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YOU MIGHT NOT BE OUR ONLY PATIENT, but it sure will feel that way. We’ve been the region’s leading hospital for over 100 years, because we put the patient first. That single philosophy is the basis for everything we do. It’s why we recruit the best doctors. It’s why we offer the greatest depth of services. And it’s why we utilize world-class technology in every specialty. It’s about tradition. Compassionate care is at the very core of our culture. As a member of the Benedictine Health System, our mission has always been to adhere to the values of hospitality, stewardship, respect and justice. St. Benedict asks us to “serve the sick as if they are Christ,” and that’s what we seek to do each day.
It’s about commitment. Our dedication to patients and the community means we are always challenging ourselves to become an even better healthcare provider. Our new 116,000-square-foot expansion and renovation project will infuse millions of dollars into the community and allow for even better medical technology and greater comfort for patients and their families.
Further proof of our commitment came earlier this year, when the Joint Commission on Accreditation of Healthcare Organizations recognized our hospital for its outstanding patient care. The commission is the world’s leading healthcare-accrediting organization.
and multislice computed tomography—and offering a 24-hour pharmacy, a helicopter pad for emergency services and a new $15 million information system for improved patient safety. It’s all there to ensure our patients get the best care possible. It’s about people. Our staff includes 100 specialists, backed by over 900 committed professionals. That’s substantially more specialists and staff members than any other hospital in the region. They all have one job: to make sure you are cared for compassionately and professionally. Because your health is everything.
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Where patients come first.
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April 2004
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’Brain pacemaker’ helps Parkinson’s patients’ muscle control
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Story/William Hathaway Hartford Courant
Photo/Tom Brown
Parkinson’s disease can lock up William programmer controls the high-frequency overnight. Doctors must tinker, someStanziano’s muscles so quickly, he says it electrical signals, which in Stanziano’s case times for months, with the strength of the feels like a crowbar thrust into a gearbox. are sent to each side of the subthalamus, electric pulses and the dosages of “Sometimes I walk into a Dunkin’ an area of the brain involved in move- dopamine-replacing medicine to get the Donuts and can’t walk out,” said ment. best results. Although doctors can adjust Stanziano, who may have to wait patiently The hardware costs $25,000. The tech- the strength of the pulse with the handfor hours until medication kicks in and nology is similar to cardiac pacemakers, held programmer, patients can only turn loosens his limbs enough to get home. used to regulate the heart, and vagus the pulse generators on or off. Four months ago, the 51-year-old nerve stimulation, used to control epilepFor Stanziano, the results have been Wolcott man went to the University of sy. mixed since he received his brain paceConnecticut Health Center, where docAlthough deep brain stimulation has led maker last November. He no longer has tors implanted a “brain pacemaker” — to a few spectacular successes in unlock- the residual Parkinson’s symptoms when electrodes placed deep he is in his “on,” or more inside his brain that are functional, state. designed to short-circuit However, when he is in the errant signals that can the “off” state, his condiimmobilize him. tion is as bad as before The procedure, known the operation, he said. as deep brain stimulation, Doctors can’t explain is one of many promising why the technology treatments that uses elecsometimes doesn’t work, tricity to treat ailing minds. because they don’t fully For Stanziano, deep understand why it works brain stimulation is at all. designed to compensate Some researchers sugfor the death of brain cells gest electrical stimulation that produce the neuroaffects the release of spetransmitter dopamine, cific neurotransmitters essential for many muscle that compensate for the movements. The death of lack of dopamine, while dopamine-producing cells others have argued that is caused by Parkinson’s electrical pulses reset disease. abnormal electrical sigStanziano’s medication nals in the brain. had stopped preventing Scientists have known the muscular lockup that for more than 70 years his doctors call the “off” Bill Stanziano wears a "brain pacemaker" and pulse generators in his chest, which help that modifying electrical state, a period when mus- provide deep brain stimulation to help his muscles stay loose, thereby counteracting impulses in the brain can cles are not functioning. the effects of Parkinson's disease. Dr. J. Antonelle de Marcaida, at right, adjusts the have therapeutic beneThe advanced stage of his electrical signals to the pulse generators. fits, said Dr. Sara H. disease and his relative Lisanby, associate profesgood health made Stanziano eligible to ing the frozen gaits and ending the debili- sor of clinical psychiatry and medical receive a brain pacemaker. People with tating tremors of Parkinson’s patients, it director of Columbia University’s depresmilder forms of Parkinson’s, dementia does not cure the disease, said Dr. J. sion center. patients and those in ill health are not eli- Antonelle “Toni” de Marcaida, director of Deep brain stimulation is an indirect gible for the procedure, which carries a the movement disorders program at descendant of some of those early treatslight risk of internal bleeding or infection. UConn. ments, she said. After more than a decade of successful “There is no real evidence that it is The earliest use, in electric shock theratrials, deep brain stimulation has now neuro-protective,” she said. py, has been condemned for the pain and entered the mainstream of Parkinson’s And it doesn’t work for everyone, side effects such as memory loss that it treatment. Deep brain stimulation although in trials eight of 10 Parkinson’s afflicted upon patients with mental illness. requires two separate operations — one patients have shown improvement that However, in the past two decades, sciento implant electrodes deep into the has lasted more than five years, de tists have rehabilitated the procedure, and patient’s brain, and a second to implant Marcaida said. today, targeted electrical convulsive theratwo hockey-puck-size pulse generators on Stanziano also now realizes that deep py “remains the most effective treatment both sides of the chest. A hand-held pulse brain stimulation does not work for depression, period,” Lisanby said.
