HealthWatch Magazine - Fall 2013 by Brainerd Dispatch and Echo Journal

Table of

Contents Who We Are

More to childhood than meets the eye . . . . . . . . . . . . . . .

Lakewood Health System Publisher • Tim Bogenschutz Advertising • Susie Alters and Phil Siebel Editor • Sarah Nelson Katzenberger

A new version of Nikki . . . . . . . . . . . . . . . . . . . . . . . Nisswa woman sheds 272 pounds and counting

By Jessica Larsen

Cover Design • Jan Finger Contributing writers Jenny Holmes, Sheila Helmberger, Jessica Larsen and Jodie Tweed

HealthWatch is a quarterly publication of the Brainerd Dispatch.

A lifetime of investment . . . . . . . . . . . . . . . . . . . . . From infant to adult — the cost of raising kids

By Sheila Helmberger

Bonded together . . . . . . . . . . . . . . . . . . . . . . . . . Cousins, born six months apart, share a deeper bond through kidney donation

Treading new waters . . . . . . . . . . . . . . . . . . . . . . . .

Email your comments to sarah.nelsonkatzenberger@ brainerddispatch.com or write to: Sarah Nelson Katzenberger Brainerd Dispatch P.O. Box 974 Brainerd, MN 56401

Water birth option comes to CRMC birthing center

Why women are opting to masectomy in breast cancer prevention

By Jenny Holmes

Life after breast cancer . . . . . . . . . . . . . . . . . . .

Essentia Health-St. Joseph’s Medical Center

Seeing clearly . . . . . . . . . . . . . . . . . . . . . . . . . . Sight machine gives clarity to area residents

By Sarah Nelson Katzenberger

Media buzz brings prevention into spotlight . . . . . . . . . . . .

Rehabilitation provides positve recovery for survivors

By Jodie Tweed

Read Healthwatch online at www.brainerddispatch.com

For advertising opportunities call Susie Alters at 218-855-5836.

By Jessica Larsen

On the cover Dr. Monica Goodwin discussed the new water birth option at Cuyuna Regional Medical Center’s birthing center. Steve Kohls • steve.kohls@brainerddispatch.com

LAKEWOOD HEALTH SYSTEMS

More to childhood healthcare

than meets the eye O

ften times the things we don’t see are the ones we forget about until they become part of a problem, or something that needs fixing. In many cases, it’s the preventative measures that can mean the difference between what we see, and that of which we lose sight.

The goal for patient care at Lakewood Health System is not only to treat current problems, but to become more proactive in preventing them from happening. This is especially true when caring for children, which is why Lakewood provides a variety of services and programs like FASD diagnostics, immunizations and well-child check-ups, Let’s Go 5-21-0, a pediatrician and play therapies which specifically focused on preventing and treating those things w e don’t always see. These preventive measures often start before a child is even born. Fetal Alcohol Spectrum Disorder (FASD) is a series of traits which occur in someone whose mother consumed alcohol during pregnancy. These effects can range from mental, including learning disabilities, to behavioral and physical, and the potential implications could have a lifelong impact. The sad, but true fact is that even though this disorder is 100% preventable, 1 in every 100 babies is affected by FASD. Some signs and symptoms to look for if FASD is suspected are low birth weight and impaired growth in babies, as well as facial malformations, hyperactivity and a short attention span, poor motor skills and difficulty with social boundaries as the individual matures. While FASD and its effects cannot be cured, there are ways to ensure those living with FASD lead happy, full lives. The FASD program at Lakewood provides diagnostic testing and assessment, prevention information, strategies for working with individuals with FASD, and follow-up assistance for those with FASD

and their families. Headed by FASD Coordinator Kelly Riepe, the specially trained staff is dedicated to the management of living a life with FASD, but even more importantly, the education of FASD prevention. Preventative healthcare becomes more of a team effort once a baby is born. This team is made up of a child’s family, and their medical provider, who offer well-child check-ups, which are routine appointments to keep up with the immunizations and growth developments of children from birth to adolescence. With the rate at which children grow and develop, it’s important to keep their vaccinations up-to-date, from the day they’re born, on through adulthood. The type of vaccination and the dosage amount a child needs is dependent on their age. Children from birth until the age of 12 need certain vaccinations to prevent disease like polio, diphtheria and hepatitis. Infections, such as meningitis and pneumonia can also be prevented with vaccinations. Vaccinations are important because little by little we are able to wipe out diseases like small pox, and perhaps one day, polio and diphtheria, by continuing to vaccinate. With these diseases becoming increasingly rare, and the inclination to discontinue vaccinations becoming more prominent, it’s important to remember the strides we’ve made in eliminating, or decreasing, the prominence of these diseases could be eradicated just as quickly. Vaccinations are one of many things a family practice physician, physician extender or pediatrician provides for their patients. Contrary to popular belief, pediatricians don’t only care for babies and toddlers, but also adolescents and children up to the age of 18. They care for their patients when they’re ill with common, chronic or life-threatening sickness or injury, as well as providing advice on healthy lifestyles, and preventing illness and injury. Caring for children with physical illness, as well as behavioral difficulties, developmental disorders and depression and anxiety disorders are also a large part See CHILDHOOD, Page 6A

