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What I learned in Vegas and bringing it back to Yakima!

Spring MedTrade 2015  

It’s that time of year again. Our semi-annual trade show in Vegas where all the business leaders who run medical supplies gather in Las Vegas to network and look at the newest products. I want to share some of my insights from the trip.

Several hundred of us cramped into a large room to hear what is next in Washington DC and legislation.
Several hundred of us cramped into a large room to hear what is next in Washington DC and legislation.

I always like seeing new products. Three of my favorites:

  1. Evolution walkers:  We have carried these for over a year now. These are the BEST walkers on the market and they are priced this way too. For the person who doesn’t want to deal with the generic Medicare walker and has the money to spend, this is the way to go. We call them European walkers because those in Europe know how to get around and appreciate walking. We have three different kinds of these walkers at our store so try both the Medicare walker and this one out and you’ll see what we are talking about!
  2. Sunrise Medical who handles all of our lightweight wheelchair products has a new no-insurance wheelchair. Howard’s is the exclusive dealer here in Yakima. Some of the neat things you get in this chair: easily adjustable push handles (which is great for someone like me who is 6’2” tall), brakes on the handles instead of having to bend down and set them on the wheels, and disc brakes. All of the other qualities of a lightweight wheelchairs are still there including quick release axils but they took a good wheelchair and made it great!
  3. How does someone who is a quad supposed to easily pull their pants up in the bathroom? There is a product now for this individual called pants-up-easy. This is a product we can order for these individual because they deserve to be independent just like the rest of us!

I hate talking about this, but most of our business is contingent on what is going on in Washington DC. In January of 2016, Medicare is planning on making rural areas accept the larger city’s reimbursements. What this really means for the residents of the Yakima Valley is we will be reimbursed less for our medical products. For example instead of being reimbursed $182/month for oxygen, this will drop to close to $100. Instead of $140 for a walker with seat, this will drop to $85. It doesn’t take a rocket-scientist to know you won’t get the same quality product.

Howard’s recently joined AA Homecare to help in the lobbying effort to make this so it doesn’t happen. If it does go though we will be okay as business; however, Howard’s will have to become even more efficient and handle more with less. What this means for our customers is we frequently have to provide a more affordable options instead of what we currently offer. Yesterday as an example, we had a patient who needed help and adjustments on a product in Mabton, we made the trip. These trips will be harder to make if Medicare forces us to do more with less and those patients will have to come to our store instead of us going to them.

It was Vegas and I did bring my daughter.  In-between networking, I did get 30 minutes of swimming in the wave pool.
It was Vegas and I did bring my daughter. In-between networking, I did get 30 minutes of swimming in the wave pool.

Last and my favorite part of MedTrade was the networking. There are not many of us here in Yakima who run a medical supply store. I had a great opportunity to go to dinner with another family owned DME out of Wenatchee and another out of Oregon. We shared some of our secrets about taking care of our customers, winning audits, and what we can do to become even better at our trade (what we call our Ninja secrets here at Howard’s).

Erik at Howard’s


What happens when you are sick or hurt?

Last year I came down with a terrible back injury and it has taken me almost 12 months to recover from it. I managed to herniate my L5/S1 disc.

No one plans on getting hurt or sick but

Here is the MRI of my herniated disc before it was repaired.
Here is the MRI of my herniated disc before it was repaired.

when it happens it is vital to have your team in place to help you recover.  In Yakima we have incredible doctors and therapists in this city to get you back on your feet. If something unexpected comes up and you need medical equipment  needs, whether  crutches, braces, nebulizer, or other items, the team at Howard’s Medical is here to help you offering two locations and delivery services for the entire valley.

The good news is after herniating my disc, I am finally healed!  Last year I did try: two rounds of physical therapy, chiropractic care, massage therapy, inversion tables, back and SI braces, etc. No two of us are the same when it comes to injuries which is why it is imperative you have a good team in place.  Howard’s is the medical supply/pharmacy to come alongside your other important team members if you ever find yourself injured or sick.

Here is hoping that your 2015 is filled with health and wellness,

Erik—Howard’s team lead

Customer Service Team Job Opening

Mission Statement
“To enhance the quality of life for the community of Central Washington by providing high quality home medical equipment and supplies with a compassionate touch.”

