Balance Magazine 2017 by Avera

balance Health & Wellness Tips for Your Life

SPRING 2017

CREATING A HEALTHY LIFESTYLE

CULINARY CREATIVITY

PHYSICIAN SHARES HEALTHY AND TASTY IDEAS

ONE STEP AT A TIME

WIDE AWAKE AT MIDLIFE?

How to Catch Some ZZZs

WINDING

DOWN HOW TO HELP YOUR KIDS RELAX

Summer Shoes: CHOICES THAT ARE KIND TO YOUR FEET

REAL FOOD

Weight loss a natural result of healthy eating

Find your

happy hour. Just 20 – 30 minutes of exercise daily can decrease stress levels.

Stress is just one factor that can affect your overall wellness.

Things that can help: • Healthy diet • Regular exercise • Deep breathing exercises • Get enough sleep • Talk to your physician

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Get more tips on how to control stress during your annual checkup. Yearly checkups are often covered by health insurance at no cost to you â&#x20AC;&#x201D; check with your policy for details. Need a provider? Search for family medicine or internal medicine doctors at Avera.org/doctors 17-AVHE-5105

FRUIT SNACKS The key to a healthy life is learning good habits early in life. Itâ&#x20AC;&#x2122;s recommended that adults and children eat more fruits and vegetables and limit sugary drinks and juices.

These re snacks a ries 100 calo or less:

A medium-size apple A medium-size banana 1 cup blueberries 1 cup grapes 1 cup carrots, broccoli or bell peppers with 2 tbsp. hummus Source: Centers for Disease Control and Prevention

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Dear Readers, Happy Mother’s Day! Welcome to a first-ever special edition of Balance magazine. At Avera, we’re committed to the well-being of all women, throughout all phases of life. This magazine is dedicated to your good health and that of your family.

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balance Health & Wellness Tips for Your Life EDITOR Lindsey Meyers COPY EDITOR Donna Farris CONTRIBUTING WRITERS Kelly Thurman, Alyssa Kuecker Katie Daniel, Jarett Bies DESIGNERS Jessica Nuenke, Jessica Potter PHOTOGRAPHERS Emily Spartz Weerheim (main photographer) Tracy Vogel, Bekah Gartner

Articles in this magazine mirror a rich storehouse of health tips and features that you can read for free and share at AveraBalance.org. You’ll want to bookmark this site as we post a new article virtually every day. We’re not afraid to tackle any topic that we feel might be helpful and interesting to our readers. Sign up today to receive e-newsletters at AveraBalance.org. It’s all about living better, and living balanced. This issue contains great features to help you do just that. You’ll read about the “secrets of confidence” of seasoned professionals, whether that’s a helpful book, a favorite outfit, the support of family, or a deeper spiritual walk. Learn how an Avera dermatologist serves up healthy, creative meals out of love for her family, and a desire to feel her best. Discover how you can get better sleep at any age – but especially at midlife, when many factors can keep us from catching our ZZZs. Get five top tips for lowering your cholesterol through diet. Other stories cover questions to ask your doctor at your annual visit and how to avoid orthopedic injuries related to running, biking or other fitness activities. Plus, don’t miss the very thing that busy moms want to know – how to help kids calm down when they’re bouncing off the walls! Please enjoy this special edition of Balance magazine, compliments of Avera. I invite you to learn more at Avera.org. Thanks for reading! Best wishes,

© Copyright 2017 Contents of Balance are protected by U.S. copyright laws. All rights reserved. Reproduction or transmittal by any means, including photocopying, is prohibited without written permission of Avera Health.

Kendra Calhoun Senior Vice President for Marketing, Avera Health

Patient stories in this magazine describe the actual medical results of individual patients. These results may not be typical or expected for the disease type that is described, and all patients should not expect to experience similar results.

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Contents AV ERABALANCE.O RG / SPRING 2017

7 CALENDAR OF EVENTS 8 WIDE AWAKE AT MIDLIFE 10 ROUTINE EXAMS Important for Your Health Today and Tomorrow 13

COOL APPS For Health and Fitness

14 CERTIFIED NURSING ASSISTANTS

Health Care’s Open Hearts

16 SECRETS OF CONFIDENCE

28 CREATING A HEALTHY LIFESTYLE

32 HOW WOMEN CAN PREVENT COMMON SPORTS INJURIES

22 CREATE A NEW HABIT OF ENJOYING REAL FOOD

24 ACCIDENTS HAPPEN: KNOW YOUR OPTIONS

26 WHEN IT’S TIME TO

34 CULINARY CREATIVITY FROM THE HEART

39 THE AMAZING POWER OF GRATITUDE

WIND DOWN

On the Cover Amy Bates is a triathlete, mom and wellness specialist who is

One Step at a Time

42 A NEW DAY FOR CANCER CARE IN PIERRE

46 FINDING RELIEF

Women with Heavy Breasts

making nutrition and wellness a priority to live her best life.

48 BE FIRM WITH YOUR FLIP-FLOPS A Careful Balance Between Foot Health and Fashion

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50 FIVE TOP DIET TIPS

For Lowering Cholesterol

52 DO YOU NEED TO BE GLUTEN FREE?

CALEN DAR

PARENT AND CHILDBIRTH EVENTS Prepared Childbirth HypnoBirthing Class Saturday, June 10, 9 a.m., Prairie Center 1000 E. 23rd St., Sioux Falls

Expectant Parent/Childbirth Prep Class (Series of 3) Tuesdays, July 11, 18, 25; 7 p.m., Avera Queen of Peace Community Room, Mitchell Breastfeeding Class Wednesdays, May 17, June 7, 21, July 5, 19; 6 p.m. the BirthPlace Conference Room, 305 South State St., Aberdeen Maybe a Baby Tuesday, June 20. Visit Avera.org/MaybeABaby to see what locations are participating

OF EVENTS

CANCER SERVICES

HEALTH SEMINARS

Saturday Mammo Hours June 3, June 24, July 15, July 29, 8:1511:30 a.m., Prairie Center, 1000 E. 23rd St., Sioux Falls

Mindfulness and Meditation for Stress Reduction Tuesdays, May 16, 23, 30; June 6, 13, 20, 27; July 4, 11, 18, 25; 1–2 p.m., Prairie Center Movement Studio, 1000 E. 23rd St., Sioux Falls. For more info, contact Lynne Hunter at 605-322-3005.

Cancer Support Group, Aberdeen Thursdays, June 8 and July 13, 1 p.m., Avera Cancer Institute, 310 S. Penn St., Suite 105, Aberdeen. Contact Jeny Barnes at 605-622-2819

Ideal Living Introduction Seminar Wednesdays, May 17, 24, 31; June 7, 14, 21, 28; July 5, 12, 19, 26, 12:45 p.m., Prairie Center Presentation Room, 1000 E. 23rd St., Sioux Falls

Cancer Support Group, Mitchell Tuesdays, May 30, June 27, July 25, 2 p.m, Avera Queen of Peace Conference Room, 525 N Foster St. Please contact Anna Mesman 605-995-2205 to register.

Free Health Seminar: Surgical Solution for Weight Loss Wednesday, June 21, 1 p.m.; Thursday, July 13, 6 p.m., Prairie Center Presentation Room, Sioux Falls Ai Chi Fitness for the Mind and Body Tuesdays and Thursdays, 5:30 p.m., Avera St. Luke’s Therapy Center, 805 1st Ave. SE, Aberdeen, $33/per month. Contact Vicki Holley at 605-622-5979 Free Monthly Blood Pressure Clinic, Mitchell Wednesdays, May 17, June 21, July 19 • 8:30-9:15 a.m., Meadowlawn Plaza, 200 E. 15th St. • 9:15-10 a.m., Greenridge, 1200 N. Kimball St. • 10-11 a.m., Countryside Living East Wing, 2100 N. Wisconsin St. • 11 a.m.-noon, Countryside Living West Wing, 2100 N. Wisconsin St. • 1-2:30 p.m., James Valley Community Center, 300 W. First Ave. • 2:30-4 p.m., Cathedral Square I & II, 501 N. Davison St. Thursdays, June 1, July 6 • 1-3 p.m., Avera Queen of Peace Hospital Lobby, 525 N. Foster St., Mitchell

ARTS ESCAPE CLASSES Events held at the Prairie Center, 1000 E. 23rd St., Sioux Falls

Prayer Bottles Monday, May 15, 6-7 p.m., Prairie Center Atrium. Arts Escape classes are offered to anyone touched by cancer. Call Carol Rogers at 605-322-3000 to register. Cherry Blossoms Painting Thursday, May 25, 6-8 p.m., Presentation Room. Call Carol Rogers at 605-322-3000 to register.

