Balance Magazine 2019

balance Health & Wellness Tips for Your Life

SPRING 2019

Wife, Mom, Surgeon and More

‘BE FLEXIBLE AND FIGURE THINGS OUT’

HAPPY

(AND HEALTHY!)

TRAILS TO YOU TWIN BOYS

LIVING AFTER LOSS

ANGELA KENNECKE’S STORY

ES THE

SOMETIM

ERAPY

BEST TH

IS A

FURRY FRIEND

DEFY ODDS

WITH A STITCH AND A PRAYER

FARM TO TABLE DINING

IS HEALTHY … AND DELICIOUS

“Your children will become who you are.

One day you’ll be embarrassed by your mother, the next you’ll realize you ARE her.

Whether it’s her love of corny puns or bad dance moves, just remember to pass it on.

Someday your child will understand the real secret: not caring what other people think will take you on great adventures.

Happy Mother’s Day from Avera.

19-AMGR-15328

So be who you want them to be.�

– Unknown

balance

Sign up for health and wellness tips at AveraBalance.org

Sign up for health and wellness tips at AveraBalance.org

BREAST CARE SUPPORT FOR EVERY WOMAN

balance Health & Wellness Tips for Your Life

PUBLISHER Kendra Calhoun EDITOR Lindsey Meyers COPY EDITOR

Personalized care is happening here.

Donna Farris CONTRIBUTING WRITERS Jarett C. Bies Katie Daniel Kelly Thurman Alyssa Waltman Heather Hitterdal DESIGNERS Jessica Nuenke Jessica Potter PHOTOGRAPHER Emily Spartz Weerheim

© Copyright 2019 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.

Learn more at Avera.org/breast

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.

It's' Just a Dog

From time to time people tell me, "Lighten up, it's just a dog," or, "That's a lot of money for just a dog." They don't understand the distance traveled, the time spent or the costs involved for "just a dog."

Dear Readers, Happy Mother’s Day! Welcome to our annual edition of Balance Magazine. Avera is committed to the well-being and better balance of women throughout all phases of life. This magazine is dedicated to providing good health information for you and your family.

In this issue, I’d like to direct your attention to a specific article about the value of pets in our lives. I do this because of my Freya—she’s a 15-year-old 70 something pound German Shepherd who loves me more than life itself. And, I love her too. She is an extra special part of my and my husband’s lives. We consider her part of our family.

She’s more than just a dog.

I found a poem from an anonymous author that pretty much sums up how I feel about Freya. If any of you out there are also “Dog Moms,” I am sure you will be as touched by this poem as I am.

Please enjoy this edition of Balance Magazine, compliments of Avera. I hope this selection of articles about various aspects of health and fitness inspires you to find your own balance.

If you like what you find here, read more at AveraBalance.org.

I also invite you to sign up for e-newsletters that link to our latest patient stories, health news and tips. Thanks for reading!

Some of my proudest moments have come about with "just a dog."

Many hours have passed and my only company was "just a dog," but I did not once feel slighted.

Some of my saddest moments have been brought about by "just a dog," and, in those days of darkness, the gentle touch of "just a dog" gave me comfort and reason to overcome the day.

If you, too, think it's "just a dog," then you will probably understand phrases like "just a friend," "just a sunrise," or "just a promise."

"Just a dog" brings into my life the very essence of friendship, trust, and pure unbridled joy.

"Just a dog" brings out the compassion and patience that make me a better person.

Because of "just a dog" I will rise early, take long walks and look longingly to the future.

So for me, and folks like me, it's not "just a dog" but an embodiment of all the hopes and dreams of the future, the fond memories of the past and the pure joy of the moment.

"Just a dog" brings out what's good in me and diverts my thoughts away from myself and the worries of the day.

I hope that someday they can understand that it's not "just a dog" but the thing that gives me humanity and keeps me from being "just a human."

Best wishes, So the next time you hear the phrase "just a dog" just smile.... because they "just don't understand."

Kendra Calhoun Senior Vice President Strategic Marketing & Communications Avera

- Anonymous

Contents AV E R ABAL ANCE.ORG / SPRING 2019

7 WHAT’S NEXT FAMILY LIFE

8 THE FIVE SENSES

Enhance Your Baby’s Development

HEALTHY LIVING

11 HOW DOES VAPING IMPACT TEENS?

30 HAPPY AND HEALTHY TRAILS TO YOU

12

HELPING KIDS THROUGH STORMY TIMES

33 KEEP THE TISSUES HANDY

14 DIABETES

It’s Allergy Season

34 FARM TO TABLE

How to Prevent or Live Well With This Disease

Healthy But Also Delicious

18 LIVING AFTER LOSS

40 TAKE YOUR SKIN SERIOUSLY

20 TWIN BOYS DEFY ODDS

43 GOOD SLEEP ISN’T

AN OVERNIGHT FIX

With a Stitch and a Prayer

24 WIFE, MOM, SURGEON AND MORE

“Be flexible and figure things out”

34

44 DANGEROUS WORDS FOR

A HEART ATTACK: “I’M FINE” GIVING BACK

48 WHEN THE BEST THERAPY IS A FURRY FRIEND

52 LEADING THE FUTURE OF HEALTH CARE

54 A VOLUNTEER MINISTRY

24

On the Cover Tricia Merrigan, MD, is a Sioux Falls breast surgeon who balances career with life at home with husband, Jon, and five children.

She shares life lessons that help her keep everything in perspective.

This magazine is published by Avera, sponsored by the Benedictine Sisters of Yankton, S.D., and Presentation Sisters of Aberdeen, S.D. Thanks to the leadership and heritage of faith of the Sisters, Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

19-AMGR-15653

WHAT’S NEXT

Your guide to healthy living, awareness and events.

MAY

JUNE

JULY

Mental Health Month: Find a NAMI walk in your area namiwalks.org/southdakota

1: PurpleStrides Walk to benefit

Pancreatic Cancer Action Network support.pancan.org

4: Celebrate safely on July 4 AveraBalance.org

(Keyword: fireworks)

11: Avera Race Against Cancer

Donate at AveraRaceSiouxFalls.org

2: National Cancer Survivors Day:

Participate in a celebration near you.

Avera.org/events

11: Cinco de Mayo Falls Park Fiesta cincofiesta.com 17: Bike-to-Work Day: Ride to work

on two wheels instead of four

14: Blood Donor Day: Make a donation cbblifeblood.org

AUGUST

SEPTEMBER

OCTOBER

National Immunization Awareness Month: Get your immunizations scheduled Avera.org/shots

10: World Suicide Prevention Day:

The HelpLine is available 24/7

by calling 211.

Or, call 1-800-273-8255

National Breast Cancer Awareness Month

14: Walk to End Alzheimer’s, Sioux Falls

1: International Coffee Day: Get the

Skinny on Lattes and More

AveraBalance.org (Keyword: coffee)

22: Walk to End Alzheimer’s, Aberdeen

NOVEMBER

DECEMBER

JANUARY

1: #T1Day – The start of National

Diabetes Awareness Month

3: #GivingTuesday: Find out

how your donations can

help Avera programs Avera.org/foundation

11: #NationalMilkDay:

Give a few gallons to

Feeding South Dakota feedingsouthdakota.org

Start the New Year right AveraBalance.org

(Keyword: New Year)

28: Celebrate Thanksgiving with

the Run for Food benefiting

The Banquet in Sioux Falls thebanquetsf.org

Get your flu shot in celebration of National Influenza Week!

FEBRUARY

MARCH

APRIL

American Heart Month: Find a Heart Walk near you and register heartwalk.org

National Colon Cancer Awareness Month: Schedule your screening Avera.org/colon

Donate Life Month: Sign up to be an organ donor organdonor.org 22: Earth Day

To learn more and register for events, visit Avera.org/events or call 1-877-AT-AVERA (1-877-282-8372).

SPRING 2019 / AV E R A B A L A N C E . O RG

7

5

THE

FAMILY LIFE

SENSES ENHANCE YOUR BABY’S DEVELOPMENT

By Donna Farris

Can stimulation to the five senses – touch, hearing, sight, taste and smell – in the earliest days of life help your baby for a lifetime?

Research suggests numerous benefits to massage and other sensory stimulation of infants.

“Studies have looked at sensory interventions such as massage or scent exposure and the effect on brain development of newborns and premature infants,” said Meggie McCoy, Senior Clinical Research Coordinator, Avera Research Institute Center for Pediatric & Community Research.