• Must be flexible, dependable, and have the ability to solve problems
• Communicate effectively with seniors and people of all ages, smile and make people feel welcome
• Have an ability to use computers, the internet, and Microsoft Office
• Must be able to make decisions and be a leader
• Must know basic math, grammar and problem solving skills
• Must have a high school degree
• Must pass a background and drug test
Responsibilities Include:
• Understanding and empathy to our customers.
• Continuously learn new skills
• Fitting of medical equipment
• Will adhere to company manual and not use any illegal drugs or smoke on the job
• Open or close the medical supply nightly
• Count money accurately
• Determines the best method for providing services by knowing what is and what is not covered by insurances
• Responds to telephone inquiries and orders from homecare patients, doctors and referral sources
• Complies with an adheres to all regulatory compliance areas, policies and procedures and “Best Practices”
• Resolves patient complaints by identifying problems and coordinating appropriate corrective action
• Limited marketing on phone, writing, deliveries, and some directly to adult homes, hospices, and doctors
• Variety of other day-to-day requirements to include filing, keeping area’s organized, etc
• Some lifting required
• Coordinates the delivery and pick-up of equipment, supplies and services with appropriate personnel
• Keeping a clean showroom
• You must communicate clearly with customers as well as manual dexterity for filing purposes.
● Part-time, mostly fixed (30 hours/week) depending on customer traffic; must be able to close the store nightly until 6:30pm and will average 3 Saturdays/month (9:45am-3pm).


● Varies depending on qualifications. $9.50-11/hr. Health club, dental, and 401k benefits. There are certain commissions regarding on-the-job performance that can add an extra $1-3/hr depending on job performance.

There are multiple jobs within Howard’s and many people have been promoted from customer service so this in no way is a “dead-end” job. We also love working with students for a few years because we realize students make for great team members while going to school.

If you are interested in this job, please respond back to this posting ( with your resume and we will email you five introductory questions. We are looking for the right team member as much as you are looking for the perfect company to work for.

Last, in the subject of the email please write: Attention Mr. Jaeger. This lets us know you are not a robot.

Day 1 at the ISS

I attended a full day seminar on measuring wheelchair seated posture and seating supports at the ISS (International Seating Symposium) in Vancouver B.C., Canada. There were people from all around the world. We began the class by discussing the proper terminology for angular measurements of someone sitting in a wheelchair. The purpose for this class was to try and standardize the language that is used in measuring someone’s posture in a seated position. If someone were to say that a patient was in a wheelchair with a hip angle of 40 degrees, how would that be interpreted? Would it be a sagittal rotation of 40 degrees, a frontal rotation of 40 degrees, or a transverse rotation of 40 degrees? In what direction is it rotated? Does the wheelchair have hips? There are many different ways this can be interpreted, which is why it is so important that a standardization of terminology and measurement be established so that there is an efficient method for communication among different people involved in the wheelchair process.

The term sagittal refers to a measurement of the patient from the side. If you are standing on a patients right side looking at them, and there head is tilted forward 20 degrees, then the measurement would be called a sagittal head angle of negative 20 degrees. The sagittal head angle is defined as: The angle of orientation of the head in the sagittal plane with respect to the horizontal, viewed from the side. There is also a transverse head angle, which would be the angle of orientation of the head as viewed from above. This can be demonstrated be turning your head from side to side, which is changing the transverse head angle. The final plane of orientation is the frontal plane. A deviation of the Frontal Head Angle can be demonstrated by tilting your head from side to side. By measuring all three angles, an accurate measurement of your heads position can be recorded.

Another key factor in measuring both angular and linear measurements of a patient is difference between relative and absolute dimensions. If I were to measure the relative angle between someone’s trunk and thighs, I would take a device called a goniometer and align one arm of it along the line from the lateral lower neck point, which is the center of the pivot of the head, to the Lateral hip center point (center of rotation), and the other arm of the goniometer from the lateral hip center point to the lateral femoral condyle (part of the knee) and I would read to angle displayed on the goniometer. There are over 130 different angular measurements that can be used, but fortunately only a small portion of those are regularly used for the majority of wheelchair patients that one is likely to encounter. There is a lot more to measuring someone for a wheelchair that just the seat width, depth and height!

The full day class on wheelchair seating measurements emphasizes how to measure far more things than what an average person might thing (the standard width and depth of the wheelchair). At Howard’s we are able to design a custom rehab wheelchair that will give the consumer a great fit increasing their independence.

Cheers, Daryl (Certified Wheelchair Technician for Howard’s Medical)

The most dangerous room in the house is . . . the bathroom

Did you know the bathroom is the most dangerous room in the house? Over 80% of all falls occur in the bathroom. A buddy of mine (who is less than 40 years old) had a nasty fall in the bathroom last year and ended up on home health . . . and he was healthy. Imagine if you or a loved one is dealing with stability issues, how this can go up.

Bathroom aids such as grab bars help in transferring throughout the bathroom. Many people use their own towel racks for this purpose which is a horrible idea because towel racks do not have a weight capacity and are usually not properly secured to the wall. If you do want to double-dip with a multi-function towel rack and grab bar, there are some grab bars that double as towel racks. Also, installing grab bars on plastic or fiberglass wallboard can be complicated and many tub and showers have gaps between the unit that make the usual attachment almost impossible. There are adapter kits available to help fill this gap in. Howard’s does not offer this service for liability reasons but most hardware stores such as Ace, Home Depot, and Loews can walk you through this process.