CHILDHOOD, From Page 4A

of a pediatrician’s specialty. Chil-

“Pediatricians aren’t only concerned with the immediate health and wellness of their patient, but also their long-term health goals and future quality of life.” dren often have different symptoms than adults, or need different treat treatments, and pediatricians are trained to understand the spespe cialized care this requires. Pediatricians aren’t only concerned with the immedi immediate health and wellness of their patient, but also their long-term health goals and future quality of life. This may include the early detec detection of certain disorders, disabilities or other health issues which may affect them later in life. Lakewood’s pediatri pediatrician, Dr. Neil Bratney, works closely with his patients and their families, as well as other medical providers, to ensure his patient receives the best care possible. For almost two years, one part of this care has included the Let’s Go 5-2-1-0 program which is a national initiative that promotes healthy lifestyle choices for children, youth and families. 5-2-1-0 is an abbreviated form of the program’s main mes message, which is that every child should eat 5 or more servings of fruit and vegetables, spend less than 2 hours in front of TV, computer and hand-held device screens, get at least 1 hour or more of physical activity a day, and consume 0 sug sugary drinks each day. The messages and ideas behind this program are being incorporated into well-child check-ups, as well as various other programs through throughout the system. Under the guidance of Lakewood’s registered dietitians, and with the help of children-fo children-focused events, educational materials and newsletters specifically designed for children ages 2 to 12, the 5-2-10 program aims to build a happier, healthier community. The goal is to encourage and teach healthy living habits in children and their families from a young age, so they carry them throughout their lifetime. Sometimes it’s not so much a

child’s physical habits and traits we notice, as it is what’s in their mind. When it comes to the mind of a child, there is a lot we cannot see or understand. For this reason, Lakewood psychotherapists Corrie Brown, MA, LPCC, LMFT and Luann Gammon, LICSW use play therapy techniques when seeing patients who are 10 years of age or under, and occasionally with teens and adults, depending on the need. Play therapy is a technique used to prevent or help psychosocial difficulties children may be having, so they can continue to grow and develop to their full potential. Developmentally speaking, children often find it difficult to communicate their thoughts, feelings and experiences in words, so by using toys, art and other child-focused objects, it provides a way to share and express themselves. Filial therapy is a technique that can help children by teaching parents simple child-centered play therapy principles and methods to use with their own children. Brown and Gammon have also found this technique to be very useful when working with parents and families with children who may have trouble expressing themselves. Being able to express their thoughts and feelings is extremely important in a child’s development, so being able to help, or better yet, prevent it from becoming an issue, is equally important. Generally speaking, when we think of healthcare, we think about needing to solve a problem or fix something that’s broken. The idea behind preventative healthcare is to become less reactive, and more proactive. With these child-focused programs and services available at Lakewood, it is possible to instill this thinking in children and their families at a young age, so the idea continues throughout their lifetime. And perhaps this thinking will make it easier to focus on the things we can see, instead of the things we can’t.

A new version of Nikki By JESSICA LARSEN Contributing Writer

Nisswa woman sheds 272 pounds — and counting

ikki O’Day squeezed into the tight airplane seat, a safety belt extension across her lap, unbuckled.

It was 1997 and at 437 pounds, not even the extension gave enough room to buckle in. A stewardess noticed. “If you gain any more weight, you’re going to need two tickets,” O’Day mimicked the stewardess in a shrill tone. That was O’Day’s most horrifying, embarrassing moment. “That’s when it hit me,” she said. “I had issues.” O’Day had always been heavy growing up, but mix in a high stress load with her now ex-husband, and O’Day was eating her worries away. She’d experienced all the classic signs of being overweight: bladder and kidney infections and knee pain. So she decided to change. Today she sits at her lowest weight since she was a high school freshman. And O’Day says she did it all through eating healthy and exercising. It wouldn’t be a quick battle, though. It would take years. The first 80 pounds was easy for O’Day. They practically “fell off” as she worked in her parents’ diner that summer. She stayed at a consistent 290 pounds until about eight years ago when another embarrassing wake-up call shook the Nisswa resident. O’Day was just hired at a restaurant and the management had to special order a size XXL shirt for her. Again embarrassed, O’Day set out to lose. She cut back portion sizes. Instead of eating until her plate was clear, O’Day set aside half the food for lunch the next day. After a while, she cut the portion size in

half again. The types of food changed, too. She started munching on fruits and vegetables instead of chips and salty snacks. A big helping hand came a few years ago when she and her husband, Chris, started A Maze N Pumpkinz, a pumpkin farm and maze attraction on their property. Planting, weeding and watering the crops proved better exercise than any workout video. “It was dripping off, melting away,” O’Day said of the excess pounds. “It was a miracle.” For O’Day the scale not tips 165 pounds — 10 pounds lighter than her dream weight — and a confidence level at an all-time high. “I’m a healthy girl finally,” she said, a smile across her face. O’Day added, “My God, I enjoy being a size 10.” Now O’Day finally fits in the pair of pants she bought 15 years ago, hoping to one day be small enough to get into. She’s also cooked up a new weight loss goal of 150 pounds to work toward.

Nikki O’Day is pictured at 280 pounds in 2010.

Chris says he sees a change in his wife as she shrinks in size. She’s more energetic, more confident in herself. “Now I’m the one who is dragging sometimes,” he said. There are always excuses to put off losing weight, O’Day says. “We think we’re so busy in life that we don’t have time to exercise,” she said. Everyone has the time, she said.

• Submitted photo

Simply put: just keep moving. Walk to the mailbox taking exaggerated high steps. Lift weights while using the bathroom and do more arm push ups after finished. “You have to not care what people think if you want to get skinny,” she said. There are plenty of misconceptions to get past, as well. “People perceive you different when you’re fat,” she said. “They

Steve Kohls • steve.kohls@brainerddispatch.com

Nikki O’Day describes how she lost 272 pounds by eating healthy and exercising. At her heaviest, O’Day weighed 437 pounds. Today, the scale hits 165.

think you’re lazy.” Another, O’Day said, is that to lose weight, you’ll have to starve yourself. Instead, she offers this advice: eat until you are truly full. If you do eat too much, then “get off your butt and walk.” Also, eat what you want, just make sure it’s healthy. O’Day’s favorites ware watermelon, salad and cottage cheese.

In the end, the choice to shed the pounds came down to wanting to be there for her husband and five kids. “These kids deserve a mom who will be alive for them someday,” she said. JESSICA LARSEN may be reached at jessica. larsen@brainerddispatch.com or 855-5859. Follow me on Twitter at www.twitter.com/brainerdnews.

