Cherokee Nation citizen Stacie Guthrie receives a flu shot from licensed practical nurse Sharon Morton at the Gadugi Health Clinic in Tahlequah, Okla. JAMI CUSTER/CHEROKE PHOENIX

Influenza hits CN but vaccines still available

Nationwide, during the week that ended on Jan. 12, 4.6 percent of patient visits reported to the U.S. Outpatient Influenza-like Illness Surveillance Network were due to influenza-like illness. This percentage is above the national baseline of 2.2 percent. CENTERS FOR DISEASE CONTROL By Jan. 12, the Centers for Disease Control reported that the flu had reached 48 states and influenza activity remained elevated in the United States. CENTERS FOR DISEASE CONTROL To help fight against influenza and inform people about the virus, Dr. Jorge Mera, of Cherokee Nation Health Services, provides a presentation on Jan. 18 in Tahlequah, Okla. TESINA JACKSON/CHEROKEE PHOENIX
Nationwide, during the week that ended on Jan. 12, 4.6 percent of patient visits reported to the U.S. Outpatient Influenza-like Illness Surveillance Network were due to influenza-like illness. This percentage is above the national baseline of 2.2 percent. CENTERS FOR DISEASE CONTROL
BY TESINA JACKSON
Reporter
02/01/2013 08:01 AM
TAHLEQUAH, Okla. – With more than 230 people testing positive for influenza within the Cherokee Nation, officials say tribal health clinics have vaccines available and urge people to get one.

Flu is a contagious respiratory illness caused by viruses. It causes mild to severe illness, and at times, leads to death. Some people, such as older people, young children and people with certain health conditions, are higher risks for flu complications.

“The flu is a virus and viruses are very, very smart you might say,” Dr. Roger Montgomery, CN medical director, said. “They change themselves every year and try to morph themselves so they can have a better success of causing illness. And there are also different strains out there, and so the CDC tries to come up with an idea of what strains of virus will cause illness each year and the vaccine has three different kinds of strains of virus in it.”

According to the Centers for Disease Control, this flu season has produced a high outbreak with more than 3,600 people hospitalized since October, most of them older than 65, and at least 20 children’s deaths.

By Jan. 12, the CDC reported the flu had reached 48 states and activity remained elevated. On average, 5 percent to 20 percent of the population gets influenza. This season, it’s hit more than 30 percent.

According to the Oklahoma State Department of Health, flu season began on Sept. 30. Since then there have been more than 500 related hospitalizations and eight related deaths in the state.

There are three types of flu viruses: A, B and C. Types A and B cause the epidemics that have up to 20 percent of the population sniffling, aching, coughing and running fevers. Type C also causes flu, but its symptoms are less severe.

The Type A virus constantly changes and is spread by infected people. Type B flu may cause a less severe reaction, but occasionally it can still be harmful. Type C viruses are milder than type A and B. People generally do not become extremely ill from them and they do not cause epidemics.

The flu usually starts suddenly and may include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue and tiredness. Some people have vomiting and diarrhea, though it’s more common in children.

Some complications caused by flu are pneumonia, dehydration and worsening of chronic medical conditions such as heart or lung disease, asthma or diabetes. Children may get sinus problems or ear infections.

“The deaths that you see reported are not really from the virus itself. They’re from the super-imposed illness that occurs after they’ve had influenza that causes them to develop respiratory failure and pneumonia,” Montgomery said.

The flu spreads by droplets released by coughing and sneezing. Occasionally touching something with a virus on it and then touching the mouth or nose may cause infection. People with the flu can spread it to others up to about six feet away.

“That’s why we emphasize if you’re out there going to work, going to public places, touching objects that other people touch don’t take your hand and rub your nose without first washing your hands thoroughly and wash them frequently,” Montgomery said.

People with flu are contagious and can infect others beginning one day before getting symptoms. Adults remain contagious up to seven days after getting sick, and children can remain contagious even longer.

“If you came in contact with the person who had the flu, you’ve contracted the virus,” Dr. Sohail Khan, of CN Health Services, said. “Within two days you will start to develop symptoms, and the important thing to remember is that you can be infectious for the next five to seven days.”

The best way to prevent the flu is vaccination. The vaccination rate for the American Indian/Alaskan Native population is 29 percent, according to Indian Health Services.

“I think as a group, because the prevalent of diabetes is so great, that it’s just recommended broadly that all Native Americans be vaccinated,” Montgomery said.

