Bob Underwood, MD (Host): Having a health care provider that places the health care needs of our community first, ensures that everyone receives the best access to the highest quality health care and support. Welcome to Tri State Health Talk, your LC Valley health podcast. I'm your host, Dr. Bob Underwood, and today we're going to get insights about our comprehensive health care services at Tri State Health from the Chief Medical Officer of Tri State Health, Dr. Carson Seeber. Now, Dr. Seeber is also a family practice provider at Tri State Family Practice and Internal Medicine. Dr. Seeber, welcome to Tri State Health Talk.

Carson Seeber, MD (Guest): Thank you very much, Dr. Underwood, for having me on today.

Host: Yeah, absolutely. So, why don't you tell us a little bit about Tri State Health and your role within Tri State Health?

Carson Seeber, MD (Guest): Tri State Health is a 25 bed critical access hospital. First opened its doors to the community in 1955. So it's a not for profit hospital. It's the only not for profit hospital in Lewiston Clarkson Valley, where we're located. And with that critical access hospital designation, there's some limited ability to grow on the inpatient side of health care provision, but so we've just chosen to, to expand on an outpatient level.

And so that could mean more family medicine physicians and certainly specialty physicians as well. I've been a Primary care provider, a family medicine provider at Tri State since 2015, so just about 10 years and I've been the Chief Medical Officer here for the last three years.

Host: No, that's awesome. And, you know, that expansion for the community, I think, is really, really critical. And the whole hospital's background about being a community hospital back in 1955, and actually even funded by the community, from what I understand.

Carson Seeber, MD (Guest): Yeah, we are dependent on philanthropy. We do get some federal and state funding and for that reason we have to kind of hang on to that designation of critical access hospital and kind of play within the rules or bookend so to speak of what that designation means. But yeah, outside of that, we do a lot of fundraising.

We have a foundation that raises a lot of money for us. We just had a 36, 37 million dollar inpatient expansion so that's allowed us to go from double occupancy rooms to single rooms and anything new is, is a good feeling in healthcare, so. A lot of growth taking place here and, most of it is on the backs of philanthropy and, businesses in the community.

It seems like people are always willing to help out when it comes to health care because it's such a universal need.

Host: Yeah. It absolutely is. Now, you made mention of some ambulatory service lines that were available. So what healthcare service lines are available at Tri State?

Carson Seeber, MD (Guest): So if it's okay, I'll just kind of go through a list um, because there are several, but I think each one is very important to mention. So we're fortunate, like I said originally, to have a primary care presence, we have pulmonology with full service sleep lab. We have cardiology and orthopedic services. We have urology, general surgery. Urogynecology, nephrology. We have a robust psych department including psychiatry, addiction medicine, and behavioral health services.

 We have interventional pain clinic. We have an urgent care and an fully staffed ER. And so all of our ER docs are ER trained physicians. We have nutritionists and diabetic education. We have podiatry, wound care, and hyperbarics.

And then we have a couple tele rheumatology and infectious disease services. So, tele is kind of a way of bridging between having a rheumatologist on site or an infectious disease specialist on site and that service line has to continue. So we've had to get creative in creating teleservices that are offered from basically somewhere else in the country and so we're actively recruiting for those two positions because we would rather have, you know, warm bodied specialists as opposed to, to, to teleservices that, you know, for just about anything.

So that's an ongoing effort, but for now, those two are teleservices just to keep that service line available going forward.

Host: That's phenomenal. I mean, considering, you know, critical access hospital and going through all of those various service lines, I would say that that's more than what most critical access hospitals have.

Carson Seeber, MD (Guest): Yeah, I mean, I, think so. When you're limited in your ability to grow with the inpatient side of things, you have to think about the community at large and you know, we have a non official motto that, our community here deserves access to any specialist, what, you know, why should we kind of have barriers there um, if there's a, a very niche specialist that's willing to come to the Lewiston Clarkson Valley, then so be it.

They can work for Tri State and we'll do our best to not only recruit, but to retain those specialists here for, you know, the long term.

Host: Yeah, absolutely. Okay, so this is the inaugural episode of Tri State Health Talk, so let's explore some topics for future episodes. What do you have in mind?

Carson Seeber, MD (Guest): I think we have a tremendous opportunity with all our specialty services at Tri State just to provide some very niche healthcare information to the community and it's not just great specialty service lines, you know, I think we have a very personable group that are keen on communicating their expertise to the community.

And, we've basically gone to specialists that are willing to participate and say hey, are the topics that you're discussing with your patients the most? What are the topics that you think patients or the community would want to hear about? So we basically will leave it up to them to pick those high yield topics and the more specific they are the better and we all love little pearls to kind of hang your hat on so to speak and we think that these specialty providers can offer that to our community.

