Balance magazine 2018 by Avera

balance Health & Wellness Tips for Your Life

SPRING 2018

KEEPING IT ALL IN

BALANCE Even when life gets chaotic

FINDING THE RIGHT RX GENEFOLIO HELPS SOLVE THE PUZZLE

GET G N I V MO NGER, O R T S A FOR YOU R E I H T L A HE

Skin Solutions

WHICH PRODUCTS WORK BEST?

FULL-BODY

IMPACT

Eating to Enhance Your Microbiome

Mother Ina Madre Ahm

“To a child’s ear, ‘ mother’ is magic in any language.” – Arlene Benedict, writer

Majka Mama Maji Mutter Avera has always believed that compassion, hospitality and stewardship make the world a better place. No matter how you say it, mothers across this region are busy sculpting the world’s future leaders into strong, confidant and compassionate human beings. We salute you for doing this every day with open arms and endless patience.

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Happy Mother’s Day

balance

from Avera.

GO PLAY OUTSIDE Remember when the only rule was to be home by the time the streetlights turned on? Your mother was right: you need to play more. Exercise is good for the body and soul.

Just donâ&#x20AC;&#x2122;t come home â&#x20AC;&#x2DC;til the lights come on.

balance

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Dear Readers, Happy Mother’s Day! Welcome to our annual edition of Balance Magazine. At Avera, we are committed to the well-being of women throughout all phases of life. This magazine is dedicated to your good health and that of your family. Working in health care through the years has inspired me to be more conscious of my own health. My husband and I have always been active, and we work out together. In terms of getting fit, he’s ahead of me right now but I’m striving to keep up with him.

balance

balance Health & Wellness Tips for Your Life EDITOR Lindsey Meyers COPY EDITOR Donna Farris CONTRIBUTING WRITERS Kelly Thurman, Alyssa Kuecker-Waltman Katie Daniel, Jarett C. Bies DESIGNERS Jessica Nuenke, Jessica Potter PHOTOGRAPHER Emily Spartz Weerheim

Concerning diet, I look at food as an adventure. I love to cook things that taste good, using fresh, whole and healthy ingredients. Moderation is key, and so is drinking lots of water — instead of caffeinated or sugary beverages. I’m at the age where my body is changing. I no longer take “feeling good” for granted. At Avera, I’ve worked with our Functional Medicine and Integrative Medicine teams to try to get my balance back. Over the past 12 months or so, I’ve lost 24 pounds. And, I feel better! But it takes a daily effort and being intentional about food and activity. I think that “balance” is about reaching a point of joy where you feel great about where you are in life — emotionally, professionally and spiritually — and excited about where you are going. Please enjoy this edition of Balance magazine, compliments of Avera. I hope this selection of articles about various aspects of health and fitness will inspire 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! Best wishes,

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.

Kendra Calhoun Senior Vice President for Marketing, Avera SPRING 2018 / AV E R A B A L A N C E . O RG

Contents AV E R ABAL ANCE.ORG / SPRING 2018

7 WHATâ&#x20AC;&#x2122;S NEXT HEALTHY LIVING

8 SKIN SOLUTIONS

Everyone Should Follow

10 ACHES AND PAINS AT MIDLIFE 13

SLEEP TIPS FOR MOMS (and Dads)

14 TWO BIRTHS, ONE BIRTHDAY

18 GET MOVING FOR A STRONGER,

HEALTHIER YOU

21 IS IT HEART ATTACK? OR HEARTBURN?

HEALTH TECH

38 NEW TREATMENT FOR SEXUAL SIDE EFFECTS

22 A CHANGED LIFE:

After Bone Marrow Transplant

26 KEEPING IT ALL IN BALANCE

EVEN WHEN LIFE GETS CHAOTIC

40 FINDING THE RIGHT RX 44 LUNCH HOUR VIRTUAL DOCTOR VISIT

31 SIX SIMPLE OUTDOOR EXERCISES

GIVING BACK

32 EATING TO ENHANCE YOUR

46 AVERA PREP OPENS DOORS

MICROBIOME

On the Cover Nancy Wenande is a Yankton professional who successfully balances career, family

OF OPPORTUNITY

48 PINK LADIES:

Where Are They Now?

52 A HEALING TOUCH FOR PREMATURE BABIES

and friendships. 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.

WHAT’S NEXT

Your guide to healthy living, awareness and events.

MAY

JUNE

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

31: Avocado Day: Learn 3: National Cancer Survivors Day: about healthy fats Participate in a celebration near you. AveraBalance.org Avera.org/events (Keyword: 22: PurpleStrides Walk to benefit healthy fats) Pancreatic Cancer Action Network support.pancan.org

12: Avera Race Against Breast Cancer Donate at AveraRaceSiouxFalls.org 12: Cinco de Mayo Falls Park Fiesta cincofiesta.com 18: Bike-to-Work Day: Ride to work on two wheels instead of four

JULY

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

National Breast Cancer Awareness Month: Register for your local benefit run

15: Walk to End Alzheimer’s, Sioux Falls 28: Walk to End Alzheimer’s, Aberdeen

4: National Taco Day: Enjoy them with a healthy twist AveraBalance.org (Keyword: taco)

28: Helmsley Center opening, home to new Avera Cancer Institute in Pierre

NOVEMBER

DECEMBER

JANUARY

1: #T1Day – The start of National Diabetes Awareness Month

Get your flu shot in celebration of National Influenza Week!

11: #NationalMilkDay: Give a few gallons to Feeding South Dakota feedingsouthdakota.org

22: Celebrate Thanksgiving with the Run for Food benefiting The Banquet in Sioux Falls thebanquetsf.org

14: #CleanOffYourDeskDay: Start the New Year right

27: #GivingTuesday: Find out how your donations can help Avera programs Avera.org/foundation

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 2018 / AV E R A B A L A N C E . O RG

HEALTHY LIVING

Skin

Solutions

EVERYONE SHOULD FOLLOW By Alyssa Kuecker-Waltman

When it comes to our skin, we’re all looking for the same thing — silky smooth, clear, vibrant and healthy. As our desperation grows, we open up our pocketbooks and buy anything a celebrity is endorsing or late-night infomercials are pushing. Pretty soon your vanity is lined with bottled potions promising who knows what!

Mandi Greenway, MD

J. Wesley Fletcher, MD

JUST THE ESSENTIALS It’s time to go back to the basics: a non-fragrant moisturizer, gentle cleanser, a retinol/retinoid and sunscreen with an SPF of at least 30. Using these four products, Mandi Greenway, MD, Avera Medical Group dermatologist in Mitchell, S.D., recommends a simple skin care regimen for your day. “In the morning, gently rub your cleanser over your face using either clean hands or a clean washcloth. Then apply your sunscreen, followed by the moisturizer,” she said. “Again, use your cleanser before bed. Then apply the retinoid and moisturizer.”

AVERABAL ANCE. O RG / SPRING 2018

Caring for your skin should begin as early in life as possible with mother applying sunscreen to baby whenever venturing out and about. Begin the rest of the skin care routine in high school to start a good habit, added J. Wesley Fletcher, MD, Avera Medical Group dermatologist in Pierre, S.D. AVOID GIMMICKS “If something is wildly overpriced and promises the world, think before you buy,” said Fletcher. Expensive anti-aging and dark spot correcting creams either

When your goal is beautiful skin, TAKE THESE BONUS TIPS TO HEART. Tanning beds — don’t even start or stop right now. “Tanning often starts in high school and can continue as an addiction,” Fletcher said. “Protecting yourself from the harsh UV rays can prevent the onset of aging and prevent skin cancer, including the most serious form of skin cancer — melanoma.”