For the shower or tub, most people use shower or transfer benches. They come with or without backs and with or without commode cutouts. Even if you don’t think you need a back we will usually throw it in because if you need it at a later date they are not sold separately and only add about $5 to the price of the chair/bench and can always be taken off and stored. I would hate to see anyone ever fall in the shower which is why we have the lowest prices in town in bath safety. We will sell a standard shower chair for as little as $39.99 and if that is an issue, tell me you read this blog and we’ll sell you a used (cleaned of course) for half that. There is also a new product on the market (electric bathtub patient lift) which is great for someone who is unstable that still needs to bath. We have these on display at our Yakima store because we know many people don’t want to plunk down hundreds of dollars before seeing and trying an item. Do know that the rubber tips need to be maintained on all bath safety equipment. If they are cracking and wearing out you will need to have them replaced.

With toilet seats there are differing degrees of raise one can add to the toilet. There are several different kinds depending on the raise one needs, how you would like to attach or bolt them on, and whether or not one needs arms. For our shorter customers, many do not need a raised toilet but will still need a toilet safety frame to aide in standing and sitting.
There are three main kinds of commodes available. The most popular is the bedside commode. Most insurances including Medicare (but not DSHS in Washington State) will cover a bedside commode if it is for use in the bedroom and there is documentation that the patient is limited to that one room with a doctor’s prescription. There are also drop-arm commodes and wheeled commodes. I prefer the knock-down commodes because when they are not needed, they fold out of the way and don’t take as much space. Please note that weak and unstable patients should never be left unattended sitting on a commode.

I’d love to tell you your insurance will help you out with covering medical equipment in the bathroom but most consider it a “home improvement” item and will not cover any item in the bathroom. Here is Yakima, we have had some success getting some bath safety items covered by the COPES program with ALTC. If you do not have the money to do some of these improvements and are on DSHS, you can call ALTC at 509-469-0500 and they can walk you through the process that this entails of getting bath safety covered by the state. Usually one has a caseworker, we send him/her a bid, and this is either covered or denied by the state. I’m hesitant to write this because it seems like Washington State insurance changes hourly so do not quote me on this. I will also say, whether it is Howard’s or another local DME store here in Yakima, if one store goes to all the trouble of creating a bid, educating the customer, and talking through the options, if they do not win the bid please contact them and let them know this so they can adjust their pricing.

Last, people love to prove me wrong regarding whether or not their insurance will cover bath safety items. If you think your insurance will cover these items I have attached a list of bathroom procedure codes. Don’t call your insurance and ask them, “Do you cover a raised toilet seat.” Call them and ask them, “Do you cover procedure code E0244 for use in the bathroom?” In insurance talk E0244 is equal to raised toilet seat. Likewise, E0163 is equal to bedside commode.

If you have any question regarding bathroom safety, give us a call at 509-654-9899. We also offer free in-home assessments if you would like us to walk through your or a loved-one’s home and offer suggestions.

There are a number of different kinds of raised toilet seats for under $50.
One of our brand new fully-electric bath lifts with a rechargeable battery. We have a unit on display at our Yakima showroom for anyone wishing to try the lift.
Erik Mickelson
Team Lead at Howard’s Medical Supply

Wheel Lock Extenders for Alzheimers

We have a patient with Alzheimer’s disease living in a memory care unit. He has had multiple falls, and the care staff and the patients family would like for the patient to get a wheelchair. One of the main concerns that the family has about the patient is that he may not remember to put on his wheel locks, which could cause further falls. The patients daughter stated that she had heard that the last color that is easily identified by the elderly is yellow, and was wondering if we could make the brake handles yellow.

The standard brake extender is dark grey with a black cap.

This is the same color as the chair, which makes it blend in. According to an article on, there should be a variation of at least 2 levels of lightness or darkness in order for most people to be able to differentiate between the colors.

“When using colors as part of an orientation cue system, remember that older individuals have a harder time distinguishing between colors in the cooler range-blues and greens particularly. Also, many individuals are color blind and have a hard time distinguishing between red and green. Therefore, color is not probably appropriate as the sole differentiating feature between different elements-they should vary in other design features as well. Varying the value of colors (the lightness or darkness) by at least 2 levels on a 10 level gray scale will enable most people will be able to differentiate between the colors.”

On the wheel lock extenders, the best way to maximize the ease of use is to press or pull on the top of the extender, allowing the patient to utilize a greater mechanical advantage due to the leverage it provides. Instead of coloring the entire brake extender, I chose to emphasize the part of the wheel lock extender that I wanted the patient to use.

