“Ok, you have some varicose veins, but… Do you have venous reflux?”

This question is more important that many people realize. Venous reflux is a common medical problem where the blood traveling in the leg veins “refluxes” or, slides back down the leg veins instead of going upwards, back to the heart. This condition is a result of the ever present force of gravity while we are standing and the fact that age, previous blood clots, pregnancy, and other conditions cause the small valves in the vein to malfunction and allow the blood to slip back downwards, towards the feet. This de-oxygenated blood then pools in the lower leg veins and creates several problems over time. One of the earliest manifestations is varicose veins, which sometimes may be noted as a painful throbbing sensation, because of the pressure of the “old” blood which is pooling in them. Other problems then result over time, such as discoloration of the skin, increased swelling of the surrounding tissue (edema), and ultimately, skin breakdown and chronic sores called venous stasis ulcers. The goal is to prevent these later changes from occurring and treat the reflux early, since it only worsens over time.

So, whenever a provider is examining a patient who has complained of varicose veins, the most important question is whether those veins are the result of venous reflux (bad vein valves). The reason this is so important, is that if the reflux, which is the actual cause of the problem, is not treated, then treated problem veins will recur. We encounter many patients who have previously been treated in a med spa or shopping mall facility where laser or sclerotherapy treatment was performed, but the patients find that their problem veins recur in a few years time. Many of these patients are found to have venous reflux on a comprehensive ultrasound evaluation. Here, at Saltzer vein clinic, patients who are suspected of having venous reflux are screened by a Registered Vascular Ultrasound Technician to find whether or not they have venous reflux. If they do, the underlying reflux is treated with a catheter inserted into the vein using laser or radiofrequency energy. If they do not have reflux, they are usually treated by injecting a sclerosant chemical into the veins or by use of a cutaneous laser for these veins.

As mentioned above, if the patient does have venous reflux, almost all insurers and medicare programs consider this a medical problem and it is covered as such. The patient who chooses Saltzer Vein Clinic benefits from our expertise in treating all sizes of varicose veins as well as the causes of venous reflux and late effects of reflux, such as venous ulcers. Not only do patients benefit from our high tech, comfortable, American College of Radiology approved imaging facility, they also receive care from a board certified surgeon and phycisian assistant. We have invested much more into these resources than most of our competitors. We have multiple options for treatment, all the way from ultrasound guided injection, different laser treatments, radiofrequency treatment, to actual surgery. As you can imagine, having all of these options available means we can tailor the best treatment for each individual patient, instead of “pushing” our patients to be treated with limited options. Just like home or car repair, having the right tool for the job at hand makes all the difference. Now that you know how much we have invested into these resources, you would likely conclude that we charge more than some of the smaller shops in the area. Our costs are cheaper than any of the area vein treatment facilities and I encourage patients to call around and prove this for themselves.

Please visit our website, www.saltzervein.com for more detailed information. Thank you.

Steven W. Williams, M.D., F.A.C.S.

Sometimes, a medical study challenges our presumptions. For instance, a recent report suggested that maybe fitness is more important than weight. A study published in the Archives of Internal Medicine in August 2008 looked at risk factors based on the body weights of 5,440 people age 20 and over. The results suggest that just looking at body weight alone can be misleading since almost 25% of normal weight adults had 2 or more risk factors that are often associated with being overweight and obese. Within the normal weight adults who had 2 or more risk factors, the study showed that older age, physical inactivity and a larger waist size were associated with increased risk.

Approximately 50% of overweight adults and 30% of obese adults had normal or only one risk factor. Of these adults, the study showed that younger age, higher physical activity and a smaller waist size were associated with decreased risk.

This study emphasizes the importance that everyone, of all ages and body sizes, should see their primary care provider to help determine the need for screening for cardiovascular risks. Some of the risk factors in this study included elevated blood pressure, low high density lipoprotein (the “good” cholesterol), elevated triglycerides and blood sugar levels.