So why do dermatologists like Fletcher and Greenway recommend just a few simple products? Together, they offer a well-rounded approach to skin care:

– Moisturizer –

take too long to work or don’t work at all. Also, a lot of “amazing” products don’t even have a complete list of ingredients listed on the back. Flip it over and you might discover that it’s mostly just lotion.

keeps skin supple and moist, and helps prevent dry spots and rashes

– Cleanser –

removes dirt and oil without drying skin

– Sunscreen (SPF 30) –

Ask your dermatologist about any “magical products” that you have heard about. He or she is more than happy to help you find products that are safe, effective and not a waste of your resources.n

prevents sun damage that can lead to cancer, dark spots and wrinkles

– Retinoid –

contains vitamin A which can help improve dark spots, wrinkles and your overall skin texture

Also, be especially careful if you wax unwanted hair growing around your eyebrows, lips, cheeks, etc. Combined with regular use of retinoid or an exfoliant, delicate facial skin is more prone to burning from the hot wax. Waxing may even remove your top layer of skin. Before purchasing a product, consult with your dermatologist about what products might be best for you. Certain ingredients or certain products may irritate skin conditions such as acne or eczema. “We’re here to help you make choices that will help you feel beautiful,” said Greenway. “Everyone should feel beautiful in their own skin.”

Aches Pains HEALTHY LIVING

AND

AT MIDLIFE By Alyssa Kuecker-Waltman

Getting out of bed before daylight or out of a car after a 12-hour trip is tough for practically everybody. Now couple that with a stiff back or sore knees, and the movement becomes even more challenging. Aging doesn’t just mean we add more candles to birthday cakes; our bones, joints and muscles age, too. Our bodies experience more aches and pains than our younger selves. And for many, health takes a back seat. Perhaps we eat too many processed foods and fewer fruits and vegetables, slouch when seated and forgo exercise.

Nathan Timmer, MD

“At midlife, we see a lot of men and women struggling with low back, knee and neck pain,” said Nathan Timmer, MD, Avera Medical Group family physician in Mitchell, S.D. “This pain is commonly caused by overuse, with conditions such as arthritis, or strained and pulled muscles.”

You can try simple solutions to address your pain as well as any inflammation: • Applying hot or cold compress to the affected area • Taking over-the-counter medication, such as Tylenol®, Aleve® or ibuprofen • Gently stretching or massaging painful joints or muscles To get the best effective results, do these non-invasive solutions regularly; it requires dedication!

If pain has slowed you down for two weeks or more — or, ahem, months — it’s time to see a doctor. He or she may recommend continuing some of the noninvasive methods mentioned, as well as a few added measures. The physician may start a series of injections or sessions with a physical therapist. When injections, physical therapy or medications are no longer effective, your physician may suggest surgery — joint preservation or joint replacement.

“Younger patients in their 30s, 40s or 50s may be a candidate for arthroscopy, a joint preservation technique,” said Vik Chatrath, MD, Avera Medical Group orthopedic surgeon in Marshall, Minn. During a minimally invasive procedure, damaged cartilage is either repaired or removed from the space between two bones through a couple of small incisions.

Vik Chatrath, MD

“It’s unlikely that an older adult in their 60s or 70s will benefit from arthroscopy because their joints have naturally aged.” At this point in the game, partial or total joint replacement can be considered, depending on severity. Just like arthroscopy, minimally invasive options are available, including custom joint replacement surgery at Avera Orthopedics in Marshall.

In a customized joint replacement, an MRI captures the joint structure and a 3-D printer creates an exact bone model which is used to plan the joint replacement surgery. “Accurate and minimally invasive techniques, such as 3-D joint replacement, allow most people to go home in a day after surgery as well as return to daily activities within a few weeks,” explained Chatrath. If you’re a younger adult — or trying to slow down or reverse orthopedic pain — take action now. • Lose weight or maintain your healthy weight to alleviate stress on bones and joints. • Replace processed foods with fruits and vegetables to relieve inflammation. Perhaps add jalapeños to more dishes; eating spicy foods regularly desensitizes nerves which lessens pain, said Timmer. • Exercise. “Regular exercise increases muscle mass, which supports your musculoskeletal structure,” said Chatrath. Timmer added, “Remaining sedentary can accelerate arthritis because the fluid in the joints becomes stagnant.” Non-impact exercise, such as walking or swimming, is easy on already painful joints. • Sit up straight. How many times do you look down at your cell phone? Addiction to technology, especially smartphones, strains your back over time. Resist looking at your phone every few minutes. Also, don’t forget to sit up straight at your desk. If you notice discomfort starting to creep into daily activities, slow down and make it a priority to address the needs of your body. There are options for all degrees of pain. You only get one life; choose to live yours pain free.n

LEARN ABOUT 2017 Top Blog

FOODS THAT TRIGGER ARTHRITIS Sally Williams, DO, one of our blog experts, gives holistic approaches to wellness and management of chronic conditions, including arthritis: Research suggests if you face inflammatory arthritis, avoid these altogether, or at least cut back on: • Fried and processed foods • Red meat • Processed meats Get the full list of trigger foods at

Avera.org/arthritis-foods

Want more like this?

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Look to to find the latest information on all 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 18-AVHE-9795

You have a never-ending to-do list. But because you’re also a parent, you never put yourself on the list! One of the best things you can do is make yourself a priority — eating right, exercising and getting enough sleep.

Sleep Tips

for Moms (and Dads) By Alyssa Kuecker-Waltman

Amy St. Aubin, CNP

“Physical, mental and emotional health are affected when we don’t get enough shut eye,” said Amy St. Aubin, CNP, with Avera Medical Group Obstetrics & Gynecology in Sioux Falls.

While you may turn to your daily cup (or cups) of coffee, getting more quality sleep is a better answer when you’re in a fog.

Follow St. Aubin’s sleep tips: Eliminate screen time. After climbing into bed (finally!), it’s tempting to indulge in a little social media on your smartphone or iPad. Resist the temptation. “The glow of our devices prevents your brain from winding down and preparing your body for sleep,” said St. Aubin. According to Business Insider, the light inhibits the brain from producing melatonin, the “getting-sleepy” hormone. Put off some chores. We know the feeling — “I can squeeze in just one more thing!”— but allow yourself some nights here and there to put off unloading the dishwasher, folding towels, sweeping the floor, etc. “Just because you’re a mom doesn’t mean you have to work yourself into exhaustion every day,” reminds St. Aubin. “If you’re tired, honor that; your energy levels will make you more effective the next day.”

Write down what’s on your mind. Sometimes we climb into bed at a decent hour, only to be kept awake by swirling thoughts. “Keep a pad of paper and a pencil on your nightstand. Write down the things that are keeping you awake — tomorrow’s to-do list or appointments you have to remember,” said St. Aubin. “You’ll sleep better knowing you are prepared for tomorrow.” Wind down. Do something relaxing before bed to help your body and mind wind down. Read, stretch or rub lotion on your hands. If you don’t get a lot of “you” time during the day, this is a great time to choose a quiet activity you enjoy. Plan ahead. At 8 p.m., the last thing you want to hear is, “I have a science project due tomorrow and I don’t know what to do…” What science project?! On Sunday, gather the troops and go over what your family’s schedule looks like for the week. Nailing down soccer games, bake sales, school projects and practices before Monday hits can prevent any unwanted surprises or late nights during the week. “When you’re a parent, it’s important to make your well-being a priority,” said St. Aubin. “One of the best things you can do for your children is model a healthy lifestyle, and that includes sleep.”n SPRING 2018 / AV E R A B A L A N C E . O RG

HEALTHY LIVING

Two Births, one Birthday

SISTERS DELIVER ON THE SAME DAY AT THE SAME HOSPITAL By Donna Farris

When sisters Karie Geyer and Jen Nelson found out they were both expecting babies during the month of November 2017, they thought it was quite the coincidence. “At first, I thought, ‘what are the odds.’ Then I started to get excited by the fact that our babies would be the same age,” said Geyer. As the due dates grew closer, Geyer was scheduled to have labor induced on Nov. 20, and Nelson was scheduled to have a C-section on Nov. 21. Although this schedule dictated they would be born a day apart, the baby boys had other ideas. Geyer went into labor naturally on Nov. 17, and she and her husband, David, headed to Aberdeen, S.D., from their home in Veblen. Little Raymond John was born at 5:23 a.m. at Avera St. Luke’s Hospital in Aberdeen.

Two sisters, Jen Nelson (left) and Karie Geyer, gave birth to sons on the same day at the same hospital.

Nelson and her husband, Matt, who live in Webster, happened to be at Veblen visiting her mother, Thea Pallansch. When they heard the news, Nelson and her mom got in the car to drive to Aberdeen to meet the newest member of the family.