To learn more and register for events, visit Avera.org/events or call 1-877-AT-AVERA (1-877-282-8372). SPRING 2017 / AV E R A B A L A N C E . O RG

Wide Awake at Midlife By Donna Farris, Avera Health

What keeps us awake? The list is long. Stress. Anxiety. Flickering screens. Demanding workdays that overflow into the nighttime hours. Worries about teenage kids or elderly parents. Noise. Hormones.

Insomnia might rear its ugly head as the inability to fall asleep, stay asleep or fall back to sleep if you wake during the night. Margaret Loewen, CNP

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Jessica Morrell, CNP

Patricia Peters, MD

“We see it cross the age span,” said Margaret Loewen, CNP with Avera Medical Group Functional Medicine. Numerous factors can make those precious ZZZs even more elusive at midlife. “Hormone imbalance at perimenopause and menopause can lead to sleep disturbances,” said Jessica Morrell, CNP with Avera Medical Group Functional Medicine. Rather than being the underlying cause of sleeplessness, it might be the one factor that makes everything else too much to handle. In addition, hormonal hot flashes might disturb sleep. Loewen and Morrell, along with Patricia Peters, MD, at Avera Medical Group Functional Medicine are Certified Functional Medicine Providers (IFMCP). A racing mind will not let you sleep. “Think of your brain as a computer and you have all these windows open… you’re sending emails, making lunches and folding laundry up until bedtime, and you’re not doing anything to close those windows,” Loewen said. Your body’s metabolism can also cause difficulty sleeping. Eating a lot of carbs late in the evening or drinking alcohol can cause a glucose drop that stimulates your body to wake up. Another sleep disorder experienced by both men and women is sleep apnea, in which breathing stops momentarily due to airway blockages, and you unknowingly wake yourself up to breathe. Snoring and gasping is a sign of this disorder which causes your oxygen levels to drop. “You’re not getting that good REM sleep that your body needs,” Morrell said. Those who might have sleep apnea are referred for a sleep study, and often the treatment is use of a CPAP.

Sometimes, the reasons for lost sleep isn’t all in your head — it’s all in your bladder — when you have to get up to “go” multiple times during the night. “This happens more as we get older for several reasons. Women who have had babies can experience greater weakness in their pelvic floor,” Peters said. Or, if you have varicose veins and fluid collects around your ankles, this fluid can move up toward your kidneys when you lie down. Many women cope by not drinking any water after supper. “But then you dehydrate yourself, and by morning you are well behind on fluids,” Peters said. Instead, she advises women to do Kegel exercises to strengthen the pelvic floor, and also try to retrain the bladder by waiting as long as you can to urinate. When you do urinate, empty your bladder completely. There are also medications that can help. If the problem is still not resolved, women can be referred to Avera Medical Group Urogynecology for specialty care. If sleep problems persist, see your doctor. While a prescription sleeping pill is a last resort, sometimes it’s needed to get you back on track. Bioidentical hormone replacement therapy can help ease hormone imbalance or hot flashes. “We do hormone testing to give you the least amount of what you need for the shortest possible time,” Morrell said. n

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TIPS TO FOLLOW ALL DAY FOR A BETTER NIGHT’S REST: Get regular exercise to burn off excess energy plus stimulate serotonin release. Expose yourself to natural daylight to regulate your sleep/wake cycle. Eat a healthy, balanced diet that emphasizes fruits and vegetables, protein and complex carbohydrates. Avoid foods that are high in carbs and sugar at night as well as caffeine. Find ways to quiet your mind before bed, for example, meditation or light reading. Avoid screen time in the evening because the blue flickering light of computer, tablet and phone screens cues your body to stay awake. Turn down the thermostat – the best sleeping temperature is 68 degrees. Go to bed and get up at the same time every day. Sleeping in on Saturdays or taking long naps won’t help your cause. Don’t depend on alcohol to put you to sleep. While it initially makes you feel sleepy, it can cause you to wake during the night. Supplements might help you, for example, chamomile tea, l-theanine or melatonin (no more than 3 mg). SPRING 2017 / AV E R A B A L A N C E . O RG

ROUTINE EXAMS: Important for Your Health Today and Tomorrow By Alyssa Kuecker, Avera Health

ou exercise, eat right (most of the time) and try to keep your stress levels under control — you’re doing great, right? Certainly your doctor would agree, so what’s the point of keeping your annual appointment this year? Not so fast.

Visiting your doctor means more than just going in when you have the sniffles, aches or breaks. It’s a relationship, a team-based approach for managing your health all life long, even when we feel our best.

And sometimes that’s the perfect time to meet with your primary care doctor. “In the last 15 years, there has been a large shift in medicine; we are taking a proactive Niel Burns, MD approach rather than a reactive approach,” said Niel Burns, MD, family medicine doctor with Avera Medical Group Pierre. “It’s easier to address an issue early, such as high blood pressure or high cholesterol,

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before the theoretic wheels come off, like a heart attack or stroke.” This appointment is mostly a conversation with your doctor about where you stand in your health journey. Think about the last year — did you experience any weird aches or pains? Learn anything about your parents’ or siblings’ health that could affect you? Deal with increased stress?

Janell Powell, MD

“We make sure you are up to date with general health maintenance screenings: Pap tests, DEXA scans, mammograms, colonoscopies, etc.,” said Janell Powell, MD,

said Powell. “Scribble down a few questions as well. We all have good intentions to ask questions at these appointments, but writing them down ensures they don’t slip your mind,” she added.

Questions Your Doctor Wants to Hear

“Ask anything and everything at all,” encouraged Burns. “When it comes to very personal parts of the body, doctors have seen and heard it all. You don’t ever have to feel ashamed or embarrassed.” This extends into what you’re putting into your body, too. Don’t be afraid to mention that diet pill or protein powder you found online or saw on TV.

Make the most of your annual wellness appointment by asking important questions about your health. Here are a few to help you get started.

Make the most of your appointment with a little preparation. “Take a few notecards and write down all medications and supplements you are taking, along with the dosage,”

Stress affects you physically and mentally, and can lead to weight gain, heart problems, depression and poor relationships. Because stress has a major effect on your health, it’s always a relevant topic to bring up at an annual wellness exam.

Q: “What’s the best way to reach a healthy weight?”

Find a primary care provider at Avera.org/doctors

with Avera Medical Group Internal Medicine Women’s. “We check your blood pressure and discuss necessary labs based on age and medical problems.”

Q: “How can I manage stress better?”

If you have something specific you need to talk about, or a screening you would like done, mention it to the receptionist as you’re making the appointment. Sometimes we think of questions a week after our appointment. Burns and Powell recommend messaging your doctor directly using the AveraChart patient portal. “Your doctor should be your health advocate and easily available for education and follow-up questions,” said Burns. “It’s a relationship worth developing and nurturing all life long.” n

While it’s tempting to turn to quick fixes and fad diets, your doctor can help you find the best diet and exercise program to fit your lifestyle. Not only will you feel more in control of your weight, but exercise is a great way to relieve stress.

Q: “What screenings should I have?” Your doctor should have all of your past screenings in your medical record. He or she can inform you as to what screenings are currently needed and when they should be fulfilled.

Q: “Why am I taking these medications?” Not knowing how to pronounce your medications is one thing, not knowing what they do is another! Before leaving your doctor or pharmacist, make sure you are completely aware of your medications’ purposes.

YOUR LIFE IS AN ADVENTURE.

BE HEALTHY FOR IT. Women are complicated creatures, but one thing remains certain no matter your age — regular checkups can help keep your health in check. Avera Medical Group provides comprehensive health services no matter what life adventure you’re undertaking. •

Women’s well checks and screenings •

Midlife care and hormonal changes

•

Management of chronic conditions

We offer these services through a variety of specialists. Find an OB-GYN, family medicine or internal medicine doctor at Avera.org/doctors

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Cool Apps We understand that illnesses don’t just happen between 8 and 5. The AveraNow app gives patients 24/7 access to video visits with providers for conditions such as colds, flu, sinus infections and pink-eye. App Store

Google play

Learn more at Avera.org/now or search “AveraNow” to download this free app.

FOR HEALTH AND FITNESS

As citizens of the smartphone age, we stay connected 24/7. Information is powerful, and with

Below are a few you might find helpful: MyFitnessPal: This free iPhone and Android app gives you a wide range of diet and exercise tracking features, provides recipes and can help you connect to wearable fitness trackers.

a little coaching from your physician, these tools can get you closer to your health and fitness goals.

