Your Practice Transformation Companion

Thursday, March 26, 2020

Coping with COVID-19

These are stressful times impacting all of us both personally and professionally in different ways. Many of us have patients and loved ones we are worried about. Some are worried about childcare during a month of no school. A simple trip to the grocery store is no longer simple. Here are some quick tips to lessen the toll this might have on your mental health along with some great resources that might be helpful to you, your patients and your practice colleagues:

  • Maintain perspective - Don't panic but follow recommended precautions. This is serious but not the apocalypse 
  • Keep informed but choose your sources wisely  - politicized news sources are not always helpful ( Take breaks from the topic
  • Take care of your body (get plenty of fluids, exercise, healthy eating, rest and good sleep. Limit junk food, caffeine, alcohol)
  • Find ways to relax - (now is good time to start mindfulness meditation - my favorite apps are "Stop, Breathe and Think" and "Insight Timer". "CBT-I Coach" is great if you have insomnia. A good app for children is "Stop, Breathe & Think Kids") 
  • In a time of restrictions and social distancing find new ways to engage in meaningful and fun activities
  • Recognize and challenge unhelpful thinking patterns and negative ruminating 
  • Stay connected to others (even if virtually)

Coping Resources:

By: Lori Lackman Zeman, PhD, LP, ABPP
Board Certified Health Psychologist

Sunday, March 1, 2020

Get Your Colonoscopy Today!

Colorectal cancer is the second leading cause of cancer death but is highly preventable when caught early. How can you catch it early? Have a colonoscopy. A colonoscopy is an exam used to find abnormalities and changes in the rectum and large intestine. It is a safe and simple procedure where a long, thin, flexible and lighted tube with a camera allows the doctor to view the inside of the colon. If polyps or other types of abnormal tissue are found, they can be removed at that time. Biopsies can also be taken during the exam.

Screening for colon cancer should start at age 50 if you are at average risk and with no other risk factors other than your age. There are other screening options besides a colonoscopy, but having one is the screening gold standard as it scans the entire colon.

What are some risk factors for colon cancer?
· Personal medical history (inflammatory bowel disease, Crohn’s disease, ovarian/breast/endometrial cancers, previous colon cancer or polyps, and people of African American or Hispanic descent)
· Physical inactivity
· Being overweight or obese
· Hereditary risks (increased risk with a close relative who has had it)
· A diet high in red and/or processed meats, low fruit/vegetable intake
· Smoking
· Alcohol intake above moderation

How can you reduce your risk?
· Get recommended screenings
· Eat fruits and vegetables every day
· Aim for whole grains in bread, cereals, nuts and beans
· Limit red and processed meats
· Be physically active and aim for 30 minutes of activity 5-7 times a week
· Lose weight if you need to
· Stop smoking
· Limit your alcohol consumption

Why is it done?
· Investigate certain signs and symptoms you may be having such as abdominal pain, bleeding, chronic constipation or diarrhea
· If you’ve had polyps found on a previous colonoscopy, a follow-up one will look for and remove additional polyps

Information on how to do the prep will be given to you from your physician. It is done the day before the procedure to clean out the colon. There are tips that can help manage your time prepping for the procedure.

Sedation is given during the colonoscopy, so you don’t have discomfort. You’ll be able to discuss anesthesia options with the anesthesiologist and nurse anesthetist prior to the procedure.

Be sure to check with your insurance company if you have a co-pay or deductible or other cost sharing for the procedure. You might also want to check if they offer any incentives for having a screening.

For this March Colorectal Awareness month, don’t put off a colonoscopy any longer. Talk to your doctor for your options and get it scheduled pronto.

Saturday, February 1, 2020

February is National Children's Dental Health Month

This National Health Observances Month is brought to you by the American Dental Association. This is the designated month of the year for health care professionals and educators to promote the benefits of good oral health for children and their families.

Tooth decay is one of the common and chronic childhood diseases. It is more common than asthma and allergies. Preventive dental care is especially important for children due to their teeth, gums and mouth still developing. Teaching good dental habits early is the best way to protect your child’s teeth down the road.

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry both recommend that all children see a pediatric dentist by age one. Unfortunately, many children lack good oral hygiene habits and the opportunity for dental care. Medical insurance is a strong predictor of access to dental care and it is proven that children without health insurance are less likely to have these opportunities for dental care. This can lead to all kinds of health issues for the future such as pain, infections, and can lead to problems with speaking, learning and playing. According to the Centers for Disease Control and Prevention (CDC):
  • About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.1
  • 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.1
  • Children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households (11%). 
  • The link below has guidance for babies, children and pregnant women.
There are some tips below to help young children practice brushing and make it a good experience for all.