Research shows that these interventions help babies reach developmental milestones and can help premature infants catch up to the developmental stage of full-term babies.

Sensory interventions can impact attention span, memory, and cognitive development, McCoy said.

“Research is suggesting that we can identify ways to be more intentional about stimulating a baby’s nervous and sensory system. We hope future studies will continue to shed light on this topic.”

- Meggie McCoy

HERE’S HOW INFANT MASSAGE CAN STIMULATE THE FIVE SENSES: • Infant massage (touch) • Scented lotion (smell) • A mix of classical music during the massage (hearing) • Sugar water on a pacifier given during the massage (taste) • Gazing into a parent’s face (sight) “We’ve known for decades that touch is an important way of bonding between parents and their babies. Hearing a parent’s voice and seeing a parent’s smile are key in a baby’s development,” McCoy said. “For most parents, these important engagements just come naturally.”n

BENEFITS OF BABY MASSAGE Touch and massage can be a wonderful way to increase the bond between you and your baby. In addition to developmental benefits, other possible benefits of infant massage: • Soothe your baby • Reduce crying • Aid digestion • Enhance sleep • Help develop good muscle tone and coordination • Help calm and relax both you and your baby • Boost your confidence in handling your baby Source: Johnson & Johnson

HOW TO • Choose a time when your baby is relaxed, not hungry or cranky • Ensure the room is warm and lighting not too bright • Choose a safe, flat surface, such as a changing table upon a baby blanket placed on the floor • Consider playing gentle music in the background • Wash your hands and remove jewelry • Use a safe and comfortable place to give your baby the massage and position him so that he can see your face clearly • Using baby oil can introduce a scent, such as lavender, into the sensory experience • Oil can also help your hands to glide comfortably over your baby’s skin

MASSAGE YOUR INFANT • Slowly stroke and knead each part of your baby’s body – head, chest, arms, tummy, back, legs and feet • Be gentle enough that it’s comfortable for your baby, but with a firm enough touch that it’s effective • Talk or sing to your baby throughout the massage • Pay attention to how your baby responds: If baby seems happy and content, continue.

If baby turns her head away and appears restless or unhappy, try again later.

• If your baby enjoys infant massage, you can incorporate this care technique several times a day • If skin is irritated or red, don’t apply oil; always read the label before using any products Source: Johnson & Johnson

SPRING 2019 / AV E R A B A L A N C E . O RG

9

Lauren Cornay, RD, LN, our blog dietitian, tells you how food can optimize your mood every day.

Tip 1: Find balance between carbs

and protein. High-protein foods are high in tryptophan but carbs help your body absorb it, and that will help regulate your mood.

Get the full story at

Avera.org/mood

Want more like this?

balance

Look to for the latest articles on things related to food and nutrition.

Find: • Healthy recipes • Expert advice on nutrition and well-being • Tips on how to eat healthier • Success stories

Get it in your inbox.

Sign up for our monthly newsletter at AveraBalance.org 19-AMGR-15345

How Does

Vaping

Impact Teens?

By Jarett C. Bies

With teenagers hooking up their friends to a wide range of camouflaged devices that look like pens or computer parts, vaping – inhaling a chemical vapor, one often filled with nicotine – is frighteningly common in school hallways across the country.

“We talk about it one-on-one and share perspectives in health classes, but vaping still comes up a ton,” said Jeremy Atkins, ACT, an addiction counselor and prevention coordinator from Avera St. Luke’s Hospital in Aberdeen.

STARTING AT SCHOOL

Vaping can lead to serious conditions such as popcorn lung – a bronchial disorder – and wet lung, in which blood vessels in the lung begin to leak.

At school, at home or out in the community, it’s not easy to identify kids in the act of vaping. Some devices are even shaped like everyday items a teen might carry, such as a pen.

“We’ve seen vape devices that look like boxes of cookies, and with their sweet flavors, it’s really troubling. They are obviously aimed at young people,” Atkins said. “We are hopeful to make parents more aware of the vape culture and these threats.”

DISCUSSIONS AND DEBATES While decades of research have proven the toll that tar and cigarette smoke take on the lungs and heart, since vaping has not been prevalent for long, those hard facts are not as readily available.

“One point we make when kids say ‘vaping is better than smoking’ is that the only thing we really should be putting into our lungs is oxygen,” he said. In addition, the U.S. Surgeon General reports that youth and young adults are at risk for long-term, long-lasting effects when their developing brains are exposed to nicotine.

These risks include nicotine addiction, mood disorders and permanent lowering of impulse control. Nicotine also changes the way synapses are formed, which can harm the parts of the brain that control attention and learning.

“When I was a kid, it was smoking that caused concern. Now, with vaping, it’s more complex but equally as addictive and dangerous,” said Atkins. “It’ll take a lot of conversations between kids, parents, teachers, counselors and health care professionals in order to stop this ongoing problem."n SPRING 2019 / AV E R A B A L A N C E . O RG

11

FAMILY LIFE

HELPING KIDS THROUGH STORMY TIMES

By Jarett C. Bies

The perfect storm of changes in mind, body and behavior make childhood – especially early adolescence – among the toughest times in life.

Mental health conditions such as depression or anxiety can create even more challenges.

AVERABAL ANCE. O RG / SPRING 2019

“Peer interactions become more powerful and mean more to kids in that age range,” said Jesse Barondeau, MD, Avera Medical Group adolescent medicine physician. “Parents can help kids by being there for them – by being available – and by encouraging healthy activities.”

Jesse Barondeau, MD

Here are some additional insights Barondeau shares with parents who want to help their children in the face of depression or anxiety:

Avoid the loop: Kids who are busy with a variety of sports, hobbies and interests – who avoid just going from bedroom to school and back again – tend to stay happier and have more avenues to meet positive peers. But don’t over-program – leave time for reading, pretend and play.

Be there, but be patient: Children who know they can turn to mom and dad with questions or problems might not do so right away. “It’ll come – so it’s up to the adults to be patient if the teen seems to ignore you right away, because they are hearing you,” Barondeau said. “Have an open door.”

Avoid “black and white” declarations and use facts: “Explain the honest consequences without exaggerating. Be the source of good information,” he said. “Parents can dispel myths, too.”

Refocus the negative: When parents are active participants in their children’s lives and activities such as band, creative pastimes and art, other hobbies or even video games, they’ll be more prone to notice if a child is withdrawing from things, which is often a sign of depression. Helping them return to positive interests that bring them happiness can be a good step.

Get help when needed: If you think your child is showing signs of a mental health condition, ask your primary care provider where to begin.

“It’s always better to get on top of a mental health condition to avoid long-term impacts.

Counseling and medication may be needed for a time, and then the child can go on toward a healthier future,” said Barondeau. n

FINDING A NEW

NORM “A New Norm” is an illustrated book with an inspirational story designed to help children and adolescents who face challenges.

The book was published in collaboration

by Children’s Home Society of South Dakota and Avera Health.

UP TO

20%

OF YOUTH experience one or more mental health conditions, such as depression, ADHD or behavior problems, according to the Centers for Disease Control and Prevention (CDC).

Many cases go undiagnosed and untreated.

Written for children ages 7 to 14, “A New Norm” is the story of a boy whose “norm” was living with a cloud over his head, and nothing he tried could make it go away.

The story expresses the confusing and stormy feelings that can overwhelm young people, but can speak to older teens and adults as well.

By identifying negative thoughts and emotions that are potentially harmful, the book encourages young people to seek conversations with people they trust. The book’s message is to be that “spark of hope” for those who are struggling.

“As the leading behavioral health provider in our region, Avera serves those who suffer from depression, anxiety, bipolar disorder and related conditions on a day-to-day basis.

These conditions cause a great deal of pain and disruption in their lives and the lives of their families,” said Matthew Stanley, DO, Clinical Vice President of Avera’s Behavioral Health Service Line. Avera’s resources include a large team of psychiatrists, psychologists and therapists in outpatient care as well as specialized inpatient units for children, adolescents, adults and seniors.

Learn more, including how to order the book, at Avera.org/new-norm.

FAMILY LIFE

DIABETES IS HAPPENING MORE OFTEN AND AT YOUNGER AGES THAN EVER BEFORE.

DIABETES How to prevent or live well with this disease

By Donna Farris

14

AVERABAL ANCE. O RG / SPRING 2019

How to prevent and live well with diabetes begins with understanding what it is.