Business Office (2)

Full-time CSR float needed for our satellite clinics. Must be flexible to work evenings and / or weekends. Must possess great customer service and have the ability to be a quick learner working in various stations and know multiple specialties.

Full-time CSR needed for busy ENT practice at our Hawaii office in Nampa. Hours are generally Monday – Friday from 8am to 5pm. Must possess great customer service skills with the ability to multitask and pay attention to detail. Previous experience preferred.

Hearing and Balance

Part-time Physical Therapy Assistant needed for our Georgia location. Hours are generally Monday – Friday from 8am to 5pm.

Imaging Center

Part-time Cardiac Ultrasound Technician needed at our Hawaii location. Two to three days per week depending on patient flow.

RICE = Rest, Ice, Compression, Elevate

The RICE method often helps with many types of joint and muscle injuries. The method will ease pain and help speed recovery. The RICE method is very helpfully if you use it right away after an injury.

REST - For most injuries, rest the area until the pain decreases. However, For simple sore muscles gentle stretching will reduce stiffness more quickly.

ICE - Ice is the most effective treatment for reducing inflammation, pain and swelling of injured muscles, joints and connective tissue. The cold helps keep blood and fluid from building up in the injured area, reducing pain and swelling. For the first 48 hours post-injury, ice for 20 to 30 minutes every 2 hours. More than 30 minutes doesn’t help heal the injury any faster, you can cause damage to the tissue.

COMPRESSION – Between icings, wrap the injured area with an elastic bandage to help control swelling and provide support. Begin wrapping at the farthest point away from the body and wrap towards the heart. The wrap should be snug, but not cutting off circulation to the extremity. So, if the extremity becomes cold, blue, or tingle, re-wrap!

ELEVATE – Raising the injured area for the first 24hours above your heart will allow gravity to help reduce swelling and draining excess fluid. The less swelling present, the faster an injury will heal.

The Car & Bike Show has been postponed until 2009 - look for details next year.

The Roger Curran Run is proud to partner with Northwest Nazarene

University to become the Roger Curran Invitational.

Dr. Roger Curran was a well respected physician in Nampa. After his

tragic death in December 2004 this event was organized to honor him and

contribute to the community he loved and served.

The event will be held Saturday, September 6, 2008 at West Park in

Nampa. Proceeds will benefit the Health Education and Leadership

Program (www.help.curran20.com) a scholarship program that benefits

those interested in pursuing a career in healthcare.

There will be eightcolleges, and three highschools competing in the

event. In addition there will be a community and kids walk.

To register for the event go to www.directathletics.com. If you have

any questions call 466-7061.

Dr. Shoemaker, an Occupational Medicine Physician, has been at Saltzer Medical Group for over 2 months now. He is very happy to be back in the Treasure Valley working with his “Team”. His “Team” consists of 3 key people.

The Director of Occ Med, Tom, who he met while working in Oregon, chose to move to Idaho to continue working for Dr. Shoemaker. Tom has 20 years experience in various Health Care related positions.
His assistant, Lynn, who had previously worked with Dr. Shoemaker, was delighted to come back to work for him. Lynn has worked in Occupational Medicine for 4 1/2 years and is currently working towards an Associate degree in Health Sciences.
And last but not least, me, Lynda. I also had previously worked with Dr. Shoemaker. I returned to nursing to work for Dr. Shoemaker at Saltzer Medical Group after a short hiatus. I have 20 years of nursing experience and 5 of those years were spent in Occupational Medicine.

Dr. Shoemaker and his “Team” come together with many years of experience. With the combined knowledge of the “Team”, it’s by far one of the best in the Valley.
If you or anyone you know could benefit from a Board Certified Occupational Medicine Physician, get on the phone and call us at 884-2965.

Dr. Howard Shoemaker is now with Saltzer Medical Group in both Meridain and Nampa, Idaho! I can’t tell you what a relief this is for me personnally as well as professionally.

