Community Health Teams and Their Maturing Impact on Chronic Illness

By Bill Monahan, RN, Grace Cottage Outreach Coordinator

Blueprint for Health? Community Health Team (CHT)?

What are these, and how can they help you for free?

The Vermont Blueprint for Health was conceived in 2003 during Governor Douglas’s administration and implemented in 2010. The goal of Blueprint is better coordination of patient care for individuals, better health for the whole community, and reduced health care costs.

This nationally recognized, multi-faceted program includes a system of Community Health Teams (CHTs). There are fourteen CHTs in the state of Vermont, all subsidized by private insurers, Medicare, and grants, so that their services are offered to the community free of charge. Each team adapts its services to the needs of its particular service area.

When a primary care provider identifies that a patients needs additional support, beyond what can be provided during an office visit, that provider can refer the patient to the CHT, thus connecting patients to additional resources.

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Staying Fit Beyond the Summer

By Cheryl Shaw, Grace Cottage Hospital Health Coach

Summer is a natural time for outdoor sports, exercise, and activities. Now, as autumn arrives, you may find yourself challenged to keep up the workout routine you established during warmer, “longer-day” months.

For most healthy adults, the U.S. Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of both. Of course, in order to determine the best level for you, have a consultation with your provider first.

Once you know what type of activity is best for you, how will you keep your routine going when days are shorter, the weather is darker and cooler, and the pull toward seasonal comfort foods kicks in?

The best solution is to prepare and think ahead.  Here are some tips. Maybe one or more of these will work for you:

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Health Benefits of Yoga

By Crystal Mansfield, Director of Grace Cottage Rehabilitation Services, Wellness Programs, and Certified Yoga Instructor

September is National Yoga Month. What are the benefits of practicing yoga on a regular basis? If you answered relaxation and stress relief, you are correct. But yoga is so much more than that.

I started practicing yoga more than 30 years ago. The benefits were so varied and profound that in 2001, I decided to become certified to teach yoga so I could share these benefits with others.

Most people already know that yoga is a great way to relax and reduce stress. Did you know that yoga originated thousands of years ago as a preparation for meditation practice? The ancient yogis realized that, in order to meditate for great lengths of time, they first had to learn to be still.

Whether you practice yoga for its spiritual or its physical benefits, anyone who practices regularly will experience a difference both on and off the mat.

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Advance Care Planning: Why it’s Good to be Prepared

By Dr. Anne Brewer, Grace Cottage Hospital

I was a Girl Scout when I was young, and well I remember the Scout motto: Be Prepared. It’s applicable to many areas in life, including medicine.

One of the most important ways that a patient can be prepared is by completing an Advance Care Planning document.   

Advance Care Planning, also known as advance directives, offers all adults the opportunity to be prepared for a time when they cannot express their wishes about what type of care they want to receive. It allows them to give guidance to their family and medical care team in the event that they cannot speak directly for themselves because of terminal illness, serious injury, coma, dementia, or another situation.

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What Do You Know About E-Cigarettes?

Elizabeth Linder

By Dr. Elizabeth Linder, Grace Cottage Family Health Pediatrician

The use of e-cigarettes is a rising trend these days, for adults, but also particularly for teens. In just over a decade, this fad has grown into huge industry, with hundreds of thousands of users.

Use among teens has seen the fastest growth. The National Youth Tobacco Survey for 2011-15 shows that the rate among teens was 2% in 2011 and had risen to 16% just four years later. In 2015, more teens reported use of e-cigarettes than conventional cigarettes (15% vs. 11%). Nearly one in four Vermont middle- and high-school students have tried an e-cigarette.

If you are a parent, or any adult who takes care of, and cares for children, what do you need to know about e-cigarettes? Are they really a safe alternative to regular cigarettes? How do you talk to your kids about e-cigarettes?

First, you have to know the vocabulary.

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Another Tick-Borne Disease

By David McCormack, Grace Cottage Family Health FNP

Lyme disease is often in the news these days, so by now, most people know at least the basics about how it is contracted, what to do if you get a tick bite, and how to avoid it.

What about the other common tick-borne disease—anaplasmosis?