“Type 2 diabetes is when the pancreas can’t keep up. It’s definitely related to obesity, inactivity and diet,” said Eric Ocampo, MD, Avera Medical Group endocrinologist in Tyler, Minn.

The pancreas normally secretes insulin, a hormone that tells Eric Ocampo, MD the body cells to absorb glucose (sugar) from the bloodstream for energy. People with type 2 diabetes develop what’s called insulin resistance.

The pancreas has to work harder to compensate for excess weight and food intake. When the insulin level increases, it changes the metabolism, making the person feel even hungrier, so they eat more, creating a bad cycle.

“The pancreas stops working as well or stops working at all,” Ocampo said.

“There are many studies that show that type 2 diabetes can be prevented 75 percent of the time with just diet, weight control and exercise,” Ocampo said.

A diet to prevent or manage diabetes should be low carb, high protein and high fiber. “You can eat carbs, just reduce the portion,” Ocampo said. Limit breads, pasta, rice, potatoes, baked products like cookies and cake, pop and ice cream.

Because exercise improves metabolism, it helps manage blood sugar. “It creates a mechanism to get sugar out of the blood, feeding the cells of muscles and organs more efficiently,” Ocampo said.

Weight loss is often a result of healthy diet and exercise.

Some cases of diabetes can be controlled with diet and exercise alone. Other patients need oral medications, insulin injections, and injections that are not insulin.

“Bariatric surgery has recently been approved as an official treatment for type 2 diabetes,” Ocampo added.

“If diabetes is not well controlled, effects can be catastrophic,” he said, including stroke, heart attack, blindness, kidney failure and lower extremity amputation.

“It’s proven that you can prevent these complications with better diabetes control,” Ocampo said.

DIABETES IN CHILDREN Type 1 and type 2 diabetes are different diseases that are similar in name and effects on the body.

Type 1 diabetes can occur at any age, but it’s most common in childhood.

Oleksandr Kachanov, MD

In type 1 diabetes, the immune system “misbehaves” and starts producing antibodies that impact the pancreas. “The body stops making insulin,” said Oleksandr Kachanov, MD, Avera Medical Group pediatrician and pediatric critical care specialist in Aberdeen, S.D.

Symptoms include fatigue, weight loss, hunger, thirst and increased urination. It can quickly ramp up to be a serious condition with more urgent symptoms such as abdominal pain and nausea, change in behavior and even loss of consciousness.

Unlike type 2 diabetes, type 1 is not brought on by poor diet, weight gain and inactivity. It can only be controlled and managed – there’s no reversal of this condition and no cure except a pancreas transplant. “In 85 percent of

A PARENT’S

STORY:

‘EVERYTHING GETS BETTER’ For 2-year-old Rayden, type 1 diabetes came on suddenly and seriously.

new cases, there’s no family history. It can happen out of the blue,” Kachanov said. Daily blood sugar checks, insulin injections, diet changes and exercise become the new normal for those diagnosed with it.

Yet type 2 diabetes – most often associated with adulthood – is being diagnosed more and more often in children.

The habits that lead to it often start around 5 to 8 years of age with a high sugar and high carb diet, portions that are too large and lack of physical activity – all leading to weight gain.

The remedy is better eating habits, putting down the electronics, and getting active.

“Kids should eat a well-balanced diet with a limit on things like pop and candy. They don’t need to eat adult portions.

They should also get at least one hour of physical activity a day,” Kachanov said. n

BLOOD SUGAR BASICS If you’re concerned about your risks for developing diabetes, ask for a blood test at your next checkup.

NORMAL: Under 100 fasting blood sugar, A1C of 5.7 percent or below PREDIABETES: 100 to 125 fasting blood sugar, A1C of 5.7 to 6.4 percent DIABETES: 126 or above fasting blood sugar, A1C of 6.5 percent or above

“He was sick and throwing up and then out of the blue he was struggling to breathe. We took him to the emergency room and he was immediately flown to Sioux Falls,” said his mother, Heather Zens, of Aberdeen.

The diagnosis turned their world upside down. “His blood sugar numbers were so high that his body was shutting down.

There was a chance he wasn’t going to make it.”

Thankfully, things turned around. Rayden is now a healthy 13-year-old, and managing diabetes is just a normal part of his life.

Zens has some advice for any

parent whose child is newly diagnosed: Photo courtesy of Hardin’s

“At first with a 2-year-old it was crazy – counting carbs all the time,” Zens said.

He required insulin shots the first year.

After that, he moved to an insulin pump.

“It’s been the best thing ever.” Rayden checks his blood sugar 10 to 15 times a day, inputs the numbers and his pump responds by giving him the right dose of insulin. “It’s just natural for him,” Zens said.

Diabetes has never held Rayden back. In fact, he’s a middle school wrestler. “A lot of people don’t even realize he’s diabetic,” Zens said.

Ask people for help and stay in communication.

Everything gets better.”

Growing Families

Start Here It may be your first baby or the last addition to your happy family – . Avera is with you every step of the way to provide personalized care before, during and after your pregnancy.

We’ll be here to answer your questions and handle the details of your pregnancy and beyond.

until grandkids, that is

Learn more at Avera.org/birthing

19-AMGR-15330

FAMILY LIFE

L ivin Beginning with that dreaded news on May 16, 2018, Angela Kennecke became a member of a club that no one wants to belong to – that of parents who have lost a child.

Her beautiful and talented 21-year-old daughter, Emily, died of fentanyl poisoning in a drug overdose.

“She hid it from us,” Kennecke said of her daughter’s addiction, although she and other family members had seen the signs. They were in the midst of planning an intervention to ask her to seek treatment at the time of her death.

“When the worst possible thing happens, the only choice you have is how you respond,” Kennecke said. She took a leave of absence from her work as a news anchor and investigative reporter with KELO. “I used that time to get counseling and take care of my family and other kids,” she said. She also spent hours collecting Emily’s artwork and having it professionally photographed to be placed online and at exhibits.

Although the fresh wounds are healing, the scars won’t ever disappear – nor will the deep ache inside that comes to the surface from time to time.

Kennecke wanted to use her grief as a catalyst to raise awareness, stop the stigma and get people treatment who are suffering from substance use disorder. She went public with her story, creating a TV special on the opioid crisis, and telling Emily’s story through numerous public speaking engagements.

ng

AFTER LOSS

She established Emily’s Hope, and this fund at the Avera McKennan Foundation will help offset the cost of treatment and allow more people struggling with addiction to get the help they need. “I have heard of at least four to five people who have sought help after hearing Emily’s story. If even one person is saved, I will know I have done the right thing to channel my grief.”

Kennecke has heard enough stories of parents from all walks of life – pastors, educators and doctors – to realize that addiction is a disease that can impact anyone. When it comes to teens and especially young adults, parents can’t control their children’s decisions.

“People thank me – parents of addicts thank me. That makes me feel like

HOW TO HELP

A GRIEVING PARENT: • Ask “how are you doing?” This allows the parent to talk about the loss if they want to, or choose not to talk about it.

By Donna Farris

“We all have burdens, losses and challenges. Many people choose to let those things define them. I kept saying to myself, ‘don’t let me die while I’m still alive.’”

- ANGELA KENNECKE

I can keep putting one foot in front of the other and help make a difference.”

There are no shortcuts through the grieving process. “You have to experience those emotions and go through it before you can begin healing,” Kennecke said.

Yet, Kennecke found gratitude to be an antidote to grief. “I stop and think of something – right now – that I’m grateful for. Even if it’s for a great cup of coffee that I’m holding or that I’m breathing.” She also finds it therapeutic to write about her experiences in a blog, and to live in the moment.

People kindly say to Kennecke, “you look so great.” She appreciates the compliments, but says, “the scars are on the inside, and they will always be there.” n

• Don’t fear that talking about the loss will cause added pain.

It’s always on their mind.

• Simply say “I’m so sorry” and convey an attitude of concern, sympathy and caring.

• Just listen.

Learn more at Avera.org/Emily

• Remember the child in meaningful ways. Kennecke established an arts scholarship through the Sioux Falls Community Foundation to honor Emily’s love of art, in addition to the Emily’s Hope fund.

SPRING 2019 / AV E R A B A L A N C E . O RG

19

FAMILY LIFE

Twin Boys

DEFY W ODDS

hen twins Jude and Levi were born at 37 weeks, they went home with their parents just three days later.

There was no stay in the Neonatal Intensive Care Unit for these boys, which is even more astonishing if you rewind to their 20-week ultrasound.