Jen Nelson, above, and Karie Geyer, below, enjoy moments with their sons.

“As we were driving, I just didn’t feel the greatest. I started having contractions, and I thought maybe it was false labor. When we got there, instead of going to see my sister, I ended up admitting myself,” Nelson said.

Although the sisters hadn’t discussed baby names in advance, both cousins ended up with the middle name of John, in honor of their grandfather who had passed away a year before they were born.

The sisters’ father, John, had passed away in September of 2016 due to ALS. So Nelson’s husband, Matt, was helping out on the family’s place at Veblen by cutting wood. “He was running the wood splitter with ear muffs and didn’t hear his phone, so we called a neighbor to let him know that he needed to call us as soon as possible,” Nelson said.

Both sisters were seeing Tage Born, MD, Avera Medical Group OB/GYN specialist in Aberdeen for their prenatal care, and both sisters had their babies delivered by her colleague, Gregg Carlson, MD, who was on call that day.

Things kept progressing with Nelson’s labor and Hunter John was delivered at 4:53 p.m., almost 12 hours after his cousin.

“Dr. Carlson had delivered my first baby, Kinsey, too. I told him he was just meant to deliver my babies,” Nelson said. “Both are wonderful physicians — very knowledgeable and very caring.”

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“The nurses are the ones who are with you in the trenches,” Nelson said. “They were also very caring and understood our story with our dad. They thought it was neat to have two sisters in the same unit two doors down from each other.”

“Dr. Born is phenomenal, and Dr. Carlson w stepped in like we were old friends. w It was a great experience through the w entire process. The birth of a child is w a big event for a family. Every nurse, w on every shift, built a relationship with w us and definitely cared.” - KARIE GEYER

The sisters said their family is close, as they grew up singing together with their parents at church and community events. Matt and Jen Nelson live in Webster, where Jen is a physical therapist and practices with her mom, Thea. Karie and David Geyer live in Veblen and Karie is a pastor at a three-point Lutheran parish in the area. The families live about 50 miles apart.

AVERABAL ANCE. O RG / SPRING 2018

Cousins Hunter John (left in left photo) and Raymond John will share many life experiences together.

The Nelsons have a 2-year-old daughter, Kinsey, and the Geyers have a 7-year-old daughter, Mahree. “The girls are close even with the difference in ages, and we adults love hanging out too,” Nelson said. The sisters imagine their sons will share lots of experiences together — birthdays, Halloweens, Christmases and July Fourths. The first of these shared experiences was being baptized together. “That just felt right — to kick off their life of doing things together in that way,” Nelson said.n

2017 NOT SO FUNNY! Top Blog HOW TO DEAL WITH WOMEN’S INCONTINENCE Matthew Barker, MD, is the region’s only board-certified urogynecologist offering expert advice on women’s health topics such as incontinence. “In the past, women were hesitant to talk about incontinence, but times are changing. Women are feeling more empowered to address issues that are affecting their lives.” - Matthew Barker, MD Learn more about your options at

Avera.org/incontinence

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Look to to find the latest information about women’s health and pregnancy topics.

Find: • Tips for healthy pregnancy • Information about preventive care • Tips to stay healthy at every age • Success stories Get it in your inbox. Sign up for our monthly newsletter at AveraBalance.org 18-AVHE-9794

HEALTHY LIVING

GET MOVING

FOR A STRONGER, HEALTHIER YOU By Katie Daniel

Physical activity provides your body with amazing benefits. And this includes anything that gets your body moving and heart pumping — from walking and playing with your children to weight-lifting and playing sports.

With each move, you can decrease your risk of disease while strengthening your heart, lungs, mind and more. “Physical activity not only increases your muscle mass, but also bone mass,” says Brandon Fites, MD, an orthopedic surgeon specializing in sports medicine at Avera Orthopedics in Aberdeen, S.D. “And stronger muscles and bones can decrease the risk of bone fractures as you age.”

Brandon Fites, MD

AVERABAL ANCE. O RG / SPRING 2018

“Being physically active when you’re younger helps build up bone mass before the aging process causes you to lose bone mass. But any time is a great time to start being more physically active. You’re never too late to benefit from it.”

Up the Gym While any kind of physical activity is beneficial, high-intensity interval training (HIIT) can take your health to the next level in a shorter amount of time. HIIT workouts include short bursts of intense exercise followed by lowintensity recovery periods. And the best part is that they can be effective in as little as 10 to 30 minutes. In fact, studies have shown that HIIT workouts can produce health benefits similar to twice as much moderateintensity exercise. And when your HIIT workout includes plyometric exercises such as jump squats, jump lunges or box jumps, you’ll reap additional benefits. “Plyometric training is great for preventing injury,” says Fites. “It’s been shown to reduce the rate of ACL tears which is a common activity-related injury.” With HIIT workouts, it’s also simple to incorporate a wide variety of moves so that you’ll not only get a full-body workout, but an added injury prevention boost. “When you cross-train, you’re working a variety of muscles throughout the body so you don’t have as much opportunity to experience a repetitive injury,” he adds.

FORM FIRST

HIIT

No matter which type of exercise you choose, the key to reaping all of the benefits is to do each move with proper form. “Starting with an understanding of your form and movement is important,” says Whitnee Fester, an exercise specialist at Avera Sports in Sioux Falls. “For example, before doing an explosive movement like a jump squat, learn what a proper basic squat feels and looks like. If you’re new to working out, go to a gym where you can work with a professional to learn the foundations of your movements.” If personal training isn’t for you, try a group exercise class where a certified trainer can explain each move and check your form. “We’re here to help you get the best workout,” says Fester. “Another nice thing about our classes is that each move can be modified. So if you’re new to working out or even recovering from an injury, you can do fewer repetitions, lower weight or a different move altogether. We can give you options.”

You’ll not only benefit from the expert guidance, but also from the energy of the group. “I see everyone work a little harder in group classes because — whether or not they realize it — they’re pushing and challenging each other,” she says. “The group atmosphere is great for motivation.”n

Avera Sports Debuts AR-FIT Classes in Sioux Falls AR-FIT classes are designed for active adults of all ages by the nationally renowned performance sports training program, Athletic Republic™.

Find everything you need to get stronger and healthier at an AR-FIT class offered at Avera Sports in Sioux Falls. During each 60-minute class, an exercise specialist guides you through a dynamic warm-up, HIIT and cool down with stretching and mobility. To learn more, call 605-322-3278.

Ready to give HIIT a try and want to learn more? Go to Avera.org/hiit

Life

Doesn’t Come with a Manual .

It Comes with a Mother. Once you become a mother, you’re the go-to person – whether it’s finding your daughter’s jersey or making a booboo feel better. But where do you go for answers? Your team at Avera provides comprehensive care before, during and after pregnancy, so you’re ready to write the manual on motherhood.

Learn more at Avera.org/womenshealth

18-AVHE-9766

Heart Attack? Or Heartburn?

By Jarett C. Bies

When you imagine someone having a heart attack, it’s easy to picture the TV version of this life-threatening emergency: chest-clutching and cries for help that are obvious to anyone nearby to “call 911 now!” In reality, there are many subtle symptoms that indicate heart attack. It’s not always easy to tell the difference between non-threatening situations like heartburn, which is known to cause pain in the chest, and a true emergency where seconds count. Avera Medical Group Emergency Medicine physician Jeffrey Anderson, MD, said when heartburn hits, use a remedy, but be ready to take additional steps, for the sake of heart safety. Women are more likely than men to experience more subtle or different heart attack symptoms. “Signs of heart attack are not like on TV, and they can include cold sweats, fatigue that comes out of nowhere and Jeffrey Anderson, MD feelings of fullness or choking, which mimic heartburn symptoms,” Anderson said. “Dizziness, nausea and neck or jaw pain also are signs that fall into both categories. We encourage everyone — when in doubt — to call 911. It’s cliché, but true: better to be safe than sorry.” If you’re uncertain, you should take aspirin, as it thins the blood and can help until medical attention is available, Anderson said. Chest pain is a warning sign, and if you try some antacid or other medication and the pain persists or worsens, get emergency help right away. “Shortness of breath and sweating also are indicators that you’re not just having indigestion,” he said. “Heartburn often rises up after eating, so if you haven’t had anything to eat or drink in a while, take emergency steps right away.” Considering that more than 785,000 people have heart attacks each year, Anderson said that a quick response makes all the difference. This is especially true for people with diabetes, who may present symptoms that align almost exactly with heartburn, when in reality they could be facing a cardiac event.

