Sudden Infant Death Syndrome remains a mystery

BY CHRISTINA GOODVOICE
09/17/2009 07:16 AM
TAHLEQUAH, Okla. – Cherokee Nation citizen Angela Garrett remembers the cold day in January 1993 as one that began like a normal day.

She had just per her 2-month-old son, Blaine, down for a nap in his crib. She checked on him frequently, but despite that, one hour later Blaine died in his sleep. The cause was Sudden Infant Death Syndrome.

October is Sudden Infant Death Syndrome, or SIDS, Awareness Month. SIDS occurs at a rate of about 0.5 per 1,000 births. However, in American Indian and African American populations, the rate is around one per 1,000 births.

SIDS is considered the death of a child less than 1 year old that remains “unexplained” after a thorough investigation including an autopsy, review of clinical history and investigation of the scene of death, said Dr. Tom Kincade, chief of Pediatrics at the Cherokee Nation Three Rivers Health Center in Muskogee.

“I think it is important for our communities to know abut SIDS due to the increased rates in Native Americans and also to be aware of the factors that can help prevent SIDS,” Kincade said.

SIDS remains a leading cause of death in healthy infants less than 1 year old, and approximately 2,100 infants in the United States die of SIDS per year, he said.

Parents can reduce the risk of SIDS by placing babies on their backs to sleep.

“Studies show that over 90 percent of infants that died from SIDS were not sleeping on their backs,” he said. “Most were sleeping on their stomachs.”

Garrett said she put Blaine on his back for his nap, but when she found him, he was on his stomach and his face was in the crib mattress.

“Somehow, at 2 months old he rolled over,” she said. “He was already gone when I found him. I didn’t even call 911(immediately.) I called my mom because he was already gone.”

She said afterward she was in a state of shock, and since then she’s blocked out most of the memory of losing Blaine to SIDS.

“I don’t even remember them taking him out,” she said. “I thought he was still in the room after the ambulance got there and everything. It was a couple of hours later and I thought he was still there.”

Even now, 14 years later, Garrett said she’s stilly trying to understand SIDS.

“From the moment I found him, I don’t remember too much of anything else,” she said. “He wasn’t sick. He didn’t have a cold. There wasn’t anything wrong with him.”

Studies have also shown that letting babies use pacifiers while sleeping can reduce the SIDS risk, Kincade said. He added that infants should sleep on a firm sleeping surface, should not be overdressed while they sleep and stuffed animals, excess bedding and blankets should be avoided.

“When babies leave the hospital nursery they should be able to maintain a normal body temperature which means if parents feel comfortable in shorts and a tee shirt, their babies will too,” he said.

Educational materials about SIDS have been placed in the clinic and exam rooms at the Three Rivers Health Center, and other tribal clinics have been encouraged to do the same, Kincade said.

