Myrtue Medical Center Welcomes New Family Physician – Tina Flores, MD

Tina Flores, MD

Myrtue Medical Center announces the addition of Tina Flores, MD, as a Family Practice Physician. Dr. Flores will be joining Myrtue Medical Center’s team of seven family medicine physicians and 14 advanced-level practitioners who serve at Myrtue’s nationally recognized Critical Access Hospital and at its medical clinics. Dr. Flores will replace Dr. Roger Davidson, MD, who retired last year. She will begin seeing patients in the Harlan Rural Health Clinic on Monday, Jan. 6, 2020.

Dr. Tina Flores received her medical degree from the University of Nebraska Medical Center where she was an Assistant Professor-Primary Care Physician for seven years. She has been in practice as a Primary Care Physician since 2012. Dr. Flores completed her residency at the University of Texas Health Science Center-San Antonio in Family Medicine.

As a Family Practice provider, she is devoted to comprehensive health care for people of all ages and has particular interest in geriatrics and chronic disease management, including the treatment of diabetes, hypertension, obesity, as well as mental health issues.

“Dr. Flores is grounded in the principles that make family practice so important to community health and well-being,” said Barry Jacobsen, Myrtue CEO. “She brings experience, a diverse perspective and vibrant personality that we are eager to share with those we serve.”

“In rural medicine you have the opportunity to treat nearly everything, and everything in medicine is always changing,” said Dr. Flores. “So, I like to read, go to medical conferences, talk to specialists and share these updates with my patients.”

“I believe in looking holistically at the entire person,” she said. “And, I particularly like complicated cases that challenge me to look at things differently to figure out what’s going on.”

Dr. Flores and her husband, Jeremy Schechinger, have four children. Jeremy graduated from Harlan Community High School. Dr. Flores and her family are rooted in traditions that orient around family, and they look forward to making this community home.

Myrtue Medical Center Recognizes Diabetes Awareness Month

Approximately 1 in 11 Iowans has some form of diabetes and about 1 in 3 Iowa adults has prediabetes, a condition in which blood glucose (sugar) levels are high, but not high enough yet to be classified as type 2 diabetes. Type 2 diabetes is the most common form of diabetes and people with this condition are at higher risk for heart disease, stroke and serious diabetes-related complications. It is important to know if you have prediabetes or diabetes.

“Most people with prediabetes don’t know they have it,” said Julie Klein, Myrtue Medical Center’s Dietitian. “That is why it is so important to at least annually have your blood glucose checked, especially if you have increased risk factors.”

IDPH encourages Iowans who do not have diabetes to take a quick one-minute risk test at to determine their prediabetes risk. If you have prediabetes, the National Diabetes Prevention Program can help prevent or delay type 2 diabetes. A list of National Diabetes Prevention Programs is available on the Centers for Disease Control and Prevention website.

On Thursday, November 21, a free educational event sponsored by Myrtue Medical Center and the Harlan Lions Club featuring a presentation by Julie Klein, Myrtue Medical Center’s Dietitian, and Jan Hastert, Myrtue Medical Center’s Diabetes Educator and Health Coach, will be held at 12:00 p.m. and again at 2:00 p.m. in the Auble Room at Myrtue Medical Center.  Interested individuals can also have their glucose checked at no cost if they desire at either session. The Lions Club will provide a healthy snack and door prizes.

 Additional information about the Iowa Department of Public Health’s (IDPH’s) diabetes prevention and control efforts is available at

Measles and Immune Amnesia

Studies published in Science Immunology found that the highly contagious and potentially fatal measles virus can cause immune amnesia. Immune amnesia results in removing antibodies that had protected patients from other illnesses. The measles virus wipes out 11-73% of patients’ protective antibodies putting them at risk of viral and bacterial strains they were previously immune to.

The biggest takeaway of this study is that measles is really much more detrimental to the immune system and overall childhood health than previously recognized,” Michael Mina, MD, PhD, assistant professor of epidemiology at Harvard T. H. Chan School of Public Health and one of the study’s lead authors. “It not only destroys overall immune function for a few weeks as children recover from the measles virus – something that has been known for a long time – but this study shows that it also prevents children’s ability to defend against pathogens they should have been equipped to deal with over the long term,” he says. “This study really drives home the real importance of measles vaccination.”