Medisafe: This free app reminds you daily to take medications and confirm it was taken. It also reminds you to refill prescriptions and offers a feature that can help couples manage their meds.

Apple Health and Google Fit: These apps that track heart rate, calories burned, blood sugar, cholesterol, blood type, sleep and more are included with Apple and Android devices, respectively.

Shopwell Healthy Diet & Grocery Food: Ditch the paper list – this free app lets you keep all your shopping needs on your phone and match foods with recipes, while providing nutrition information.

INGREDIENTS ¾ cup extra virgin olive oil ¼ cup apple cider vinegar 1 teaspoon minced garlic OR ¼ teaspoon garlic powder 1½ teaspoon salt ¼ teaspoon pepper

Use this salad dressing to add a little to your salads.

zing

Apple Cider Vinaigrette 17-AVHE-5116

INSTRUCTIONS Combine all ingredients into a salad dressing shaker, mason jar or other container. Close with a tight-fitting lid and shake to combine. Drizzle on salads or use for cooking.

AveraBalance.org

CNAs: Health Care’s Open Hearts By Alyssa Kuecker, Avera Health

Like most high school graduates, Chelsea Dombrovski found deciding what she wanted to do for the rest of her life a daunting decision. However, she knew whatever path she chose, she wanted to do more than help people; she wanted to make a difference in the lives of others.

closely with our residents; I thought this was a good chance to get to know them even better.” Her CNA training didn’t occur in the classroom, but rather on the job, side by side with other health care professionals. She earned certification after experiencing the necessary rotations and completing a designated number of hours.

“It’s a quality I’ve always had — the ability to put myself in others’ shoes and do what I feel is right because of it.” Fast forward 13 years and you’ll find Dombrovski enjoying her career as a certified nursing assistant at Avera Morningside Heights Care Center in Marshall, Minn. CNAs take on a variety of tasks, being the attentive and helpful hands that keep health care settings running smoothly. “We are constantly present and engaged with residents’ care,” Dombrovski explained. “We wake and help dress our residents, bring them to meals and serve them, give medications, and make sure they attend daily and fun activities.” Dombrovski, who moved up to a managerial role after completing additional education through North Central Kansas Technical College’s online classes, now oversees the day-to-day activities of CNAs. She admires her coworkers’ ability to adapt to situations, a crucial skill needed in a CNA’s toolkit.

“CNAs practice with an open mind and open heart. Caring for people is such incredible, meaningful work.” – CHELSEA DOMBROVSKI

On the surface, they remain calm and collected, but underneath, they are anticipating the needs of not only the residents, but visiting family members as well. Dombrovski’s journey to become a CNA began with working as a dietary aide at a local long-term care facility. Rumblings began of implementing a “neighborhood concept” to crosstrain employees to fill various roles, as needed. “I was eager to try this new model,” said Dombrovski. “I already worked

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Her hard work continues today. “It is a physically and emotionally demanding job, but so rewarding. It brings me joy when I can bring joy to others. The laughter and jokes I’ve experienced — I could write a book! The people you care for really do become a part of your family.” CNAs are integral to health care, whether in long-term care facilities, memory clinics or inpatient hospital units. This job can even serve as a stepping stone toward other health care careers. n

Interested in joining Avera? Visit AveraJobs.org

MaybE BABY Becoming a parent is a challenging, rewarding, life-changing commitment. During this free event, talk one-on-one with physicians, providers and other educators as they cover topics including: • Pregnancy planning

• Financial planning

• Healthy living and fitness

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Find an event location near you at Avera.org/MaybeABaby

The Secrets of

CONFIDENCE By Kelly Thurman, Avera Health

How has your confidence changed over the years? I’ve had different life experiences that have driven me to have a closer examination of myself, how I tick, what I’m good at and what I’m not good at, and how to not feel bad about it. I think it starts with self-awareness. I have a book called “Soar With Your Strengths.” It focuses on changing the paradigm on our weaknesses and accepting that we’re not going to be perfect at everything and be confident to say, “That’s not my area of strength.”

How do spirituality or wellness play a role?

Mary Maertens Regional President and CEO, Avera Marshall Regional Medical Center Marshall, Minn.

ary Maertens began her career in the health care industry as a nursing assistant for Avera at age 16 and is now Regional President and CEO of Avera Marshall Regional Medical Center in Minnesota.

During my mature life I’ve continued to develop myself from a spiritual perspective. Part of that is learning to let go and have that degree of trust that life will work out if I just stand back to let it work itself out. The last few years in particular I’ve rededicated myself to wellness, nutrition and exercise. I’ve started yoga and golf. One of my personal goals has been to focus on the people and things in front of me and not be so distracted. Yoga and golf require your entire mind to be present.

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How do you balance it all? Sheryl Sandberg’s book “Lean In” is a great reference for both men and women. One thing I appreciate is the title — you lean into your work, sit up to the table and offer your opinion. Don’t complain about being heard if you’re not going to speak. You need to own it and be proud of it, and be willing to accept feedback. Speaking to finding balance, I’m very grateful to have the husband I do to help me raise my girls. He can make them supper better than I can. It’s OK to lean into that and not think I have to do everything.

Do you have a go-to item that gives you strength? I always say, “Keep the faith.” I have a sign on my office wall that says, “Let your faith be bigger than your fears.” n

THOUGHTS FROM SEASONED PROFESSIONALS

Whether you’re fresh out of college or an experienced leader, confidence in your daily decisions is key to success. We talked to providers and leaders throughout the Avera system about how self-confidence has shaped their careers and what they’ve learned along the way.

Dena Jundt, MD Family Medicine/OB specialist at Avera Medical Group O’Neill O’Neill, Neb.

ena Jundt grew up about two hours south of O’Neill and returned to work at Avera Medical Group O’Neill with her husband who is also a physician. The pair, who are expecting their second child in June, work together to balance their busy work and family lives.

What does being confident mean to you? If you feel good, you can go to work with more confidence. I try to exercise and stay in shape and eat a healthy diet so I feel good about myself, and that helps me make confident decisions in my practice every day. Spirituality plays a role as well, and we are blessed to work in a facility that encourages spirituality.

How has your confidence changed over the years? My confidence changes with each new role I take on. I became a confident student, then a confident resident, and now a confident

attending physician. Each new role requires me to find a new comfort zone. I find confidence by learning from and relying on my partners, coworkers and through my faith.

Do you have any role models that have helped you be a better leader? I have a role model who once told me to request that people call me Dr. Jundt and not by my first name, and that ended up being great advice, because to be treated like a physician you have to play the part. She also is a great example of a successful physician and mother.

How do you find balance? When we had our first son our priorities changed at home. Instead of being totally dedicated to work we had to find a work-home balance. My husband is a physician and having that support system has made it a lot easier, because he understands my job. We help each other out to keep that work-life balance.

Do you have any go-to items or outfits that give you a confidence boost? I like to dress professionally for my job, I know if I do this and fix my hair I will display a more confident demeanor. n SPRING 2017 / AV E R A B A L A N C E . O RG

I try to exercise every day at lunch. I try to use the 80/20 rule. Eighty percent of the time I try to exercise and eat well and that leaves 20 percent for indulgences.

How does balance play a role?

What does confidence mean to you? It’s just being sure of who you are and knowing your strengths and weaknesses. I don’t feel like it is always having the right answer and knowing what to do in every situation. You can really tackle any new situation with confidence if you know your strengths and limitations. As an ophthalmologist and a physician in general I have to be confident in the decisions I make and the treatment plans I set out for my patients. I think experience breeds confidence. When I don’t have the answer I also have a strong support network of colleagues whom I reach out to for support.

Jessica Claussen, MD Ophthalmologist with Avera Medical Group Ophthalmology Mitchell Mitchell, S.D.

essica Claussen has been at Avera Medical Group Ophthalmology Mitchell for more than three years building her practice. She finds confidence comes with experience and the realization that it’s OK not to be good at everything.

Do spirituality or wellness play a role in self-confidence? I believe in the power of prayer. I say a prayer for my patients and myself before each day. I pray to have the knowledge and intuition to deal with the unexpected.

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If your personal relationships are out of whack it has a big impact on mind clarity. If particular situations outside of work are making me anxious or upset it definitely spills over into work life. Finding the perfect balance might be the holy grail of the working mother and wife!

Do you have any role models you look to? My mom has always been a role model for me. She has always promoted independence and that I have the ability to do what I set my mind to.