Choosing a toothbrush. Use a soft-bristled toothbrush designed for brushing an infant’s or child’s teeth. There are also a variety of child’s battery and electric toothbrushes on the market.

Holding a toothbrush. If the child has trouble holding a toothbrush, try making the handle thicker by putting it inside a tennis ball. The toothbrush handle can also be strapped to the child’s hand with a wide rubber band, a hair band, or Velcro. Toothbrushes with thick handles can also be found in retail and discount stores.

Teaching the child how to brush. Break the process into small steps that the child can understand and practice. Ask a dentist, dental hygienist or early childhood specialist for help, if needed. Another way is to place a hand over the child’s hand to guide the toothbrush as the child brushes.

Using toothpaste with fluoride. Use toothpaste with fluoride that the child likes and that feels good in his or her mouth. An adult should always place toothpaste on the toothbrush.
  • For children under age 3: Use a small smear of fluoride toothpaste (or an amount about the size of a grain of rice). 
  • For children ages 3–6: Use a pea-size amount of fluoride toothpaste. 
If a child cannot spit: Have the child tilt his or her mouth down so that the toothpaste can dribble out into the sink, a cup, or a washcloth. Since the fluoride in toothpaste is clearly meant to be swished but not swallowed, make sure to help or watch the child while brushing. When she is old enough, tell her to spit out the toothpaste after brushing.

Positioning the child. There are many ways a child can be positioned to make the child feel comfortable and allow an adult to brush his or her teeth.

Keeping the child engaged in brushing. Use a timer, a short song, or counting as a game to encourage brushing for 2 minutes. 

Cavities are preventable and fluoride has helped immensely in kids living in areas with fluoridated tap water. Brushing with fluoride toothpaste, getting dental sealants, and fluoride drops are also a big part of prevention. Note: The American Academy of Pediatrics recommends that you check with your pediatrician or pediatric dentist to find out if any additional fluoride supplements are necessary, or whether your child is already receiving the right amount.

For this children’s dental health month, there are links below for fun activities to be done at home. Scroll down to the bottom. There is a crossword puzzle, coloring sheet, calendar (to mark off when they brush) and a maze activity. Get your children involved in wanting to brush their teeth.

Those little teeth need our protection. Starting dental care early is a step in the right direction for building a life-long habit of good dental care.

Tuesday, January 7, 2020

2020 Educational Opportunities at PTI!

January 2020

Happy New Year and warm greetings from all of us here at Practice Transformation Institute (PTI). We are a non-profit organization that provides medical, nursing, dietetic, social work and other health care professional continuing education through our customized learning programs. We hope that you will consider letting us be a part of your personal and organizational education goals in 2020.

Continuing Medical Education. We are accredited by the Michigan State Medical Society (MSMS) to provide continuing medical education (CME) for physicians. If you’re interested in attaching CME to your learning event, let us help with our CME Joint Providership Program. We will make sure that your CME event is planned, implemented and evaluated in accordance with the MSMS requirements.

IACET. PTI is an International Association for Continuing Education and Training (IACET) accredited provider and adheres to the highest standards of the training profession. We follow the ANSI/IACET Standard for Continuing Education and Training. IACET CEUs are recognized by a wide range of organizations including professional organizations, regulatory boards, corporations and universities.

Care Coordination and Care Management Training (Self-Management). Care Coordination and Care Management Training is one of PTI’s signature ongoing programs. We have trained hundreds of interprofessionals with a knowledge base and skill set to enable high quality chronic disease care for patients in the ambulatory care setting. The program provides contact hours for nurses, continuing professional education units for dietitians, and continuing education hours for socials workers. IACET CEUs are also available.

National Diabetes Prevention Program. The Centers for Disease Control (CDC) and Prevention established the National Diabetes Prevention Program to help prevent or delay the onset of type 2 diabetes. The program is evidence-based with research showing that lifestyle modifications can cut the risk of type 2 diabetes in half. PTI has master trainers and lifestyle coaches who can bring this program to your organization.  

Learning Collaboratives. A learning collaborative is a learning and innovation community that links a variety of organizations together to rapidly test and implement meaningful, sustainable change within a specific topic area. PTI has been facilitating learning collaboratives for years and is a proven expert.