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3
What lives in your mouth
The medical field never ceases to amaze me. Even right here in the Brainerd lakes area, medical professionals perform what I call miracles every single day. To go to work and cure someone of a plaguing disease or illness or to save lives through emergency surgery, is something my mind can hardly grasp. For many in the medical profession, this is everyday life. This issue of HealthWatch follows the amazing acts performed at local
Any first-grader can tell you that if you don’t brush your teeth, creepy sugar “bugs” will take over and cause cavities. But not all of the bugs, or microbes, in the mouth actually affect oral health. And not all of them are bad. A vast and diverse community of microscopic organisms — including viruses, bacteria, fungi and protozoa — thrive in the mouth, scientists are learning. Some of them may play important roles in preserving health and causing diseases, says Dr. David Relman, an associate professor of microbiology at Stanford University. “We already know so much about so many disease-causing agents that it tends to give you the feeling that there is no reason to be going out and trying to find others,” he says. But the causes of many diseases remain unknown — and the mouth appears to be a good place to look for clues. “We are increasingly becoming aware of the connection between the oral cavity and the body,” says Donna Mager, a researcher at the Forsyth Institute, an
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hospitals and clinics, from the heroics of a surgeon, to delivering babies, to curing sleep disorders. To the doctors, nurses, paramedics and everyone who has a hand in medically improving the lives of others, don’t take your job for granted. You truly are miracle workers.
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Heidi Lake, Editor
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plaque deposits on teeth, is probably caused by several organisms, but no one has identified all the microbes responsible for this common disorder. Some microbes found in the mouth may even contribute to disease in other parts of the body, such as the heart, although those links are still tenuous. Mager is trying to identify possibly precancerous changes in the mouth’s bacteria colony. About half of all people diagnosed with oral cancer die within five years because the disease is detected at advanced stages. But if scientists could find clues that disease could develop — based on changes in bacteria — they might be able to intervene earlier, she says. “We are tracking the changes in those colonization patterns,” says Mager, whose research is in collaboration with the Dana Farber Cancer Institute. “Hopefully, we will be able to predict which people will develop cancer.”
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independent research center in Boston. “Whatever grows in the oral cavity could have an impact on what happens to the body.” Research by Relman and Mager is helping to advance this notion. In his lab, Relman samples the region in the mouth called the subgingival crevice, the deep space between the gum and tooth. So far, scientists have found more than 500 bacterial strains or microbes in this area, and Relman has identified 37 others. Other mouth microbes have yet to be identified, he believes. Ultimately, researchers want to better understand the patterns and prevalence of particular microbes and what those patterns suggest about a person’s health. “I think it’s fair to say that the vast majority of members of the oral microbial flora are not disease-causing agents. They may be necessary or important for maintaining health,” he says. “Some small subset may be involved in disease.” Gum disease, in which gums become inflamed, red and swollen because of
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Appointments with a midwife at CentraCare clinic are 20-30 minutes long, giving Wingeier and her patients plenty of time to talk and get to know one another, something both Wingeier and her patients enjoy. “Right now I’m delivering the daughters I delivered,” Wingeier said with a smile. With a bachelor’s degree in nursing and a master’s in nurse-midwifery, Wingeier spends much of her day providing prenatal, postpartum and newborn care, and also provides routine gynecological care. Wingeier is on call 24-hours a day and rarely has time to catch her breath between laboring and birthing patients as well as doing regular patient checkups. She gets calls in the middle of the night, regardless of weekends or holidays. But with more than 20 years experience as a midwife, Wingeier said helping women stay comfortable while giving birth to healthy babies makes it all worth while.