Health

BY STAFF REPORTS
06/10/2016 12:00 PM
WASHINGTON – A Cherokee Nation physician was honored at the White House on May 19 for the tribe’s commitment to testing and treating patients for hepatitis C, which has led to more patients being cured of hepatitis C and living longer lives. Acting Assistant Secretary of Health Karen B. DeSalvo presented Dr. Jorge Mera, CN infectious diseases director, his award during a White House ceremony in observance of National Hepatitis Testing Day. “The award is a wonderful recognition from the White House to all the Cherokee Nation providers, health professionals and administration for making this program a success in changing lives and combating hepatitis C,” Mera said. “In the last couple of years we have tested thousands of patients and cured hundreds who suffer from the hepatitis C virus. We have a lot of work ahead, but I think we have made the invisible epidemic, now visible.” The CN, thanks in large part to Mera, began a hepatitis C elimination project in 2015. The tribe executed plans developed by the U.S. Centers for Disease Control and Prevention. To date, the CN has screened more than 12,000 Native American patients for hepatitis C. Among those testing positive, more than 300 have been treated and are considered cured of the infection that causes liver disease. “At Cherokee Nation we are diligently addressing hepatitis C infection within our tribal population. We are able to do that because of the ongoing partnership with the CDC, and I thank Dr. Mera and his team for their work. It is a pioneering effort and I am proud we are making great strides,” Principal Chief Bill John Baker said. “Indian people face a huge disparity in the rate of contracting hepatitis C in America, but through our efforts we are educating our citizens and systematically fighting, and even curing, hepatitis C. Hopefully, these best practices will soon be replicated across Indian Country.” An estimated 850,000 Americans have hepatitis B and 3.5 million have hepatitis C, and fewer than half are aware of their infections, according to the U.S. Department of Health and Human Services. Since 2012, deaths associated with hepatitis C outpaced deaths due to all 60 other infectious diseases, and in 2014, the number of hepatitis C-related deaths reached an all-time high of 19,659. National Viral Hepatitis Testing Day is an annual CDC-sponsored observance. This year, the HHS collaborated with the White House Office of National AIDS Policy and Office of National Drug Control Policy for the Hepatitis Testing Day event to highlight the impact of viral hepatitis in the United States. It is the first year the HHS presented awards to organizations testing for hepatitis. Other health organizations recognized were from Hawaii, Rhode Island, New York, New Jersey, Washington, D.C., San Diego, Dallas and Wyoming. “Increasing testing for hepatitis B and C is a critical part of ensuring good health for all Americans,” DeSalvo said. “With coordinated efforts by diverse partners like those being recognized…we can reduce deaths and disparities in hB and C and improve the lives of people living with chronic viral hepatitis.”
BY STACIE GUTHRIE
Reporter – @cp_sguthrie
06/03/2016 08:15 AM
KENWOOD, Okla. – The Cherokee Nation’s Trust Land Kenwood Units have plants such as Trillium, which contain medicinal properties, and Buckbrush, which can be used for making baskets. Pat Gwin, administrative liaison, said the approximately 160-acre Delaware County tract, which is not accessible to the general public, is home to culturally significant and medicinal plants. “We might have hit five acres of it and we saw this list of what is twentyish really important plants, so that’s a neat tract,” he said. While on the tract, Gwin spotted Trillium, a short-lived medicinal plant. “A lot of Cherokee medicinal, cultural food plants only grow in like a two-to-four-week window here in the spring, and Trillium is one of those. It’s a medicinal plant and there are years when it is very prevalent and there are years when you can’t find it very often,” he said. Gwin declined to comment on the plant’s medicinal purposes for safety reasons. He suggested people wanting to use medicinal plants seek a Cherokee medicine person. He did the same for May Apple, which he also found. “May Apple was another one of those medicinal plants, cultural-use plants. The strange thing about the May Apple is that it was used for a lot of cures that western medicine hasn’t really done a lot of research on or is just now starting to do some research on. If you go to other parts of the world it’s been used for a lot of the same medicinal uses that the tribe has for centuries,” he said. He said another plant he saw was Sassafras, which was used as a blood thinner. “Sassafras, its medicinal qualities have been made known for a longtime. It’s used as a blood thinner,” he said. “Today, it’s got some controversy surrounding it because one of the main ingredients, the Safrole Oil, is a carcinogen, so there’s a lot of warning out there for people that do partake of it do so in moderation. It has three distinct leaves. It has the sock that’s the round leaf and then it has the mitten and then it has the glove. No other tree has that so I think that’s pretty cool.” Other notable plants found were Wild Ginger, which Gwin said is used as a food additive and for medical purposes; Solomon Seal, which he said “highly skilled Cherokee healers” would have used; and Green Dragon, which Gwin said is kin to Jack-in-the-Pulpit and used for medicinal purposes. Gwin also found Sochan, a plant offered through the tribe’s Seed Bank Program. “(It’s) one of the traditional Cherokee greens that’s eaten in the spring,” he said. “You might say it’s somewhat a kin to