As a parent, how do you try to instill confidence in your children? I have two kids, 5 and 2 years old, and another one coming. I want them to know they can do anything they put their mind to. As a parent I will support them in any way that I can. n

What gives you confidence? My kids. They have all become amazing young adults. I know I must be doing something right when I look at them.

Do you have any mentors when it comes to leadership? A role model of mine would be Ayn Rand. She was a visionary novelist and philosopher in the 1950s. Her book, “Atlas Shrugged,” is one of the most influential pieces of literature I have ever read. She predicted what would become of our society and economics in the future based on our principles of government. Most of her predictions have come to fruition. Many of her ideas are very relevant today and I use them in many aspects of how I live my life.

How does balance play a part?

Tage Born, MD OB-GYN with Avera Medical Group Obstetrics & Gynecology Aberdeen Aberdeen, S.D.

age Born has been in practice for more than 20 years. She’s found that experience is key to self-assurance.

How has your self-confidence changed over the years?

Finding balance is crucial. If you cannot keep work and personal life in proper perspective, you will not find happiness and fulfillment. Stay true to your goals. In my personal life, photography gives me balance as a creative outlet completely unrelated to my work. I’ve been doing photography off and on since I was a teenager — when all camera settings were manual with no options for automatic modes. I’ve recently become more interested now that my children are in college and I have more time on my hands. I am trying to improve — I take pictures of anything. I drive my family crazy. n

Self-confidence comes with experience. After 23 years in practice, while I would never be so naïve as to say, “I’ve seen it all,” I have seen a lot. With that comes knowledge and the ability to handle new circumstances, hopefully with ease, grace and self-assurance.

Is wellness important to you? How does it affect your confidence? If you feel comfortable in your own skin, how you feel about yourself becomes irrelevant. To me, good health is imperative to be able to put my best foot forward every day to try and make my family’s lives and patients’ lives better. SPRING 2017 / AV E R A B A L A N C E . O RG

How has your confidence changed over the years? I’ve been in leadership roles for 40 years and I have the skills to really do that thanks to the educational opportunities and experiences I’ve been provided. I’m a good communicator and I listen well. I have done a lot of searching and reflection about who I am and what I’ve been called to do and that helps me focus. Daily prayer helps me focus and stay balanced.

How does being a Sister play into your self-assurance as a leader? A big responsibility as a System Member is to make sure our mission is at the forefront of all that Avera does. If the board doesn’t talk about mission, then we ask the question for them. The support and encouragement of the Sisters has been a gift in my self-assurance as a leader.

How has spirituality guided your confidence? I’m an introvert so I like to have quiet time to myself to reflect, and wellness is a part of that. I often take walks and have time to myself; it’s really a stress reliever for me. I like to be outside and in nature. My prayer is to be quiet and listen to where the Lord is taking me. It helps me focus on who I am and what I’m called to do, and it gives me passion for what I’m doing. I need to believe in what I’m doing and confidence follows.

Sr. Lucille Welbig System Member for Avera Health, Vice President of the Presentation Sisters Sioux Falls, S.D.

r. Lucille Welbig is a System Member for Avera Health, which acts as a link between Avera and the system’s sponsors —the Benedictine and Presentation Sisters. She sits on multiple boards including those of Avera Sacred Heart Hospital in Yankton and Avera McKennan Hospital & University Health Center in Sioux Falls.

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How does balance play a part in making tough decisions? For any big decision with Avera, we try to do the preparation and get the information and the education ahead of time. We have discussions one day, but we don’t make the decision until the next day. This gives us time to reflect in the evening and pray. n

David Starks, MD Gynecologic Oncologist with Avera Medical Group Gynecologic Oncology Sioux Falls, S.D.

Katherine Wang, MD Neonatologist with Avera Medical Group Neonatology Sioux Falls Sioux Falls, S.D.

avid Starks and Katherine Wang met where pretty much all doctors meet — medical school. The couple has been married for more than 10 years and say that focusing on family is a great way to recharge and center their lives.

Why is self-assurance important in your day-to-day lives and careers?

people think. I always want to make a good impression, but I don’t get fixated on that.

Starks: Particularly in our specialties, things can change quickly and you don’t have time to second guess or poll a crowd. You have to have that confidence to fall back on your experience and intervene.

Do you have anything that really gives you a boost or helps you in a tough situation?

Wang: Once you’ve walked through a situation when you’re between a rock and a hard place, you get a couple tools for the next time. For myself, there is a lot of self-reflection afterwards: what could I have done differently? Those are the things that can keep the mind going to the next situation.

Starks: We both bolster each other. It’s very nice having someone at home who is in the medical field. Sometimes bouncing ideas off each other actually is very helpful and comforting.

Also, confidence comes when you stop worrying about what other

Wang: I have my dresses. I really enjoy dressing up when I’m not on call because it puts me into work mode and helps me to focus: I am the doctor, if there is a tough situation, you call me because I’m the one who has to make the decision. It’s kind of like putting on a uniform.

So you help balance each other out? Starks: After 10 years I think we have decent teamwork with two kids and two jobs. I’m terrible at organization so I’m lucky I married someone who loves lists. It seems to work out with our strengths and weaknesses. Wang: You spend all this time building confidence as a physician so you can be the person in the know. The second half of that is learning to have the grace to say maybe it is someone else who has the best idea how to solve this problem today. It doesn’t always come from the top down. n

Wang: Touching base with our families is huge. All our vacations are focused on seeing family. That’s how I recharge and re-energize.

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Enjoying Create a New Habit of

REAL FOOD By Katie Daniel, Avera Health

AVERABAL ANCE. O RG / SPRING 2017

She offers practical tips, such as:

The journey of making diet and lifestyle changes is challenging, but also rewarding. When you focus on real, wholesome foods, you’ll discover a new way of eating that not only fuels, satisfies and even heals your body – you’ll also lose weight.

Eat at least three times per day.

“When you focus on improving overall health through eating nutritious foods, weight loss is a natural result,” says Lauren Cornay, RD, LN, a community and clinical dietitian at Avera Heart Hospital.

Get plenty of fiber through vegetables, fruits and whole grains.

And it all starts with your mindset, according to Cornay. “It’s very easy to not realize how much we’re eating and what kinds of food we’re eating. A good starting point is becoming more mindful.”

Limit daily alcohol intake to no more than one drink for women and two drinks for men.

Pay attention to your body. When you feel like you have had enough to eat, stop before you feel full. If you still feel hungry or unsatisfied, wait at least 10 minutes before eating more. The craving will often go away. Drink plenty of calorie-free fluids such as water, unsweetened tea and coffee.

Cut back on simple sugar by limiting fruit juice, regular soda, desserts and white/refined grain products.

If you have more than four to five hours between your meals, add a planned snack to curb overeating at meal times. An ideal snack includes a protein and a carbohydrate to improve its “staying” power.

For healthy recipes visit AveraBalance.org

Healthy eating isn’t designed to be a quick weight-loss solution. Instead, it’s about creating healthier habits. You may not see results as quickly or dramatically as you might with other weight-loss programs. However, you’ll be equipped to achieve and maintain your weight-loss goals and, more importantly, your health in the long term. n

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ACCIDENTS HAPPEN:

KNOW YOUR

OPTIONS Injury and illness can happen anytime, so we provide many options to fit your life.

YOUR OPTIONS $

Physician’s Office

$49 Our virtual visit program connects you to a provider 24/7 for simple illnesses via laptop, tablet or smartphone. Patients must be 2 years old.

• Colds • Urinary tract infections (Must be 16 years of age or older.) • Flu • Fever • Vomiting • Diarrhea

per visit

App Store

Google play

Download the app at Avera.org/now • Sinus infections • Seasonal allergies • Rashes • Pink eye • Headache • Acid reflux • Cold sores

Our providers can handle sickness, injury and preventive services during normal business hours. Your provider knows you best, so this is the best option if possible. Find a physician at Avera.org/doctors

If you’re struggling with whether an emergency department visit is the best choice, ask yourself this:

Can it wait until tomorrow?

$$$$

Avera Urgent Care Our Urgent Care clinics are designed to treat acute illnesses evenings and weekends. This is a great option for issues that are not serious enough to merit an emergency department visit but can’t wait until the next day. Find an urgent care location near you at Avera.org/urgentcare

• Minor cuts, burns, skin irritations • Suspected fractures of the arms or legs • Sprains or strains • Mild to moderate asthma attacks • Upper respiratory illness such as cold or flu symptoms • Ear infections • Fever • Symptoms of illness such as sore throat, vomiting, diarrhea, etc. • Urinary tract infection

Emergency Department

This service should be saved for the most serious and life-threatening medical conditions. Our emergency department has all the capabilities to treat the most serious injuries 24/7.