By SHEILA HELMBERGER Contributing Writer

A lifetime investment From infant to adult – the cost of kids

t’s a wonderful spot to be in … expecting a new baby.

You joke with friends about the bonus deduction you’ll get on your taxes and you’ve already picked up a cute new crib, a few baby bottles and some diapers so you feel like you’re ahead of the game.

Sure, you know this baby means that down the road you’ll be buying several dozen pairs of shoes, a yearly backpack loaded with new school supplies, and probably some sports equipment for your fu future superstar and a couple of musical in instruments. Then somesome day there will be drivdriv ers’ education classes and those dreaded calls to your insurance agent. Is it starting to feel overwhelming yet? Luckily, we approach child-raising with our hearts and don’t dwell on the overall toll it will take on our pocketbooks. From generation to generation the cost of having and raising a child changes drastically. Since 1960 the United States Department of Agriculture (USDA) has been releasing figures on what it costs to raise a child through age 18. The latest numbers, although they fluctuate by geographic area and income level, put the grand total of raising a child today at over $240,000. The tally includes things like clothing, health care, housing, childcare, education through

high school and food but doesn’t even include the cost of a college education. With numbers that are that hefty – how do parents do it? Cutting corners Most initial baby supplies only have to be purchased once and are reused as a family grows so that means some savings on additional children. Couples know when they start their family to expect compromise and trade-offs. The things that seemed important before might not seem as important once a baby comes along. There might be an upgrade to a bigger home in a safer neighborhood for instance, over the new boat the couple was eyeing up earlier. It might also mean trading the smaller sensible car you drove as a couple in for the infamous minivan or SUV to accommodate car seats, strollers and other baby gear. Although some of the costs of raising our children are out of our control, like groceries, and gas, parents are pretty good at controlling the costs that we can. Some couples are able to start saving and investing when they get married right away for their future family. Others save money by accepting hand me downs from friends and relatives and shopping for children’s clothing from second hand stores, garage sales, and discount stores. Clothing makes up about six percent of the cost of raising a child. Parents can use the internet to their advantage to shop for deals on everything from clothing, outerwear, weekend getaways and family vacations. Coupons can be a parent’s best friend and having a garden means saving a few dollars in the checkout line of the grocery store. So how do experts come up with an almost $250,000 price tag for raising our kids? Daycare and preschool costs make up a good chunk of the expense for younger children. The USDA

Luckily, we approach child-raising with our hearts and don’t dwell on the overall toll it will take on our pocketbooks. says child care and education make up 18 percent. Deciding on a place for your children when they can’t be with you is one of the most important decisions parents must make and shopping for a good daycare and preschool means weighing the fees a facility charges against the programs and activities they are able to offer. Groceries make up 16 percent of the cost of child rearing. From a gallon of milk to a box of cereal most people are shaking their heads as they walk out the doors of the local grocer these days. And the price at the gas pump continues to hit the pocketbooks of consumers in a big way too so taking our children all of the places that they need to go means more money at the pump. Health care and dental costs continue to rise. Each year changes are announced to co-pays and coverage that affect everything from the initial cost of labor and delivery to a child’s stitches, minor sur-

geries, broken bones, check-ups, braces and other surprises. Besides school, participation in extra-curricular activities can be costly too as organized youth sports start earlier than ever and continue on through graduation. Sometimes to save money parents with multiple children let them try different things while they are young and then ask their kids to choose activities that they want to continue carefully as they get older and the fees go up, maybe limiting each child to the one extra-curricular activity they enjoy the most. Electronics is a relatively new cost parents have today that they didn’t have in the 1960’s. Computers, smartphones with calling plans, video games and other gadgets can add up to big money for parents starting already in elementary school. The older they get the faster the expenses mount, too. Feeding a 15-year-old boy is a lot

different than feeding a fifteen-month-old boy. And some day the car he is pushing around the living room on his knees will be replaced by a life sized one parked in the driveway next to yours. Even though the USDA doesn’t include the cost in their figures, what about those college expenses? Each family has to come up with their own arrangement to meet the expenses and the cost of tuition with room and board at a state university can typically mean about $17,000 and private colleges can come closer to $40,000. Securing grants and scholarships to help curb expenses is more important than ever. Maybe having kids is a little costly. The numbers might surprise you but it’s a pretty good investment. The dollars of raising a child might be in the $200,000 range but the experience is still priceless.

By JODIE TWEED Contributing Writer

Bonded together Cousins, born six months apart, share a deeper bond through kidney donation

EQUOT LAKES – Liz Mackenthun was working at Lakes Area Neurology in Brainerd back in 2009 when a patient file with a familiar name slid across her desk.

It was her cousin Paul Wgeishofski’s medical file, containing the results of his recent kidney biopsy. The diagnosis: Renal cancer. Liz was devastated. She and Paul were the same age. The pair had only seen each other a couple of times since they graduated from Pequot Lakes High School in 1985, but they had grown up together. “It was very much a shock,” Liz recalled. “I told everyone, ‘This is my cousin. Treat him right.’” Their mothers were sisters, and so naturally they shared many of the same childhood memories. They were born six months apart – Liz is the oldest – and they had been classmates from kindergarten through their senior year of high school when their lives led them in separate directions as adults. Doctors had been monitoring Paul’s high blood pressure for seven years before he was diagnosed with IgA nephropathy, a disease that causes kidney failure. In January 2010, doctors removed about 15-20 percent of Paul’s right kidney due to cancer. They were continuing to monitor

a spot on his left kidney, but this kidney had to be removed in November 2012 because the cancer had returned. Paul thought he’d only be on dialysis three times a week for about six weeks, but he ended up on full dialysis for 10 months. His son’s mother-in-law had offered to donate one of her kidneys to Paul, a surgery they thought would take place within two months. Unfortunately, she ended up not meeting the criteria for a good match, and Paul was placed on a waiting list for a cadaver donor. While his wife, Tonya, and all three of Paul’s adult children, Ashley, 24; Nathan, 22; and Matthew, 20, would have given him one of their kidneys in a heartbeat, none were a match. They also have three granddaughters and another due in November. He had a lot to live for. Last April, Paul’s daughter Ashley posted a Facebook status asking that anyone who has O-positive blood consider being a kidney donor for her dad. Paul’s health had deteriorated significantly. He was still putting in 55-60 hours a week at his sales job at Pan O’ Gold in Brainerd, but would collapse in his chair each night he got home. A benefit was planned in May at the Pe-

quot Lakes American Legion to help pay the family’s medical expenses. Liz knew immediately what she needed to do when she saw Ashley’s post. Now living and work-