I first started working with Dr. Shoemaker and his nurse Lynda some four years ago. That was when I discovered that I had a passion for this line of work. Through Dr. Shoemakers indirect influence and Lynda’s direct influence, I made the decision to go back to school (after 20+ years) to obtain an Associates Degree in Health Sciences. I felt that through this degree and a certification as a Medical Assistant I would be able to give more of myself to the area of work comp and the injured worker. I can’t begin to tell you how they both have influenced me; both professionally and spiritually and how good it is to be a part of his Occupational Medicine team again.

Dr. Shoemaker has over thrity years of experience in the world of Occupational Medicine. His willingness to treat injured workers and to assist them in their rehabilitation process is commendable. Dr. Shoemaker prides himself on his specific protocols which help him to return the injured worker back to a full duty status sooner.

I value Dr. Shoemakers’ experience and the knowlege that both he and Lynda posses and am truely blessed to be a part of the Occupational Medicine team here at Saltzer Medical Group. If you have experienced a work related injury, I would not hesitate to recommend Dr. Shoemaker and his staff to you. So if the occasion should arise, we would be glad to see you and to help serve your needs as a work comp patient.

We have two new family practice physicians starting at Saltzer in August

John Freeman, MD will begin seeing patients August 7. Dr. Freeman is a pediatrics, internal medicine physician who will be working in our family practice department at 215 E. Hawaii Ave in Nampa. To schedule an appointment with Dr. Freeman call 468-5910

Mark Clinger, MD, family practice, will begin seeing patients at 745 S. Progress Ave in Meridian on August 20. To make an appointment with Dr. Clinger, please call 884-2920

Beginning in May, 2008, Saltzer Medical Group rededicated itself to developing a quality Occupational Medicine program in the greater Boise area. With clinics in both Meridian and Nampa, their hope is to offer quality care and service to both the employers and employees of the Treasure Valley. The first move was to find a board certified and residency trained Occupational Medicine physician. This was accomplished when Dr. Howard Shoemaker took the position with Saltzer Medical Group. Doctor Shoemaker, who had been a part of the Primary Health Occupational Medicine group, left for the rains of Oregon in 2005. During his time in Oregon his wife had continued to operate as a real-estate agent with the Tamarack development in Donnelly, Idaho. Because of this business interest, when Saltzer Medical Group offered Dr. Shoemaker the opportunity to return to Boise he decided that it was time to return to Idaho.

For the past thirty years, Dr. Shoemaker has practiced exclusively occupational medicine. Why is this important to area employers? The reasons are way too numerous for one short blog. However, some of the primary reasons include an aging workforce, getting your workers back to work as quickly as possible, and finally to provide the highest quality of care for the injured worker.

Lets first address the aging workforce. As we age, there is a natural amount of deterioration which occurs within the body. Whether it is cartilage between our bones, or the natural de-calcification of our bones, it is important to have a skilled specialist who can identify between what is a work related injury and what is just a part of being a baby-boomer. As any claims adjuster, safety manager or HR manager will attest to, a miss-diagnosed injury can become a financial nightmare within the Workers Comp system. As Dr. Shoemaker frequently states, “it is 10% of the cases that creates 90% of the expenses”.

Second, getting workers back to work is extremely important to the company’s bottom line. In a study conducted by Lilly Ramphal, MD, MPH, she states that companies pay $62 billion dollars in lost productivity or “lost time”. This translates into approximately 42% of work related injuries expenses in the United States ($140 billion). Without the proper diagnosis of the work-related injury, or the granting of excessive time off due to injury, this number would escalate even further out of control. As Dr. Shoemaker has frequently stated, “you always want to do what is best for the patient, and in virtually every instance what is best for the patient is to get them back to work”. Dr. Shoemaker has told me many times, he believes that a worker is like an athlete and it is his job to get them “back in the game”. By doing so, the employee will heal faster.

Finally, everyone wants the employee to receive a high level of care. By properly identifying the injury, the employee can begin an aggressive regimen of treatment. In doing so, they can get back to work and continue to do what they were trained to do. By having a specialist monitor the worker’s progress, success is more likely to occur.
Because of the above reasons, we welcome Dr. Shoemaker back to the Treasure Valley.