Ruth Wingeier, certified nurse-midwife at CentraCare clinic in Long Prairie, checked Sheila McCoy’s baby for problems following a car accident the previous night.
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Dr. Charles Schotzko, Family Practice Physician
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ST. CLOUD — All Carissa Peterson wanted to do was live a normal life — a life where this bubbly 17-year-old could be free to wear clothes of her choice without a constant feeling of self-consciousness. Instead, the Sartell High School student was forced to wear sweatshirts and dark tops to hide an embarrassing excessive sweating condition, also known as hyperhydrosis. That is, until she learned about the medical uses for the increasingly popular drug, Botox. It was the eighth grade when Carissa Peterson realized her excessive sweating wasn’t normal. “It’s not something you really talk to your friends about,” the blond-haired, blue-eyed girl said. But after literally being drenched in sweat during stationary activities from watching movies to sitting in class, Peterson said she’d had enough. “All I wanted to do was be able to wear a little blue T-shirt,” she commented, adding the sweating condition forced her to hide under bulky sweatshirts and dark colors. Her involvement in the Sartell Sabres Dance Team was even affected as her sweat glands were kicked into an even higher gear when active and sweat was vis-
ibly obvious on costumes. “Literally, every shirt she bought before this was based on the excess sweating,” said mom Cindy Peterson. “I started worrying about her wearing sweatshirts all the time. And I knew (the sweating) wasn’t caused by her being hot.” Cindy contacted Carissa’s pediatrician who diagnosed the hyperhydrosis and prescribed her a heavy duty antiperspirant. Carissa even tried an electronic device that, when applied, would send a series of painful shocks into her arm. But nothing seemed to help. Until one day, paging through a Seventeen magazine, Carissa says she came across an article regarding the use of Botox to treat conditions like hers. After consulting her pediatrician on the information she read, Peterson was referred to the Midwest Clinic of Dermatology Laser and Cosmetic Surgery in St. Cloud. Dr. Daniel Elieff, owner of the eightyear-old private practice with offices in St. Cloud and Alexandria, gave this young girl hope that with the use of Botox, the sweat production could be controlled. For the last two years Peterson has undergone Botox injections every three to
four months. Each session entails approximately 20 to 30 punctures into each armpit. Once injected, the Botox partially paralyzes the muscle that is to blame for putting pressure on the sweat glands and causing them to contract. Each injection is done with a 30 gauge needle, smaller in diameter than an insulin syringe, to minimize invasion and discomfort. Lying flat on an exam table while each injection is made, Peterson takes each poke and prod in stride. “You just have to tell yourself that it’s not that bad,” she said, likening it to repeated pricks with a safety pin. “But it’s totally worth it.” Each injection is superficial, Elieff said, explaining the small needle penetrates the dermis, or second layer of the skin. Because the treatments have proven clinical benefits, each of Peterson’s visits are covered under her family’s health insurance policy. Other medical purposes for Botox have included treating lazy or crossed eyes, headaches, club foot disorder and even for Peterson’s cousin who has cerebral palsy and finds relief from chronic muscle tension with help from the powerful drug.
The nurse-midwifery program at CentraCare clinic in Long Prairie prides itself at putting the comfort and wellbeing of moms and their families first. “I want to help people be healthy and have healthy babies,” said Ruth Wingeier, Long Prairie’s certified nurse-midwife. Two large birthing suites resemble hotel rooms, complete with a couch and night stand. Medical equipment is hidden behind pictures on the wall, making the rooms feel inviting. “We try to keep moms from being afraid (of giving birth) because it tends to make labor take longer,” Wingeier said. “The rooms are calm, relaxed and comfortable.” Wingeier said she averages 11 or 12 deliveries per month, and the interest in midwife-aided births seems to be on the rise, with more than 20 babies born under Wingeier’s care in the month of March. Long Prairie’s clinic will soon be hiring a second midwife and will possibly add another birthing suite, due to the continued popularity of midwife-assisted births. The birthing suites have private bathrooms with whirlpool bathtubs allowing expectant mothers to labor, or actually give birth in the water.