Watercress, but most people don’t know that Watercress probably isn’t even from North America.” He said another plant in the area that is culturally important is Buckbrush. “Buckbrush would have been the one they (Cherokee baskets weavers) used,” he said. “A lot more difficult than Honeysuckle because it just doesn’t grow as long.” Gwin said most of these plants would be found in “low-lying wetland areas.” “One of the things that when you look for areas that are going have a lot of Cherokee plants you have to think at a couple of things. Cherokees always needed water,” he said. “A significant number of those plants would be found in those low-lying wetland areas, which environmentally, those are sensitive areas.” Gwin said it’s important for Cherokees to know about plants that are important to their people. “There were a couple of things that our ancestors told us that we had to retain in order to be Cherokee. Obviously one of them was language. Obviously one of them was the ability to grow our own food. The ability to utilize and respect plants was another one of those things,” he said. “The Cherokee homeland is a very diverse plant environment as is northeastern Oklahoma. I always found it interesting. The relocation could have been far worse than what it was, but they stopped here in northeastern Oklahoma where we may not have all the same plants as we did back there but, for example Jack-in-the-Pulpit, very cultural Cherokee plant, very prevalent back East, not so much here but we have the Green Dragon, which…it’s so close in relation.” He said he plants are some of the things that helped Cherokees thrive in the modern CN. “Even now we might not have the exact same plants. We have very, very close cousins, kins to them. That’s one of the things that I always thought allowed us to, once we got here, build up the tribe as quickly as we did,” he said. “I’m not sure any other population on the planet would have been able to survive that but that was one of the things that we were able to do, and I truly think the plants was one of the reasons for that.” For information about Cherokee-important plants or to tour the tribe’s Garden and Native Plant Site, email <a href="mailto: pat-gwin@cherokee.org">pat-gwin@cherokee.org</a>.
BY LENZY KREHBIEL-BURTON
Special Correspondent
05/27/2016 09:00 AM
TAHLEQUAH, Okla. – With international health officials sounding the alarm, Cherokee Nation Public Health officials are preparing for the Zika virus. Earlier this year, the CN was one of three tribes to participate in the Centers for Disease Control’s Zika summit in Atlanta. Lisa Pivec, Public Health senior director, said while the CN’s jurisdiction is considered to be a low risk for an outbreak, plans and partnerships with the Oklahoma Department of Health and the CDC are in place as a proactive measure. “The most important thing for us right now is getting a process in place,” she said. “The CDC has been great about helping us with that. We’ve seen what they’ve done with other infectious diseases, and they’re great about helping us get that done at the local level.” For now that process involves keeping current information available to the public through www.cherokeepublichealth.org and maintaining regular contact among epidemiologists, communications professionals and environmental health specialists with all three entities. As part of that partnership, any testing for the virus conducted at the tribe’s facilities is at no cost to the CN. Samples taken for testing are sent to the state health department’s offices in Oklahoma City and to the CDC in Atlanta where the actual test will be conducted. So far, no tests have been submitted from a CN health facility, but Dr. David Gahn, Public Health medical director, said the tribe would be immediately notified if that changes. According to the Oklahoma Department of Health, as of May 5, four cases of Zika had been reported statewide. All four were caused by travel to one of the more than 40 countries with a reported case of the virus. The most common symptoms are fever, rash, joint pain, muscle pain, headaches and conjunctivitis. However, with the incubation period estimated at up to seven days, only 20 percent to 25 percent of those infected with the virus show any symptoms. No vaccine is available. The people highest at risk of contracting the virus are men and women who have traveled to one of the countries or U.S. territories on the CDC’s advisory list. Pregnant women are considered particularly vulnerable due to the virus’ link to birth defects, including microcephaly, stunted fetal growth, vision problems and hearing problems. “Most people who get Zika don’t really get ill,” Gahn said. “Among those who do, it’s very rare for even children to need hospitalization.” The virus is also linked to an increased risk for Guillian-Barre syndrome, a disorder in which the body’s immune system attacks part of the peripheral nervous system. However, the CDC and other epidemiologists have not determined what causes the connection or which populations are more likely to be at risk of developing Guillian-Barre as a side effect of the Zika virus. “We don’t know what’s the risk yet, as in how many people who are infected with Zika will get and which ones,” Gahn said. “We just don’t know the risk factors yet. Does it go after older people? Men? Women? Teenagers?” Although the virus can also be spread through unprotected sexual contact with an infected man, many of the preventative measures being touted to the public are aimed at its other means of transmission: mosquitoes. As a mosquito-borne virus, many measures used to curb the spread of the West Nile virus are equally effective against Zika. Along with the use of an EPA-registered insect repellant, wear