• Chest pain (call 911) • Shortness of breath • Severe burns • High fever • Severe vomiting • Poison ingestion • Unconsciousness • Major head injury • Broken bones

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$$$

When itâ&#x20AC;&#x2122;s

Time to

WIND DOWN By Donna Farris, Avera Health

AVERABAL ANCE. O RG / SPRING 2017

Virtually every parent and teacher understands what it means when their kids are “bouncing off the walls.” The rough-housing, screeches of laughter, silliness and fidgeting can drive you to the brink. It’s all part of being a kid, but what about those times when you need to get kids to settle down to eat, learn, do homework, sit in church or go to bed? “It’s natural for all kids to get wound up — most definitely when you’re talking about boys from age 6 to 10,” said Jesse Barondeau, MD, Avera Medical Group Pediatrician in Mitchell, S.D. How can you know if your child is displaying normal childhood Jesse Barondeau, MD behavior, or if their hyperactivity could signal a problem like ADHD? “One way to tell is to compare them to their peers. For example, when you look at a tee-ball team or scout pack, you might notice that one or two are more difficult to handle than the others. Teachers might call out the behavior, and you can also talk to your doctor about your concerns,” Barondeau said.

A little planning can go a long way, and these tips from Barondeau and healthcentral.com might help:

Stay calm yourself – If you get upset, frustrated or angry, children might react by raising their level of emotion and activity as well. Take a few deep breaths or take a short break. Staying calm and reacting with a neutral voice will help your child remain calm.

Teach relaxation techniques – If adults can benefit from these, so can children. Deep breathing exercises, yoga, tai chi or meditation can help a child learn to slow down their thoughts and their bodies.

Some of the basics of life, like food and sleep, make a difference. Is your child eating a lot of sugar and fried foods? Or getting caffeine from soda or energy drinks? Help your child include more fruits and vegetables, lean protein and complex carbohydrates, like whole grains and cereals, and you might see a little less hyper behavior. You might think that inadequate sleep will make children drowsy and lethargic, but it can also make them hyper. Help your child get a better night’s sleep by limiting use of electronics in the evening, not allowing a TV in the bedroom, and setting a consistent bedtime so that the child can get the recommended eight to 11 hours of sleep. Healthy, active children need opportunities to let off steam, Barondeau said. So go to the park as a family and play, or find a good place for indoor active play during the colder months. When parents participate and play along, you’ll get more exercise and might sleep better at night yourself, he added. To find a pediatrician or family medicine provider visit Avera.org/doctors. n

Serve a good breakfast – Start your child off with foods that are high in protein and whole grains, and low in sugar. Hunger and blood sugar peaks and valleys can make a An egg and child more hyperactive.

toast is a better

Create a choice than a boredom box – toaster pastry. Kids might get more hyper when they are bored. Assemble a box of activities such as dress-up clothes, read-aloud books, art supplies, building blocks, models, or whatever activity tends to hold your child’s interest. Use music – Soothing music, such as classical music, can help some children calm down. Experiment with different types of music to find out what works. Play soft music in the background for times like homework time, dinner time or before bedtime. SPRING 2017 / AV E R A B A L A N C E . O RG

CREATING A HEALTHY LIFESTYLE – One Step at a Time By Katie Daniel, Avera Health

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Mom, triathlete and wellness specialist Amy Bates discovered the healthy lifestyle she loves, one step at a time. “When my husband Chris decided to train for his first triathlon, I thought he was crazy,” laughs Amy Bates, a 40-year-old from Colman, S.D. Little did she know that the competitive combination of swimming, biking and running was about to become her new passion, too. “I’ve always been a runner, so my training strategy was to pretty much just put on a lot of miles,” she says. “Later, I realized how that plan put constant strain on my knees and IT (iliotibial) band on the outside of my knee.”

Her first endurance race was in 2010, when she crossed the finish line of the Sioux Falls Half Marathon with a new medal and a new, persistent pain in her knee. Although it was hard to slow down, Amy took time to heal while working with orthopedic physicians and physical therapists.

“It made me realize how much I need to take care of my body, so I can be active throughout my life.” – AMY BATES

First Step in a New Direction While Chris completed his first triathlon in 2008, Amy was inspired by the “amazing energy” surrounding the event. They soon joined the Avera Sports triathlon club together. Although Amy didn’t consider herself a swimmer, she knew it’d be a beneficial way to exercise while allowing her IT band to heal. “It was really great to mix up my routine.” Amy also had to adjust to waking up at 4:30 a.m. for group workout sessions. “I’ve always been more of a night person so it was tricky at first, but now I really love it,” she says. “The club was good camaraderie and motivation. We worked out together, but at our own pace.” With young children at home, Amy and Chris took turns going to the triathlon club workouts. But that didn’t mean a day off. They built a modest workout area in their garage with a treadmill, bike, weights and resistance bands. SPRING 2017 / AV E R A B A L A N C E . O RG

Learning from the Avera Sports experts and friends in the triathlon club helped Amy and Chris continue training on their own after moving to an acreage in Colman. To date, Amy has completed 23 triathlons, as well as a 70.3-mile half Ironman triathlon. And surprisingly, she’s grown to enjoy swimming. “With coaching and practice, swimming eventually came to me. It’s a really good workout and a timeless one too. I often see people in their 70s and older swimming and hope to be like them someday.”

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“Pushing myself a little further than I think I can go inspires me. Over the years, I’ve learned that we can do a lot more than we think we can. We just have to be willing to give it a try.” – AMY BATES

Stretch Yourself: “Stretching is a time that you can focus on yourself and your body while you breathe and relax.” - MICHELLE MCCORMICK

Fueling an Active Lifestyle Amy became curious about how food affected not only her performance, but her overall well-being. That’s when they decided to add more organic vegetables, meat and fruit to their diets while limiting the amount of processed foods. Many of their vegetables come from their own backyard garden. They also began making their own yogurt, bread, cheese, protein bars and bone broth, plus fermented foods like kombucha, kefir, sauerkraut and kimchi to support a healthy gut. “We’re not perfect though,” she admits. “There are days when we’re running around like crazy and we decide to pick up a pizza. But we always try to return to healthy eating as quickly as we can.” Healthy living developed into such a passion for Amy that her job at BCD Travel, a worldwide travel company

based in Atlanta, Ga., transitioned from a human resources generalist to a wellness specialist. Finding Inspiration So, how does this triathlete, mother of three and career woman manage to do it all? First of all, she doesn’t do it alone. “We’re a team and I couldn’t do it without him,” Amy says of her husband, Chris. “Take time to discover what works for you and what helps you live your best life,”she adds. And remember that relaxation is essential, too. “On Sundays, we just try to relax and be together. It’s a good day to sleep in, go to church, read, watch movies and recharge. And then we’re usually ready to go again Monday morning.” Amy also finds inspiration by testing her own limits — whether that means trying new, unique foods or activities like surfing and scuba diving. n

Is It Really That Important?

Yes!

“Stretching is an often overlooked aspect of overall health and strength,” says Michelle McCormick, PT, a physical therapist at Avera Therapy in Watertown, S.D. “Proper stretching can actually enhance your strength and cardio workouts because it gives you improved range of motion in your joints and muscles. It’ll not only allow you to move better, but will also help you reduce your risk of injury.” A little known fact is that stretching regularly can also be one component in reducing the risk of osteoporosis, a disease that causes weak, thinning bones which women are four times more likely to get than men. “Stretching, especially in a way that causes you to bear weight through your joints, can help you maintain bone density, flexibility and posture,” she says. n

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How Women Can Prevent Common Sports Injuries By Katie Daniel, Avera Health

Stress fractures are small, painful cracks in a bone that often occur when bones aren’t strong enough to endure the impact of repetitive exercise. Brandon Fites, MD, an orthopedic physician at Avera Orthopedic Surgery Specialists in Aberdeen, S.D., notices this is often the result of female athlete triad disorder, an energy-in, energy-out imbalance Brandon Fites, MD due to overtraining or possibly an eating disorder. “What we often see is that a woman’s weight gets so low that it affects her hormones which also regulate bone metabolism. Because of that her bones are weakened and more easily fractured. It’s important to note that some women don’t have an actual eating disorder — they simply have a low body weight,” he adds. So what’s the best way to prevent stress fractures? Fites recommends maintaining a healthy body weight and good nutrition, in addition to listening to your body so that you’re not overtraining.