Wingeier said about one-third of her expecting patients choose to give birth under water, an option first offered at Long Prairie three years ago. “(The water) helps moms relax and is more calming for the baby,” she said. Babies are in water while in the womb, and to be born under water eases their transition of entering the world and breathing on their own, Wingeier said. CentraCare clinic in Long Prairie, having one of the oldest midwifery programs in Minnesota, even makes house calls. Wingeier said women who have had no complications during their pregnancy, or have many children and are prone to having quick, easy labors often opt to give birth at home, with the assistance of a midwife. “Some people just don’t like all the intervention they get at a hospital,” Wingeier said. Others just like the feeling of getting personalized health care. Debbie Sauer, 42, on the verge of having her eighth baby, used a midwife while having all but two of her children. “(Midwives) are less routine than doctors,” Sauer said. “They give you options and respect your wishes. I feel more con-
fident in their care.” Wingeier said she educates women and encourages them to make their own decisions during pregnancy, often times using alternative methods such as herbs and nutrition instead of medication. “Midwives attract people who want alternative methods,” Wingeier said. Shelly Crenna wanted to give birth to her second child at home, but her husband, Brian, wasn’t comfortable with the idea. So the Royalton couple decided to compromise and use Long Prairie’s midwifery program. “I wanted a home birth because hospitals scare me,” Shelly Crenna said. “I wanted something more personable (than a doctor’s office).” Fifteen days overdue, weighing in at 10 pounds, 6 ounces, Levi Thomas Crenna entered the world via Cesarean Section. Each mom under midwives care has a consulting physician in case of complications. If a C-section is required, if pregnant with multiples, or if there are other risk factors, the doctor is called in and the midwife assists during the birthing process. “Sometimes you just need two sets of hands,” Wingeier said.
Introducing…
Previous page photo: Tracy Blumberg, 28, has received Botox treatments in her forehead and between her eyes for the past two years. The St. Cloud resident said the procedure has become “addictive.” Dr. Daniel Elieff of Midwest Clinic of Dermatology Laser and Cosmetic Surgery in St. Cloud, administered Botox injections in Carissa Peterson’s underarm area. Peterson, 17, suffers from hyperhydrosis, or excessive sweating, and found Botox helps control the condition.
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Midwifery
Before . . . . . . and after
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After getting Botox injected in her forehead, Tracy Blumberg was unable to use the muscles that move her eyebrows. The Botox procedure weakens facial muscles that are related to expression lines. Botox works by blocking the impulses from the nerves to the facial muscles, relaxing them. The result is a smooth, unwrinkled look. Brian and Shelly Crenna of Royalton welcomed the newest addition to their family, Levi Thomas Crenna, at CentraCare clinic in Long Prairie. The Crenna’s used the midwifery program during their pregnancy, but when a Cesarean Section was needed, a doctor was called in to perform the procedure.
A parent’s alternative to hospital birthing
Story and photos/Heidi Lake
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LONG PRAIRIE — With teary eyes you clutch your coach’s hand. Sweat beads gather on your brow and you can’t help but smile at the thought of your child being born. Having a baby is the happiest day of many people’s lives. Although known for being rather painful, giving birth in a calm and relaxing atmosphere could help ease the stress of the laboring situation.
The other side of Botox While Botox has provided relief to those suffering with chronic disorders, the drug has gained popularity mostly for its cosmetic contributions. Hollywood stars have helped launch this drug into superstardom. According to the Cosmetic Surgery Times publication, more than 2 million Botox procedures were done in the United States during 2003 alone. And Elieff predicts that number will double after the turn of 2004. Elieff explained Botox temporarily paralyzes muscles at the injection site disabling the individual to create the lines caused when raising their eyebrows, squinting or frowning. Botox is used by many newscasters, actors and politicians “to eliminate those facial miscues people can see,” he added. Tracy Blumberg, a 28-year-old St. Cloud woman, began having regular Botox injections about two years ago after being told she had hyperanimation of her facial muscles. Without being consciously aware, Blumberg would excessively squint or frown, giving those around her miscues about her temperament. “People would think I was mad when I wasn’t,” she said. Elieff suggested Blumberg try Botox to
prevent her facial muscles from contracting. “I’d heard a lot of good things about it,” Blumberg said. “So, I tried it. And I loved it.” And now, she admits, she’s hooked. Results, which typically take about 72 hours to appear, last between two to three months before another treatment is necessary. “It doesn’t hurt at all,” Blumberg said. “The first sensation, when the needle goes in, feels like a pin prick. And you can feel the Botox being injected into the muscles. But it’s just so quick. I love Botox. It’s my best friend.” An admitted Botox user himself for the past 10 years, Elieff said the three most popular areas where Botox is injected into the face include the forehead; the glabellar, or area between the eyes; and on the outside of either eye where lines, nicknamed crow’s feet, develop. The number of necessary injections per session to treat lines depends on the muscles and areas being treated as well as the individual, but usually range from five to seven. “It’s just super, super dramatic stuff,” Elieff said, adding each Botox session in the facial area is done in a matter of min-
utes with affects to be seen for months. Other areas that can be injected for cosmetic purposes include the tip of the nose, drooped lower lips, in aging neck muscles and, believe it or not, to sagging breasts to provide more lift. When opening his practice eight years ago, Elieff said only a couple viles of Botox were kept in stock. Now, his clinic keeps a couple dozen in the refrigerator for their continually growing client base. While approximately 90 percent of his Botox clients are female, Elieff said more men are catching on to the craze. The average Botox users at this St. Cloud clinic are women in their mid-30s to mid-40s who are concerned with reducing the signs of aging. “One thing we see a lot of is the people who come in for Botox don’t want to create a stroked-out, paralyzed face,” Elieff said. “They want to retain some motion of the facial muscles, but soften the wrinkles and lines.” Elieff stressed the importance of a good overall familiarity with the anatomy when administering Botox. If injected into the wrong place, Botox can cause stroke-like affects, including paralysis of limbs and facial muscles as well as drooping eyelids.