long-sleeved shirts and long pants whenever possible and citizens are encouraged to not leave doors and windows propped open unless covered with a properly maintained screen. Additionally, mosquitoes can be kept at bay by not leaving standing water around the home. Birdbaths, rainwater collectors, kiddie pools, trash cans and other containers that could potentially hold water should be emptied out at least weekly, as mosquitoes lay eggs in standing water. Cracks or gaps in septic tanks should be patched and any exposed vents or plumbing pipes should be covered. More preventative measures are available at <a href="http://www.cdc.gov/zika/prevention/controlling-mosquitoes-at-home.html" target="_blank">http://www.cdc.gov/zika/prevention/controlling-mosquitoes-at-home.html</a>. The two main species of mosquito that carry Zika, Aedes aegypti and Aedes albopictus, are generally not found in Oklahoma. However, that has not deterred officials with tribe’s health department from encouraging CN citizens from taking a proactive approach to prevent Oklahoma’s first mosquito-borne case from arising in the jurisdiction. “For us, it’s about putting together the best plans we can based on risk levels and being as responsive as possible without creating worry or concerns that are not warranted,” Pivec said. “We know that we’re prepared if the situation changes.”
BY JAMI MURPHY
Senior Reporter – @cp_jmurphy
05/23/2016 04:00 PM
TAHLEQUAH, Okla. – At the May 16 Health Committee meeting, Tribal Councilors questioned Health Services Director Connie Davis and Brett Hayes, who oversees the tribe’s contract health department, about contract health referral reductions for the rest of the fiscal year and the department’s shortfalls. According to an emailed letter from Health Services Executive Medical Director Dr. Roger Montgomery to Davis, who then forwarded it to Tribal Councilors, each year the tribe overspends its contract health budget and he recommends “people cut back on the referrals they write.” “People don’t really cut back all that much and administration makes up the difference with collections from the clinics, etc., so we don’t end up having to push the issue,” Montgomery states. “This year, with the implementation of a new electronic health record leading to reduced clinic schedules, and the addition of approximately 10,000 patient visits this year, there are no additional collections to pad Contract Health’s overruns.” Montgomery states that in the first seven months of FY 2016 the tribe spent $25 million of its $35 million contract health budget. “That leaves $10 million available for the last five months of the fiscal year and no expected increased collections to cover the remainder. If payments for transfers out continue at the same pace of about $200,000 per month, it actually leaves $9 million for everything else,” he writes. At the meeting, Davis said She said the lack of in-house procedures because of referrals has caused contract health spending to get out of control. “So we’ve asked our docs to do a better job managing patients within our own health centers and not sending them out for things like knee injections, shoulder injections or casting,” she said. She added that the health system had grown by about 10 percent annually since she’s led Health Services and that has impacted spending. “We’ve budgeted a flat budget with contract health all these years, and so it’s obvious that there’s at some point that we’re going to have to slow some of the (referrals),” she said. Many referrals are approved now that historically hadn’t always been approved, including pain management and orthopedic procedures, Hayes said. Montgomery states that to solve overspending for the rest of FY 2016 requires referral reductions. “Because of our three chance appeals process, the only real way to ensure not spending money on a referral is to not write the referral at all. In our case, this means reducing the number of referrals written by as much as 50 percent. Contract Health money is and was traditionally earmarked only for urgent and emergent care. It was never intended for elective care,” he states. “It was never intended for routine follow-ups in patients not having further issues. It was never intended for things we could do ourselves, even if it meant waiting a bit for the care. We added money in the past in programs such as Back to Work to help pay for some of the elective procedures. However, when that money was no longer available, we never dropped those new service lines.” <strong>Referrals that could be reduced included in Montgomery’s statement were:</strong> • Dizziness workups that were instigated by a vendor apart from the original reason for the referral, • Prophylactic mastectomy that could be performed at Hastings, • Circumcision revisions for cosmetic purposes, • Dermatology: simple excisions, punch biopsies, actinic and seborrheic keratosis treatments and skin tag removals, • Simple wound care, • Elective gallbladders, hernias, hysterectomies, etc., that could be performed at Hastings, • Cardiac clearance by cardiologists that can be done in-house, • Varicose veins, • Long-term follow-ups for benign or distant conditions, • Elective orthopedics-joint replacements, • Elective repairs, • Injections at outside vendors, • Non-elective orthopedics-simple casting, • PET scans that don’t change treatment, • Cataracts before Medicare kicks in, and • Allergy testing and reduction mammoplasty. Not all non-urgent, non-emergency procedures are included in the list. The list was in reference to one day’s referrals, according to Montgomery’s statement. Montgomery also states that providers would have to “police themselves” when writing referrals. “If your case manager is writing all your referrals