According to WebMD, the vaccine is highly effective for preventing the flu, though not 100 percent. People can get the flu despite getting vaccinated, although it’s usually less severe and resolves quicker. According to the CDC, vaccines given this year appear to be about 62 percent effective overall. Of people who got the flu, 32 percent were vaccinated.

“It can either completely eliminate you from having any symptoms at all or it can, the word we use is, attenuate,” Montgomery said. “It can lessen the severity of the duration of symptoms that you have.”

There are two types of vaccines: the shot and nasal spray. The shot is contains a dead virus that’s given with a needle. The shot given in the muscle is for people older than 6 months, including healthy people and people with chronic medical conditions. The shot given below the skin is for 18- to 64-year-olds.

The nasal spray vaccine contains live, weakened viruses. It’s for healthy people ages 2 to 49 who are not pregnant. Neither vaccine causes the flu.

It takes about two weeks for antibodies to develop that protect against infection for the entire year. Flu vaccines will not protect against illnesses caused by other viruses such as the common cold.

If positive for flu, there are antiviral drugs that can be used to treat the illness.

“The main one that most people have heard about is called Tamiflu,” Montgomery said. “It’s most effective if you start it within 48 hours of the onset of your symptoms.”

Annual vaccination is recommended for everyone regardless of past vaccination status or flu infection. Vaccination should begin in September or as soon as the vaccine is available and continue throughout the flu season, which can last as late as May.

To view a CN Health Services flu presentation, visit http://legislative.cherokee.org/StreamingEvents.aspx
and click on influenza presentation.