Paul Wgeishofski, Pequot Lakes, and Liz Mackenthun, Little Falls, share more than a bond as first cousins. In July Mackenthun donated her left kidney to Wgeishofski, who is doing remarkably well following the transplant.

ing as a nurse in Little Falls, Liz spoke to her boyfriend, Brian Duncan, and her sons, Josh, 19, and Justin, 17, first about becoming Paul’s donor. They all gave her their blessing. Not only was Liz O-positive, thanks to her late mother, Cathy Schmidt, who passed away when Liz was a child in 1979, but she was a perfect match for Paul, whose own mother, Carole Wgeishofski, passed away in 2012. “The sisters in heaven have a lot to do with this,” Tonya, Paul’s wife, said with a smile. The cousins announced the plans for the transplant at the May benefit for Paul. Tonya said when Liz came forward and offered to donate a kidney to her husband; it gave him hope that there would be an end to his health struggles. While there was a minor glitch and delay when a tiny kidney stone was found in Liz’s kidney, it wasn’t enough of a problem to call off the transplant. “I told Tonya, ‘Bottom line, I don’t want Paul to die. Don’t worry, I’m not going to back out. I was in it to the end with Paul and they were going to have to tell me no if I wasn’t going to donate,’” Liz said. The night before the transplant, Liz said she slept well, knowing that she was doing the right thing. Tonya, their three children and each of their spouses gave him letters they wrote to him, telling him that he was their hero. On July 9, doctors removed Liz’s healthy left kidney and implanted it into Paul’s abdomen. The waiting room at Hennepin County Medical Center in Minneapolis was packed with 18 family members between them. Doctors were amazed at how well Paul’s body im-

mediately responded to the new kidney. His skin and lips were pink again. Tonya said she felt that if Paul hadn’t had the transplant this summer, he probably wouldn’t have made it. His health had deteriorated so significantly. Liz, she said, gave him a new beginning. “She was always saying it was no big deal, but it was a huge deal,” Tonya said of Liz, as they reunited in late August to share their story at the Wgeishofski’s rural Pequot Lakes home. “He went from looking like death to having color and looking like life again. He had a smile and color in his face. You can’t put into words what it’s like to watch your loved one and not knowing if he was going to make it. I wasn’t sure he was going to make it by the end of summer.” “I didn’t realize I was so sick,” said Paul. “When you don’t feel good, you don’t eat and I just didn’t eat.” Kidney transplants are often harder on the donor than the recipient. Liz spent three days in the hospital and took four weeks off from her job as a licensed practical nurse at Family Medical Center in Little Falls to recover. Paul was hospitalized for five days and then needed to remain in the Twin Cities for two months in order to be closely monitored. Paul’s health has rebounded. He and Tonya are walking three to five miles a day and he’s slowly regaining weight. He was taking 48 pills a day after surgery and is now down to about 30 pills a day. He is gaining energy every day. Both 46, Paul and Liz have grown closer since the

transplant. Paul calls her his angel. They plan to spend more time together in the future, especially by cel celebrating their “transplantiversary” together every July 9 from now on. “I miss my kidney so I have to come visit it every once and awhile,” Liz joked. “She’s so humble but she doesn’t realize how amazing she actually is,” added Tonya. “You gave him life.” JODIE TWEED lives in Pequot Lakes with her husband and three daughters. A former longtime Brainerd Dispatch reporter, she now writes features for several regional publications and stories and blog posts for clients throughout the country.

By SARAH NELSON KATZENBERGER Health Watch Editor

Treading new waters Water birth option comes to CRMC birthing center C

ROSBY — Anyone who has ever had a baby knows, you never forget the moment the little human you’ve been carrying around inside you for 9 long months makes its official debut into the world.

“Whether it’s beautiful or not, you remember it,” said Dr. Monica Goodwin, who specializes in family medicine and obstetrics at Cuyuna Regional Medical Center (CRMC). Childbirth is a unique element of health care because it doesn’t involve sick people needing care, it’s made of individuals who are in need of support in one of the

Steve Kohls • steve.kohls@ brainerddispatch.com

Dr. Monica Goodwin discussed water birth at the birthing center at Cuyuna Regional Medical Center. The Crosby hospital became certified to offer water birth in June.

most life-changing moments they’ll ever experience. So, when CRMC held patient focus groups to better understand what their patients were looking for in their health care, one topic that continued to surface was offering water birth as an option for labor and delivery. Goodwin said the answer seemed pretty simple — let’s give women what they want. On June 1, CRMC was officially certified to offer water birth as an option for laboring mothers who meet the necessary criteria. “It’s something where we have the ability to respond and help women have the delivery they desire,” Goodwin said. “They’re asking for support on this — we want to be able to give that to them.” Water birth is not much different than a normal birth, Goodwin said. “Water in general shortens labors,” she explained. “It relaxes women and the process of dilating seems to speed up a bit.” Reports have shown that women who have opted for water birth experience less pain, shorter labor process, decreased need for pain medicine and decreased bleeding and lacerations. The process is exactly what it sounds like it is — instead of laboring and delivering their baby in a hospital bed, women have the option to deliver in the waters of a small inflatable pool. “It’s sort of like a backyard inflatable tub,” Goodwin said. The pool is inflated and filled in the delivery room and water maintained at 35-37 degrees Celsius. Normal body temperature is around 37 degrees Celsius. The water is hosed into the pool before the mother gets in and is refreshed as needed. Goodwin said the biggest differences with a water birth have to do with the equipment used to monitor maternal and fetal activity. With most normal births, fetal monitoring is intermittent, with 15 minutes of every hour monitored. In the tub, a waterproof thermometer is used to gauge temperature and a waterproof Doppler is used to monitor the baby. Once the baby arrives, the care given is the same as with a normal delivery. Goodwin said the idea of water birth is not new to CRMC. For the last few years, she has received requests and inquiries from patients who desired water birth for their delivery. Plus, the hospital’s birthing center has had its share of surprise, precipitous (fast) deliveries that have occurred in the bathtub.

