The health-care industry is notoriously complicated. There’s the unpredictability of an individual patient’s response to treatment, insurance or the lack thereof, legal obligations, constantly updated information, education, technology and logistical hurdles that must be navigated.
Sheridan Memorial Hospital is proof that diverse, comprehensive and conscientious care can be offered at the small community level.
Having a competent team close to your home that can help through the physical struggles and uncertainty of illness makes a huge difference in a rural community. In addition to baseline internal medicine and common baseline care, SMH offers multiple specialty practices via partnering with larger health-care facilities in the region. In-house specialties include dialysis, a state-of-the-art intensive care unit, cardiac care and a cancer care center.
Less than a decade ago, residents of Sheridan County diagnosed with cancer had no choice but to travel at least four hours round trip for care. The protocols of treatment usually require multiple appointments for consultations, checkups, radiation and chemotherapy. In addition to the cost of treatment itself, the logistics and expenses of traveling while sick were an incredible burden for patients. That changed in 2012, when a community initiative birthed the Welch Cancer Center.
The WCC staff consists of Dr. Megan Ratterman, who holds specialties in oncology and hematology, nurse practitioner Nina Beach, as well as weekly visits from two radiation oncologists from Billings Clinic. Community resources have combined with advancing technology to make cutting-edge treatments possible in rural communities.
“What we can do now is amazing,” said Ratterman. “That’s what I love about oncology care. It has drastically changed in the past 20 years. Treatments are much less toxic, and our supportive therapy is much more effective – we are able to control nausea and vomiting much better. Also, the treatments are becoming very targeted. We are able to identify mutations or cell pathways that can be specifically targeted, and those therapies are being better tolerated.”
Ratterman said she frequently treats the most common types of cancer – colon, breast, prostate and lung. One of the tools she is most excited about is intravenous immunotherapy, a new and revolutionary technique that can harness an individual’s immune system to fight cancer cells.
“Cancer has a way of hiding from your immune system,” she explained. “IV immunotherapy drugs can ‘unmask’ those cells so your immune system recognizes them.”
Ratterman, who spent a portion of her childhood in Evanston, completed her medical training in Chicago before relocating to the Rocky Mountains. She said it was the outdoor lifestyle and rural culture that brought her back.
“In the city, we got 20 minutes to spend with patients at each appointment, and 40 minutes for a new consult,” she said. “Here, we get much more, and we can take the time to fully explain what they are going through and help them navigate one of the scariest times of their life.”
Ratterman said she is honored to be a part of the WCC.
“I really want to emphasize I really do have the most incredible staff. I could no do what I do without them. It’s so incredible to see someone conquer adversity in a way that cancer patients do,” she said. “It’s incredible and rewarding to help them do that.”
Along the corridors of the WCC, each room is titled not only by its function, but also the name of a local company that contributed funding to construct the treatment center.
“I do think it’s important to note this facility was really offered to the community by community efforts,” said Welch Cancer Center Manager Tommi Ritterbusch. “Philanthropy built this center and keeps us funded.”
Today, the center averages 220 visits for chemotherapy and 255 for radiation each month.
“I think one of the things I always like to mention about our facility is you can get really comprehensive care in a rural environment,” said Ritterbusch. “We have all the technology and specialty trained providers and nurses to provide care to them here.”
The community initiative to bring a cancer care center into the community of Sheridan is a limb of a mindset geared toward cultivating the best possible health care for the community of almost 18,000 residents.
Dr. Jamie Ramsay is one of four board certified anesthesiologists of Big Horn Anesthesia Associates, the group that partners with SMH to provide relevant patient care when necessary, which is mostly for surgeries, and labor and delivery. Having four anesthesia doctors is rare, and this team works closely with hospital administration to offer forward-thinking options to patients.
Over the past few years, there has been a “long-acting anesthetic available on the market,” explained Ramsay. “It’s basically a delayed-release injection, and that means that instead of providing a single shot that lasts for eight to 14 hours, this medicine can last up to 72 hours.”
The availability of a long-acting numbing agent has big implications when considering the plague of addiction that begins with a post-op pain prescription.
“Overall, my excitement about the whole thing is we can really aggressively treat post-op pain without the use of opioid pain medications,” said Ramsay. “With the whole national opioid crisis, that’s a big deal to potentially get somebody through the first one to three days after a painful surgery without using any opioid-based pain medication at all.”
Patients work with their care team to determine if long-acting anesthetic injection is suitable for their post-operative recovery. Presently, the injection is approved by the Food and Drug Administration for a few, specific types of nerve blocks, but that approval is likely to expand over time as relative safety is established.
“The question is who can get them. It purely depends on what the surgery is, the site of the surgery, patient desires, and comorbid health conditions,” Ramsay said, adding that cost is presently a prohibitive factor.
“Because they’re relatively new compared to other forms of anesthetic or pain control, insurance companies are slow to ramp up in their process of approving them,” Ramsay said, emphasizing that the expense is something patients must be aware of because they will receive a separate bill from their anesthesiologist.
“Because it’s so costly, some systems will restrict its use to certain procedures or instances. SMH does not have those restrictions, and leaves it up to providers to decide who is a good candidate or not,” Ramsay said.
There are a lot of things that have to do with health that can’t be controlled. But things that can be influenced are having the best possible equipment and people a community can manage.