Two common activity-related injuries for women include anterior cruciate ligament (ACL) tears and stress fractures. Although there’s no definitive answer about why they occur more often in women than in men, there are ways women can help prevent them.

When an ACL tears, it most often occurs during athletic activity, especially when there is a sudden twisting motion or change in direction. “Plyometric training is great for preventing injury and has been shown to reduce the rate of ACL tears,” he says. Plyometric training — also known as “jump training” — can easily be incorporated into your workout routine by doing a series of jumps such as jump squats, one-leg hops or box jumps.

Chris Krouse, DO

“Preventive medicine is the best medicine,” says Chris Krouse, DO, an orthopedic physician at Avera Medical Group Orthopedics and Sports Medicine in Mitchell, S.D. “Resistance training, including weight lifting, is very important for women. It strengthens muscles, tendons and ligaments, which helps stabilize joints. It’s also very good for bone health.”

Krouse adds that consistency and variety are key. Maintaining a regular exercise program that includes a variety of activities and intensity levels — including appropriate rest — can also reduce your risk of injury. Before starting any new exercise program, Krouse recommends getting an annual physical with your primary care provider to make sure your heart, lungs and other important body systems are working well. “Once you have clearance, work with a certified trainer or attend a workout class to get expert guidance. Progress slowly to develop a solid base and avoid injury. Stick with a consistent routine and don’t be afraid try some different things.” To learn more visit Avera.org/orthopedics. n

AVERABAL ANCE. O RG / SPRING 2017

Put a little heart into it. Your heart has a lot to beat for. Weâ&#x20AC;&#x2122;re here to help you make sure you can do everything you love, longer.

Exercise daily Eat at least five servings of veggies daily Take up an active hobby Find a fitness buddy Get recommended cholesterol and blood pressure checks Get a heart screening to learn more about your risks

Avera.org/heart

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Culinary Creativity FROM THE HEART “I think one thing that’s rooted in my mom’s cooking and mine is that it’s all about love, not just of food and of trying new things, but a love for sharing the meal with family and friends. That’s what fuels my passion.” – Jana Johnson, MD

By Jarett Bies, Avera Health

Growing up, Avera dermatologist Jana Johnson had a front-row seat to her mother’s culinary expertise, which she now shares as she unveils her own dinner designs with her family of six. “She has amazing skill,” Johnson said of her mother, Jean Beddow. “My father was a university president, so she’d often plan and cater events for 100 to 200 people, doing everything from the menus to the centerpieces. She fed our family well, too. We had a lot of traditional family-time dinners together every week. She’s still like that and sometimes comes over with a meal of five or six courses to share with us.”

She loves the shared nature of creativity with foods and recipes. As a physician, mom and wife, Johnson has tailored her approaches to cooking over the years, adopting approaches that lead to healthier meals. “We were in the low-fat camp, but we realized it wasn’t all it was cracked up to be. So now, we do avoid bad carbs and added sugars,” she said. “We aim to make our dishes ‘plant-centric’ and that helps. When you have kids, a lot changes, and I love to share healthy and tasty food with them.” From wheat berries to vegetarian to a global list of dishes, Johnson experiments widely.

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SWEET POTATO HASH

QUINOA SPINACH BAKE

2 large sweet potatoes 1 pound ground Italian turkey sausage, thawed Large onion Coconut oil Salt and pepper

1 cup quinoa, dry 2 eggs 1 cup milk 2 teaspoons minced garlic ½ cup Parmesan cheese ½ cup cheddar cheese 3-4 large handfuls of fresh spinach 1-2 teaspoons olive oil 1 cup cottage cheese Salt and pepper

Chop onion into small pieces. Grate sweet potato in food processor. In large fry pan, brown turkey sausage, add a little olive oil if necessary. Add in grated sweet potato and onion. Stir frequently on medium low until sweet potato and onion are completely soft, 20 minutes or so. Add in 2-3 tablespoons of coconut oil while cooking to avoid burning. Salt and pepper to taste.

balance

Preheat oven to 375 F. Cook quinoa according to package directions. Drain and set aside to cool. In a separate bowl, whisk two eggs and 1 cup of milk together. Add in cottage cheese, cheddar and Parmesan cheese, garlic, and salt and pepper to taste. In a large pan, heat 1 teaspoon olive oil over medium heat and add 1-2 large handfuls of spinach. Saute until just wilted, about 1-2 minutes. Remove from pan and add to cooled quinoa. Repeat with another 1-2 large handfuls of spinach. Combine egg and cheese mixture with the spinach and quinoa mixture and stir thoroughly. Transfer to a small square or rectangular glass pan, sprinkle with Parmesan and cheddar, and bake for 20-25 minutes.

AVERABAL ANCE. O RG / SPRING 2017

“Our holidays are all about the food, and we do enjoy some traditions, but we love trying to find healthier approaches,” she said. “We no longer use rice, we just use cauliflower rice. We found the same results with zucchini noodles. I think they’re both tastier.” “We’re the same as any other family — busy! I take time on Sunday mornings to plan the week out and shop.

ZUCCHINI MUSHROOM STIR FRY

1-2 yellow squash 1-2 zucchini 8-10 ounces mushrooms (any type) 1-2 teaspoons diced garlic, fresh or jarred 1 tablespoon grass-fed butter Chicken broth Fresh Parmesan cheese, grated Salt and pepper Dice squash and zucchini and slice mushrooms, set aside. In a large skillet or wok-style pan, melt butter and add veggies and garlic, stirring to cook them until just tender. When they are nearly finished, salt and pepper to taste. Sprinkle Parmesan cheese on top and turn off heat. Let sit in pan until cheese melts. Makes about three to four smaller portions or two meal-sized ones.

If I don’t plan, we’ll end up with pizza,” she said. “We do a lot of stir fries — they are easy, quick and you can pile on the veggies.”

Jana Johnson, MD

Plan, plan and plan some more, but also experiment. You can achieve good-tasting healthier food, said Johnson, who lives and practices dermatology in Sioux Falls. “I’m lucky as I have a husband

In order to “get healthy” with her cooking, Johnson said planning is critical.

who really helps — he does a lot of the grilling and helps me in the kitchen,” she said. “And I’m lucky that my family is open to new ideas I can share with them. I love to read and to go running, but those are fairly solitary passions. Cooking and feeding my family well means something to them. That’s why I love to do it.” n SPRING 2017 / AV E R A B A L A N C E . O RG

#adulting Your kid isnâ&#x20AC;&#x2122;t ready, but you sure are.

26th bi r thday window to enroll 60 days prior

60 days after

Turning 26 is one of the final steps into adulthood. It means your kid is no longer eligible to be on your health insurance plan. Turning 26 is a qualifying life event, which gives your son or daughter a small window to apply for a new plan.

Agents can help decide on the best plan for any budget and see if your kid will qualify for reduced monthly premium payments. Visit AveraHealthPlans.com to check out our plans and find a local agent.

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The Amazing Power of

GRATITUDE By Jarett Bies, Avera Health

Living thankfully — noticing support as you get it, stopping to reflect on things that helped you make it through the day — it’s a recipe for a better life.

Avera Medical Group Behavioral Health Psychologist Nancy Wise-Vander Lee, PhD, recommends the simple step of putting gratitude front-and-center in our lives. “It’s not only polite — it can change your life,” she said.

Nancy Wise-Vander Lee, PhD

Start by actually counting the things that you’re grateful for, Wise-Vander Lee said. “Living a grateful life requires a little work.

Researchers in several universities grouped individuals, and then asked them to keep journals. One group was coached to write only about things they appreciated — their blessings. That group reported a nearly 30 percent increase in happier feelings compared to other groups.” n

“It’s something we could all use — more happiness.”

Choose a time — first thing in the morning, just before bed, during your lunch — when you’re going to write three to 10 things down that make you grateful. Start simple — house with heat, great meal with family or a good coworker who helped you.

Set apart an initial gratefulness period of one week where you will do your best to avoid all complaints. Instead be thankful for what you have. Start today and think about it: one week from now, you’re going to be more grateful and happier.

– NANCY WISE-VANDER LEE, PHD

Wear a charm or bracelet as a reminder. When you look down and see it, it’ll help you remember to write in your gratitude journal. When people ask, tell them what you’re up to, and naturally, be grateful they noticed!

With the three steps and a week’s effort, most people can start to see the difference gratitude makes.

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Live Better. Live Balanced.

