not a set of chronic conditions – there’s a very high commitment to service.” 

Ray also appreciates being able to offer general women’s health services, including preventive measures like mammograms and pap smears. “We want to elevate the level of woman and family health, which can be a challenge for woman and families living in rural areas,” she said.

Serving as a nurse practitioner has special moments, including once when Ray helped with a delivery that was being securely streamed by video to a military serviceman serving in Afghanistan. “That was an amazing moment, giving a father serving across the world the chance to see his baby being born in southern Indiana – those are priceless experiences.”

 

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About the Southern Indiana Community Health Care (SICHC) nonprofit organization – Well-known as a high-impact health care provider committed to continuity of care, the nonprofit Southern Indiana Community Health Care (SICHC) organization is committed to providing high-quality, comprehensive, community-sensitive health care utilizing Christ-centered principles to medically underserved, rural communities.  As a Federally Qualified Health Center (FQHC), SICHC serves as a “safety net” provider for vulnerable populations and focuses on increasing access to primary care services for Medicaid and Medicare patients in rural communities. SICHC offers medical care in medically underserved areas of Crawford, Martin, Orange, and Washington counties. SICHC is a member of the National Health Services Corps and receives program funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. SICHC offers services to all persons, regardless of the person’s ability to pay. For more information, please visit https://sichc.org/

Posted by Tim Meyers in Obstetrics, Rural Healthcare

How health partnerships can help rural communities prep for COVID

Yolanda Yoder M.D. and Priscilla Barnes PH.D.

Author: Priscilla Barnes, Ph.D. & Yolanda Yoder, M.D.
National Rural Health Association – See the story here

With stark images of urban hospitals overrun with patients, the national media coverage of COVID-19 has focused largely on cities. Less discussed and less understood is the impact on rural communities, which have been grossly underprepared for a pandemic. As we contemplate an additional wave of the virus, now is the time to assess how rural communities can achieve greater resilience.

We now know that having an adequate supply of ventilators, testing, and PPE is essential, but this alone won’t be enough. Just as important are the structures we have in place — specifically, community partnerships around health. In hindsight, it is increasingly clear that communities that developed relationships within their health network were able to respond faster and more effectively than communities where organizations operated in isolation.

Given the realities facing rural America — physician shortages, a dearth of health care resources, and a population that’s highly vulnerable to chronic disease — these partnerships were always important, but increasingly so during a pandemic. This virus has served as a wake-up call to strengthen these partnerships and tackle rural health challenges in a more committed and enduring way.

Building more resilient rural communities means maximizing existing resources, staging health interventions that address root causes, and thoughtfully sharing information. Partnerships are at the core of these interventions. We must find ways to incentivize and support community health networks that include health care providers, local and national nonprofits, businesses, and local government officials. Such partnerships, whether they are formal or informal, can help rural America whether the next wave of the virus and address underlying health challenges.

Fundamentally, rural health partnerships enable communities to more effectively address social determinants of health. As America’s experience with the pandemic has made clear, populations that were already experiencing health disparities have fared worse than those that were not. Rural health partnerships can help address social determinants of health that lead to disparities and remove some of the strain from health care providers.

When community health organizations band together to holistically address social determinants of health — as we have seen in Orange County and Daviess County, Ind., through the development of community health improvement plans — we can free up practitioners within the formal health care system to do what they do best. When patients are receiving help gaining access to housing or food from community partners, doctors and nurses are able to concentrate on treating the most serious cases. In rural America, where the proportion of providers to the general population is far below the federal recommended level, this type of coordination is especially needed.

Such coordination also applies to sharing resources like in-demand PPE between community health organizations. As we prepare for a potentially prolonged economic downturn, we need to extend this model to address other social determinants of health. If one community’s food pantry stock is bare, another town may have a surplus. We need to expand rural health partnerships to enable this type of coordination.

The impact of rural health partnerships can also be felt in less obvious ways. One of their most important functions is information sharing. Rural health practitioners often wear many hats and lack the ability to focus deeply on any one area of their practice. Health partnerships can ease this burden by delivering customized solutions. The Indiana University Center for Rural Engagement and Southern Indiana Community Health Care recently developed a new app to track the spread of COVID-19 in consultation with local physicians and public health leaders. Moving forward, it will provide surrounding communities with advance warning of an outbreak.

Information sharing can be as simple as sending daily or weekly updates and COVID-19 safety recommendations. Other groups have developed an online directory of financial and physical resources such as food and medication delivery services for individuals and families. Some respond directly to inquiries and manage social media channels dedicated to informing organizations and residents and supporting local needs.

Rural health partnerships yield tremendous value that we cannot afford to ignore. As we expand our work, we need local governments and community-based organizations to help us better shape our approach to fit individual rural communities. But this is just a start. We need continued investment and partnership from government to strengthen rural health networks.

If necessity is the mother of invention, then crisis is the mother of adoption. Rural health partnerships were providing value for rural Americans before COVID-19. Now that the pandemic is here, such partnerships are indispensable and should be greatly expanded.