WITH A STITCH AND A PRAYER

By Kelly Thurman

It was then that parents Dan and Sarah Heckmann were told she had a cervical insufficiency and was at risk of losing her pregnancy.

It isn’t until 24 weeks that babies have a chance of surviving outside the womb.

Levi (left) and Jude’s lives were saved by a timely intervention.

Just two hours later, Heckmann was in surgery to have an emergency cerclage placed in her cervix by Avera Medical Group perinatologist, Les Heddleston, MD, and his team. The tiny tie is meant to close the cervix and keep the expectant mother from delivering preterm. But it’s not often used with twins and isn’t always effective. It can only be done if the mother isn’t already in labor, which was the case for Heckmann.

A Stitch and Bed Rest “It’s a pretty simple idea, but can be challenging to place,” said Maria Palmquist, MD, perinatologist with Avera Medical Group Maternal-Fetal Medicine.

“You can put it in and it may not work very well or it may work for just a few weeks and then the mother ends up delivering.”

Heddleston, who retired in early 2019, worked with Heckmann’s OB-GYN, Amal Salama, DO, FACOG, to co-manage the pregnancy.

“At that point we’re just hoping we get a month, maybe get these little babies to a place where they have a chance,” Salama said. “To get them another 16 weeks was the best possible scenario.

We’re sitting here now taking a deep breath, but there was a lot of walking on pins and needles for some time.”

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21

“It’s not lost on us how special they are,” - SARAH HECKMANN

On bed rest, Heckmann began to tick off the days and then the weeks. At 24 weeks she was readmitted to the hospital for signs of pre-term labor and was given some medication to stop labor.

At that point, Heckmann credits Heddleston for saving the babies’ lives a second time. “I attribute these guys’ lives to him,” she said.

“Without him we wouldn’t be sitting here.”

Upper left: Sarah and Dan Heckmann hold twin boys, Levi (left) and Jude (right). Above: Dan holds Jude as Sarah holds Levi in the twins’ bedroom.

From Bed Rest to Natural Labor

Instead, she went into labor and had a vaginal delivery.

Under the team’s monitoring she was able to go home and maintain bed rest. She bided her time with visits from friends and family, crossword puzzles and sharing updates about the boys on social media.

Every step of the way the twin boys continued to exceed expectations for the best possible outcome.

“We were surprised by how many people were invested in our story,” she said. “It was nice to know people who didn’t even know us cared and were praying for us.”

Eight months later, Sarah and Dan are getting to know each of their personalities – Levi is the watchful cuddler while Jude is always on the move. The Heckmanns, though still sleep deprived, understand their story could have been different.

At 28 weeks they celebrated with cake. At 36 weeks the cerclage was removed and activity restrictions were lifted. “We ended up getting an induction date set, which at the beginning of this was just in our wildest dreams,” Heckmann said.

“We have a real story to think back on how we might not have had them. I want moms of twins to know there is something that can be done in this situation.

We’re a success story and we wanted to give other people encouragement and hope.”n

22

AVERABAL ANCE. O RG / SPRING 2019

25% of your bones are found in your feet

IT’S YOUR

MOVE

SM

A complex system of bones, joints, ligaments and tendons choreographs every movement throughout your day. Where you get care for your body matters. Turn to the experienced team at Avera Orthopedics, where technology and orthopedic care, sports medicine and recovery meet to support your every move.

MAKE YOUR MOVE TO THE LARGEST ORTHOPEDIC PHYSICIAN TEAM IN THE REGION — AVERA ORTHOPEDICS.

Avera.org/orthopedics

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Source: foot.com

FAMILY LIFE

Wife, Mom, Surgeon

and More

‘BE FLEXIBLE AND FIGURE THINGS OUT’

By Jarett C. Bies

“We do tend to fly by the seat of our pants sometimes, and we text on the fly a lot to make everything in the day connect.

We’re not too huge on planning – our mantra is simple: it’ll work – let’s go with it.”

– TRICIA MERRIGAN

PRECONCEPTIONS ARE POWERFUL – JUST ASK TRICIA MERRIGAN. Patients and colleagues are often surprised that this specialized breast surgeon has five children – including Royce, the newest addition to the family, born on New Year’s Day. And when she meets the moms and dads of her children’s friends, they’re often surprised when they hear of her profession. For Merrigan and her husband, Jon, it’s all about “making it work.”

It’s a life philosophy of balance and flexibility, but it’s also a mindset Merrigan sees as helpful across life and career’s many aspects. Jon is similar in his poise and team-first mindset.

It’s something they continue to tweak as they close in on knowing each other for 20 years.

“In some ways, we’re a throwback family because there are seven of us now. But my dad was one of 13 children,” said Jon Merrigan, who operates his own business as a driver’s education instructor when not busy with Grace, Landry, Avery, Greta and Royce. “We started our family when Tricia was in general surgery residency, and while it wasn’t common in that training program, it wasn’t like anyone said you can’t do it.

We went with it and we learned.

It gets easier with experience.”

Tricia and Jon Merrigan are pictured at home with their children, from left, Grace, Landry, Avery, Royce and Greta.

From left, Grace, Avery, Jon (holding Royce), Tricia (holding Greta) and Landry.

BETWEEN A LARGE FAMILY, A BUSY ENTREPRENEURIAL SMALL BUSINESS AND A FULL SURGICAL PRACTICE – DOES IT EVER FEEL LIKE IT’S TOO MUCH? “I do receive congratulations from many people – and many friends say they’ll pray for us. Yet I don’t think it’s really felt overwhelming,” Tricia Merrigan said. “It’s been an ongoing lesson in lifestyle and learning to deal with challenges you face along the way.

It’s not always the perfect mediaconstructed ‘ideal family time’ scene.

Sometimes it’s Domino’s for supper.

And you know what? That’s OK.”

Tricia and Jon Merrigan shot baskets during their first date.

A BASKETBALL BEGINNING Jon and Tricia were students at the University of South Dakota in 2000 when they met in the DakotaDome’s weight room. They shot baskets together on their first date and went on to marry in 2005. Both came from families of four kids – Jon the oldest, Tricia the youngest – and both had influential parents who offered abundant encouragement.

Tricia’s father was a general surgeon in Mobridge, S.D., and she said many memories of her youth involved patients of her father’s telling her how much they appreciated her dad’s skills in saving and improving lives.

“I still meet people from that area who remember him or bring me stories of him helping them,” she said. “He was certainly an influence on my career path.”

Her husband earned bachelor’s and master’s degrees in education, and he gained insight on family life from his dad. “Big families prepare you for a lot of things life can throw your way,” he said. “His example has helped me as our family grows. It takes planning and flexibility, but it also requires patience and communication.”

“Being flexible with a family of seven isn’t simple, but we’ve come to realize that if you try that approach, you’re better off than letting a small setback ruin everything.“ – TRICIA MERRIGAN

Above: Tricia Merrigan reads a book with her son, Landry, who’s holding baby Royce.

Right: The Merrigan family enjoys game night in their Sioux Falls kitchen.

When she completed her training and began her practice, Jon found a niche in driver’s education, a choice that helps them maintain a balanced life. “My job is busy, but I have the control I need to say when I will work and when I will not,” Jon said.

BALANCING CAREERS AND A GROWING FAMILY The Merrigans’ first child, Grace, was born when Tricia was in residency in Des Moines, Iowa.

“Jon and I both learned a lot,” she said. “He was the caregiver at home, for the most part, as I was working 80-hour weeks and pulling my weight on the residency team. We worked together to figure everything out as it was changing.”

As an Avera breast cancer surgeon, Tricia Merrigan’s schedule is also more straightforward than it might be in another medical specialty. There are long days when she’s in conferences and the operating room for more than 10 hours. But there are weekends she can spend with the family, riding their horses, Maddie, Paris, Jet and J-Wow or attending a flag-football game.

“There are going to be frustrations – that’s part of life. But for our big family, it’s all about figuring things out,” Tricia Merrigan said.

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Q A AND

WITH

TRICIA MERRIGAN, MD

Q. What’s your advice to other parents – regardless of how many children?

A.

My mother always told me: You have to pick your battles. I don’t think that a sink with dirty dishes or piles of laundry in the living room is the end of the world. Most days, my bed isn’t made – and that’s OK. I have a healthy family and I’m healthy. Seeing patients who face breast cancer shows you how tough things can be. It makes me not take anything for granted.