So, just another way to communicate. Not everybody's into podcasting, but it certainly is the here and future of media, I suppose. And so why not Tri State too?

Host: Yeah, no, I agree with that a hundred percent, obviously, because I participate in them. But so what goals do you aim to achieve by providing this information through the Health Talk podcast?

Carson Seeber, MD (Guest): Yeah, so you know again, it's another media that allows us to connect to our community and connect our healthcare providers to the community, but with that, like I mentioned before, like, we've got some great personalities too, and I just think a podcast maybe allows some of that personality to come out and, um, you know, I, I think, yeah, I think, I think people recognize, healthcare providers as being professional and, and if anything, you know, limited access and limited time, you know, when I do get an appointment with them.

But these are people with personalities who love what they do and they love to talk about it. And so maybe it gives them a chance to kind of put their own personalities out there. And, you know, at the end of the day, we want patients to consider, hey, maybe there's a specialized health care provider at Tri State, or closer to home who can help me with my issue instead of, this cliche of needing to go two to three hours away to bigger health care institutions to get that specialized care.

Host: Yeah, absolutely. And, I'm an emergency physician. And so I like listening to them as well, because sometimes I'll be listening to a specialist who will, I'll learn something about the care of my patients too. So it's not just for the patients, but even for other providers to know what's out there and what are those folks doing within their own subspecialties?

Carson Seeber, MD (Guest): Absolutely, 100 percent agree with you. I do the same thing, love to, love to find podcasts and, you know, I have a 45 minute commute to work and just to use that time wisely just to pick up a few pearls for the day is good stuff.

Host: Sure. And so with that in mind, are there any specifics about your specialty that you'd like to share with us for our initial episode?

Carson Seeber, MD (Guest): Well, as you know, uh, it's a bit of a paradox I suppose family medicine, I always say we, have to know a little bit about everything but not a lot about anything. I guess the trouble is there's a lot of things to know a little about in health care. So, nothing specific to talk about other than maybe something more generalized or generic that I, I think is equally important.

And so I just want to mention the importance of the annual wellness visit with your primary care provider. You know, we consider annual wellness visits maybe, you know, newborn babies and infants through toddlers, adolescents, and maybe even teenagers where annual visits and sometimes shorter intervals is important. But then, people get in their 20s, 30's and 40s and maybe that annual wellness visit isn't such a priority.

And the other side of it is maybe in those demographics primary care providers aren't a luxury or, people in that age group don't necessarily have access to a primary care provider or even health care insurance. But just a good habit to get into. You know, when patients are relatively young and healthy, developing a good relationship or foundation with your primary care provider, and maybe that's not an annual wellness every year, maybe it's every couple years or even two to three years, but have some kind of consistency over time where we're checking in and by the time you get to 50 or beyond, we can be in the habit of maybe visiting with our PCP on a regular basis.

So I was thinking, Dr. Underwood, it would be good maybe even to just talk about some screening, some preventative health screening milestones. And I think that, when we talk about these, we're talking about average risk patients. And there's also the acknowledgement that there's different guidelines out there.

And so, there's a lot of overlap between different recommendations. But certainly there's some kind of fringe ideas that may be a little bit different when it comes to preventative health screening. Would it be okay to just kind of go through a list of those?

Host: Yeah, please do.

Carson Seeber, MD (Guest): Okay. So I was just thinking a little bit about colon cancer screening. We used to say that colon cancer screening started at 50, but the new 50 is 45. And so, that can be kind of a big undertaking for patients. There's a couple different ways to do it. The gold standard is the colonoscopy, and we often hear people talk about how challenging the prep is, you know, that the big amount of liquid that you have to get through you to kind of help clean you out.

Um, but that's changed, right? So that's changed in recent years. Sometimes the amount of liquid is reduced. Other times there's like pill prep. That is basically, minimal liquid. It's pills that, you would swallow to do the same thing. And then, the other side of it is there's kind of other options that have kind of popped up in recent years and one of them is stool DNA testing.

So maybe patients have seen commercials for Cologuard and this is basically a box that comes to your door with directions on how to leave stool samples. That gets packaged up, sent to a central location for processing and patients basically get a positive or negative report.

And if it's negative, then you don't have to do that test again for another three years. Uh, if it's positive, then there's you know, a certain percentage of chance that it's positive because of colon cancer, albeit a very small percentage, but a larger percentage chance that there's maybe pre cancerous polyps there that should be removed. And so, if a positive test comes out of that, then, you have to send that patient for a formal colonoscopy.

Mammograms is another one. So, again, depending on guidelines, but it's generally accepted that at 40 mammogram screening should begin for females. This would continue every year or two until 75 years of age.