Measles is easily preventable. One vaccine dose is 93% effective in preventing the disease. The two doses that are recommended by the Advisory Committee on Immunization Practices (ACIP) make the vaccine 97% effective.

In light of these new studies, protecting your children from vaccine-preventable illnesses like measles is even more important to protect their health. Vulnerable people count on herd immunity as well to reduce their risk of acquiring diseases from others in their communities. Herd immunity is attained when a sufficient percentage of a population is immune to an infectious disease either through vaccination and/or previous exposure to that illness. Vulnerable people include young children, senior citizens, pregnant women, and immune-compromised individuals.

Shelby County Public Health encourages all residents to follow the ACIP immunization recommendations for adults and children including the measles vaccine. For more information about immunizations or the diseases they prevent, please contact your health care provider or go to   

Breast Cancer Awareness: Dense Breast Tissue – What Does It Mean to Me?

Dense breast tissue is common and normal, but it can make it more difficult for doctors to identify cancerous lesions. Below we will explain what dense breast tissue is, how it may interfere with a breast cancer diagnosis and ways to reduce the risk of breast cancer.

What is dense breast tissue?

Breast tissue consists of ducts, milk glands, and supportive connective tissue, which may be fatty (non-dense) or fibrous (dense).  Breast tissue appears to be dense on a mammogram when it contains a lot of fibrous tissue rather than fat. The dense tissue appears as a solid white area, which is difficult to see through. 

What causes dense breast tissue?

It is not known why some women have more dense breast tissue than others. What is known is that women are more likely to have dense breast tissue when the following are true:

  1. You are younger. Breast tissue generally becomes less dense as we age. However, some women’s breast tissue may be dense no matter their age.
  2. Your body mass index is lower. Women who are obese are less likely to have dense breast tissue than women who have less body fat.
  3. You are taking hormone therapy. Women taking hormone therapy for symptoms of menopause are more likely to have dense breasts.

Does breast density matter?

Yes, having dense breast tissue matters. It can increase the likelihood that breast cancer is undetected by a mammogram. In addition, it increases a woman’s risk of breast cancer, but the reasons for this are unknown at this point.

What breast cancer screening tests are recommended?

In the U.S., a number of major medical organizations recommend that women with an average risk of breast cancer begin annual screenings at 40. Women with dense breasts are considered to have a higher than average risk of breast cancer.

While dense breast tissue does make it more difficult to interpret a mammogram, mammograms are still considered to be effective screening tools. Digital mammograms are more effective at finding cancer in dense breast tissue than older technologies because they save images as digital files and allow for more detailed analysis.

Sometimes when dense breast tissue is detected on a mammogram, additional imaging tests are recommended.

Are additional tests necessary?

Several additional tests could be performed if dense breast tissue prevents a good interpretation of a mammogram. These include a 3-D mammogram (breast tomosynthesis), a breast MRI, a breast ultrasound, or molecular breast imaging (MBI). Each test has its pros and cons that a woman should discuss with her doctor based on her own risk factors and preferences.

We provide 3-D mammogram, technology that uses low levels of radiation to produce high quality images. Our kind and skilled staff promote a healing environment to give our patients excellent health care. Follow us on Facebook. and/or Twitter. To schedule an appointment, call us toll-free at 833-MMC-CARE (833-662-2273).



Time for Influenza Vaccine

Shelby County Public Health reminds all residents that it is time to prepare for the upcoming influenza season by getting vaccinated. Influenza is a contagious disease that can lead to serious illness, including pneumonia. Even healthy people can get sick enough to miss work or school for a significant amount of time or even be hospitalized. An annual flu vaccine is recommended for everyone six months of age and older. Pregnant women, young children, older people and people with certain chronic medical conditions like asthma, diabetes and heart disease are at an increased risk of serious flu-related complications. Getting a yearly influenza shot is particularly important for these vulnerable people.