Q. Balance requires recharging the batteries – how do you do it?

A. For me, working out and the horse barn are my main ways that I re-center myself.

For Jon, it’s definitely playing baseball – it’s a sport he loves and he still plays on two teams. I couldn’t imagine his life without it.

We also re-center as a family on our annual trips to Florida and Montana.

Q. Big families need teamwork – how do you keep that going?

A. With kids, there’s a lot of reminding about how we need to work together.

We do the best we can to reward for chores and instill responsibility, but we’re by no means perfect. A messy house (sometimes) just goes with life with five kids. Someday, my house will be empty and clean and extremely quiet – and I embrace the craziness of our life and try to enjoy every minute.

Qyour . What do you hope to teach kids?

A. My mom said that she raised successful children by

making them feel like they could do anything, so instilling that confidence is important to me. My father set a great example of work ethic; he expected nothing but our best, and he treated everyone with respect, regardless of race or social status. I will forever remember the comments from patients about this.

AVERABAL ANCE. O RG / SPRING 2019

I hope that my children understand these things, and that’s why we adopt a family and deliver gifts to them during Christmas, or serve at The Banquet. We often come up with random acts of kindness as a family and then we commit to them and give back.n

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A remarkable cancer care team is a perfect blend of passion, drive, expertise and innovation. That’s the type of team that never stops working for you to pinpoint your best treatment. It’s the type of team you trust to be there for the hard days and want to celebrate with during the good ones.

WE ARE your team. WE ARE Avera.

Meet your team at Avera.org/cancercare or call our 24/7 Navigation Center at 866-572-3741

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HAPPY

HEALTHY LIVING

(AND HEALTHY!)

TRAILS TO YOU

By Heather Hitterdal

“Although it’s limited in our part of the country, the time we can be out, when we get fresh air is so refreshing for your mind and for your mood,” said Vik Chatrath, MD, Avera Medical Group orthopedic surgeon in Marshall, Minn.

Chatrath added that in the Upper Midwest, people often are deficient in vitamin D, which is made when our skin is exposed to sunlight. We need vitamin D to absorb calcium and keep our bones healthy. In effect, the vitamin D gained during outdoor exercise helps make our bones stronger.

But hitting the trails — especially for the first time in the spring — might also cause injuries if you don’t prepare in advance. Wrist fractures, clavicle injuries, knee injuries, and more can occur when people bike without the appropriate gear.

“We see a lot of people who have fallen from their bikes. Maybe they are not wearing the appropriate gear or not paying attention. Sometimes other people don’t see them and pass too closely, and they lose balance and fall over,” said Chatrath, who himself is an avid cyclist.

30

AVERABAL ANCE. O RG / SPRING 2019

Vik Chatrath, MD

To help prevent these injuries, Chatrath encourages cyclists to invest in a good bike.

Also, wear a helmet, protective glasses and wrist guards.

Brightly colored clothing will help other cyclists see you, and if you are riding in the dark, have a light on your bike as well.

“Biking is a low-impact activity especially good for people with arthritis, so I prescribe it often.

Outdoor exercises like biking help lubricate joints, work muscles, increase heart rate and lower blood pressure,” Chatrath said. “Every adult should get 30 minutes of weight-bearing exercise five days a week. If you can get your heart rate up, that’s great, but even a walk is better than nothing.”

From exploring state park hiking paths to cycling city bike trails, opportunities abound for outdoor activities.

The numerous benefits of outdoor exercise go beyond the body to touch the mind and the spirit.

Tanner White, Certified Personal Trainer and Director of the new Avera Human Performance Center in Aberdeen, S.D., offers these tips for minimizing the risk of injuries such as twisted ankles and lower back pain and getting the most out of a bike ride, walk or hike.

BEFORE

Tanner White

DURING

YOUR WORKOUT

YOU EXERCISE Get warmed up. “You really just want to get your body moving and do exercises that replicate what you will be doing during the activity,” White said. It might include a five-minute joy ride on your bicycle, squats or lunges.

Keep proper body mechanics in mind. White said it’s important to understand your own center of gravity. If hiking, keep your backpack weight close to your back. Engage your core. Don’t bend over or stoop, and maintain proper posture.

Dynamic stretches (stretches not held for too long) warm up your muscles. However, wait for more intense stretching until the end of your workout.

If you want to get more from your workout, every half mile of your hike, do 25 squats or 25 pushups.

AFTER

YOU EXERCISE After your muscles have been warmed up during exercise is the time for static, longer stretches in which you hold the stretch for 30 seconds each.

“You are letting your body cool down, and stretching gives you a chance to increase your flexibility and mobility to lead to a better lifestyle,” White said.

Another important step after you exercise is to replenish fluids (drink water!) and other nutrients. n

ercise x e e k a is to m ur life. l a o g eal out yo me “ Thearinable throu, hgavhe fun with it,egcehtasnoics, m e r body ut ther sust pe are o the pro ay living.” h ile you it h w W y

ryd ctivit ur eve sical a HITE rt of yo a phy p NER W it N e A k T a – m and

Learn more at Avera.org/ortho

5 WAYS TO REDUCE 2018 Top Blog YOUR RISK FOR BREAST CANCER Breast health expert Traci Redmond, CNP, gives you the tools to create your best chance to prevent breast cancer — a healthy lifestyle.

American Cancer Society estimates that more than 80,000 of the 270,000 new breast cancer diagnoses each year could be prevented by lifestyle changes.

Get the tips from Traci Redmond, CNP, at Avera.org/risk

Want more like this?

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Find: • New technology and treatment methods • Tips on symptom management • Cancer screening and prevention tips • Survivor stories Get it in your inbox.

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Keep the Tissues Handy…

IT’S ALLERGY SEASON!

By Alyssa Waltman

16 IN

individuals suffers from allergic rhinitis, or seasonal allergies, that cause annoying sniffling, stuffiness and runny noses.

“Seasonal allergies are limitless. When you think of them, think: tall, medium, small; spring, summer, fall,” said Arthur “Skip” Moeller, MD, an Avera Medical Group ear, nose and throat physician in Yankton, S.D. Moeller breaks it down right here: In the spring, budding trees often cause the majority of allergic reactions. Lush grasses and growing fields are Arthur “Skip” Moeller, MD attributed to the nuisance during the summer. When fall rolls around, weeds release pollen and grain dust billows into the air, creating watery eyes and a difficulty to breathe.

Another very common source of allergies is mold, which is found year round in homes, within piles of grain as well as any other damp, dark area.

If you suspect you have an allergy, your physician may perform a skin test. Exposure to many common allergens will confirm your sensitivity. Once the source is known, you and your doctor will take action to reduce discomfort.

The first step is simple: avoid exposure.

The second step is often medication.

Second generation, non-sedating antihistamines block histamines from forming in your body which cause runny nose and eyes as well as other symptoms.

Steroids and allergy shots are usually the last resort.

“Many antihistamines are over-the-counter and pretty darn safe,” said Moeller.

While you might be adamant about solving allergies yourself, it’s a good idea to talk to the store pharmacist about over-the-counter solutions. Even better yet, talk to your physician, as he or she will know how these readily available products will interact with your current medications or if they are OK for you in general.

SEASONAL ALLERGIES ARE THE FIFTH MOST COMMON CHRONIC DISEASE IN ADULTS AND THE MOST COMMON CHRONIC DISEASE IN CHILDREN.

Interestingly, physicians aren’t too sure why some people are more sensitive to allergy sources than others. Allergies aren’t entirely genetic, but experts can’t exactly boil it down to one common denominator.

If you want to try dealing with the symptoms of allergies before going to the doctor, Moeller recommends gently cleaning out the blankets of mucus by using a salt water irrigation system.

When pollen and dust become lodged in your sinuses, irritation begins and so does your runny nose in an attempt to rid the nose of invaders.

“We know that the way a body responds to the outside world changes about every 20 years,” explained Moeller. “In other words, you may grow out of childhood allergies when you hit your adult years; or, you might develop allergies later in life.”

If you’re burdened with chronic allergy symptoms, it may be time to see a physician.

“You may not always be able to control your environment, but there are steps you can take to control your symptoms,” said Moeller. “Work with your physician, and you may see your quality of life increase.”n SPRING 2019 / AV E R A B A L A N C E . O RG

33

HEALTHY LIVING

FARM TO TABLE Healthy, But Also Delicious

By Jarett C. Bies

“I see the impact of better, fresher food daily in my clinic as people change habits.