The Vermont Department of Health says that anaplasmosis is the second most commonly reported tick-borne disease in Vermont, and it’s on the rise. In 2011, there were only 10 cases of suspected or confirmed anaplasmosis. In 2016, there were 201.

When not diagnosed and treated properly, over one-third of those with the disease end up hospitalized, and anaplasmosis can in rare cases be fatal, especially for those with compromised immune systems. While less than 1% of people infected die as a result, this is a disease to take seriously.

One of the hardest things about diagnosing this disease is that, unlike Lyme disease, there is no telltale rash, and the symptoms are fairly common: aches and pains, headaches, chills, fever, fatigue. So how do you know if it’s anaplasmosis?

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Hypertension: What It Is, How to Manage It

By Dr. Moss Linder, Grace Cottage Family Health

In the doctor’s office, emergency room and hospital, we are always on the lookout for high blood pressure, also known as hypertension. Unfortunately, in the United States, hypertension is a common condition and is prevalent in about 32% of adults 18 years or older. The prevalence is higher in people over age 60 compared to younger adults and is higher in African-Americans than white or Hispanic Americans.

Hypertension is generally referred to as a “silent illness.” That is, most people who have elevated blood pressure do not have any symptoms associated with it. Sometimes someone with hypertension may have a headache, but this is more likely an exception, rather than the rule. Therefore, it is very important to have regular blood pressure checks.

Because hypertension is usually an asymptomatic illness, it would be recommended that people check their blood pressure once a year just to make sure that it is normal. This is probably best done as part of an annual wellness examination. The frequency of checking blood pressures in a person with hypertension would be at the recommendation of their clinician.

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Having Happy Feet

By Margaret van den Bergh, Grace Cottage Physical Therapist 

Are your feet happy?

Our feet hit the ground first every morning. They are so important to everything we do, but it is easy to ignore them. Many times we cram them into shoes that don’t even resemble the shape of a foot, or walk in heels that change everything about our gait. We stand on them all day long, and we carry heavy loads that add to the body weight our feet are already carrying.

The amount of force every time your heel strikes the ground can be 2.5 times your body weight and 3.5 times when running. Multiply all that force with the amount of steps that you take in a typical day, and you can begin to imagine how tough our little feet need to be to handle all that abuse. Our feet were initially designed to be barefoot and to be on softer surfaces than what modern life throws at us. 

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Doc, Should I Go to the ER?

By Dr. Kenneth Rudd, MD, MPH, MHCDS from Grace Cottage Family Health & Hospital

How do you know when it’s time to go to the hospital Emergency Room versus seeking care elsewhere?

Because I work as both an Emergency Room doctor for Grace Cottage Family Health & Hospital in Townshend, VT, and as a primary care doctor for Dartmouth-Hitchcock in Lebanon, NH, and have also worked for an Urgent Care Center, I enjoy helping patients navigate the best place to go for healthcare.

The Primary Care Advantage:

My main advice, which I have seen hold true all over the world, from living in China for seven years, to studying Public Health, to working at Dartmouth College and the World Health Organization on international healthcare collaborations, to global primary care research on shared decision making, is, whenever possible, see your primary care provider (PCP).  

What doctor knows you best?  Where do you have relationship and trust? If it isn’t with your PCP, then find a provider that is a good fit for you and build this. 

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Lymphedema Therapy: Not Just for Breast Cancer Survivors

Lymphedema Therapy

Abigail Abbott and Cindy Kenyon, Grace Cottage Physical Therapists

If you have had breast cancer, it’s quite likely that you’ve heard of Lymphedema. As many as 50% of breast cancer survivors must deal with this condition.

But breast cancer isn’t the only cause of Lymphedema. It can be congenital, meaning you can be born with the tendency. Or it can be caused by dysfunction of valves in the vein of an arm or leg (in medical terms, this is called chronic venous insufficiency). If you have unexplained swelling in an arm or leg, it could be due to Lymphedema.

The good news is that help is available to relieve this swelling. Specially trained therapists can offer treatment to start you in the right direction, and they can teach you to carry on with this treatment for yourself.

Further good news: Lymphedema therapists are few and far between, but Grace Cottage now has two physical therapists certified to provide this therapy, Cindy Kenyon and Abby Abbott.

In order for us to explain what is involved with Lymphedema therapy, we first need to explain what causes Lymphedema.

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