AVERABAL ANCE. O RG / SPRING 2017

balance

balance Health & Wellness Tips for Your Life

Our newly designed Balance blog gives you the latest health and wellness information at your fingertips any time you need it, day or night.

AveraBalance.org

The Adams share their journey, and why they’re glad their friends and neighbors can stay closer to home for cancer care.

Pictured, from left to right, are Conrad, Karl, Phillip, Jack, Paul, Katherine and Joan Adam.

A New Day for

CANCER CARE IN PIERRE By Donna Farris, Avera Health

If anyone understands the benefits of cancer care closer to home, it’s Karl and Joan Adam of Pierre, their son Conrad and their entire family. After Conrad’s cancer diagnosis in 2012, they traveled throughout an entire year to not only Sioux Falls, but also Mayo Clinic in Rochester, Minn., and MD Anderson Cancer Center in Houston, Texas. Since that date, medical oncology has been brought to Pierre through the practice of Sreekanth Donepudi, MD, and outreach visits. Soon, thanks to a generous donation from The Leona M. and Harry B. Helmsley Charitable Trust, the Avera Cancer Institute in Pierre will be home to enhanced cancer services, including radiation oncology. The diagnosis in August 2012 truly turned their lives upside down.

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AVERABAL ANCE. O RG / SPRING 2017

“Conrad was a junior in high school who excelled in basketball, playing year-round,” Karl said. When he began experiencing knee pain, as young athletes often do, he was prescribed ice, ibuprofen and rest. Yet the pain worsened. Diagnostic tests revealed that Conrad had a rare bone cancer known as osteosarcoma. A stage IV case, he had a primary tumor on his left knee and femur and a secondary tumor on his backbone. The Adams were amazed by their son’s response. “When they gave us this news, Conrad said it was so much better that it was him, rather than one of his siblings,” Karl said. Conrad’s cancer required an aggressive treatment plan that included amputation of his left leg above the knee, chemotherapy, and proton radiation to treat the tumor on his spine. This was specialized radiation for which Conrad was referred to MD Anderson. “We made a commitment to keep as much normalcy in our family as possible,” Karl said. “There was no script.” The couple traded off, traveling with Conrad, yet also spending as much time as possible with their other four children at home. “Conrad was given a very special grace from God, allowing him to face it head on with positivity and a sense of humor,” Joan said. They were also bolstered by the prayers and support of their family and community. Conrad missed his entire junior year of high school. However, because he was already ahead in high school credits and took a heavy class load during his senior year, Conrad was able to graduate with his class with highest honors. In June of 2013, the Adams heard the wonderful news that Conrad was in remission, and after 40 months, there’s still no sign of recurring cancer. “He is truly a miracle,” Joan said, and his case has been presented at national and international conferences. Today, Conrad is a junior at the University of South Dakota, studying finance and accounting. He is an ambassador for the Beacom School of Business, the student representative on the South Dakota Board of Regents, and involved in many campus organizations, all the while maintaining a 4.0 grade point average. “He’s doing great and is embracing every opportunity he has,” Joan said.

Bringing Cancer Care to Central South Dakota Be a part of something big. The Leona M. and Harry B. Helmsley Charitable Trust is offering a dollar-for-dollar matching challenge up to $2.5 million to build The Helmsley Center, home of Avera Cancer Institute in Pierre.

Learn about the Helmsley Center project at 605-224-3451 or AveraStMarysFoundation.org

The Adams are aware that Conrad’s case of pediatric cancer was rare enough that they would have needed to travel for care in any event. Yet most people with most cases of cancer will be able to benefit from enhanced cancer services at The Helmsley Center in Pierre. “The Helmsley Cancer Center will have the most significant impact on health care in central South Dakota that we’ll ever experience during our lifetime,” Karl said. n SPRING 2017 / AV E R A B A L A N C E . O RG

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My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor and some style. â&#x20AC;&#x201C; Maya Angelou

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Be your healthiest self so you can do more than survive, but live life with love, humor and joy. Those are the moments your children will remember.

Happy Motherâ&#x20AC;&#x2122;s Day from Avera.

Find your inspiration at AveraBalance.org

UNDERSTANDING THE BENEFITS OF BREAST REDUCTION SURGERY By Jarett Bies, Avera Health

finding

RELIEF

WOMEN WITH HEAVY BREASTS OFTEN BELIEVE THEY JUST HAVE TO LIVE WITH IT.

AVERABAL ANCE. O RG / SPRING 2017

Avera Medical Group Plastic Surgeon Mark Shashikant, MD, said back and neck pain and a low level of activity related to heavy breasts get in the way of a better quality of life. “Some women feel resigned — that it must be OK because this is me,” he said. “Just because you have them doesn’t mean heavy breasts are the best fit for your body.” Shashikant and Avera Medical Group Plastic Surgeon Barry Martin, MD, are board-certified plastic surgeons who have helped many women experience fewer skin rashes under their breasts, less pain and in many cases, an end to the misery that result from heavy breasts.

“The primary reason for this surgery is relief from pain, which can be severe and significantly impact the woman’s quality of life,” Martin said. “The second part is the benefits that come with reduction and reshaping, so she has a better sentiment about how she looks and feels. This surgical procedure is consistently among the most satisfying in the way it helps patients.” Barry Martin, MD

Martin said that the procedure itself is as safe, if not safer, than almost any other in plastic surgery, with most patients leaving for home the same day. Women can self-refer, or work with their family practice physician to begin the process. “We’ll do an exam and look at the patient’s overall health and also use our Vectra imaging software to provide the patient a better idea of what the surgery will change,” Martin said. “We work with the patient’s insurance carrier to get pre-authorization and make sure everything is set up properly.” Shashikant said the Vectra 3-D imaging system his clinic uses is unique and helpful, especially with insurance. “It can provide us insight on the breast volume and that is a key piece of information that insurers ask for, so we’re glad we are among the few clinics in the Midwest who offer that technology,” he said. “It can help us share insight on the procedure long before we enter an operating room. Mark Shashikant, MD

Reduction surgery usually takes about two hours, and the recovery period is about 10 days. Women can usually return to more vigorous activity about two weeks after the surgery. But the changes they feel are dramatic, Shashikant said.

“Almost every patient I’ve worked with said they felt the difference on the walk out to their car,” he said. “Each procedure is tailored to the individual, and the decision to have reduction is a very personal choice. We partner with women to achieve their goals,” Shashikant said. “For some, the reduction in neck and back pain can lead them to a more active life and more exercise. The bottom line is that it helps them live better lives.” n

WHEN SHOULD YOU CONSIDER BREAST REDUCTION SURGERY? You have • Back pain • Neck pain • Shoulder pain • Tingling or numbness in your arms

Your breasts keep you from • Picking up your children • Doing aerobics or other exercise • Sitting comfortably at a desk

Other measures don’t help, like • Physical therapy • Pain medications • A better fitting bra Vectra 3-D imaging system.

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BE FIRM

WITH YOUR FLIP-FLOPS

A careful balance between foot health and fashion By Jarett Bies, Avera Health

Among the many pleasures of spring and summer is that chance to slide your toes into the unrestricted feel of your favorite sandals.

Testing shoes for support is pretty easy:

This spring, as you return to the airy atmosphere of slip-on footwear, remember those shoes that offer no-to-low support can cause tendon strains and other ailments that can curtail your celebrations in the sun.

just hold them by the toe and heel and squeeze.

Those injuries are why doctors like Christine Wiarda, DPM, of Avera Medical Group Podiatry Yankton, stress the facts about your feet, ankles and footwear.

Christine Wiarda, DPM

“Flip-flops, sandals — really any shoe without laces — can put extra stress on your feet because you use your toes to grip the shoe and that can aggravate muscles and tendons,” she said. “When you’re wearing nothing but sandals or flip-flops for too long, especially if you’re active, you can cause tendonitis, or irritation of these tendons. It can also affect your joint capsules and cause leg-muscle fatigue.” She’s not saying to “outlaw sandals.” Just use common sense. Slip sandals off and choose a more supportive running or walking shoe if you’ve got a big Disney World or beach trip planned.

Any shoe, laces or not, that you can bend in half or twist quite a bit, is not going to offer your foot much support, and over time, especially with activity, that can lead to pain. There are so many good choices, but sometimes our fashion sense will lead us to make poor choices for foot health.