“They’re actually really beautiful births,” Goodwin said. “It got me wondering why don’t we offer water birth in a way that is actually approved?” The certification process for water birth required CRMC providers to watch a recorded water birth, read articles on the benefits and risks of the process, as well as understand the rules of exclusion. And they had to take an exam. “The biggest obstacle is getting staff comfortable with the idea that they are going to get wet,” she said. “It’s kind of the mess of it that people are a little more uncomfortable with — the delivery itself is not really any different.” Goodwin said there was some initial resistance from CRMC providers, but confidence in the service came when an OB nurse from Abbott Northwest Hospital in Minneapolis, visited CRMC to share about Abbott’s water birth services. “That was the turning point,” she said. “It really got us to say, ‘We can do this. This is safe.’ It’s not just something that only people in the sticks or home deliveries can offer.“ In addition to Goodwin OB providers, Drs. Rachel Cady and Leigh Bauer have also completed certification for water birth along with the entire OB nursing staff. Bauer said the east coast medical program she trained in did not offer water birth, and that the concept has not yet gained the popularity on the East Coast that it has in the Midwest. “This is new to me as a practitioner,” she said, adding that water birth seems like a logical step in expanding the OB program at CRMC to meet the needs of patients. “I’m excited that we can now offer this to patients and help them create the birth experience they are looking for.” Popularity in the Midwest is growing. Goodwin said providers at Abbott who offer water birth have been surprised at how fast their branch has grown. Requests started with midwives and later moved to OB providers. “They saw how many patients where flocking this direction,” she said, adding that soon sub-specialist groups MORE ABOUT WATER BIRTH Water birth is a fairly common practice in many European countries, as well as Australia and New Zealand and has made its way into U.S. hospitals and birthing centers in the last several years. During labor, water immersion decreases the need for pain medication. When delivery takes place underwater, there may be less trauma. In addition, mothers might like the idea of the baby

were asking how they could get involved. “It’s starting from women who support more of a natural approach and moving with some resistance into more specialists wanting to get involved.” Goodwin pointed out that water birth is not for everybody. “Some people are not at all attracted to it,” she said. “It’s not ever meant to be something that we would encourage — it’s more available upon request.” But even if it’s requested not everyone meets the criteria required for water birth. Criteria required included: - An uncomplicated single gestation that has reached at least 37 weeks (considered full-term). - Established active labor with regular moderate contractions. - Normal maternal vital signs. - Fetal monitoring that shows adequate fetal oxygenation. - Patient must be physically able to get in and out of the tub. - Absence of infection (HIV, Hepatitis B). In addition to required criteria, CRMC has a list of exclusions that would rule out additional patients. Some exclusions include multiple gestation, Group-B strep positive, excessive bleeding, maternal temperature, maternal weight more than 250 pounds, presence of pre-eclampsia, need for analgesia (epidural), and alcohol or drug use during pregnancy (see MORE ABOUT WATER BIRTH BOX for full list of CRMC exclusions). There are not many high-quality studies on water birth to weigh the risks associated, but some fringe reports show rare but serious complications could be associated, including brain injury from lack of oxygen and infection from contaminated water. Goodwin said she refutes both. “All births have associated risks for disrupted oxygenation,” she said. “But being in the water should not increase any of those risks.” Goodwin explained that concern regarding a baby breathing water in is unfounded because a baby’s lungs aren’t triggered to breathe until they reach the air. Babies receive oxygen through the umbilical cord until the moving from the fluid environment of the amniotic sac to the warm water of the birthing tub.

Criteria required for water birth at CRMC: • An uncomplicated single gestation that has reached at least 37 weeks (considered full-term). • Established active labor with regular moderate contractions. • Normal maternal vital signs. • Fetal monitoring that shows adequate fetal oxygenation. • Patient must be physically able to get in and out of the tub.

cord is cut. Goodwin pointed out that the cord is not cut until the baby is removed from the water. Other concerns regarding contamination are fairly simple to dismiss considering the nature of childbirth. “It’s not like a deliv-ery is a sterile event,” Goodwin said. “Being in the water doesn’t make it any less sterile.” To date, CRMC has yet to con-duct a live water birth. Several patients have requested it, but did not meet criteria or fell under other exclusions. Some even got in the tub and later changed their mind. But Goodwin said she’s OK with that. The idea is to have the option available for those who want it. “It’s not about how many we do but rather about meeting the needs and desires of our pa-tients,” she said. “For those who meet the criteria and desire the opportunity for a water birth, we are happy to now have this ser-vice available — it is our desire at CRMC to make the birthing ex-perience the best possible.” Bauer said she hopes for in-cluding water birth as an option at CRMC will help new parents make the decision of where they will deliver their baby. “Helping people create their birth story is an important part of our jobs as obstetricians,” Bauer said. “At the same time, we are creating an environment for a healthy delivery and healthy mom.”

Dr. Monica Goodwin

Dr. Leigh Bauer

SARAH NELSON KATZENBERGER may be reached at sarah.nelsonkatzenberger@ brainerddispatch.com or 855-5879.