PATH (Personal Action on Health) Training and Workshops. PATH is Michigan’s name for the Self-Management Resource Center’s (SMRC) self-management programs that were developed and tested at Stanford University to help people learn techniques and strategies for the day-to-day management of chronic and long-term health conditions. PTI can do PATH leader trainings and workshops at your place or ours.

As you can see, PTI can provide a wide range of educational programs for health care professionals that can be customized to fit your organization’s need. Bring an idea to us and we can bring it to fruition. PTI knows the benefits of working collaboratively on interprofessional teams and how they help improve patient outcomes.

Our programs can be delivered at your facility, a facility of choice or at PTI. We want to help you jumpstart your education goals for 2020. Email Harmony at for more information.  We hope to see you in 2020!

Thursday, December 12, 2019

A Healthy Start to Winter: Good Handwashing and a Flu Shot

We have not reached the winter season yet which officially starts on December 21st. I know many people who have already been ill and haven’t adjusted to the temperatures spiraling from the forties down to the teens and back up again. I’m one of them. But the spiraling will soon stop since we are in December. The outside weather will now throw us into a frozen winter wasteland or wonderland (depending on your attitude for this type of thing) and there is nothing we can do about it. With the holidays upon us and the opportunity to see friends and family that we may not have seen for a while, it’s important to stay as healthy as we can to avoid any excess bugs flying around in the air. Most of us know what we need to do, but do we do it? If we get a flu shot and use good handwashing techniques, we have a big head start to stay healthy over the winter months.

Wash your hands with soap and clean water for at least 20 seconds. Clean the back of the hands, all around and between the fingers and even under the nails. Dry your hands off well using a clean towel or hand dryer. The Center for Disease Control says to remember the five steps of “wet, lather, scrub, rinse and dry.” There are 4 principles of hand awareness that are endorsed by the American Medical Association and the American Academy of Family Physicians. These are:

  • Wash your hands when dirty and before eating
  • Don’t cough into your hands
  • Don’t sneeze into your hands (sneezing is like a mini hurricane that blows germs everywhere)
  • Don’t put your fingers into your eyes, nose or mouth

The CDC reports that only 31 percent of men and 65 percent of women wash their hands after being in a public restroom. Gross! We know what you’re doing in there. Please wash your hands afterward, even if you must stand in front of the hand dryer that you don’t like for a couple of minutes. Handwashing prevents many illnesses, including influenza, which brings me to our next topic. 

What is influenza, which is commonly called the flu? The CDC states that it is a “contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent flu is by getting a flu vaccine each year.” The flu is spread by tiny droplets when people that already have the flu end up coughing, sneezing or talking and the droplets land in our mouths or noses. It can also be spread by touching an object or surface that has the flu virus on it and then touching our mouth or nose. 

What are some of the differences between the cold and flu? The flu is always worse. With the flu, there may be an abrupt onset with fever, severe aches and pains, chills, chest discomfort, sometimes severe cough, and headache. A cold is much milder with a gradual onset, rare fever, perhaps some aches and pains, sneezing, sometimes coughing, stuffy nose, and sore throat. 

Complications associated with the flu can be life-threatening especially for people at high risk. This includes people over 65 years of age, anyone with a chronic medical condition (like diabetes, heart disease, asthma), children younger than 5 years old, and pregnant women. 

The flu shot is available everywhere and is covered by health insurance. Make sure to get one to help protect yourself, your loved ones, work buddies, and anyone else with whom you come in contact. We are a global community and prevention is always the gold standard.

As we dive into the cold Michigan months, that also contain a few major holidays, PTI wishes you and yours happy holidays and best of health!

Monday, November 11, 2019

Let’s Talk About GERD

What does GERD stand for? Gastroesophageal Reflux Disease. Gastroesophageal refers to the stomach and esophagus. Reflux refers to the backflow of stomach contents into the esophagus.

How common is it? Very common. One out of every five people experience it on a weekly basis. Two out of five people experience it at least once a month. Studies show that one-third of our population has it!

What are the symptoms?
  • Chronic heartburn (a burning sensation in the center of the chest that can be painful, disrupt activities of daily living, and keep you awake at night.)
  • Acid regurgitation (a sour or bitter taste in the mouth from stomach contents backing up into the esophagus.)
  • Frequent belching
  • Chronic sore throat
  • Laryngitis
  • Chronic cough
  • Chest pain or pressure (rule out heart conditions first!)
  • Dysphagia (difficulty swallowing or the feeling of food stuck in the esophagus. This is an alarming symptom that requires medical attention as soon as possible!)