While the timing of influenza season is unpredictable, seasonal activity usually begins in late fall and winter and can last as late as May. Timing of the flu vaccine is important to make sure you are protected before influenza viruses start to spread in the community and throughout influenza season. It takes about two weeks after vaccination for immunity to develop, making October a great time to get the flu vaccine.

Shelby County Public Health will be providing influenza clinics throughout Shelby County so all residents have access to influenza vaccine. Clinics will be held at a variety of times and dates throughout the month so everyone has a chance to be immunized during October. While protecting yourself by immunizing, you also protect your loved ones and those who are vulnerable to influenza in the community.

To schedule your flu vaccine or for questions, please call Shelby County Public Health at 712.755.4422 or go online at  

How is a Well-Child Exam Different from an Athletic Physical?

girl stretchingChildhood is a time of rapid growth and change. The Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the “periodicity schedule.” It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence which includes children up to age 18.

If your child is in grades 7-12 and wants to participate in sports or other activities, they are required to have an Athletic Pre-Participation form completed by a medical provider. This form can be completed during either a well-child exam or an athletic physical. So, how do Well-Child exams compare to Athletic Physicals? A well-child annual visit is similar to the Athletic Physical, but much more comprehensive.

An Athletic Physical usually includes a physical examination and a brief examination of child’s medical history. The Athletic Physical is also a time to ensure your child is current on his or her vaccinations. Most schools require children to be vaccinated in order to attend classes. What is not included in a sports physical are developmental histories, long-term health concerns and risk factors and advice for developing a healthy lifestyle.

A Well-Child Exam is a schedule of screenings and assessments recommended from infancy through adolescence. “Well-child visits are also key times for communication with your practitioner,” said Dr. Markham. “We talk about normal childhood development, nutrition, sleep, safety, and healthy options for your child. Talking about ways to improve care and prevent problems helps keep your child healthy.” A well-child check is generally covered 100% by most insurance companies, with no co-pay. These exams are generally covered on a once yearly basis and allows the practitioner more time with your child.  It also allows the practitioner a chance to further address any developmental, emotional, or social concerns with the child and parent.

As children become teens and begin to face new social and physical issues, a well-child annual visit gives them an opportunity to discuss topics they may not feel comfortable discussing with their parents, topics like drugs, smoking, alcohol, sex, and sexually-transmitted diseases. A doctor’s insight on these subjects can provide another point of view and guidance in a child’s life.

Here are a few things parents can do to make the well-child visit more productive:

  • Take note of any odd or unusual behavior you have noticed in your child. Family physicians have a great deal of experience with children at each stage of development and can often offer professional insight into whether or not you should be concerned about particular behaviors in your child.
  • Sit down ahead of time with your child to prepare a list of questions for your doctor. You can cover topics ranging from nutrition to emotional issues, to sports injuries, or just odd aches or pains.
  • Be sure to bring any health documentation you have received from your child’s school that needs to be completed for sports, school-related trips or anything else. Schools will provide a list of vaccinations and other requirements of their students.

A well-child annual visit includes the following:

  • Vital Sign Checks. Vital signs are checked by reading blood pressure and checking heart and respiratory rates. Blood pressure should be checked at least once every year unless there is something in your child’s history to indicate otherwise. It is possible for even young children to have hypertension so regular blood pressure checks should begin at age 3.
  • Updated Health History and Tracking Growth. Your doctor will want to know of any updates and changes in your health to add to your chart and history. Talk with your doctor about your child’s development. You can discuss your child’s milestones, social behaviors and learning, sleeping habits and development behavior.
  • Physical Exam. Your doctor will visually check your appearance for signs of any potential conditions. They will check the abdomen, eyes, head, chest, hands and wrists, musculoskeletal system and nervous system functions such as walking and speech. They will also examine the ears, eyes, nose, throat, heart, and lungs. This exam also includes touching parts of your body to feel for abnormalities – abdomen, skin, hair, and nails, possibly genitalia and rectum, and testing your reflexes and motor functions.
  • Team Approach. Regular well-child visits create strong, trustworthy relationships among your practitioner, parent and child. This team approach helps in the development of optimal physical, mental and social health of your child.

Is the Athletic Physical Covered by Insurance?