• Absence of infection (HIV, Hepatitis B) indicated in lab tests. No currennt untreated skin, vaginal or urinary infection present. Exclusions from water birth: • Multiple gestation. • Meconium fluid. • Group-B strep positive. • Intrauterine growth restriction (IUGR). • Excessive bleeding. • Need for pitocin. • FHR concerns. • Active herpes. • Maternal temperature greater

Dr. Rachel Cady

than 100.4. • Presence of pre-eclampsia. • History of risk of shoulder dystocia. • Previous uterine surgery. • Weight greater than 250 pounds. • Hemoglobin level less than 8.5. • Need for analgesia. • Alcohol and drug use during pregnancy. • Any other condition at the discretion of the provider. Information provided by Cuyuna Regional Medical Center

Mayo Clinic, Mary M. Murry, R.N., C.N.M.

Media buzz brings prevention into spotlight By JENNY HOLMES CONTRIBUTING WRITER

Why women are opting for have mastectomy in breast cancer prevention

nternationally acclaimed celebrities like Angelina Jolie and Christina Applegate have created a buzz around preventative bilateral mastectomies over the past few years.

So, what exactly is the rationale behind such an invasive, and life-changing surgery? And is it a trend women are likely to follow when faced with genetic disposition or an actual diagnosis of breast cancer?

Doctors Laura Joque, Oncologist, and Troy Duininck, General Surgeon, of the Cancer Center at Essentia Health-St Joseph’s Medical Center in Brainerd say the growing media attention has made women more aware of the option. “I do think more women now, who have been diagnosed with cancer in one breast, are opting for the bilateral mastectomy,” noted Joque, who has worked in the oncology field for nine years, four of which at Essentia Health-St Joseph’s Medical Center. “This has been our experience as well,” added Duininck, surgeon at Essentia-St Joseph’s, with special interest in breast health and cancer surgery. “It helps that the options are more readily available to women, in-

Stefanie Keenan • used with permission

cluding more positive cosmetic outcomes.” According to the National Cancer Institute, preventive mastectomy, also called prophylactic or risk-reducing mastectomy, is the surgical removal of one or both breasts. It is done to prevent or reduce the risk of breast cancer in women who are at high risk of developing the disease. Existing data suggests that a preventive mastectomy may significantly reduce the chance of developing breast cancer in moderate- and high-risk women by 90 percent. Joque explained there are specific groups women fall into – including those with a higher risk of breast cancer due to a family history or have a known genetic mutation that increases their risk. Examples of these genes are BRCA1 and BRCA2. These are identified by testing for a specific gene mutation detected through a blood sample. The presence of these genes also make the patient at higher risk for developing other cancers such as ovarian cancer. A patient with a detected gene mutation may have a lifetime risk of breast cancer up to 80%. Actress Angelina Jolie falls into this category, Joque noted. While not diagnosed with breast cancer, Jolie tested positive as a carrier of a mutation of the breast cancer susceptibility gene, or BRCA1, which sharply increases her risk of developing breast cancer and ovarian cancer. Some patients falling into this category opt for immediate action, including the bilateral, or double, mastectomy, oftentimes for “peace of mind,” Joque said. However, the procedure also comes with its own set of psychological and physical stressors. “While a prophylactic bilateral mastectomy reduces a woman’s risk, it doesn’t eliminate it altogether,” she said, adding women must continue to be closely monitored as not all of the breast tissue is removed with

mastectomy and therefore there still remain some risks of developing cancer even after mastectomy. A second group of women who may opt for a bilateral mastectomy are those who have been diagnosed by a physician with breast cancer in one breast. Actress Christina Applegate’s situation resonates with this category, as she was diagnosed with breast cancer at the age of 36. As the daughter of a breast cancer survivor, Applegate began getting regular mammograms at the age of 30, so the cancer was caught at an early stage. However, like Jolie, she also tested positive for the BRCA gene; making her at high risk for developing a second cancer in the other breast. In 2008, Applegate made the difficult decision to have a bilateral mastectomy. In cases of breast cancer, only between 10 and 15 percent are due to a known underlying genetic susceptibility. That means that the majority of breast cases are sporadic. “While knowing your family history is critical,” Joque said, “just because someone in your first, second or third generation has had breast cancer doesn’t mean you’re in need of a bilateral mastectomy. It is important to review your personal history with your physician to understand your possible risk.” Through the Cancer Bitte bei Bildverwendung auch Link setzen • used with permission

Center at Essentia-St Joseph’s Medical Center, once diagnosed with breast cancer, a patient is surrounded by a cancer team consisting of a surgeon, oncologist, counselors and other health care professionals to help the patient make the best choices possible for their particular situation. “The hard thing to understand is that if you have a bilateral mastectomy, it may decrease your odds of reoccurrence in the breast, but it won’t eliminate the risk for cancer recurrence outside of the breast,” said Duininck. “There’s a general feeling that if I do more, my outcome will be better,” Joque reiterated, adding that isn’t necessarily always the case. “As part of the cancer team, we would discuss the patient’s options based upon the size and location of the tumor. It is a multi-disciplinary approach.” “It’s a very emotional and personal decision,”Duininck said. “I think there are some women who are diagnosed with breast cancer and immediately decide they are going to have a bilateral mastectomy. Maybe they’ve had experience with friends or family. But we see many who struggle with the decision. There are some who don’t want to have either breast removed. In these cases, they may opt for partial mastectomy or lumpectomy plus radiation or other treatment methods.” The key takeaway points for women are these

– know your family history and communicate it with your physician. “Know who it was and their age at the time of diagnosis,” Joque advised. “The more information you are able to provide, the better able your doctor will be to assess your risk and underlying genetic syndromes.” Only a physician can refer a patient to a genetic counselor for genetic testing. “Genetic testing has a lot of ramifications for the patient and their family,” Duininck said, noting results bearing positive genetic mutations could put stress on relationships with siblings and also may result in additional testing for children. However, both doctors agreed that testing and subsequent treatment methods and approaches have come a long way, allowing for a multitude of options for women when faced with making critical decisions. One size certainly does not fit all when dealing with health care options, they agreed. “We are now enabled to best empower women with the information they need to make the best decision in regard to their treatment options,” Joque noted. “While we’ve moved to more of a patient-centered care model, we work as a team to meet with the patient to discuss their options and the risks and benefits of each treatment option.”