Local produce is better for you, and it’s getting easier to obtain.”

- SALLY WILLIAMS, DO

During the first two decades of this century, time travel of a sort is taking place in cafes and cafeterias, restaurants and hospitals, homes and hotels.

In eras past, almost everyone knew where the foods they enjoyed came from, but somewhere along the way we strayed from that with heavily processed convenience foods.

Today, food lovers of all stripes are returning to a simpler time via the Farm to Table movement when a focus on fresh, flavorful and healthy food reigns.

There are no better people to share insight on this than Sally Williams, DO, Avera Medical Group Integrative Medicine specialist and Chef Nicholas Skajewski, Executive Chef with Avera.

“From weight loss to better sleep – and for many other reasons – people are really coming to realize that what you eat does matter,” said Williams, who in addition to her medical practice is an avid gardener on her family’s farm home in southeastern South Dakota.

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SPRINGTIME

FRESH SALAD

Skajewski said the abundance of local, fresh products in the Midwest goes beyond what people might expect, and not just in terms of what’s available.

DRESSING

SALAD

Serve as a large “family style” salad or on individual plates.

1-2 bunches of Bibb, baby or other spring lettuce, torn to bite-size pieces 1 hefty bunch (about 6 ounces) fresh spinach or baby spinach, torn to bite-size pieces 1 yellow pepper, chopped to ½ inch pieces ¼ red onion, sliced 1½ cups strawberries, sliced 1 medium cucumber, sliced ¼ cup almonds, sliced and toasted 2-5 ounces local Parmesan or other hard cheese, or cheese of choice, shredded Fresh locally baked sourdough, torn to craft rough croutons (optional) 1 tablespoon vegetable oil Juice of 1 lemon 2 tablespoons white-wine vinegar ¼3 cup sugar (or use honey or agave nectar) 1 tablespoon poppy seeds

1. Mix together all ingredients for dressing in a small bowl until well combined. Set aside.

2. Combine salad ingredients in this order: Greens, veggies, cheese and croutons.

Source: Sally Williams, DO

“Everyone knows the Midwest for our top-shelf livestock, but don’t forget about the produce – there are so many local growers doing amazing things, all year long,” he said.

“Indoor growing allows us to have fresh mushrooms and microgreens, as well as root vegetables grown in hoop houses. We’re incorporating many of these local foods in our menus (at Avera) and a key is prepping them when you have abundance and preserving that supply for use year-round.”

Vacuum sealing and freezing can give you fresh-cut tasteslike-summer dishes in the midst of a snowy February day.

Choices abound throughout the area. Community-supported agriculture (CSA) programs, an online food hub, seasonal farmers markets and even grocery stores are trying to keep it local.

Williams said as more people realize how certain foods, especially processed ones, can lead to increasing inflammation, and how those internal irritations are often associated with chronic diseases, they start to change the way they eat.

“It’s quite well-known that the typical American diet lacks nutrients and can be pro-inflammatory, so it makes sense to seek foods that would reduce that irritation by removing some triggers,” she said. “For some that means removing gluten or dairy. We can all benefit from adding more nutrient-dense vegetables, fruits, nuts and other whole foods to our daily meals. I’m passionate about using food as medicine – and I see the results.”

SO

start a garden, head to the farmers market or just to the grocery store and think local.

“Practically anything you grow yourself is going to be healthy and anti-inflammatory,” Williams said. “It seems to taste better, too.”n

MULTI-VEGGIE

HASH

WITH EGGS 1. Prepare a non-stick skillet for the hash and sautĂŠing, and another small non-stick to cook the eggs.

2. Peel and chop vegetables.

3. Cook meat in skillet at medium-high heat; judge the remaining fat in the pan and either add oil or omit it.

4. As meat finishes, add sweet potato, shallot and pepper and cook until tender; if using bacon, remove it and allow it to drain excess fat on paper towels while finishing the vegetables. If using link or patty sausage, do the same. Bulk sausage can be left in the pan.

5. Once cooled, chop the removed meat and set aside as you finish the vegetables.

2 bell peppers, any color, but mixed is best, chopped 1 shallot, diced 2 sweet potatoes, peeled and diced to ž inch dice 2 fresh-from-farm eggs ½ pound locally produced sausage, bacon or uncured bacon 3-6 ounces of locally made shredded cheese, such as Colby Salt, pepper Grapeseed or avocado oil Salt and freshly cracked pepper Fresh herbs as available, chopped Microgreens for garnish and to add crunch Source: Chef Nicholas Skajewski

6. Using the second skillet, prepare eggs individually as desired. Once cooked, remove pan from heat.

7.

Once veggies are soft and thoroughly cooked, add shredded cheese and toss so it melts. Add salt and pepper to taste.

8. Plate the hash and top with cooked egg, fresh micro greens and more pepper as desired. Enjoy!

Cultivate Every day you have a choice to open your heart and spread goodness in the world.

One kind gesture can improve a life; many can change the world.

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Kindness

HEALTHY LIVING

FARMERS AND RANCHERS:

TAKE YOUR

SKIN SERIOUSLY

By Alyssa Waltman

AVERABAL ANCE. O RG / SPRING 2019

Skin cancer is often associated with people using tanning beds to get ready for a special event or a trip to the Bahamas — not farmers and ranchers.

However, think about it: farmers, ranchers, gardeners, construction workers, and so many more spend entire days, back to back, working in the sun.

“One thing people don’t realize is that skin cancer is the most common type of cancer in the U.S.,” said Katie Bonnichsen, MD, Avera Medical Group dermatologist in Pierre. “Dermatologists work in conjunction with patients to enable them to make decisions to protect their skin.”

Katie Bonnichsen, MD

The sun is the strongest between 10 a.m. and 2 p.m. During those times, it’s best to seek shade and stay indoors. If being outdoors is unavoidable, take these steps to protect yourself:

Apply sunscreen every two hours. If it’s an extra hot day, apply more frequently as you’ll be sweating a lot more. Make sure the label reads “SPF 30+” and “broad spectrum.” This protects the skin from both UVA and UVB rays.

Consider what you wear. Invest in light, long-sleeved

clothing. Special sun-protective clothing is available that wicks away moisture for an added level of comfort. “Studies have shown that wearing light, long-sleeved clothing keeps your skin cooler in the hot summer sun,” said Mandi Greenway, MD, Avera Medical Group dermatologist in Mitchell.

Wear wide-brimmed hats. Baseball caps are popular with farmers and ranchers; unfortunately, they don’t offer enough protection for your ears, neck and nose.

“Often times, I hear farmers and ranchers say that they thought it was a pimple or bug bite that wouldn’t heal,” Greenway said.

“Any skin blemish that refuses to heal should always be checked out.”

Mandi Greenway, MD

The first step to protecting your skin is to know your skin.

This means checking over your body for any peculiar changes or additions.

The three different types of skin cancer include: BASAL CELL CARCINOMA – This most-diagnosed form of skin cancer is marked by pink or red spots that often become crusty and eventually bleed.

SQUAMOUS CELL CARCINOMA – Not quite as well-known, squamous cell carcinoma is characterized by pink spots that grow quickly.

MELANOMA –

Nearly of Americans will develop skin cancer in their lifetime.

The most well-known and serious form of skin cancer, melanoma, has spots that may alter between different shades of brown. The outline of the spot may appear irregular.

“Dermatologists can administer full or half body-checks, depending on the patient’s preference,” said Bonnichsen. “It gives dermatologists the opportunity to look for any abnormalities and offer guidelines and tips for skin protection.”

Lack of moisturizer and sunscreen are huge stumbling blocks when it comes to skin health. But the biggest mistake among farmers, ranchers and people in general is not taking skin cancer seriously.

“I hear many people say, ‘It’s just skin cancer; it’s not going to kill me.’

It can kill you, especially if it’s melanoma.”

– MANDI GREENWAY, MD

Even if the cancer is not life-threatening, skin cancer treatment can be intense and it sometimes results in losing a part of the nose, ear, lips, etc. “It’s time to take skin cancer seriously,” said Greenway.n

Learn more at Avera.org/dermatology

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Where Do I Go? START HERE

It’s hard to know where to go for care when you’re sick or injured.

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EMERGENCY

I have a minor illness or injury and might need a prescription. I don’t know what’s wrong

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Use this map to understand your options.

Questions to ask yourself based on your situation Is it after office hours?

AVERANOW APP $49/VISIT Use our 24/7 provider video visits to get diagnosed without leaving the house.