tesina-jackson@cherokee.org


918-453-5000, ext. 6139

Health

BY JAMI MURPHY
Senior Reporter – @cp_jmurphy
08/25/2016 08:15 AM
TAHLEQUAH, Okla. – Cherokee Nation citizen Pam Turtle will spend the rest of her life taking medication to help her live with a transplanted kidney. The transplant was needed because she’s had polycystic kidney disease since she was 24. Turtle, 49, is from Stilwell but lived in Kansas, Oklahoma, until five years ago. That’s when she got extremely sick and doctors told her the disease had progressed enough to necessitate dialysis. So she and her husband Mike Turtle moved to Tahlequah to be closer to a dialysis center. PKD causes cysts to take the place of normal tissue. They enlarge the kidneys and make them work poorly, leading to kidney failure. The disease also runs in families. As a child, Pam watched her mother suffer from PKD, so Pam carried a lot of responsibility, including helping keep the house and family together. “My mom was sick the whole time I grew up. In fact, I had to miss some school to take my mom to dialysis and to drive her back. When I was 24 years old I was going to donate a kidney to my mother. I had just had my second child – my last child – and they told me I couldn’t. They told me I had the same disease that my mom had,” Pam said. “They had found cysts bilaterally on my kidneys, and they told me that I would have to start seeing a doctor.” Pam said the disease progresses slowly and affects the whole body. “It took 20 years for this disease to progress. That’s the best thing about this disease, is that it takes years and years and years for it to become a problem.” As the years passed, Pam’s blood pressure increased to where she had to take several pills a day. Still her symptoms and disease progressed. About five years before her kidneys failed, she was referred to a nephrologist in Muskogee. “It got to where I would see him once a year, and then I saw him every six months. Then I saw him every three months, and then I saw him every month. It was just a process I had to go through,” she said. Then one day her nephrologist told her she needed a fistula and dialysis. A fistula is an abnormal connection between two body parts, usually the result of an injury or surgery. “So in November of 2010, I got my first fistula. It’s dead now. I have really bad veins, so they had to harvest a vein and pull it over so that I could use it,” she said. After a year of dialysis in that location, it clotted. “So they sent me to go get a catheter, and it would go straight into my heart, and I took treatment on it for eight months, and while I had this in they did another surgery and put a graft in my arm,” Pam said. The plan was to do dialysis off the graft, but six months later it too had clotted. So she was sent for vascular surgery. After cleaning that vein, it too died and again she had to have catheter. “In eight months I had 13 catheters put in. It’s really hard to do a treatment with them. You’re really prone to infection, and if you get an infection here it goes straight to your heart,” she said. “I’ve watched two people die on dialysis using a catheter.” After dialysis, she said her life changed greatly. “I did it three days a week. I went at 5:30 in the morning. I got through by 9 (a.m.)…There were things we couldn’t eat,” she said. Pam said the disease has a process, and that’s what she was going through. Her mother, grandmother, two uncles, two aunts as well as Pam’s daughter and granddaughter were diagnosed with PKD. Aside from one aunt, her mother, daughter and grandchild, the rest died from complications. “They all passed away with that disease. My aunt has a transplant. My mom’s transplant is the same age as my daughter. My daughter is 26 years old. Mine is four years old…I got it on Dec. 21, 2012,” she said. She said she and her family members with the disease wouldn’t be alive without the transplants. The organ donations, she said, gave her a new start because the disease doesn’t attack the new kidney. Pam said her daughter, Shaye, is 26 and was diagnosed when she was 10. “She hurts a lot and she has very high blood pressure. A migraine can set her back for days. She sees a doctor every six months for her kidney disease and dialysis is just around the corner,” Pam said. “My granddaughter was diagnosed while in the womb. She sees a nephrologist every year. She has some pain issues, but she’s doing great.” Pam said eventually they would need dialysis and transplants. “I encourage donation. If everyone could just understand what it means to donate. There’s a lot of misconception about donation. You don’t have to die to donate, and living donors are the best for kidney donation because they work immediately,” she said.
BY JAMI MURPHY
Senior Reporter – @cp_jmurphy
08/15/2016 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation Health Services officials said although the Affordable Care Act’s open enrollment begins in November, American Indians, Alaska Natives and their non-Native household members can enroll any month, and they are encouraging Cherokee Nation citizens to take advantage of this and other Native provisions in the ACA. Connie Dunavin, Health Services special projects officer and ACA lead, said the use of one’s tribal health care facility is not considered insurance coverage but a benefit by the federal government’s Indian Health Services. Dunavin explained “we get calls now that Cherokee Nation citizens think that because they have access to Cherokee Nation Health Services facilities, that they are considered covered by insurance.” But IHS is limited in certain services offered, Dunavin said, therefore having coverage under the Affordable Care Act (ACA) through the Marketplace will help insure things such as specialty care, or accidents that could occur out of state. “So we’re trying to encourage completing a marketplace application,” Dunavin said. “As a member of a federally recognized tribe, one of the special provisions for American Indian/Alaska Native is an opportunity to qualify for a zero-cost-sharing plan.” American Indian/Alaska Native households or individuals whose income falls between 100 percent and 300 percent of the federal poverty level can qualify for the zero-cost-sharing plan, she said. “That is no co-pay, no deductible and zero cost for medicines whether they’re name brand or generic. Many of our people qualify for that,” she said. “And that is an American Indian special provision.” Health Services has certified application counselors available in each