“Emphasize what’s important. Within any setting, there are some elements that carry important information, such as orientation cues, or views to interesting vistas or activity areas. Pay close attention to those elements that have the potential to provide useful information to the cognitively impaired individual, and give these more emphasis with brighter colors (using hue, value and chroma), higher contrast with the background, and more light.”

Yellow may not be perceived as being yellow by the patient, but it is does provide a high level of contrast in hue, value and chroma. By having the handles such a bright color, it should catch the patients attention, and remind him that he needs to use his wheel locks.

At first I attempted to color the brake handle extenders with yellow spray paint, however the finish is designed to resist stains, so the paint dried to a flaky finish and peeled off. I then decided to switch to a product called Plasti-Dip, as when properly used it sticks to pretty much anything, while providing a texture that is easy to grip.

There was no extra cost to the patient or his family for this alteration. It is just another way for Howards Medical to show that we treat all of our customers like family.

Baucom, A. (1996) Hospitality Design for the Graying Generation. New York: Wiley Press.
Brawley, E. (1997). Designing for Alzheimer’s Disease. New York: Wiley Press.
Itten, J. (1970). The Elements of Color. F. Birren (Ed.). New York: Van Nostrand Reinhold.
Reeves, V. (1985). Color and its effect on behavior modification in correctional detention facilities. In Research and Design 85: Architectural applications of design and research technology.
Rizzo, M., Anderson, S., Dawson, J. & Nawrot, M. (2000). Vision and cognition in Alzheiemr’s Disease. Neuropsychologia 38(8): 1157-1169.
Wijk, H. (2001). Color perception in Alzheimer’s disease with implications in the environment. In B. Vellas, L. Fitten, H. Feldman, E.. Giacobini, M. Grundman & B. Winblad (Eds) Research and Practice in Alzheimer’s Disease, Vol 5. Paris: Serdi Publisher.
Wijk, H., Berg, S., Sivik, L &Steen, B. (1999). Color discriminationm color naming and color preferences among individuals with Alzheimer’s Disease. International Journal of Geriatric Psychiatry. 4(12): 1000-1005.

Sports Related Injuries

With warmer weather also comes playing outside more. This means sports related injuries. Remember that even at a local picnic at the park, you need to warm-up before any kind of activity because it does not take much to turn an ankle or aggravate a back injury.  You can also use numerous soft braces that Howard’s has in stock for your ankle, knee, or back at both our Yakima location on 16th Ave. or Selah next to the Red Apple Market or call us at Tel: 509-654-9899..  Have a great time this summer, and stay healthy!


What does Medicare Cover with Durable Medical Equipment?

I get the question daily, what does Medicare cover in regards to durable medical equipment. The general rule of thumb is Medicare stops at your front door and your bathroom door. They will pay for a wheelchair, walker, hospital bed, oxygen, and other items imperative to daily living. Unfortunately they will not pay for two items in the same classification such as a walker and a wheelchair (they think that if you use one, you don’t need the other). Medicare also changes their rules frequently so if you have any questions, give us a call at Howard’s Medical in Yakima and Selah at 654-9899.

The Importance of Receiving the Flu Vaccine

The pharmacists of Howard’s Drug provide flu vaccine to hundreds of patients in Selah every year. The best way to prevent the flu is to receive the flu vaccine. The flu usually comes on suddenly. People who have the flu often feel some or all of these symptoms:

• Fever* or feeling feverish/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue

Some people will develop complications (such as pneumonia) as a result of the flu, some of which can be life-threatening. The flu can make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu.

We will begin vaccinating at Howard’s Drug the first of September. We will also be at the fairgrounds at the Yakima Regional / Yakima Health District booth providing flu, pneumonia, and Tdap vaccines. This booth will be running all 10 days of the fair, and we will be there the last Saturday and Sunday (Oct 1 and 2).

Joel Thome, PharmD, is a pharmacist at Howard’s Drug and assistant professor of pharmacology at Pacific Northwest University of Health Sciences. He obtained his Doctor of Pharmacy (PharmD) from the University of Washington School of Pharmacy in 2005. Since then Dr. Thome has worked as a clinical pharmacist at Yakima Valley School (a home for the developmentally disabled) and has co-managed a locally owned pharmacy, Howard’s Pharmacy & Medical Supply, both in Selah. He also serves as a preceptor for 4th year pharmacy students for Washington State University (WSU) and is adjunct faculty as an Assistant Professor of Pharmacotherapy with the WSU College of Pharmacy. Professional memberships include the ASCP (American Society of Consultant Pharmacists) and ACCP (American College of Clinical Pharmacists). He has traveled to the Dominical Republic and Kenya on missions to provide medical services to rural areas.