for you without any real discussion, you will need to halt this practice…Another option is to advocate to your patients the importance of signing up for available resources, such as insurance from the Affordable Care Act, Medicaid, and Medicare Part B,” Montgomery states. “We can pay for 5 insured referrals for every one uninsured referral. This also brings money into your individual clinics, which allows you to pay for raises, new providers, and creates the cushion that Contract Health used to use when there are overruns. Explain to your patients that signing up for these things are a huge help to Cherokee Nation Health. Ask them if they can afford to and are willing to help.” Montgomery states that if these options were unsuccessful each clinic would be given a budget to work from and be required to review their referrals daily and work within that budget. “If we still aren’t getting under budget, more drastic action would need to be taken,” he states.
BY STAFF REPORTS
05/20/2016 04:00 PM
CLAREMORE, Okla. – The Claremore Indian Hospital will host its second annual “Kids Summer Safety Fest” from 9:30 a.m. to noon on June 4. The event will take place outdoors at 101 S. Moore and is geared toward school-aged children and will include games and fun educational learning activities created by local agencies and businesses. Door prize drawings will take place at 11:30 a.m. Safe Kids Coalition Tulsa, with the assistance of the Claremore Fire Department, will conduct a car seat safety checkup event in which nationally certified technicians will show caregivers how to properly install car seats and check those already installed. Also, there will be a limited number of car seats provided to those in need at no cost. Grand River Dam Authority officials will provide education about water safety. City of Claremore Lights and Power officials will have an interactive electrical safety booth. Operations Lifesavers will perform education activities surrounding the importance of railroad safety, while Will Rogers Masonic Lodge No. 53 will provide a free child identification program that consists of height and weight measurements, dental impressions with DNA, scent, fingerprints, photos and recording for child’s voice recognition. This package will be given to the caregiver for utilization if their child is ever missing. Pete Goltra, of the Akdar Shriner Tulsa, will also attend with his popcorn truck providing snacks. American Red Cross will attend with its emergency response vehicle with its water station. Tulsa Life Flight will be on scene with its helicopter for kids to sit inside. Contech Inc. will have heavy machinery on site to teach about the dangers of playing on construction sites. The Claremore Fire Department will have a fire truck available for children to take tours. Pafford EMS will also provide tours of an ambulance. Claremore Indian Health Service will provide various games and education from its dental, dietary, pharmacy, benefit coordinators and emergency department. Tulsa Emergency Infant Services will provide information regarding the services that it provides along with a diaper giveaway. Safenet Emergency Services will have games teaching children how to address bullying. Claremore Auto Parts has provided a wrecked car to stress the importance of using seat belts. Also, Nabatak Outdoors will give away a life jacket and fishing pole, and other agencies attending with booth and activities include Saint Francis Children’s Hospital, Claremore Hillcrest Hospital and Rogers County Sheriff’s Department K9 unit.
BY STAFF REPORTS
05/10/2016 03:30 PM
WAGONER, Okla. – To curb prescription drug abuse, the Cherokee Nation is encouraging the public to drop off any unused prescriptions on Saturday during the Wagoner Family Fun Day in Maple Park. The tribe’s regional prevention coordinators will have an “Rx Take Back” booth at the event from 10 a.m. to 2 p.m. for those who want to safely dispose of prescriptions that are no longer needed. Wagoner County ranks among the highest in the state for prescription overdose deaths related to painkillers, according to state data. “The Cherokee Nation knows the importance of not only physical health, but mental health, and is working to ensure our communities and citizens are healthy and safe,” CN certified prevention specialist Coleman Cox said. “Painkillers such as hydrocodone, oxycodone and codeine, are some of the most abused prescription drugs in our 14-counties. That’s why it’s important to have safe drop off bags and locations to get these no longer used drugs out of medicine cabinets and homes.” The CN is using a grant from the Oklahoma Department of Mental Health and Substance Abuse Services and the Substance Abuse and Mental Health Services Administration to raise awareness of the problem and create prevention plans. The CN regional prevention coordinators who work through the tribe’s Behavioral Health department routinely drop bags at pharmacies with information on safe use, safe storage and safe disposal of prescription drugs. In Wagoner County, Owl Drug on Main Street gives the bags out to raise awareness. “We like the prescription take back bags and handing them out with some prescriptions,” pharmacist Matthew Villandry said. “We think it helps and have also seen a decrease in hydrocodone use because we now ask customers to fill another prescription along with it.” Residents can dispose of prescriptions at the booth on Saturday or at any time at the Wagoner County Sheriff’s Office at 307 E. Cherokee St., Wagoner Police Department at 105 S. Casaver Ave. or the Coweta Police Department at 212 N. Broadway, where each has disposal bins. For more information email <a href="mailto: bhs-prevention@cherokee.org">bhs-prevention@cherokee.org</a>.