health center and at W.W. Hastings Hospital to assist tribal citizens with applications, enrollments and exemptions. Without coverage or an exemption, people who are required to file income taxes will be assessed penalties called shared-responsibility payments. “We have another special provision, the American Indian/Alaska Native or AI/AN Exemption,” she said. After filing for this exemption the marketplace will issue a lifetime Exemption Certificate Number (ECN), Dunavin said, which is an indicator to the IRS that the filer is of American Indian status and has been confirmed by the federal government and not just claiming to be an American Indian/Alaska Native to avoid a penalty. She said this spring in Dallas, the Regional Center for Medicare and Medicaid/IHS meeting informed tribal officials that filing for the exemption would end soon and the last ECN would be issued in December 2016, but officials are still waiting for that official notification. “The only option then (without an ECN) will be to just check on your income tax form (8965) and claim to be Indian,” Dunavin said. “So the IRS has said, it’s not in writing, but they have told us that they will no longer audit you based on a claim of being Indian to avoid a penalty.” However, this year, Dunavin said she and other tribal officials attending the regional meeting reported accounts of families that were contacted by the IRS based on the claim of being Indian (not having an ECN), as well as accounts of citizens unknowingly claiming use of their tribal facilities as insurance coverage. With the ECN on tax form 8965, Dunavin said, the IRS knows that the federal government has confirmed a person to be a citizen of a federally recognized tribe and not just claiming Native status to avoid the penalty. “We are encouraging our citizens to come in before or by November and let us help you file for the ECN to confirm your status,” she said. For those wanting to file for the ECN or read more information, go to <a href="http://www.healthcare.gov/tribal" target="_blank">www.healthcare.gov/tribal</a> and follow the AI/AN Exemption links. Dunavin said applying for health coverage through the marketplace can be confusing and difficult and that many tribal citizens have tried the “Quick Estimator” for pricing that’s provided at healthcare.gov not knowing the estimator does not reflect the zero-cost-sharing special provision for American Indians/Alaska Natives. “So health officials are urging citizens to utilize the CN staff available that can help with looking at types of coverage one may qualify for at a zero or low cost.” Health Services has 24 certified application counselors to help tribal citizens, she said. “Call to set up an appointment, or come in and meet your community health center’s PBC (Patient Benefit Coordinator) and let us help you with applications, enrollments, to see if you qualify for those zero-cost-share plans, and to help you with the AI/AN Exemption,” Dunavin said. For more information, call your local CN health clinic or 918-453-5000, ext. 5657.
BY STACIE GUTHRIE
Reporter – @cp_sguthrie
08/15/2016 08:15 AM
TAHLEQUAH, Okla. – Nurses from Florida Atlantic University in Boca Raton visited Cherokee communities July 18-25 as part of a “cultural exchange” and spoke about health-related topics. Dr. John Lowe said he’s been bringing nurses to the area since 2004. “I looked at the curriculum at Florida Atlantic University and wanted to…have a way of contributing back to the communities here,” he said. “So in this program that these nursing students are in, it’s what we call a completion program. They have associate degrees in nursing, so they’re now coming back to the get a bachelor’s (degree). They’re practicing nurses. They have a lot of knowledge, but one of the things that they usually do not get in their associate degree program is a community-based type of experience. So we have a course in our curriculum that focuses on community-based experience.” Lowe said the Community Cultural Immersion Experience is a one-week class that provides students and community members with a cultural exchange. He said the 35 nurses were from various places, including Jamaica, Brazil, Syria and Nigeria. “The nice thing is that the majority…they were internationally born, and so they’re citizens down here and they live and work in Miami (Florida), but a majority were born somewhere else and raised somewhere else for the most part,” he said. “So they come and they interact with the tribal youth and the elders and the communities and they talk about where they’re from.” Melessa Kelley, a United Keetoowah Band and Cherokee Nation citizen who has a Ph.D. in nursing, helps with the class. She said aside from the cultural exchange the nurses also promote on healthy lifestyles. “The nurses are doing their topics on nutrition, diabetes, heart health and exercise, first aid and safety, and then we talk about nursing health careers and different health professions that the kids can go into,” she said. “Then they also do personal and dental hygiene, and then they do their…cultural presentation or exchange with the elders at the elder center. So we’ve kind of been all over this week. And we also do provide physical examines for them to do for their school physicals because some of the kids really need that service. It’s been really good for us to be able to do that.” Steven Boyd, a registered nurse who participated in the class, said he enjoyed the immersion experience while in Oklahoma. “I think it’s important for us because coming from south Florida we’re such a melting pot there, but we’re so far removed from much of what’s going on in the rest of the country, and so for us, a lot of us have never encountered anyone from the Cherokee Nation. So to learn sort of the rich history of the people has been absolutely fascinating,” he said. Lowe said at the end of the week the students gain “a lot” from the experience. “I open with a circle and then…close with a circle. Each student is given time to share what they experienced, and it’s really moving. They really get a lot out of it,” he said. “They feel really accepted by Keetoowah communities.”
BY LINDSEY BARK
Staff Writer
08/11/2016 04:00 PM