The Athletic Physicals are an out of pocket expense – meaning no insurance claim is filed. However, the Well-Child yearly visits are reimbursed by insurance, typically with no co-pay. And the Athletic Pre-Participation form can be completed at the time of your regular well-child exam. If you need to have an Athletic Pre-Participation form filled out and your child has already had a yearly physical examination in the past 12 months, bring the form in and your provider will complete it.

We are proud of our medical practitioners, leadership, and staff who have dedicated their lives to delivering the utmost quality of healthcare for all who walk through our doors. We want your child to be as healthy as possible. Myrtue Medical Center is committed to you, your family and the health of our community. Please visit our website or contact us at (712) 755-5161.


Myrtue Medical Center and Harlan Community School Meet with Governor Reynolds Second Time to Discuss Innovative Approaches to Mental Health in the Schools

School based Therapy-Governor ReynoldsSchool-based therapist, Katie Sandquist, and Harlan Community School High School Principal, Scott Frohlich, were invited to the Governor’s Teachers Cabinet to discuss mental health in schools.  The Teachers Cabinet is a group of educators that advises the governor on education policy for the state. The Governor reached out and asked Frohlich and Sandquist to share their innovative approach of removing barriers for kids and building collaboration between the school and Myrtue Medical Center in addressing mental health issues for students and staff in the school district.

The school-based therapy program got the attention of Governor Kim Reynolds and Lieutenant Governor Adam Gregg when they visited Harlan Community Schools earlier this year. Governor Reynolds was interested in the success of Myrtue Medical Center’s unique permanency model within the school versus mobility of care that others tend to offer across the state.  With the Governor’s recent bill covering recommendations for establishing an Iowa children’s mental health system in Iowa, the state board will take a comprehensive look at current resources and create a strategic plan with specific recommendations to implement a better approach to help children with mental health issues.

“If we are going to effectively address mental health in schools, we have to come together in a collaborative and mutually supportive way,” said Katie Sandquist, Myrtue’s School-Based Therapist for 6th through 12th grade students. “Partnership and service are two of the core values of Myrtue Medical Center, so this program is a natural extension of our mission.”

Sandquist shared with Governor Reynolds and the Teachers Cabinet ways to creatively remove barriers to evidence-based treatment and grow a school culture that is trauma-responsive and promotes holistic wellness for students and staff.

School-based mental health services are outpatient services delivered in schools to work through behavioral, emotional and social challenges that impact success at school and at home. Families have the option for greater collaboration between the therapist and other supports at the school. With the parent/guardian’s support, the child’s therapist can work with school staff such as school counselors, administrators and teachers to develop a plan for support that will help the student thrive in and outside of school.  Therapy provided at the school mirrors therapy provided at the main Behavioral Health office, including use of the same process for intake, diagnosis, and planning goals for treatment.

“The partnership with Myrtue has been a seamless transition to better meet our student’s mental health needs,” said Mr. Scott Frohlich, Harlan Community High School Principal. “The support and collaboration has been a crucial link in making this a successful program. This partnership provides service to our students much quicker than if they would schedule with an outside clinic. Students are scheduled on a regular basis either weekly or bi-weekly within the school day, which reduces instructional time missed from the classroom.”

If you want to learn more about school-based therapy services, please call Myrtue Medical Center’s Behavioral Health at (712) 755-5056.

Rabies Remains a Health Threat for Iowans

RabiesEvery 10 minutes someone in the United     States is treated for possible exposure to rabies, accounting for about 55,000 people each year. About 5,000 animals that have tested positive for rabies each year in the U.S. Seven out of 10 Americans who die from rabies in the U.S. were infected by bats.

Any mammal can be infected with rabies, but in Iowa, rabies is most commonly identified in skunks and bats, accounting for 78% of the animals that have tested positive for rabies over the last 10 years. Cats, cows and dogs are the next most commonly identified rabies-infected animals in Iowa.

Rabies is spread when the virus from an animal’s saliva or neural tissue gets through a person’s skin via bite, contact to wounds, or contact with the eyes, nose or mouth. In addition, people known to be in the same room as a bat, but do not know for certain that they were bitten or had direct contact with the bat, may have been exposed to rabies. This would include persons who awaken to find a bat in the room or children alone with a bat in the room.