Dr. Priscilla Barnes, Ph.D. is an associate professor at Indiana University Bloomington School of Public Health and an affiliate faculty member at the IU Center for Rural Engagement.

Dr. Yolanda Yoder, M.D. is a physician of family medicine at Southern Indiana Community Health Care.

Posted by Tim Meyers in Rural Healthcare

SICHC expands obstetrics services into Crawford, Martin counties, restores critical services to medically underserved areas

SICHC Obstetrics Team
NEW OB TEAM – Southern Indiana Community Health Care (SICHC) launches new OB services for expectant mothers and families in Crawford, Martin and Washington counties. From left: Dr. Karen Farris, Dr. Yolanda Yoder (SICHC Medical Director), Dr. Sean Sales, and Missy Ray, FNP.

New family practice physician will also join SICHC in August, serving families and OB patients in Orange County as SICHC also opens new facilities in Shoals and Salem.

PAOLI, Indiana – Long-time medical provider Southern Indiana Community Health Care (SICHC) formally launched its new obstetrics services in Crawford and Martin counties in early August. The new OB service will now provide a full spectrum of services, including well-woman visits, female health, birth control, pregnancy care (pre-natal and post-partum), well-baby care, tobacco cessation and other OB-related services.

“We are very pleased to introduce these new services locally in what has sometimes been described as a medical desert for critical OB services for pregnant mothers and babies,” said Dr. Yolanda Yoder, MD, SICHC Medical Director. “We are excited that our medical professionals will begin seeing obstetrics and gynecology patients this month in Crawford and Martin counties.” SICHC is also planning to bring OB services to the Salem area in Washington county later in August.

The new OB services will be provided at rural facilities in English, Marengo, and Shoals. The facilities provide convenient access and reduce barriers of transportation in securing quality health care, including being closer to under-served Hoosier mothers and segments of Indiana’s Amish population. The services in Shoals will take place at the Hoosier Uplands Health Department/WIC site, which is partnering with SICHC to provide a broad spectrum of services.

“Rural Indiana faces real challenges in combating infant mortality and securing quality pre-natal, pregnancy, post-partum and well-baby care, and we are grateful to see SICHC stepping up to deliver these important health care services where there is a demonstrated critical need,” said Indiana State Health Commissioner Kris Box, MD, FACOG. “SICHC’s demonstrated commitment to provide health care regardless of a patient’s ability to pay represents a real asset in these medically underserved and economically challenged areas of southern Indiana.” 

A traveling Family Nurse Practitioner (FNP), Missy Ray, MSN, will serve OB patients in the three offices. In addition to holding a master’s degree in nursing with her FNP certification, Ms. Ray has considerable experience in obstetrics. SICHC has also secured the services of Dr. Karen Farris, a family practice physician, who will begin taking appointments in mid-August for OB patients in the SICHC Valley Health Care office in West Baden Indiana (Orange County).

Service to OB patients will be directly coordinated with the selected delivering physician, including secure video, phone, and electronic connectivity with the physician during prenatal visits. Patients will transition to direct physician care at 36 weeks in SICHC’s Paoli or West Baden offices until delivery, which will take place at the IU Health hospital in Paoli, according to Dr. Yoder. Transportation assistance is available for patients in need.

“SICHC has a demonstrated passion for providing medical services to communities and regions in southern Indiana that sometimes face serious challenges in securing access to health care,” said Nancy Radcliff, SICHC CEO. “We are privileged to continue to do what it takes – even seeing patients in our facilities parking lots during this time of COVID-19 – to support the patients, families and rural communities in our southern Indiana region.”

SICHC OB services will be offered at three locations:

  • Uplands Health Department/WIC – 127 West Water Street, Shoals, IN 
  • Patoka Health Care – 307 S Indiana Ave, English, IN
  • Crawford County Health Care – 5604 E. White Oak Lane, Marengo, IN

Hours are 9 a.m. – 4 p.m. (EDT), with offices closed for lunch between noon and 1 p.m. To schedule an appointment, please call 812-723-3944 and specify the location.

Another new SICHC OB service site will be operational this fall in Salem, Indiana in Washington County.

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About the Southern Indiana Community Health Care (SICHC) nonprofit organization – Well-known as a high-impact health care provider committed to continuity of care, the nonprofit Southern Indiana Community Health Care (SICHC) organization is committed to providing high-quality, comprehensive, community-sensitive health care utilizing Christ-centered principles to medically underserved, rural communities.  As a Federally Qualified Health Center (FQHC), SICHC serves as a “safety net” provider for vulnerable populations and focuses on increasing access to primary care services for Medicaid and Medicare patients in rural communities. SICHC offers medical care in medically underserved areas of Crawford, Martin, Orange, and Washington counties. SICHC is a member of the National Health Services Corps and receives program funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. SICHC offers services to all persons, regardless of the person’s ability to pay. For more information, please visit https://sichc.org/

Posted by Michael Snyder in Obstetrics, 0 comments