“The esophagus and the heart are close together, so pain from heartburn — that’s where it gets its name — is easy to confuse with life-or-death heart attack pain. So use antacids immediately but be ready to take more significant steps as well,” Anderson said. “Even if you come to see us and it ends up not being a heart attack, you’ll be better off. Erring on the wrong side could lead to tragic consequences.”n

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HEALTHY LIVING

Bone Marrow Transplant Patient Reflects on Her Journey

A CHANGED LIFE By Jarett C. Bies

AVERABAL ANCE. O RG / SPRING 2018

Bone marrow transplant patient Kristin Van Laecken was having a follow-up exam at the Prairie Center, home of the Avera Cancer Institute in Sioux Falls, when she realized it was one year — to the day — since she’d learned she had leukemia. That news changed everything for the Watertown mother of five and her family. That particular follow-up appointment was filled with good news for Van Laecken. She had blood drawn, and reviewed her various numbers with Kristen Hurley, CNP, as well as the physician who guided her through this entire complex journey, Kelly McCaul, MD. Amongst the best news was the fact she was literally cleared for takeoff: Van Laecken and her husband, Rob, along with Rob’s parents, made plans to travel to France in February, to visit Paris and to bathe in the healing waters of a natural spring near Lourdes.

One of the most long-lasting lessons Van Laecken gained over the course of this journey, which included chemotherapy, a search for a bone-marrow donor and much more, is the reality of the support system around her. It starts with her husband, naturally, and in fact he was sending texts and asking questions during her exam, wanting to see phone photos of information on the screen, in between patients at his orthodontic practice. It continues to their children, who range in age from the 2- and 4-year-old boys to the three girls, ages 6, 10 and 12. If Van Laecken says the word, they’re her first-responder team, ready to help Mom, no matter what. “There are just so many cogs in the machine that helps me, but it’s all nothing without God,” Van Laecken said. “There are good days and bad ones, and some days I have no energy at all, so long-term commitments are tough. Actually, just scheduling a hair appointment can be tricky.” But faith is something, like her tight-knit family, that hasn’t faltered.

Each day meant finding so many positive surprises, and so many people who generously, and sometimes anonymously, came to help us. I learned through this process that you don’t have to – you really cannot – do it all on your own. You have to let people in and be patient with yourself. I came to understand that these people love me for who I am, even on the really rough days. They still love me for me, no matter what.” – KRISTIN VAN LAECKEN

Kristin Van Laecken meets with members of her care team with Avera’s Bone Marrow Transplant program, including Kristen Hurley, CNP, top left, and Kelly McCaul, MD, bottom right.

“It’s comforting to know that I have to trust that faith, and that He has this,” she said. Kristin’s mother, Elizabeth Johnson, and her father, Mark, joined the efforts in Watertown last year, moving from Minnesota to be closer and help as they can. “It takes an army and we have one — Kristin’s Army is amazing,” Johnson said. “Watertown has been amazing to us all. So many nice folks, and they keep fighting alongside us, reminding us over and over that they’re here for us. It’s just been an amazing experience. Kristin’s a tough cookie — but that army is always ready to help.” Van Laecken said Hurley, McCaul and her entire care team at the Prairie Center were blessings during the decisive days, weeks and months that led up to her April 11, 2017, bone marrow transplant. Yet once the hospitalization was over, she returned home, and “Kristin’s Army” came to her aid. The shower of blessings, and the journey itself, while daunting and tear-filled at times, is something she feels a unique gratitude for experiencing. “I do not want to go back to the experience, but at the same time, I wouldn’t change it,” she said. “You learn a lot facing this sort of thing. I am learning to be patient with me, to put things in God’s hands and to realize how faith can guide you through anything.”n

AVERA’S NEW 2017 Top Blog

RESOURCE FOR GESTATIONAL DIABETES

Kimberlee McKay, MD, is finding innovative ways to connect expectant mothers to specialized care for gestational diabetes. “ Using AveraNow, we can avoid blood sugar increases and decreases that might go with a more traditional approach, since we’re getting their blood-sugar data in real time, and working with them closely every day.” - Kimberlee McKay, MD Learn how the program works at Avera.org/gestational

Want more like this?

balance

Look to to find the latest technology and therapies available to keep you healthy.

Find: • Benefits of new technology and treatments • Information on new research and clinical trials • Success stories Get it in your inbox. Sign up for our monthly newsletter at AveraBalance.org 18-AVHE-9792

HEALTHY LIVING

KEEPING IT ALL IN

BALANCE

Even When Life Gets Chaotic By Jarett C. Bies

Sometimes Nancy Wenande’s hectic life gets even more chaotic. But she keeps things in perspective. Like the day she got a call from her daughter, Courtney, while busy at her job as public relations director for the National Field Archery Association Easton Yankton Archery Center. Turns out that Iris, the family’s 8-month-old golden lab, was sick. Her husband, Brad, couldn’t leave work early, and Wenande was swamped with final preparations for more than 600 guests from 30-plus countries coming to Yankton for the World Championships her organization was hosting.

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“For me, I view life as having a plan for me, and to find it I need to be open-minded about what it can be.” – NANCY WENANDE

determined roles, but seeks new ones that allow her to give back — she serves on six boards of directors, volunteers often and still makes times for family and a small group of friends to have regular lunches and catch-up sessions. Wenande recently began a new career challenge as CEO of Yankton Area Progressive Growth, an organization that seeks to recruit businesses and workers to the Yankton area.

“Ten years ago, would I have seen this job as possible? No. Now my mindset is all about moving forward and it helps me to stay balanced by doing just that, moving forward. Move on. Life has a plan for me.” Her career journey has taken her from working within the family business, to serving as a member of the City Commission, which in time led her to serve the council and the community as mayor. In 2015, when her re-election was unsuccessful, it wasn’t a life-shattering event. “I spent about a day feeling bad about it, but I was busy volunteering for an archery tournament. They liked the way I got things done and offered me the job with them,” she said. “It’s been a lot of fun, getting to show people from around the world, many elite athletes and Olympians, the beauty of Yankton and its surroundings.”

So she called her 82-year-old mother, Mary Albrecht, who popped over and helped out. “It was just one of those situations where you stop and realize: OK, let’s figure this out,” said Wenande. “That’s life — it’s not perfect and you can’t expect perfection. You can’t worry yourself sick about stuff that happens. You can’t sweat the small stuff.” Her life reflects someone who gets things done. She is dynamic in her

These opportunities came to her because she became more proficient in various areas of her life.

Shy growing up, Wenande learned to be more self-assured and vocal. “I’ve learned a lot about worrying, and about how I tick, and one thing I just cannot do is worry about what other people think,” she said. “I work hard, make plans and try to avoid worrying about things I cannot control. It’s what lets me work a busy job and still make time for myself. I know my limits, and when I need help, I seek it out.” SPRING 2018 / AV E R A B A L A N C E . O RG

Nancy Wenande AGE: 48 FAMILY: Husband, Brad; mother, Mary Albrecht; sons Tyler, 21, and Drew, 18; daughter, Courtney, 16.

PETS: Dogs, Iris and Emmy. PASSIONS: The community of Yankton, family, puzzles and long lunches with her five-some of close friends.

CAREER: CEO, Yankton Area Progressive Growth.

PASTIMES: Spending time on the river and lake in beautiful Yankton, S.D., along with the dogs; archery; public speaking; service projects too many to name.

PERFECT, ENJOYABLE EVENING: Being at home, two-screening it while watching Big Brother and playing a little Candy Crush.

Nancy Wenande enjoys lunch out with friends — Jen Bell and Misty Nockels (left), and Maria Cameron (right).