What are the causes?
  • The esophageal sphincter that normally stops backflow of stomach contents into the esophagus is relaxed at inappropriate times or may become weak
  • Other factors:
    •       Distention of the stomach from too large of a meal
    •       Delayed emptying of the stomach
    •       Sliding hiatal hernia
    •       Too much stomach acid in general

What can we do about it? GERD can be a chronic disease with treatment sometimes being long-term.

Treatment includes:
  • Lifestyle change measures (experiment to find out what may be your problem: avoiding spicy foods, large or fatty meals, alcohol, onions, chocolate, caffeine, citrus fruits/juices, tomato products, times you eat, positions you use, being overweight)
  • Over-the-counter medications
    • Antacids
      • Chewable gummy or tablet
      • Liquids
      • Dissolvable tablet in water that you drink
      • Include Tums, Rolaids, Mylanta, Maalox, Alka-Seltzer
  • Low dose H2 (histamine 2) blockers
    • Include Pepcid, Tagamet, Axid, Zantac (Zantac is currently under recall until more details are available)
  • ·Proton pump inhibiters (long-lasting reduction of stomach acid production)
    • More powerful than the ones mentioned above
    • Recommended to be taken daily for fourteen days
    • Long term use can have risks
    • Include Prilosec, Zegerid, Nexium, Prevacid
These medications may only provide temporary symptom relief. Long-term heartburn can become serious as it has the potential to damage the lining of the esophagus. Please consult your physician for any questions related to a GERD diagnosis and appropriate treatment, tests and medications.

Gastroesophageal Reflux Disease Awareness Week is happening this month from November 17-23, 2019. If you feel you possibly have GERD, make this a time to do something about it.

Tuesday, October 15, 2019

Oktoberfest and Chiropractic

Oktoberfest was originally celebrated 200 years ago for the wedding of Bavaria’s Crown Prince Ludwig and his bride, Princess Therese of Saxony-Hildburghausen.  Oktoberfest continues to be celebrated in Germany and around the world with the parties modeled after the original one. These celebrations include lots of beer, dancing, music, games, amusement rides, and traditional foods and clothing. So why am I mentioning Oktoberfest on a PTI blog alongside of chiropractic?

Drinking too much, along with some wild dancing may just throw your back out of whack. After some riotous Oktoberfest celebrations, you may need a chiropractor. Since it is National Chiropractic Health Month, this is the perfect time to talk about chiropractic.

Chiropractors are licensed health care providers who work on the body’s ability to heal itself through spinal manipulation and other forms of treatment. Chiropractic is considered complementary and alternative medicine. Chiropractors are not medical doctors; they cannot prescribe pain pills, nor would they want to. Chiropractic is a whole person, patient-centered approach.

A chiropractor will take a health history, perform tests and an exam, perhaps diagnostic imaging such as x-rays, and develop a management plan for your diagnosis. Spinal manipulation and other manual therapies to the joints and tissues may be done and recommended monthly or at other intervals. A chiropractor may also refer to another appropriate specialist or co-manage with other health care providers.

The musculoskeletal system (muscles, bones, joints) enables our body’s movements and what we can and cannot do. If it’s damaged, then so are we. Injuries or normal aging can be a source of pain, with the most common being low back pain. Improving our musculoskeletal system helps us to become more active and take care of those injuries by keeping us strong and stable.

With the opioid epidemic in the United States, promoting natural healing without the use of narcotic drugs is a welcome choice. Health insurance is paying for chiropractic more and more as insurers are looking to chiropractic as an acceptable form of therapy. 

Yes, the Oktoberfest and chiropractic connection may be a loose one, but I love history and how we can connect it to the present. As you party for Oktoberfest, remember that chiropractic is available if you overdo your musculoskeletal system with those wild, drunken dance moves. Party responsibly.

Tuesday, September 10, 2019

Back to School 2019

Summer is moving into its final weeks and fall is upon us. We can already see changing leaves, cooling temperatures and the beginning of the football season. A big part of this time of year is “back to school” with the non-stop advertising of clothes and school supplies. But once we’ve gotten our children ready for the new school year, it’s time to think about what we could do for our education. Yes, our education. One of the best things about life is that we can keep learning new information and skills to further our careers or because we just want to learn. How can we jumpstart our brain for this fall season? What will be our “back to school?”