Great for simple issues: pink eye, flu, sinus infections, UTIs, rashes

GO TO THE NEAREST ER!

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$$$ This is the most expensive option; use for critical issues such as chest pain, head injuries, trouble breathing, fevers over 103 degrees in babies 3 months and older

Can it wait until the morning?

Sign up at Avera.org/now Google play

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PRIMARY DOCTOR

URGENT CARE

$ Your primary care doctor knows you best and the clinic can handle all minor and serious issues. Make sure they’re in-network or you’ll pay more!

$$ Urgent care can handle issues that require immediate attention after normal clinic hours: minor cuts and burns, sprains and broken bones, respiratory issues

Find a provider at Avera.org/doctors

Find an after-hours clinic near you at Avera.org/urgent-care

19-AMGR-15336

App Store

Good Sleep Have you ever thought of sleep as something that’s just as important to your health as exercising and eating a nutritious diet?

“We often take sleep for granted, but it’s very important for good health,” says Darla Klinger, Lead Sleep Technologist at Avera McKennan Hospital & University Health Center. “In fact, getting the recommended seven to nine hours of sleep each day helps nearly everything in your body function better.”

Isn’t an Overnight Fix

“You know you’re getting enough good, quality sleep when you’re able to wake up without the help of an alarm and feel rested,” she says.

You may be sleep deprived if you wake up – even after a seemingly good night’s sleep – and: • Feel tired or not well rested • Have a headache • Experience mood swings and/or irritability If this describes you, the best place to start is by setting better sleep hygiene practices.

By Jarett C. Bies

“Look at your sleep patterns and environment to see if they promote sleep. Fix that first and foremost. Because no matter what a doctor might prescribe or recommend – if you don’t have a good environment that promotes restful sleep, then nothing else can make it better.”

Yet anyone – no matter what age, gender or weight – can suffer from a sleep disorder. If you still have concerns after two to three weeks of practicing better sleep hygiene, talk to your health care provider or see a sleep specialist who’s specially trained to identify sleep disorders.n

STRAWBERRY

frozen yogurt INGREDIENTS • 2 cups frozen strawberries • 2 tablespoons honey or agave nectar • ¼ cup plain yogurt (Greek, non-fat or full fat) • ½ tablespoon fresh lemon juice

balance

Sign up for more recipes at AveraBalance.org

Source: biggerbolderbaking.com

DIRECTIONS 1. Add the frozen strawberries, honey (or agave nectar), yogurt, and lemon juice into a food processor (or liquidizer).

2. Process until creamy, about 2-3 minutes.

3. Put in airtight container and freeze for a minimum 6 hours, preferably overnight. Store it in the freezer for up to 1 month.

19-AMGR-15331

SPRING 2019 / AV E R A B A L A N C E . O RG

43

HEALTHY LIVING

DANGEROUS WORDS FOR A HEART ATTACK:

Jessica Armstrong’s advice is to take symptoms seriously.

“If something doesn’t feel right, get it checked out.

God gave us these gut feelings for a reason: for our protection.”

– JESSICA ARMSTRONG

12

AVERABAL ANCE. O RG / SPRING 2019

“I’M FINE.”

By Alyssa Waltman

It was a Wednesday morning, and Jessica Armstrong was bustling around her home getting ready for work.

At one point, she went back into her bedroom and saw the duvet on the bed was crooked. When she bent over to straighten the blanket, pressure filled her chest and upper back.

Armstrong mentioned her discomfort to her husband, describing the pain as an elephant sitting on her chest.

He gently recommended going to the hospital. Not wanting to be a bother, she waved away his concerns with those risky words, “I’m fine.”

A half hour after he left for work, Armstrong went into the bathroom for one final look into the mirror.

Her mind went to her children and grandchildren; she decided to go to the emergency room just to be safe.

“I had a mild heart attack,” said Armstrong.

The emergency team at Avera admitted her for the night. The next morning, just before she was to have a stress test, her chest pain returned.

An angiogram at the Avera Heart Hospital revealed a blockage in her right coronary artery.

During an angiogram, a contrast agent (iodine dye) is introduced into the patient’s system, which allows the physician to observe any abnormalities captured on the X-ray. Doctors immediately placed a stent inside the artery to relieve the blockage and promote blood flow.

“They were so fabulous and caring, the team who treated me,” said Armstrong. “Every day, they see worried people and they handle each person with grace.”

While Armstrong never showed signs of heart problems, the risk runs in her family. Her mother worked at managing high blood pressure and thyroid disease all her life. Armstrong’s mother passed away at an early age.

Today, Armstrong prioritizes her health during a busy day by eating healthier and walking her eager yellow Labradors.

The thought that a health emergency could happen to even her is always in the back of her mind.

“It was a lesson to care for and listen to my body,” Armstrong said.

“I have a lot of life left to live, but I’m also taking time to enjoy every moment now.” n

Do You Know the Warning Signs of a Heart Attack?

You don’t have to have all the symptoms for it to be a heart attack. Armstrong only experienced pain in her chest and upper back; she thought she would have had more symptoms.

Common Symptoms • Chest pain or pressure • Jaw and/or back pain • Arm and/or shoulder pain • Sweatiness • Nausea • Feeling weak, light-headed or faint • Shortness of breath

Learn more at Avera.org/heart SPRING 2019 / AV E R A B A L A N C E . O RG

45

Farmer’s Stress Hotline 1-800-691-4336 Even those with toughened hands and hearts need someone to talk to. Extreme weather conditions, machinery breakdowns, a volatile ag environment, long hours that prevent time with family, and lowered income all cause frustration.

Avera offers the Farmer’s Stress Hotline.

It’s free, confidential and available 24/7.

Recognizing Stress and Anxiety • Nervous, irritability, on edge • Sense of panic • Increased heart rate • Difficulty concentrating • Trouble sleeping • Breathing rapidly (hyperventilation)

19-AMGR-15327

WHY THURSDAYS 2018 Top Blog WITH GEORGE ARE SO SPECIAL George is a furry friend who takes time to cuddle with patients every Thursday. The standard poodle is part of the 10-year-old pet therapy program at Avera Children’s.

“Kids light up when George comes in.

It’s a nice way to comfort kids while they are here.”

– Johanna Simpson, George’s owner

Get the full story at

Avera.org/george

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Look to to see how Avera is improving patients’ lives and area communities.

Find: • Success stories • Stories about the Avera mission • Tips on healthier lifestyles • Expert advice on health issues

Get it in your inbox.

Sign up for our monthly newsletter at AveraBalance.org 19-AMGR-15347

GIVING BACK

Sometimes the BEST THERAPY is a

FURRY FRIEND

By Jarett C. Bies

Medical school with its many demands can be stressful and lonesome.

“That all changed when I met Harley,” said Aaron Burkhardt, DO, Avera Medical Group internal medicine physician who adopted his Great Dane rescue dog during a trying time in his life and career.

Aaron Burkhardt, DO

“He quickly became my best friend, and he remains my best friend to this day, helping me to make it through some tough times and challenges in life,” said Burkhardt, who now owns three Great Danes. “Harley was really there for me – I could come home from a long day and he’d run up and the concerns would just melt away from my mind.”

Recognizing the unconditional love dogs bring to people doesn’t require a degree in medicine. Their “best friend” moniker is well-earned. Spending time with a dog can benefit patients in hospitals, clinics and hospice, as they soak in the absolute joy dogs dole out with abandon.

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“It was 15 years ago when I started therapy-dog work.

I had a great German Shepherd, Patriot, with a perfect temperament for therapy,” said Mary Jo Jaqua, PhD, a volunteer who brings her therapy dog to health care facilities, schools and retirement communities in the Sioux Falls area.

“I wanted to share that precious dog with others. Training him and testing for certification as a therapy dog team would let me do just that.”

– MARY JO JAQUA, PHD

NATIONAL STANDARDS Jaqua trained her temperament-blessed dog to meet the requirements of Therapy Dogs International (TDI).

Since, she has certified three additional German Shepherds – Justice, Austin and Spirit. Over time, she paired with each of them to bring unreserved affection to patients, staff, family, visitors, children and the disabled.

AMAZING REWARDS Dogs like Jaqua’s current therapy teammate, Spirit, need elite levels of discipline to gain status as therapy dogs, such as acute attention and rock-solid demeanor.

Mary Jo Jaqua, PhD, (right) and her dog Spirit spend some quality time with Avera patient Elaine Greer.