Life

ST. JOSEPH’S ESSENTIA HEALTH SYSTEM

after breast cancer

Rehabilition provides positive recover for survivors

occuhen the fatigue from chemotherapy made it difficult to move or even stay awake, Cindy Bourassa still kept every appointment with her occu pational therapist, Pam Miller.

“I knew Pam would help me physically and menmen tally,” said the 47-year-old breast cancer survivor. “Her hands are so healing to me. She took her time and made me feel important.” Last December, Cindy’s routine mammogram discovered a Stage III breast cancer that had spread to her lymph nodes. She had a mastectomy in JanuJanu ary. Chemotherapy and radiation therapy followed. Cindy’s first appointment with Pam, an occupaoccupa tional therapist at Essentia Health-St. Joseph’s RehaReha bilitation Clinic, came before surgery. Among all the other tests and exams, Cindy saw it as just another nagging item on her pre-op checklist. Then she met Pam, another breast cancer survivor who has special training in caring for people with cancer. “Pam is all in. You can tell she loves what she does just in how she cares for you,” said Cindy who lives in Breezy Point. “You leave feeling like you visvis ited a friend.” While Pam has worked with cancer patients throughout her career, she’s leading a new program designed to provide comprehen comprehensive rehabilitation care to anyone with a cancer diagnosis, either new or old. The Survivorship Training and Rehabilitation (STAR) program brings together specially trained doctors, nurses, rehabilitation thera-

pists, psychologists, dietitians and others to meet each survivor’s unique needs. The team helps survivors increase their strength and energy, reduce pain, and get back to the tasks of daily life. Pam explains the goal is to help cancer survivors recover from treatment and function at their highest level. “Some people take it for granted that this is the nor way they are going to be, that this is their ‘new normal,’ ” she said. “But often life can be better. We can help improve their quality of life.” While rehabilitation is common for patients who have had a heart attack or stroke, bringing services such as physical therapy, occupational therapy, speech therapy and counseling to cancer patients is new. Diagnosed with breast cancer five years ago, Pam relied on her training to guide her recovery. Her biggest challenge was fatigue, which lasted long after treatment had ended. Cindy also battles fatigue, which is a wom new feeling for the active woman who runs, works out and has even done body-building. She’s relied on Pam to help restore the full range of motion in her right arm and shoulder after the mastectomy and removal of 26 lymph nodes. Exercises and massage reduce e x -

tensive scarring and the swelling of lymphedema. “Therapy isn’t just an extra, it’s literally a part of your recovery,” Cindy said. As she completes radiation therapy, Cindy is adding physical therapy, speech therapy and a dietitian to her recovery plan. The physical therapist can help with issues like fatigue while the speech therapist can give her strategies to deal with the fuzzy thinking that survivors often call “chemo brain.” Cindy hopes to pick up tips from the dietitian on what she can eat to help her body heal. “I’m always game for learning more so I can make better decisions,” Cindy said, adding she’s also eager to share what she’s learned with other breast cancer survivors. “I believe this is part of God’s plan, for me to share what I’ve learned.”

St. Joseph’s Essentia Health System’s occupational therapist Pam Miller (right) practices rehabilitation exercises with breast cancer survior Cindy Bourassa.

Support breast cancer patients in the Brainerd lakes area Fourth annual Pink Tie Party to be held Oct. 3

elebrate the fourth annual Pink Tie Party to support Breast Cancer patients in the Brainerd Lakes Area at Prairie Bay Grill & Catering in Baxter Thursday, Oct. 3. The Pink Tie Party will feature hors d’oeuvres, cocktails (one free with your ticket purchase), music, and engaging activities. A silent auction includes a private plane ride over the Brainerd Lakes area, Vikings Tickets, a getaway at Grand Ely Lodge, a sunset cruise on Gull Lake. 6 course dinner at Prairie Bay, golf at Cragun’s Legacy Courses and much more! The Pink Tie Party hosted by Charter Media offers a special occasion to socialize with the members of your community while supporting an important cause. All proceeds benefit breast cancer patients through the St. Joseph’s Foundation at the Essentia Health Cancer Center and The Pink Ribbon Cupboard. Last year the Pink Tie Party raised $8,000 and we hope to surpass that amount at this year’s event. In addition to the silent auction, we will feature a reverse raffle of a diamond pendant necklace donated by Riddle’s Jewelry. The funds are used to support patients who are undergoing active treatment for breast cancer through continued improvements in care and non-medical assistance. The St. Joseph’s Foundation and Pink Ribbon Cupboard distributed to patients the following with last year’s funds: • Gas cards • Wigs for breast cancer patients • Rent for a month to lessen the stress on a family • Payment of mortgage for a month to prevent home foreclosure • Payment of auto insurance to keep this transportation resource avail able to the family • Payment of utilities to keep the lights on • Grocery gift cards for help with family grocery expenses “It’s one way that as a community, we can collaborate to extend our outreach to improve the life of cancer survivors and their families in the

Brainerd Lakes Area,” said Marian Foehrenbacher, Cancer Center manager at Essentia Health-St. Joseph’s Medical Center. “Having resources for helping to treat the entire patient, not just physically, spiritually, and emotionally through compassionate care by Essentia Health staff, but practically by helping to meet the needs patients have beyond the disease.” Miranda Anderson, Director of St. Joseph Foundation, comments, “We are so excited and appreciative to Charter Media, Prairie Bay, Riddles and all the individuals and businesses that are supporting this event. We hope both men and women will attend and help us raise money to support breast cancer patients at Essentia Health-St. Joseph’s Medical Center and those served through The Pink Ribbon Cupboard. All money raised will stay local—to help the men and women in the community undergoing breast cancer treatment.” Come and join in on the excitement of this event! Advanced tickets receive a great swag bag filled with goodies at the event. Tickets may be purchased through Kristin Larsen of CharterMedia, Prairie Bay Grill & Catering, Miranda Anderson of Essentia Health-St. Joseph’s Foundation, Kathy Buxton of Pink Ribbon Cupboard, Essentia Health-St. Joseph’s Medical Center Gift Shop, and Riddle’s Jewelry located in the Westgate Mall. Tickets are $25 per person and will also include a coupon for a complementary cocktail. The Pink Tie Party will be held Thursday, October 3 at Prairie Bay, located on 15115 Edgewood Drive in Baxter, MN from 6-9 p.m.