Perhaps take a class at your community center, local college or from a wonderful training and education institute like PTI. Here at PTI, we have a great program whether you’re a nurse, dietitian, social worker, medical assistant or any other interprofessional care team member. Our Care Coordination and Care Management Training supports the patient centered medical home by educating health care professionals on the specifics of care management. This training is a blend of two onsite training days and multiple on-demand courses that cover the following topics:
  • Introduction to Care Management Principles
  • Chronic Care Model, Self-Management Background and Goals
  • Motivational Interviewing to Enhance Self-Management Support
  • Goal Setting, Problem Solving, Decision Making
  • Communication and Team Building
  • Health Coaching/Counseling with Self-Management Support
  • Flinders Self-Management Model
  • Care Coordination and Transitions Management
  • Integrating a Care Management Team into a Practice
  • Evidence-Based Guidelines Across the Life Span
  • Health Literacy, Cultural Competency, End of Life Care
  • PCMH and PCMH-N
  • Case Studies and Discussion

PTI’s Care Coordination and Care Management Training is approved by four different entities for continuing education:

Nurses. This continuing nursing education activity was approved by the Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation. Contact hours awarded are 12.5.

Dietitians. PTI is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive12.5 Continuing Professional Education Units (CPEUs) for completion of this program.

Social Workers. This course is approved by the Michigan Social Work Continuing Education Collaborative for 12.5 CE Hours. The Collaborative is the approving body of the Michigan Board of Social Work.

IACET. Does your professional organization accept IACET Continuing Education Units (CEUs)? IACET CEUs are recognized by a wide range of organizations, including professional associations, regulatory boards, corporations and universities. Check with your organization to see if they qualify for you. PTI is authorized by IACET to offer 1.25 CEUs for this program.

There is still time to register for the September 25 and 26, 2019 program at If you have any questions, please contact Yang at 248.475.4839 or email her at If you’re unable to attend the September program, we will be announcing a program slated for December 4 and 5, 2019 soon. Make this “back to school” time of year the best for yourself and your family.

Thursday, August 1, 2019

Immunizations Are for Everyone

August is National Immunization Awareness Month. With the importance of this month comes also comes the responsibility of getting yourself and your children vaccinated.
Why get vaccinated? Here are some important reasons:
  • Vaccines can save lives. Vaccine-preventable diseases can cause long-term illness, hospitalization and even death.
  • Reduce the chance of spreading disease. Many of these vaccine-preventable diseases are contagious. Getting the vaccination can reduce the risk that you’ll get sick and spread the disease. For young children or others who may not be able to get certain vaccinations due to their age, health or other factors, you are helping to protect them by getting your vaccinations.
  • People with chronic conditions are more vulnerable to complications. Adults who smoke, have weakened immune systems or have a chronic health condition (such as asthma, heart disease, lung disease, diabetes are more vulnerable to complications including long-term illness, hospitalization and death.
  • Being non-vaccinated can make you sick and it costs money. Medical visits and treatment cost money. Work is missed, co-pays and lots of out-of-pocket expenses can add up. Children may have to stay home from school and day care, and you may have to find alternative child care arrangements. Getting vaccinations can avoid unnecessary expenses to your household.
  • Vaccinations protect your health when you travel. International travel may expose us to illnesses that aren’t circulating in the United States. Check the CDC website before you travel to other countries.

During this National Immunization Awareness Month, I would be remiss not mentioning the measles outbreaks that have occurred in many parts of the United States. This is not something to take lightly. The number of cases continue to jump each year due to people being unvaccinated and the prevalence of international travel.

Measles used to be common when I was a kid. I had it. The only thing I remember is being moved to my parent’s bedroom to isolate me to protect my younger sister with whom I shared a room. I had a high fever and light hurt my eyes so bad that my mother had to keep the shade down in the room. I was lucky not to have any lasting effects and, thankfully, my sister didn’t catch them from me.

For many years we had widespread immunity in the United States, but due to reduced vaccination rates, the incidence of measles has increased significantly. Measles is highly contagious virus in the nose and throat of an infected person that can cause many complications. If you haven’t received the vaccination, you’re more likely to get the disease. The Centers for Disease Control and Prevention (CDC) recommend that children and adults receive the measles vaccine to prevent measles.

The CDC has recommended vaccination schedules for all age groups. Get up to date on your immunizations now and tell your family and friends. Please. We all thank you.