“They cannot be alarmed by loud noises or take food on the floor – they have to be on their best behavior,” she said. At home, they are, after all, dogs. They love all the things pups love – eating, napping, playing and treats.

All Give Love,

BUT NOT ALL THE SAME SERVICE DOGS: These highly professional animals provide guidance to people with impaired vision, brace patients with unstable gaits, help to predict seizures for those people who face them or lend aid in diabetic crises. You should refrain from distracting them with petting while they work, because their loyalty and focus is solely placed on the owner/handler.

Aaron Burkhardt, DO, relaxes at home with his fiance, Liz Cunningham, and his three Great Danes.

Burkhardt said that he hopes his younger Great Danes, Quinn, a 4-year-old, and Freya, who is about 1, will eventually test for and become certified as therapy animals. He’s seen first hand, as a physician, how beneficial a dog’s presence in a clinical setting can be.

“While in residency, we had a stroke patient, and her children were hoping to reach her before she passed. She was struggling with a ventilator, and we were struggling to keep her vital signs stable,” he said. “I told one of her kids to bring her Chihuahua to the room. When they did, the dog curled up on her lap. Her vital signs normalized and she stopped fighting the vent. All of her family was able to come and say their goodbyes. That visit from her dog – that conscious and unconscious bond – made a huge difference. It does for so many patients and for so many people.”

CERTIFIED THERAPY DOGS: These dogs also are highly trained, tested and certified. They provide emotional support to people in retirement communities, hospitals, schools and other facilities. In each setting, the calm, friendly dogs Mary Jo Jaqua, PhD, with Spirit. bring peace to those they visit.

It also brings smiles to the faces of residents, patients, staff, family and visitors. Dogs that provide this valuable service must have kind, outgoing temperaments, outstanding obedience skills and the ability to remain calm in the face of many distractions. While they provide appreciated affection, AVERABAL ANCE. O RGdogs. / SPRING 2019 therapy dogs are not service 50

Jaqua said the love her dogs have had for the work is uncanny.

“The minute I put on my volunteer uniform and get Spirit’s red bandana out, he becomes excited, running around with his tail wagging,” she said. “Once we arrive, he knows he is there for patients as well as visitors, family and staff. And he loves it.”n

Experienced.

Innovative.

Dedicated.

Avera Heart Hospital Almost 20 years ago, we created South Dakota’s first hospital dedicated to heart and vascular care. Today, Avera Heart Hospital is home to the region’s most experienced cardiovascular team. Their innovations are leading to better outcomes for tomorrow.

Helping you love longer — for whatever adventures await.

Learn more at Avera.org/heart 19-AMGR-15329

GIVING BACK

Deanna Larson CEO, Avera eCARE® Hometown: Howard, S.D. Education: Bachelor of Science, Presentation College Accolades: 2018 American Telemedicine Association Woman of the Year

LEADING THE FUTURE OF HEALTH CARE

By Kelly Thurman

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Deanna Larson works in a forward-thinking and ever-changing environment as CEO of Avera eCARE®, a world-renowned leader in virtual health care.

She began her career as a nurse and moved into management positions over the years, with an understanding that a great leader knows when to step back and let the team learn and when to step in to help them thrive.

HERE’S MORE ABOUT WHAT SHE’S LEARNED OVER THE YEARS. What are some traits of a good leader?

Early on at St. Mary’s Hospital, where I started my leadership career, I recognized the importance of teaching and working with other young nurses to advance their careers.

Later in my career at Avera McKennan Hospital & University Health Center and Avera Health, I continued the focus of providing education and training opportunities for others.

It is a great accomplishment to watch individuals experience growth and become confident in new leadership roles.

It takes a lot of self-awareness and restraint to not jump in and give your team all the answers. It takes good leadership to step back and allow them to develop solutions and answers themselves. So, your work becomes developing people, helping them to be successful, versus a direct patient care provider.

Another important trait is simple but hard – and that is the ability to be quiet and listen carefully to those who report to you. Ask them what the issue is and what they think the solutions might be.

What advice do you have for men and women hoping to move into management?

When you come into a job, do your best work and see opportunities where things can be improved.

Don’t be satisfied with good enough if you have ideas about making something better. Be sure you are speaking up and being vocal with ideas and solutions.

How about life/work balance?

How do you find the time for fun with the demands of work?

If you really enjoy your work it can be difficult not to put work as a first priority in your life. Think about the balance you want in your life. My mantra is: faith first, family second and work third. When I’m struggling to meet demands I can go back to that mantra to figure where I am out of balance. If the first priorities are out of balance, that is — faith and family — then I can’t be my best at work. When work takes time away from faith and family, things can get misaligned and I feel distracted and distraught.

You work in an innovative field.

How does that play a part in good leadership?

Being a leader who encourages innovation means you’re going to be very open to new ideas and new ways of doing things. Somebody is going to throw something out there that seems really unbelievable. As a leader, you have to be willing to listen to those new ideas and try to see the whole picture so you can understand the opportunity and give the innovation a chance. It has a lot to do with being open to risk taking and being OK with making a mistake – calling a mistake a learning experience and moving on.

What leaders who embrace innovation do best is help their team navigate change to make these wild dreams a reality. n

DEANNA’S

RECOMMENDED READING “Start with Why: How Great Leaders Inspire Everyone to Take Action”

by Simon Sinek “Serve to Lead: 21st Century Leaders Manual” by James Strock “Turn the Ship Around!: A True Story of Turning Followers into Leaders” by L. David Marquet

GIVING BACK

A VOLUNTEER

MINISTRY

By Alyssa Waltman

A difficult season in life can turn into a ministry.

After Paul Eidsness won the fight against cancer at Avera back in 2008, he and his wife, Darlene, decided to give back by volunteering their time every Tuesday at the Prairie Center in Sioux Falls.

Paul and Darlene Eidsness volunteer at the Prairie Center every Tuesday.

“Darlene and I volunteered at the Prairie Center since the day it opened,” said Paul. “It’s a beautiful facility to care for those who are facing cancer like I did.”

“It’s just a privilege to meet and serve people when they are in their most desperate moment,” said Darlene.

“We’ve been in their position; we’ve heard the ‘big C’ word. We believe God blessed us through that experience to be a blessing to someone else.”

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While they mainly work the front desk, Paul and Darlene volunteer wherever a helping hand is needed. They direct patients to various clinics within the building, run errands for the pharmacy, clean tables and overall, just ensure each guest is met with a pleasant atmosphere.

Darlene Eidsness is on hand at the Prairie Center to help patients feel welcome and at ease.

Sometimes they see someone in the hallway who can’t bear to take another step. It’s in that moment the Eidsnesses know to make their move and change the course of another’s day.

There’s also something to be said about the Avera employees the Eidsnesses encounter.

“They greet us by name every time, and always leave us with a sense that our work is deeply appreciated,” said Paul.

“It’s our mission to be a light in their darkness.”

- PAUL EIDSNESS

Not only do they offer an encouraging word, but they share their faith with patients.

“That’s the neat thing about Avera – you feel empowered to pray with people and talk to them about Jesus and his healing ministry,” said Darlene.

If your heart is moved to care for your neighbor, there are endless areas in which you can volunteer at Avera. Taking patients to appointments, stuffing envelopes, moving labs to and from clinics, rocking babies, answering the phone – service is needed in every part of the hospital.

When they aren’t serving patients at Avera, the Eidsnesses spend time with their two sons and daughters-in-law, and seven grandchildren. They also volunteer at their church, the University of Sioux Falls and the Fellowship of Christian Athletes.n

Contact your local Avera hospital or clinic to learn more about volunteer opportunities.

SPRING 2019 / AV E R A B A L A N C E . O RG

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A BOLD, NEW ERA

IN HEALTH CARE

Louise Avenue & 69th Street Learn more at Avera.org/onlouise

OPENING FALL 2019 AVERA ON LOUISE HEALTH CAMPUS Gastroenterology | Internal Medicine | Orthopedics | Rheumatology | Urogynecology

what’s Next:

Future phases will include the Avera Addiction Care Center and the Avera Human Performance Center. Together, this new campus will provide care for the entire person – mind, body and spirit.

19-AMGR-15344

We’re rethinking how we deliver health care with this new consumer friendly campus on the growing southwest side of Sioux Falls. The first phase of Avera on Louise Health Campus will include the 24-bed Avera Specialty Hospital and Avera Medical Group clinics.