EVEN THE BUSIEST PEOPLE CAN GET SICK Nancy Wenande’s five-some of friends enjoy lunches together at their usual spot: Mexico Viejo in Yankton. They met as a group of Mothers of Preschoolers in about 2000-2001. “It’s a girls group, just us five,” Wenande said. Last fall, she reached out to her friends because she needed to talk. Everyone dropped appointments or shifted things around — they wanted to be there for her. “That’s the type of people they are —they will drop things if you need them. I trust them, and they trust me,” Wenande said. “It’s a core group and a real treasure.”

“Knowing they were there to listen, and to support me — that’s what our group is all about. No matter how big or small the problem, my friends and I rally to our group. It means a lot to me, knowing I can trust in them and share anything I face.” – NANCY WENANDE

Wenande had been experiencing health problems, but until that time, hadn’t let on. After an emergency room visit and many medical tests, she was diagnosed with a congenital defect in her heart, as well as a few other issues. Her doctor continues to monitor the condition, which may require cardiac surgery. Wenande is focused on a familiar refrain about life — not worrying about those things she can’t control — and knowing her family and friends are at-the-ready to provide support.

CONSIDERATIONS FROM A COUNSELOR Balancing a busy life filled with family, fun, work, chores — and fitting a little sleep and a few meals in there, too — isn’t simple.

Reach out to others. “When we learn that all the problems of the world are not on our shoulders, we can reduce stress and set healthy expectations. Sometimes the ‘healthiest’ people are at a B+ level, and that B+ isn’t so bad. It’s part of being human.”

Nancy Wise-Vander Lee, PhD

HOW CAN YOU GET MORE BALANCE? Avera Medical Group Behavioral Health Psychologist Nancy Wise-Vander Lee, PhD, shares some tips:

Learn to express what you want, need and feel. “It doesn’t come overnight or easily for many people. Practicing what you want to say with someone you trust can make expressing yourself more natural over time.”

Practice mindfulness. Centering yourself in the moment can help keep the “what if” thoughts from gaining ground.

Be fair to yourself. “Leave work at the office, schedule time to have fun or just veg-out watching TV. If you’re fair to you, you’ll likely be more fair to your family, friends and coworkers.”

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“Supportive relationships and a positive attitude can make a tremendous difference in what people can accomplish.” – NANCY WENANDE

Nancy Wenande, right, enjoys time scrapbooking with her mom, Mary Albrecht.

FRIENDS AND FAMILY Busy is normal — but so too is balance. To get it, Nancy Wenande relies on her family and friends. She’s a devoted mom to three — two boys away in college and a daughter in high school.

She and her husband, Brad, have been married since 1994. Both are “type A” personalities and team up in all regards to keep things on track with their families and work duties. The family is close, but each child is independent. While they might not eat supper together often, they talk regularly and remain closely connected. Wenande spends time with her own mother,

AVERABAL ANCE. O RG / SPRING 2018

“Supportive relationships are a two-way street. It’s not about what other people do for you, but about how you can be there for each other, whether it’s personal or work-related.” – NANCY WENANDE

who also lives in Yankton. She draws strength and regroups when she spends time at home, with her family, or on outings with her close-knit group of friends. “Balance isn’t about dividing time. Some weeks are 50-60 hours of work — but it works because I communicate with my family, my teams, the boards I serve on — and I know my limits,” she said.n

Simple Outdoor Exercises By Debbie Lancto, Health and Wellness Champion, Avera Health Plans

With the amount of options in outdoor activities, the park can be your gym and walking trails your treadmill this summer.

The sun is finally shining and the grass is turning green. After our long winter, I am ready to get outdoors and get active!

My plan is to do 12 to 15 reps each exercise as one set. To not hurt myself or overdo it, I am going to start out doing one set the first time, then work up to three to four sets by the end of the summer.

HERE IS THE ROUTINE 1. Jump squats. Find an open space

and “jump around.”

2. Pull-ups. Use the monkey bars

on the jungle gym.

3. Dips. Use the parallel bars. 4. Crab walk. Try 20 yards in the grass

to stretch out your back and legs.

5. Sprint 50 yards. Just like the

50-yard dash in elementary school.

6. Monkey bars. Go across and don’t let

your feet drop to the ground (1 rep).n

Bring your kids, meet a friend or find like-minded people at the park to participate with. Let’s get outside and enjoy the warm weather!

e Chocolatwell combinerse than with moerries! strawb

Chocolate-Dipped Orange Slices Source: Hy-Vee

INGREDIENTS Melting chocolate 1 – 2 oranges, peeled and sectioned Course salt, optional DIRECTIONS 1. Melt chocolate in microwave on LOW or in a double boiler on the stove top, stirring frequently. 2. Dip each orange segment into melted chocolate and place on waxed paper. Top with salt if desired. 3. Let chocolate set and enjoy!

balance

18-AVHE-9761

HEALTHY LIVING

FULL-BODY

IMPACT

Eating to Enhance Your Microbiome By Katie Daniel

It’s common knowledge that the food we eat gives us the energy and nutrients we need to survive and thrive. But did you know that it also feeds the vast amount of bacteria that live inside your gut? Yes, you heard that correctly — the bacteria that live in your large and small intestines — also known as your gut microbiome.

Although this bacterial community is invisible to the naked eye, it has a powerful impact not only on those “gut feelings,” but also your overall health and well-being.

THAT’S BECAUSE:

70% of your immune system is located in the gut.

So when your gut isn’t healthy, your immune system isn’t able to work at full strength.

90%

of your body’s serotonin, the“feel-good hormone,” is produced in the digestive tract. So any issues within

“It all starts at birth,” describes Casey Finnicum, a graduate research assistant at the Avera Institute of Human Genetics specializing in microbiome research. “As we pass through the birth canal, we’re coated with microorganisms that our mom passes on to help colonize us with a community of microbes. Then, as we go through life, a number of different things — including our genetics, diet, activity level and the people around us — continue to influence our microbiome which then influences our health.” “We’re finding that these microorganisms really have a great impact on our health in a number of very important ways,” he says. “We’d like to take it a step further by analyzing what’s driven by environment. We hope to discover how we can help our good bacteria — and therefore our bodies and minds — flourish.”

When the microbiome is in balance, all is well. However, it’s possible for the microbiome to become imbalanced, contributing to a wide variety of symptoms that include GI distress such as constipation, gas or bloating, but also brain fog, fatigue, joint pain, nasal congestion and skin issues. Emerging research has also shown a strong connection between the state of an individual’s gut microbiome and the development of conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), obesity, anxiety, depression, chronic fatigue syndrome, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), cancer and more.

your gut will also impact your mood, energy levels and more.

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GUT-CHECK: “In functional medicine, we believe that everything stems from the gut. Our goal is to help our patients heal the gut by eliminating inflammatory foods, lowering stress and reducing exposure to environmental toxins.”

Simple Steps to Improve Your Microbiome Today So how can you improve an imbalanced microbiome? Start with your diet, advises Annie Ailts, MS, RDN, LN, IFNCP, dietitian at Avera Medical Group Functional Medicine in Sioux Falls.

How does the food we eat impact the bacteria in our gut? “Harmful bacteria in the gut feed off carbohydrates so they love Annie Ailts, RDN sugar, refined carbs and sugar-sweetened drinks,” Ailts says. “On the other hand, you can nourish the beneficial bacteria in the gut with a whole foods diet, including plenty of fiber-rich vegetables.”