Tickets may be acquired through: Kristin Larsen, CharterMedia—218-259-5771 Prairie Bay—218-824-6444 Kathy Buxton, Pink Ribbon Cupboard – 218330-6648

Miranda Anderson, St. Joseph’s Foundation – 218-828-7564

Essentia Health St. Joseph’s Medical Center Gift Shop

Riddle’s Jewelry—located in the Westgate Mall

By JESSICA LARSEN Contributing Writer

Sight machine gives clarity to local residents

Brainerd resident is giving sight to those in need. It all started two years ago. Ron Reph, a member of the Nisswa Lions Club, heard of a local widow who faced the decision of buying groceries or paying the $55 monthly fee to use her rented sight machine. Shocked at the cost, Reph decided he would build his own sight machine. Now, anyone who needs a little assistance in vision can get a better look at prescription bottles, letters, photographs, TV guides, recipes, and many other things. Here’s how it works: Place a TV monitor on top of a specially built stand. A camera below the monitor faces down and captures live video of any item placed under it. The video projects on the TV monitor, magnifying the object up to 14-times. A similar machine sold by retailers can cost up to $3,000, Reph said. But he can make one for $350, or cheaper if the person already has a TV to hook it up to. With a background in mechanical engineering, Reph built a feasibility model in about two months. A prototype did exactly what Reph wanted. By August 2011, he brought the idea to the Nisswa Lions, which funded the program from then on. One Lions member hand-crafts the wooden cabinet the camera lens system sits in. Reph then finishes the project off, wiring the camera in and plugging it into the TV. “It’s extremely simple,” Reph said. About 10 of the sight machines are in the homes of local residents, but the Nisswa Lions are trying to spread the word about the machines so they can reach more people. “We’re trying to get it out to other Lions clubs to help more people,” said Dell Draves, spokesman for the Nisswa Lions Club.

Reph gets emotional when he thinks about the difference the simple machine is making in the lives of those who have sight limitations. He keeps each thank-you letter he receives. “It gives (people) the ability to live on their own, to be able to exist on their own,” he said. “They can pay the bills, read. It gives them better opportunities.” Draves agreed, adding that it gives people back the “ability to live” without constant care from others. In the end, though, Reph says it comes down to one simple mission: “Helping people. That’s basically it.” Contact Dell Draves with the Nisswa Lions at 218-568-4732. JESSICA LARSEN may be reached at jessica.larsen@brainerddispatch.com or 855-5859. Follow me on Twitter at www.twitter.com/brainerdnews.

Inventor Ron Reph (right) shows how his sight machine can help people see photos on their cell phones.

E-cigarettes L

By MARIA CHENG AP medical writer

as good as nicotine patches?

ONDON (AP) — Electronic cigarettes worked just as well as nicotine patches to help smokers quit, according to the first study to compare them. E-cigarettes are battery-operated products that look like real cigarettes and turn nicotine into a vapor inhaled by the user. Since the devices hit the market nearly a decade ago, sales have spiked so quickly some analysts predict they will outsell traditional cigarettes within a decade. E-cigarettes are often marketed as a less harmful alternative to traditional smokes and come in flavors including cinnamon, vanilla and cherry. “This research provides an important benchmark for e-cigarettes,” said Chris Bullen, director of the National Institute for Health Innovation at the University of Auckland in New Zealand, the study’s lead author. Until now, there has been little information about the effectiveness or safety of e-cigarettes. “We have now shown they are about as effective as a standard nicotine replacement product.” Bullen and colleagues recruited 657 adult smokers in Auckland who wanted to quit for the study. Nearly

300 got nicotine-containing e-cigarettes while roughly the same number got nicotine patches. Just over 70 people got placebo e-cigarettes without any nicotine. Each group used the e-cigarettes or patches for 13 weeks. After six months, similar rates of smokers — 6 to 7 percent — managed to quit after using either the nicotine-containing e-cigarettes or patches. Only 4 percent of smokers using the placebo e-cigarettes successfully quit. Among smokers who hadn’t managed to quit, nearly 60 percent of those using e-cigarettes had cut down the number of cigarettes smoked by at least half versus 41 percent of those using nicotine patches. Smokers were also much bigger fans of the e-cigarettes; nearly 90 percent of users said they would recommend them to a friend compared to just over half of people who got patches. Researchers also found similar rates of side effects in smokers that used the e-cigarettes and the patches. The most common side effect in all groups was breathing problems.

The European Union and Britain are planning to regulate e-cigarettes as medical devices, a decision that has provoked criticism from some scientists who argue that would limit their availability to help smokers while cigarettes are not as tightly regulated. It is the tar and other toxins in cigarettes which are deadly, not the nicotine. In the U.S., the FDA plans to assert regulatory authority over the fast-growing category in the near future. E-cigarettes could also still be regulated as drugs or drug-delivery devices, if they are “marketed for therapeutic purposes” — for example, as a stop-smoking aid. Bullen suggested e-cigarettes could be monitored like lifestyle or consumer products to avoid restricting their access. “There needs to be a middle ground where regulation is commensurate with the risk,” he said. “For people who are dependent on nicotine, we’ve got to provide them with a safer alternative ... crushing their availability completely will be bad for public health.”