Moderation, when it comes to supportfree footwear, can save you from pain. “There are some fun and fashionable shoes for summer that do offer support, so you have to be a picky shopper,” said Wiarda. “Shoes that have a back-strap to hold the shoe above your heel can help avoid strain. But we see a lot of people who wear them without the strap, and when you do that, you’re making those muscles in your feet work more,” she said. “It’s sometimes better to just focus on foot health instead of fashion. If you have sore feet or ankles, you’ll be less active. That’s not any fun when the weather’s nice.” Summer heels add variety to your summer wardrobe, but can also lead to problems with foot health. “Most women realize that heels, such as platform or stiletto shoes, are not good for your feet. They cause discomfort and that discomfort is telling you something — they are creating increased stress to parts of your foot that is not meant to carry that stress load,” Wiarda said. From heel pain to plantar fasciitis, many troubles of the foot start with the shoe. “We remind patients with foot pain to avoid re-aggravation. Sometimes people are ‘good’ about support all day, then come home and walk barefoot or in flip-flops and the pain returns. Support is key — all day long,” Wiarda said. “If pain is making the fun summer months unpleasant, evaluate your shoe choices and if you need to — come get some help from us.” n

Learn more at Avera.org/podiatry.

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TOP DIET TIPS FOR LOWERING CHOLESTEROL By Donna Farris, Avera Health

hen you have high cholesterol, changes to your diet and exercise habits are always a good idea.

“You might have a genetic disposition to high cholesterol, but changes to your diet and lifestyle could still improve your numbers,” says Mary Beth Russell, Registered Dietitian at the Avera Heart Hospital. If the changes you’ve made to date haven’t made a difference, it might be that you haven’t made the right changes, Russell says. For example, perhaps you’ve reduced your intake of saturated fat, but you haven’t cut down on sugar or simple starches — like white bread or pasta. High blood cholesterol is not a direct correlation to future heart disease, but it does increase your risk. Not everyone will be able to impact their cholesterol numbers enough through diet and exercise alone. If you have high cholesterol plus other risk factors, your doctor might prescribe a statin medication,

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said Timothy Mok, MD, Avera Medical Group family practice physician at Marshall, Minn., who consults the ASCVD (atherosclerotic cardiovascular disease) Risk Estimator provided by the American College of Cardiology and American Heart Association. Find it on the American College of Cardiology website at: tools.acc.org/ascvd-riskestimator. Timothy Mok, MD

The online risk estimator takes several factors into consideration including gender, age, race, HDL, total cholesterol, blood pressure, diabetes and smoking. The estimator will provide a 10-year and lifetime risk percentile for heart attack and stroke, and recommend whether or not statins are advised. “Talk with your doctor about your cholesterol numbers and risk for heart disease. Ultimately, you cannot control some risk factors, such as your gender, age or race. But you can control what you eat, how much you exercise and whether or not you choose to smoke. Make the changes you can and you will still impact your heart health for the better,” Mok added. n

Five tips to improve heart health and/or maintain a healthy weight:

EAT A HEALTHY

EAT FISH AT LEAST TWICE A WEEK. Top fish choices are salmon, tuna and tilapia. If you don’t like fish, try new types of fish or different cooking methods. It’s always better to get fish oil from fish itself rather than supplements. CHOOSE HIGH QUALITY WHOLE GRAIN Look for whole grain or whole wheat as the first ingredient. “It should say whole wheat, not bleached or enriched wheat flour,” Russell said. “It should say 100 percent whole grain, rather than ‘made with whole grain.’”

The goal is to reduce your intake of white processed starches that increase your triglycerides, lower HDL (helpful cholesterol) and increase LDL (lousy cholesterol). Watching sugars and processed carbohydrates is equally as important as watching your fat intake.

CHOOSE HEALTHY FATS. Olive or canola oil are good choices, Russell said. Natural sources are better than man-made shortening or margarine. “I tell my patients to use a small amount of butter instead.” Use oil instead whenever you can. For example, brush a grilled sandwich with olive oil instead of buttering the bread.

BREAKFAST, EVERY DAY. Include different nutritious choices such as an egg and whole wheat toast, oatmeal, or yogurt and granola. Eat fruit for breakfast instead of juice. If you do have juice, limit it to 6 ounces.

EAT FIVE SERVINGS OF FRUITS AND VEGETABLES EVERY DAY. Eat fruit for breakfast, a fruit and vegetable for lunch, and two vegetable servings or a vegetable and fruit for supper. “Fruits and vegetables deliver fiber, nutrients, low-calorie content and lots of flavor and variety,” Russell said. “If you eat five servings a day, it will help fill you up and you will eat less of other foods.” Look for choices with deep color: berries, spinach, kale or broccoli. These are high in antioxidants, which can decrease inflammation. Tea and dark chocolate are also high in antioxidants.

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Do you need to be

gluten free

By Donna Farris, Avera Health

Gluten free. We’re seeing this label everywhere from cereal boxes, to restaurant menu selections to sections in the grocery store. But what is gluten and who really benefits from not eating it? Gluten is a general term for protein found in rye, barley, wheat and some oats. It creates the elastic texture of dough. There’s nothing bad or unhealthy about gluten, unless you have a condition known as celiac disease, or have gluten intolerance or sensitivity. If you have this, eating gluten can cause symptoms such as abdominal pain, nausea, diarrhea, constipation, vomiting and unplanned weight loss. However, only one-third of adults with celiac disease have digestive symptoms. Other common symptoms include unexplained anemia, fatigue, bone or joint pain, arthritis, depression or anxiety, seizures, migraines and more. “It’s important that people don’t skip ahead to treating possible celiac disease or gluten sensitivity with a gluten-free diet without knowing for certain what’s causing their symptoms,” said Cristina Hill Jensen, MD, of Avera Medical Group Gastroenterology. Cristina Hill Jensen, MD

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Left untreated, people with celiac disease can be at risk for serious conditions such as malnutrition and osteoporosis. Celiac disease affects an estimated one in 100 people, and can strike both children and adults. The immune system forms antibodies to gluten, causing inflammation in the intestine.

Patients with celiac disease or gluten sensitivity often feel better soon after going gluten free. Yet it can take a year and a half to three years for the small intestine to return to normal.

“When someone is diagnosed with celiac disease, a first reaction is to head to the grocery store to buy bags of expensive gluten-free products,” said Amanda Curley, MS, RD, LN, Registered Dietitian who specializes in gastroenterology care.

While the gluten-free diet is gaining momentum for the entire population, there’s no health benefit to eating gluten free unless you have been diagnosed with either celiac disease or gluten intolerance or if your doctor advises you to go gluten-free for other medical conditions. No harm is done if you go gluten free and don’t have this diagnosis. But the gluten-free diet is an expensive and radical change in lifestyle that may not have any real impact.

Yet once people understand the shopping lists and menu plans for gluten-free eating, it doesn’t take them long to adapt; in fact, sometimes entire families go gluten free when only one member has been diagnosed with celiac disease in order to prevent cross-contamination and make meal planning easier.

“On the other hand, for people with celiac disease, the results of a gluten-free diet are fantastic; no medications are needed,” said Hill Jensen.

“Once patients are educated about gluten-free eating, they realize that there are a lot of foods that are naturally gluten free, and perhaps they’ve even unknowingly had gluten-free days in the past,” Curley said.

The current gluten-free fad is actually helpful for celiac disease patients, because more gluten-free choices are on the market, and they are also clearly marked.

If patients “cheat” on the gluten-free diet, they either get sick, or they don’t get sick but continue damaging the intestinal tract by eating gluten, Curley said. “Patients often ask, ‘is it really going to hurt me,’ and my answer in a word is ‘yes.’” n

Is it gluten -free? YES:

Fresh fruit, fresh or frozen vegetables, potatoes, fresh meats, eggs, most dairy products, potato chips, corn chips, popcorn, plain nuts and seeds, beans, rice, corn tortillas

NO:

Barley, bran, durum, graham flour, rye, semolina and wheat. Beer, luncheon meats, pasta, soup base, supplements, lipstick and candy can also contain gluten. SPRING 2017 / AV E R A B A L A N C E . O RG

e h T f o Schedule your mammogram today at Avera.org/mammo for earlier detection of breast cancer.

THE MOST EFFECTIVE WAY TO DO IT, IS TO DO IT. â&#x20AC;&#x201D; Amelia Earhart

r e w o P u o Y f 17-AVHE-5104

BETTER EVERY DAY Avera Medical Group Orthopedics and Sports Medicine helps you live life to the fullest and train to be better every day. Our goal is for you to be fit at every stage of life.

• Increase activity gradually • Warm up and cool down before exercise • Stay hydrated • Stop if you feel pain • Cross train to prevent overuse injuries • Consult your provider about previous injuries or chronic conditions

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Find an orthopedic physician at Avera.org/doctors

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