And then the third one I wanted to mention was prostate cancer screening. And so, as it stands right now, that testing starts at 50, 50 years of age and can involve a combination of tests. One would be just blood test for a PSA or a prostate specific antigen test, and if it's high, it can be high for different reasons, but generally makes you think about prostate cancer, or, next steps in, terms of ruling in or ruling that out and otherwise uh, a lot of physicians will do digital rectal exams starting at 50.

So, again, something that's not overly comfortable, maybe, or maybe something that people might try and avoid, but, you know, it's optional. Your physician is not going to hold you to that test, and certainly with the help of other screening tools, there's options to discuss, so.

And then I would just briefly mention PAPs in our female population. They can start as early as 21 years of age, and may not need to be done more than every five years until 65 years of age. So again, different guidelines for men recommend something slightly, different maybe, but general rule of thumb and average risk patients would fall under that recommendation.

So, those are the big ones. And if it's okay, you know, Medicare, I'd like to talk a little bit about Medicare recommendations, if that's okay, too.

Host: Yeah, absolutely. Let's bring in Medicare. And I think that, you know, all of those screening exams, they've changed over the course of my career, certainly. There's a lot of technology that's kind of come in. The ages have changed. But also the methodologies that we follow for the screening exams, still very, very important.

And I think a lot of them have gotten easier.

Carson Seeber, MD (Guest): Yeah, I agree with you, and I think part of it is any screening is better than no screening, and some of these guidelines, thankfully, have gone to being a little bit more lenient. You can overscreen for something that really isn't going to present for bigger and bigger, gaps of time.

And I think the Pap screen is a good example of that, you know, therewas a time when we're saying every year, you absolutely need to do this every year, and realizing that cellular changes, when it comes to cervical cancer, really weren't happening faster than these newer proposed five year intervals.

Host: Yeah. You know, and who knows what that changes are going to be as we have newer and newer generations that are actually vaccinated for papillomavirus too.

Carson Seeber, MD (Guest): Exactly, and if we have success here, maybe we're not talking about PAPs anymore. Maybe it's something that's archaic, and I can tell you, there's a lot of females out there that would be very thankful for that.

Host: Indeed. So what about the CMS recommendations?

Carson Seeber, MD (Guest): Yeah, so this kind of has its own guidelines, so to speak. Um, as most people know, like, you get set up with Medicare as government subsidized health care insurance at 65 years of age, some sooner and some later.

Say if you're working and you have commercial insurance, maybe you don't get access to Medicare, and that's usually by choice, until after 65 years of age, but in any event, it's an insurance that's available to 65 year olds and older. And basically what they do is a preventative health screening questionnaire.

And so some of this, those that have done it can maybe get a little bit irritated with it year after year. But the questionnaire, if you just consider what it's trying to do has a lot of primary prevention talking points, such as tobacco and alcohol use, fall risk reduction measures, mini cognitive testing. Depression screening, dietary and exercise strategies, essentially preventative health measures that can help keep people health conscious and on track with their health in a preventative way. And so, just thinking about even from the the primary care provider standpoint like there's a lot of times that maybe we go visit our doctor about specific issues, and you know if you do that three or four times a year you may not have that kind of checkpoint with your doc to sit down and say okay, I got to get my colonoscopy squared away. That's coming up or I don't even remember when the last time that was. Mammograms would you know be the same you know, same thing, or prostate cancer screening.

So by checking in with your primary care doc once a year, it kind of allows him to have this checklist, him or her to have this checklist that, makes sure that all those boxes are checked. And, or we probably should be compared maybe to the airline industry in many ways. And there's, been books about that where, certain situations, a checklist is probably the most efficient and you know, most successful way of making sure that all these preventative health measures are addressed on an annual basis. So easy to forget them if we don't have that kind of checkpoint every year. And so I think Medicare has good intentions. I guess that expression comes to mind, ounce of prevention versus a pound of cure, and certainly health insurances, they definitely do not want that pound of cure compared to just preventative screening every year, but neither, neither should patients or their doctors.

So, trying to keep people on track to healthy lifestyles. The body fails us eventually. Um, it's nice if we can delay that as long as we can by addressing the things that we can control.

Host: Yeah, absolutely. Dr. Seeber, thanks for being on today. Really appreciate it.

Carson Seeber, MD (Guest): It was a pleasure, a lot of fun. Thanks for talking with me today.

Host: Yeah, and I'm sure we'll talk again in the future.

And to our audience, thanks for listening to Tri State Health Talk, your LC Valley health podcast. You can learn more about all of these services that Tri State Health has to offer at TSH.org. And if you found this podcast helpful, please share it on your social channels and check out our future podcasts at TSH.org/TriStateHealthTalk, where you can listen to more of your

L.C. Valley health podcasts. I'm your host, Dr. Bob Underwood.