- ANNIE AILTS

FRUIT AND VEGGIE SMOOTHIE Yield: 1 (16 oz) serving

1 cup raw vegetables (carrots, spinach, mixed greens, kale, cucumber, zucchini, summer squash, etc.) 1 cup water, unsweetened milk alternative, or milk ½ banana ½ cup fruit (frozen or fresh) 1 tablespoon coconut oil 2 scoops collagen powder (ex. Vital Proteins Collagen Peptides) Add all ingredients to blender and blend until smooth. Source: Annie Ailts, RDN

SALMON CAKES Yield: 6 patties

2 (6 oz) cans of wild-caught salmon, drained ¼ cup cooked and mashed sweet potato or regular potato 2 eggs 2 tablespoons coconut flour ¼ cup onion, chopped 1 clove garlic, minced 1 tablespoon lemon juice 1 tablespoon coconut aminos ½ teaspoon sea salt 1 teaspoon lemon zest (optional)

1. Preheat oven to 350 degrees F. 2. Line a baking sheet with parchment paper. 3. In a bowl, combine all ingredients with a fork. Form into 6 patties, and place on the baking sheet. 4. Bake patties until firm, about 30 minutes. Source: Annie Ailts, RDN

TO SUPPORT A HEALTHY MICROBIOME: Eat a wide variety of fruits and vegetables Enjoy fermented foods

Include

(which contain probiotics) such as yogurt with live and active cultures, sauerkraut, kombucha, kefir and kimchi

Limit processed foods in your diet

prebiotics (which feed probiotics) in your diet such as green bananas, plantains, garlic, onions, asparagus and legumes

Take a high-quality probiotic supplement

Ailts has seen many of her patients experience positive results as soon as three weeks after modifying their diet. For others it may take longer, but it’s worth the wait. “They’re often surprised by how not only their gut issues improve, but also other symptoms that they never associated with their gut,” she says. While there’s still a lot to learn about the microbiome, you can’t go wrong by feeding your body — and bacteria — with more whole, unprocessed, nutrient-rich foods.n

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ACCIDENTS YOU R O P T I O N S $

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

Our providers can handle sickness, injury and preventive services during normal business hours. Google play

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

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?

HAPPEN:

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

$$$

$$$$

Avera Urgent Care

Emergency Department

Our Urgent Care clinics are designed to treat acute illnesses evenings and weekends.

This service should be saved for the most serious and life-threatening medical conditions.

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

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

18-AVHE-9767

HEALTH TECH

New Treatment Addresses Sexual Side Effects By Kelly Thurman

Imagine having a hysterectomy in your 40s or becoming a breast cancer survivor in your late 30s only to learn that one of the side effects is pain during intercourse.

This common side effect is no longer something women have to live with thanks to a new, noninvasive treatment called the MonaLisa TouchÂŽ.

AVERABAL ANCE. O RG / SPRING 2018

“We’ve been working so hard to diagnose breast cancer earlier, but we forget about what happens to a 37-year-old mom in a great relationship who can’t maintain intimacy anymore with their whole lives ahead of them,” said Matthew A. Barker, MD, FACOG, Avera Medical Group urogynecologist in Sioux Falls. “This treatment provides something that we’ve never been able to offer before.”

MonaLisa is an in-office procedure that takes less than five minutes. Women typically need about three treatments followed by yearly maintenance treatments.

Women who had a hysterectomy or were treated for breast or uterine cancer often experience dryness or pain during intercourse. This is because estrogen, which provides lubrication and elasticity, is often depleted following hysterectomy or during cancer treatment. The MonaLisa Touch is a laser treatment that helps restore blood flow and generate new healthy vaginal tissue without using estrogen, which can increase the risk of cancer. It’s recommended when lubricants or topical treatments are not enough to restore normal sexual function.

Matthew A. Barker, MD, FACOG

“The only thing more effective is giving estrogen to the vagina, which we can’t do for cancer survivors because of the risk of cancer recurrence,” Barker said.

MonaLisa is a key component to the Sexual Medicine Program at Avera, which helps women with the emotional, physical and mental side effects of sexual dysfunction. Women’s sexual function changes throughout their life. Sexual dysfunction can not only affect intimacy with a spouse but also cause anxiety and depression. In addition to providing treatment for pain during intercourse, Barker assembled a team that provides counseling and physical therapy according to the patient’s needs. “Sexual dysfunction in women is individualized,” Barker said. “It’s not one procedure or pill. Our goal is to treat the emotional component, pelvic floor issues, anxiety issues and also the anatomical changes that can happen, which we can rectify with the laser treatment.”n SPRING 2018 / AV E R A B A L A N C E . O RG

HEALTH TECH

Finding the Right Rx

Helps Solve the Puzzle By Kelly Thurman

Clazina Blom could better benefit from her medications after taking the GeneFolio test.

Sometimes when you’re trying to find the right medication it can feel like you’re lost in a sea of possibilities. That’s how Clazina Blom felt at times while she and her doctor tried to find the best medication and dosage to treat her anxiety and depression related to an eating disorder. In 2016 Blom, a traveling nurse who lives in northwest Iowa, took the GeneFolio® test at the urging of her care team. The test gave Meredith Powell, MD, Avera Medical Group psychiatrist in Sioux Falls, a clearer guideline of what medications should work better for her. “To have some guidelines to follow was very much a relief, knowing this is what my body should respond to,” Blom said. “I hated to go through the trial and error and to have to wait three months to know if it was going to work. In the meantime I would just have to suffer through it.” GeneFolio is a blood test developed by Avera scientists that analyzes the patient’s DNA to understand how he or she will metabolize certain medications. GeneFolio analyzes multiple genes that impact medications in three main classes: pain, depression and other psychiatric disorders, and statins for cholesterol and certain types of blood thinners.

AVERABAL ANCE. O RG / SPRING 2018

The test can’t tell providers what to prescribe, but it can narrow the options to a more personal level with less trial and error. “Psychiatry is a particularly challenging field as the neurobiological origin of many of the diagnoses we treat are not fully understood, and they are also unique to the individual who is suffering,” Powell said. Anxiety and depression are complicated disorders and there’s still a lot that’s unknown about their causes and treatment. Meredith Powell, MD GeneFolio can help provide patients some reassurance about trying a new medication.

While Blom has had to contend with some other health issues that have kept her from working several months, she is feeling good and focusing on maintaining her well-being during her time off. “I’m feeling pretty good as far as I don’t feel the hopelessness,” she said. “Prior to that I was feeling so hopeless, I didn’t know how to keep going.” Powell said tests like GeneFolio will only continue to improve as more is discovered about mental health disorders and what triggers them.

“One of its primary benefits is that it gives patients a sense of control and confidence,” Powell said. “It’s something black and white that they can look to.”

More effective medications

Guided by GeneFolio, Powell was able to maximize the dosage on a medication that Blom would metabolize and tolerate well with few side effects.

“It’s exciting to think of the coming years and what more will be discovered that will help us better understand mental health disorders and how these medications will work for patients,” she said.n

Personalized treatment

Fewer side effects

“GeneFolio

offers helpful information that can potentially guide treatment choices resulting in a more successful outcome.” – MEREDITH POWELL, MD

Reduced costs

Consider GeneFolio if you*: • Take five or more medications • Are being treated for depression, ADHD or other behavioral health conditions • Need better pain control or are preparing for surgery • Take certain types of blood thinners

Inspired Medicine by Avera. Call your provider to see if this test is right for you. Offered at participating locations. Avera.org/genefolio

• Take cholesterol medication * Other medications will be added to the GeneFolio report in the future and your medication compatibility report can be updated.

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2017 Top Blog

HIGH HEELS – HOW HIGH IS TOO HIGH? Michael Zimmerman, DPM, provides expert advice to keep your feet healthy and happy. “Shoe fit is crucial, from the heel to the toes, and the thing that occurs with high-heel shoes is that people who purchase them tend to get a bad fit because they want them tight.” - Matt Zimmerman, DPM Get the full story at Avera.org/heels

Want more like this?

balance

Look to to find the latest health and wellness stories to keep you healthy.

Find: • New treatments • Tips on healthier lifestyles • Expert advice on common conditions • Success stories Get it in your inbox. Sign up for our monthly newsletter at AveraBalance.org 18-AVHE-9793

25% of your bones are found in your feet

IT’S YOUR

MOVE

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 SPRING 2018 / AV E R A B A L A N C E . O RG 18-AVHE-9763

Source: foot.com

HEALTH TECH

LUNCH HOUR VIRTUAL DOCTOR VISIT PROVIDES FAST RELIEF By Katie Daniel

“It was so fast and convenient. I didn’t have to make an appointment and still got exactly what I needed. It was awesome.” – BRENNA FURRY

Those unexpected moments when you need to see a doctor don’t always happen at the most convenient times, right? For Brenna Furry it happened when her skin started to become irritated while she was out to lunch with her husband and friends. She and her family had just moved to Sioux Falls after a military deployment, so she didn’t have a primary care physician yet. She knew she needed help quickly, but didn’t know where to find it. That is, until her friend mentioned AveraNow.