JAY, Okla. – The Cherokee Nation’s Women, Infant and Children program celebrated World Breastfeeding Week Aug. 1-5 at the Sam Hider Health Center to support breastfeeding awareness. WIC lactation coordinator Euphemia John said the program supports breastfeeding awareness by educating and supporting women who currently breastfeed or plan to breastfeed. WIC serves as an institution where mothers with newborns can get help and advice about breastfeeding. Peer counselors and consultants serve the WIC clinics in the tribe’s 14-county jurisdiction by visiting homes, placing routine calls to check on mothers and providing breast pumps when necessary. Jessica Green-Wagnon, a mother of a newborn, said she is learning how to breastfeed her second child. She said her first child was “tongue-tied” and was not able to nurse. “It’s a different experience for sure. I feel closer to her (newborn) just because I get to do that,” she said. Green-Wagnon said she is supplementing breastfeeding with bottle feeding because she plans to go back to work and the WIC program is teaching her techniques such as getting the “milk to drop,” expelling the milk, how often to feed and using a breast pump. WIC peer counselor Ashton Leach has two children and said she also went through the program. She said WIC lactation supervisor Twila Whitekiller helped her get through the nursing stage with her first child. Now Leach works with Whitekiller and assists mothers in the same process. “Twila told me that the ‘breast is best,’” Leach said. WIC employees advocate breastfeeding as a means for healthier mothers and babies. Whitekiller said nursing mothers have a decreased chance of getting certain types of cancers and babies are at a lesser risk for getting infections because they receive needed immunities from the mother’s milk. She said a mother’s milk releases antibodies and antibacterial agents specific to the baby’s needs. Breastfeeding can also help new moms lose weight by burning 350-500 calories daily, according to Women’s Health magazine. Whitekiller said 11 years ago when she started in WIC breastfeeding rates were low but that she’s seen a gradual increase during the years. “Our goal is to increase breastfeeding rates,” John said. Mothers who go back to work after having a baby, such as Green-Wagnon, need to pump milk in the workplace. And according to state law, they have the right to do so. A CN policy also supports and accommodates working mothers who wish to “express breast milk during her workday” when she is apart from her newborn child. Outside the workplace, there are different opinions when it comes to breastfeeding in public places. “Society and media has made it that breasts are a sexual thing. We have breasts to nurture our babies,” Whitekiller said. She added that breastfeeding can be a “beautiful thing.” “And when you see a mom who’s able to breastfeed her baby without pain and know that her baby is satisfied and drinking milk from her breast and she’s providing it, it’s this whole new confidence that comes over the mom. There’s this peace and it’s ‘I’m doing this,’” she said. For more information, call 918-453-5000 or email <a href="mailto: WIC@cherokee.org">WIC@cherokee.org</a>.
BY STAFF REPORTS
08/04/2016 12:00 PM
TAHLEQUAH, Okla. – On Aug. 10, the Oklahoma Breast Care Center’s mobile mammogram unit will be at the Gadugi Health Center. Any woman who has a mammogram due or has never had a mammogram and has health insurance coverage, call the clinic at 918-207-4911to see if you are eligible for this service. The OBCC provides this service at no out-of-pocket cost to the patient after insurance pays. The American Cancer Society recommends that women over the age of 40 have a mammogram yearly. Regular mammograms can often help find breast cancer at an early stage, when treatment is most likely to be successful. A mammogram can find breast changes that could be cancer years before physical symptoms develop. Results from decades of research show that women who have regular mammograms are more likely to have breast cancer found early, less likely to need aggressive treatment such as surgery to remove the entire breast (mastectomy) and chemotherapy and more likely to be cured.
BY LENZY KREHBIEL-BURTON
Special Correspondent
07/28/2016 12:00 PM
TAHLEQUAH, Okla. – The federal government’s Indian Health Services is changing its policies regarding opioid prescription, but patients at Cherokee Nation health clinics will see little change in their pain management options. On July 6, CN citizen and IHS Principal Deputy Director Mary Smith announced that health care providers at Claremore Indian Hospital and other federally operated facilities are now required to check state Prescription Drug Monitoring Program databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment for 90 days or more. According to the Centers for Disease Control, the rate of opioid abuse-related deaths among American Indians and Alaska Natives nationwide has increased almost four-fold, going from 1.3 for every 100,000 people in 1999 to 5.1 per 100,000 in 2013. Data collected by IHS also indicates that the rate of drug-related deaths among American Indians and Alaska Natives is almost double that of the general population. With Oklahoma ranking ninth nationally in the number of prescription drug overdose deaths, the Legislature passed a measure in 2015 requiring all physicians to check the state’s prescription database before writing a scrip for schedule II-, III-, IV- and V-controlled substances, which includes oxycodone and hydrocodone. State law also requires similar checks to be performed periodically after prescribing the medication if it is to be used for chronic pain management for more than 180 days. Doctors, pharmacists and nurse practitioners at CN health facilities have been using the database since November. “We are very cognizant of the drug problem in our communities,” CN Senior Pharmacy Director Jeff Sanders said. “Our formulary manages what we offer as options. With the high number of patients that go through our facilities…we try to limit access to certain medications while still addressing pain needs.” Although CN Health Services officials said that it is too early to tell whether the new database policy has had any effect on the rate of prescription drug abuse or overall opioid prescription among CN patients, they did point out that it has sparked more conversations between patients and health care providers. “This has facilitated many positive discussions on how they (patients) are taking their meds and in some cases, if the provider has concerns about abuse or diversion of their medication,” CN Health Executive Medical Director Dr. James Stallcup said. “This provides valuable information. It’s taken a little time to get used to using, but it has been well worth the time and investment.”