Prevention Tips

Leave all wildlife alone, including injured animals. If you find an injured animal, don’t touch it; contact local authorities for assistance.

Because pets can get rabies from wildlife and then could spread it to humans, preventing rabies in pets is also an important step in preventing human rabies cases. 

If Exposure Occurs

If you do come into contact with a rabid animal, rabies in humans is 100% preventable through prompt appropriate medical care. If you are bitten, scratched, or unsure, talk to a healthcare provider about whether you need post exposure treatment.

The Iowa Department of Public Health (IDPH) provides 24/7 rabies consultation and receives about 500 rabies-related calls each year. IDPH can be reached at 800-362-2736 during business hours or 515-323-4360 after hours.

Myrtue Medical Center-The First Critical Access Hospital in the state of Iowa to receive American Heart Association’s Mission: Lifeline Silver Referring Achievement Award

Lifeline STEMIMyrtue Medical Center has received the Mission: Lifeline® Silver Referring Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks. Myrtue is the first Critical Access Hospital in the state of Iowa to receive this elite cardiac care designation.

Every year, more than 250,000 people experience an ST elevation myocardial infarction (STEMI), the deadliest type of heart attack, caused by a blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication.

The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call, to EMS transport and continuing through hospital treatment and discharge. The initiative provides tools, training and other resources to support heart attack care following protocols from the most recent evidence-based treatment guidelines.

Myrtue Medical Center earned this award by meeting specific criteria and standards of performance for promptly diagnosing STEMI patients and transferring them to hospitals that provide emergency procedures to re-establish blood flow to blocked arteries when needed.

“Every second counts in these types of critical situations. This recognition for our level of cardiac care is truly an honor,” said Jenny Lefeber, manager of Myrtue’s Emergency Department.

“We commend Myrtue for this award in recognition for following evidence-based guidelines for timely heart attack treatment,” said Tim Henry, M.D., Chair of the Mission: Lifeline Acute Coronary Syndrome Subcommittee. “We applaud the significant institutional commitment to their critical role in the system of care for quickly and appropriately treating heart attack patients.”

Myrtue Medical Center’s Economic Impact on Local Economy Tops $29 Million in 2019

Economic Impact-Myrtue Medical Center-5.19

In all, Iowa’s Healthcare Sector Provides 342,914 Jobs Across State

DES MOINES – According to the latest economic impact study by the Iowa Hospital Association, Myrtue Medical Center generates 613 jobs that add $29.7 million to Shelby County’s economy. A multiplier methodology is used to determine the level of impact, which means that the health sector and employees in the health sector purchase a large amount of goods and services from local businesses, having a multiplying effect in the community. It is also estimated that Myrtue Medical Center’s employees by themselves spend $4.3 million on retail sales and contribute $259,832 in state sales tax revenue.

“At a time when many rural hospitals throughout the country are struggling financially, with some closing, this report is critical in illustrating the enormous impact that hospitals in rural areas have on the economies of the communities they serve,” said Barry Jacobsen, CEO-Myrtue Medical Center.

The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s health care sector. The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact.

The study found that Iowa hospitals directly employ 76,203 people and create another 64,453 jobs outside the hospital sector. As an income source, hospitals provide $5 billion in salaries and benefits and generate another $2.7 billion through other jobs that depend on hospitals.

“Hospitals positively influence their local economies not only with how many people they employ and the salaries of those employees, but also through hospital purchases from local businesses as well as the impact of employee spending and tax support,” said Kirk Norris, IHA president/CEO. “Whether at the local level or statewide, there are few Iowa employers that generate economic activity comparable to hospitals.”

In all, the health care sector, which includes offices of physicians, dentists and other health practitioners, nursing home and residential care, other medical and health services and pharmacies, contributes $18 billion to Iowa’s economy while directly and indirectly providing 342,914 jobs, or about one-fifth of the state’s total non-farm employment.

The Iowa Hospital Association is a voluntary membership organization representing hospital and health system interests to business, government and consumer audiences. All of Iowa’s 118 community hospitals are IHA members.