AVERABAL ANCE. O RG / SPRING 2018

Brenna Furry, left, has lunch with a friend – similar to the day when she used AveraNow.

of her skin reaction through the high-definition two-way video and photo upload capability. “The AveraNow provider diagnosed me with what we suspected — I was having a reaction to a new laundry detergent. And she prescribed me exactly what I needed. We finished our lunch and went to pick up the prescription and it was ready to go,” Furry described. “Having a primary care provider is valuable, but for this circumstance it was very handy to just open the app on my phone and have a quick consultation,” she added.

Download.

Connect.

Recover.

AveraNow providers are available 24/7 to diagnose and treat a variety of symptoms, including: • Acid reflux • Cold • Cold sores • Diarrhea • Fever • Flu • Headache • Pink eye • Rashes

HEALTH CARE IN THE PALM OF YOUR HAND The convenience and high quality care that Furry experienced are exactly what AveraNow was designed for. Her friend explained how she could see a provider right away through an AveraNow video visit for only $49. All she needed was an Internet connection and the free AveraNow app. So Furry stepped away from their lunch and into a private bathroom. After logging on to AveraNow from her smartphone, she was able to see a doctor within minutes. She was even able to show a clear picture

“Several years ago we looked at online banking and shopping and realized that health care was heading in that direction too,” says Jason Knutson, DO, an Avera Medical Group family medicine physician in Sioux Falls. “So we decided to find a way to offer health care in the palm of your hand.” “The future of this technology is fantastic,” he added. “New tools will be coming out soon that’ll give patients even more diagnostic capabilities from the comfort of their own homes.”n

• Seasonal allergies • Sinus infections • Sore throat, including strep • Urinary tract infections (for females ages 16-65) • Vomiting

$49 per visit

Download the app at Avera.org/now 12

GIVING BACK

AVERA PREP OPENS DOORS FOR INTERNATIONAL NURSING STUDENT By Katie Daniel

“To be here, I’ve come a long way.” That’s how 22-year-old Stephanie Donkor begins the story of how she came to be a nursing student at The University of South Dakota and patient care technician at Avera McKennan Hospital & University Health Center in Sioux Falls. Donkor grew up in the West African country of Ghana. At the age of 14, she moved to Qatar in the Middle East with her parents and two younger siblings. After graduating from high school, her desire to travel and become a nurse led her to USD. With the blessing and support of her parents, she made the move — on her own — to a new country and a new culture at age 19.

Preparing for a Career in Health Care An important step in Donkor’s journey was accepting an invite to the Avera PREP program during her first year at USD. Avera PREP is a unique summer experience designed to give college freshmen and sophomores who aspire to a career in health care a backstage pass into Avera’s mission and organization. During the three-day event, students meet and shadow a variety of health care providers. They also get the opportunity to meet with an Avera workforce consultant for tips on career planning and applying for jobs.

Stephanie Donkor assists a patient in her role as a patient care tech at Avera McKennan.

During the event, Donkor toured several departments on the Avera McKennan campus, including the neonatal intensive care unit (NICU) and pulmonary unit which are now the two areas she’s most interested in.

sugar, but also how to interact and be comfortable with patients. Working at Avera has given me confidence. It’s also helped me with school, especially when things that I’m doing in the short-stay unit appear on my tests.”

“It was a great opportunity to get insight into the health care field before I started nursing school. It opened my eyes to all of the different opportunities there are within nursing.”

Support Team

Donkor also learned valuable skills about applying for a job at Avera. And she didn’t wait to put that advice into practice. Later that same day, she applied for a patient care technician job in the short-stay unit at Avera McKennan. She received a job offer and now works every other weekend and picks up extra shifts when she can while attending school full time. “The Avera PREP program gave me the passion to go for it. It also gave me a foot in the door,” she said. As a patient care tech, Donkor is cultivating both relationships and skills that’ll set her up for success as a nurse. “Before becoming a patient care tech, I literally had no skills whatsoever,” she laughed. “They taught me how to do things like monitoring vital signs and blood glucose

Donkor radiates gratitude for the opportunities and support she’s received — from her parents, the Avera PREP program, her professors, mentor and Avera Heart Hospital nurse Mary Adebayo, classmates and coworkers, to name a few. “The nurses at Avera are very down-to-earth and ready to help me with my shortcomings,” she said. “They’re always there to help me when I need anything and I know I can depend on them.” For those interested in pursuing a career in nursing, Donkor offers one piece of advice: “If you enjoy helping people, go for it. You can do it. Because I can, you can do it too.”n

“I’m breaking w boundaries w in my family w because I’ll w be the first w to become w a nurse. w If I can help w someone or w even change w a life, I’m going w to do that. w It’s not easy, w but I think I w can get there.” - STEPHANIE DONKOR

To learn more about career opportunities at Avera and Avera’s Career Planning Service, visit Avera.org/careers.

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pink GIVING BACK

JUDY DAVIS

come out to celebrate the survivors and honor those who have gone before us.

Read more of Judy’s story at Avera.org/davis

How has having breast cancer impacted your life?

When were you diagnosed? I was diagnosed in 1986 with inflammatory breast cancer. Even though I had a poor prognosis at the time, I was blessed with wonderful medical professionals who helped in my recovery.

Judy Davis has attended nearly every Avera Race.

What has your journey been like since then? Since my original diagnosis, I’ve had endometrial cancer. I also have been bothered with lymphedema in both arms due to the surgical removal of lymph nodes. Radiation was also much different then. They radiated the entire chest area. As a result, three years ago I had to have my chest wall and skin replaced with skin grafts. I feel fortunate that I have had such wonderful doctors who have been able to help me over the years.

Even though I have a few limitations, I have been able to live a full and productive life. How have you been involved in the Race? When I was first diagnosed, I found that there was very little information available about breast cancer. My sister, Peggy Kirby, and the Junior League took on a project to raise awareness. That is how the Race got started 30 years ago. The Race is my special day. I love that day. It is thrilling for me to stand on the stage with Jackie and look out and see what we have accomplished. Family and friends

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Had I not been diagnosed with breast cancer, I wouldn’t have the opportunity to meet and become friends with so many wonderful people. As a middle school teacher at Patrick Henry for 40 years, I was able to help many students through difficult times when someone they loved was dealing with cancer. Talking to someone like me who was surviving and thriving made the experience a little less scary. I am proud that I was able to help in a small way with the building of the beautiful Prairie Center. It provides a calm and serene environment where people can go for treatment. I am happy that perhaps I have made a small difference in the lives of cancer patients and their families.n

Ladies Where Are They Now? Read more about these Pink Ladies’ journeys on AveraBalance.org

KAREN KAYL

Read more of Karen’s story at Avera.org/kayl

When were you diagnosed? I was diagnosed in July 2009 at age 38. During my annual appointment, it seemed like an angel nudged me to mention that I was experiencing a very subtle change in my breast. It seemed so minor, I almost didn’t mention it. I figured if there was no pain and no palpable lump, there was nothing to worry about. The odd sensation ended up being HER2-positive breast cancer. Although it was caught at stage I, receptors were moving out into my body and I was given the news no one ever thinks they will hear. Standard treatment involved a double mastectomy, chemo and Herceptin infusions. What has your journey been like since then? I have never had a recurrence of cancer; I’m doing great now. I’m healthy and living a blessed life.

How have you been involved in the Race?

the advanced treatment that Avera is able to provide for breast cancer. My own little motto that helps me keep life in balance is “I have been given life. So, I will do things to help others because I can!”

As a middle school teacher at Patrick Henry School in Sioux Falls, I had been on Judy Davis’ team for about five years before I was diagnosed. Around that time is when she retired, and so I picked How has having breast cancer up the torch and have continued impacted your life? to have a team that involves It has given me so much more staff and students. I remember perspective about the important stepping into the Avera Race things in life and not taking little Survivor Pavilion the first time. things for granted. I was given I was overcome with so many a second chance at life. I’m very emotions knowing I made it open about being a breast cancer through the worst part and I survivor to my students and was into the next phase of my others. I’ve learned that every survivorship. So, I am blessed to birthday is a gift, so I’m never give back to others having to go shy about telling others my age!n through cancer to help them feel extra welcome Karen Kayl (wearing pink) is surrounded by her team from Patrick Henry. on the day of the Race. It’s just so empowering to see people banding together in support of breast cancer. I’m here today because of

KRISTIE SCHRECK Read more of Kristie’s story at Avera.org/schreck

Kristie with her husband, Phil, who runs on Kristie’s team at the annual Race.

When were you diagnosed? I was diagnosed in 2007 at age 40.

What has your journey been like since then? Compared to other people, my journey has been smooth sailing, although it seems like a lot happened in the first two years after I was diagnosed and had my initial surgery. I found out through a genetic test that my body didn’t metabolize Tamoxifen. My cancer was estrogen driven and Tamoxifen blocks estrogen, so I was at risk to develop other cancers. An alternate drug resulted in too many side effects. So I had a total hysterectomy to prevent future estrogen-driven cancers. Last Mother’s Day was 10 years since I was diagnosed with breast cancer, and realizing that was such a good feeling — wow, I made it!

For women who are newly diagnosed, whatever you are feeling is normal for you.

My husband, Phil, ran in the Race for the first time the day after I was diagnosed.

But before you know it, an hour has gone by or a day has gone by without it consuming every moment.n feeling that day. When I was first diagnosed one of the things that helped me was seeing women 10 to 15 years after diagnosis. It gave me so much hope. I hope that I give that sense of hope to someone else now.

Jean Snyders, left, is pictured at the Race with her friend, Karri Stearns.

I was diagnosed in 2000 at age 42.

Seventeen years later I now have a yearly mammogram and I’ve had no recurrence. It’s always in the back of my mind when I go in for a screening but it gets better over time.

It’s helped my whole family grow stronger, learn to be sensitive to the needs of others, and show kindness.

How have you been involved in the Race?

Read more of Jean’s story at Avera.org/snyders

What has your journey been like since then?

How has having breast cancer impacted your life?

I remember being in that place and not being able to think beyond the moment.

JEAN SNYDERS When were you diagnosed?

Since then, every year, my team of HOPE (Helping Others through Prayer and Example) has been faithfully running. I help with planning logistics and the survivorship tent. It’s a sisterhood and being involved in the Race has opened my eyes to the need to be a place of belonging for all kinds of cancer.

How have you been involved in the Race? I volunteered before my diagnosis but after I finished treatment I wanted a bigger role. I started helping organize volunteers and that turned into being the volunteer coordinator for the last several years. It’s an overwhelming

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How has having breast cancer impacted your life? It taught me I had strength. If you had told me shortly after going through a divorce that God would put cancer on me and I’d have the strength to get through it, I would have thought it was impossible. It teaches you when life gets tough the tough get going. It also helped me realize the support I had from friends and family. I don’t think I cooked a meal for six months!n

2017 Top Blog

DEBUNKING THE MYTHS OF BREAST CANCER Our breast cancer experts are a trusted source for information and tips regarding cancer and treatment, including setting the record straight on common myths. Only 5 – 10 percent of breast cancer cases result from a hereditary gene. Get the full list at

Avera.org/debunking-myths

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balance

Look to for the latest information on cancer care and treatment.

Find: • New technology and treatment methods • Tips on symptom management • Cancer screening and prevention tips • Survivor stories Get it in your inbox. Sign up for our monthly newsletter at AveraBalance.org 18-AVHE-9791

GIVING BACK

A Healing

TOUCH for Premature Babies By Katie Daniel

Judy Ashton was recently recognized as a Volunteer of the Month at Avera McKennan for her compassion, care and dedication to the Avera NICU Rock-A-Baby program.

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“After retiring in 2009, God gave me an amazing opportunity to start baby-rocking,” recalls Judy Ashton, a Rock-A-Baby volunteer at Avera McKennan Hospital & University Center’s Level IIIB Neonatal Intensive Care Unit (NICU). “It’s a real privilege to get to be the arms of Jesus for these babies when their parents aren’t able to be here.”

But for her, it’s not just about rocking premature babies. “When I hold babies I also pray for them. I ask God to finish knitting them together and making them whole and healthy. I pray that they’ll be a real blessing to their families. Then I just talk to them. And some of them will smile, even while they’re sleeping.” - JUDY ASHTON

Healing Touch Volunteers also provide a special, healing touch by holding babies while they’re being fed. Oftentimes, premature babies associate eating with being poked or prodded with feeding tubes and wires. “Adding human touch during feedings helps the babies build positive associations with eating,” says Riley. “This is very important for their growth and development.” Kayla Konrady — the mother of Arya who was in the NICU after being born at 25 weeks and weighing only 1 pound 15 ounces — is thankful for how the nurses and volunteers helped her daughter grow to a healthy weight. “Feeding was a rollercoaster for a while, but if she was held while eating it became a positive thing for her. It’s awesome that (volunteers) could love on her, too. It helps a lot.” Grateful Hearts Riley notices a similar gratitude among many NICU families. “Most parents aren’t able to be here full time, so they have a sense of relief knowing that someone is holding their baby when they can’t be here. And if babies are too small or fragile to be held, they still benefit from having a volunteer talk, read or sing to them.”

According to Avera NICU Operations Manager, Angela Riley, NP, talking is one of the most important things a NICU Rock-A-Baby volunteer can do, in addition to providing the comfort of human touch.

Ashton relates to the feelings that many NICU parents may experience. After the birth of her second child, a daughter, she wasn’t able to hold her for nine days due to a medical complication. “That’s why I’m excited and thankful that they have this program,” she says. “I think it’s really helpful to the parents whatever their situation.”

The new NICU rooms at Avera McKennan provide a quiet, healing environment. However, that quietness can also have a drawback. “Research has shown that language development is slower for patients in single patient rooms like ours. So we really encourage our volunteers to talk, read and sing to the babies. We don’t even care if they’re in tune,” she laughs.

“It’s a real privilege for me to be able to snuggle these babies and give some love to them,” she adds. “And it’s amazing to see how much they improve. Like when they no longer need breathing or feeding tubes anymore and you can see their whole face and their smiles. It’s very rewarding and a real blessing.”n

Comforting Voice

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ONE IN THREE PEOPLE DIE OF HEART DISEASE. A

cardiac and vascular screening

will help you understand your risks and how to manage them. Your heart has a lot to beat for.

Take care of your heart, so you can love longer.

Find a location near you and schedule today. Just $75 could save your life. Avera.org/heart | 1-877-AT-AVERA 18-AVHE-9764

Don’t Give Cancer the Upper Hand Avera.org/cancer Regular screenings can find cancer in the earliest stages before symptoms occur and when it’s easiest to treat. Talk with your provider about the need for screenings, which can vary by age and family history.

CERVICAL CANCER

• Ages 21-30, Pap every 3 years • Ages 30-65, Pap plus an HPV testing every 5 years • Stop at age 65 if you had 10 years of normal Paps*

BREAST CANCER

• Yearly mammogram • Consult with your provider; he or she will help you determine a screening schedule that is best for you

PROSTATE CANCER Discuss need for screening with provider. For men who decide to proceed:

LUNG CANCER Certain patients are candidates for low-dose CT screening of the chest, which can find lung cancer in its earliest stages.

Women Men Men and Women

20 years old 18-AVHE-9768

COLORECTAL CANCER 30

PSA screening with or without digital rectal exam

If you are age 55-77 years old and have at least a 30-pack-year smoking history, currently smoke, or have quit within the past 15 years

Colonoscopy recommended every 10 years. Beyond age 75, discuss the risks and benefits of testing with your provider

These guidelines are recommended by Avera Medical Group. *Certain medical conditions may require you to be screened on a different screening schedule. Consult with your provider to discuss.

LET’S GET

REAL

SPECIALIZED CARE FOR EVERY WOMAN Women sometimes pee their pants while sneezing and battle bloating and irregularity. Life is full of ups and downs with a lot of ordinary days in between. From preventive care to health concerns, you should be able to get real with your provider. Avera Medical Group women’s providers take the time to listen to your needs and discuss real solutions for every situation. • Women’s well checks and mammography • Nutrition and wellness oversight • Stress management • Management of chronic conditions • Personalized care for you

We offer these services through a variety of women’s health specialists. Get to know our providers and learn more at Avera.org/getreal

18-AVHE-10341