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CMYK
A job well done The fact that Botox injections are now the No. 1 non-surgical cosmetic procedure in the United States proves the drug is getting and giving not only the aesthetic, but also the medical results people are seeking. Carissa Peterson’s story has especially reinforced Elieff’s confidence in this often controversial drug. Elieff said he treats several patients with conditions similar to Peterson’s, but says her case was one of his first and remains one of his favorite success stories. “It’s something people need to know about,” Peterson added. “Had I not discovered (Botox) I’d be miserable. If something can help you, you don’t really have to be ashamed of it.” Not only is Peterson free of shame, she’s also ready to show off what has been hidden under bulky shirts for too long, noting she will be wearing a strapless black dress to prom this spring. “It has changed my self-esteem and confidence,” Peterson said. “Getting stuck for 15 minutes can change the rest of your life.”
What is Botox? Botulinium Toxin, or Botox, was discovered by accident at a Belgian picnic in 1895 when 34 people ate sausages contaminated with a lethal substance (later known as Botulism) and, subsequently, three died. Botulism is defined as an anaerobic, spore-forming bacteria that, under the right conditions, can germinate and create toxins. After being isolated, purified and experimented with by scientists, the first batch of toxin for human use was prepared in 1979. The Botox procedure has been widely used and is considered a safe, effective way of treating aging skin. Previously approved for the treatment of lazy eye and eye spasms, Botox was approved by the Food and Drug Administration for the treatment of frown lines between the eyes, also known as glabellar lines, in 2002.
expression lines. The constant contractions of those muscles result in wrinkles. Botox blocks the impulses from the nerves to the facial muscles thereby relaxing them, resulting in a smooth, unwrinkled look. What does it cost? Each treatment can cost anywhere between $100 and $800, or more, depending on the affected area to be treated and the units of Botox used.
Where is Botox available? Any authorized health care professional can administer Botox, including dermatologists, plastic surgeons and other cosmetic physicians. Local providers include Dr. Kurt Waters at Facial Plastics at Brainerd Medical Center; Dr. Daniel Elieff of Midwest Clinic of Dermatology, Laser and Cosmetic Surgery in St. Cloud; and Midsota Plastic and Reconstructive How does it work? The Botox procedure works by Surgeons with physician services weakening facial muscles related to offered at St. Joseph’s Medical Center.
Centers of excellence The decision to open an ambulatory surgery center has been a long time in the making. Waters said he and several other surgeons decided to pursue the opportunity with the support of SJMC. “Obviously there are communities where hospitals and doctors compete, but that’s not the case here,” Waters said. Thomas K. Prusak, SJMC president, said, “SJMC and the physicians are very excited about the future of the ambulatory surgery center and the development of a medical park to meet the current and future needs of the community.” Prusak said the development of the surgical center will enable SJMC and the physicians to develop two centers of excellence for the area. “It was more patient driven than anything,” Waters explained. “This center will provide convenient, easy access and will continue to uphold patient privacy.” Along with the operating and procedure rooms, the center will provide patient care suites where the patient and their family will begin the process and prepare for surgery. The family will also be allowed to wait in that suite until their loved one is returned from recovery.
There will also be a refreshment center for families to utilize and a children’s play area. Waters also noted a separate recovery area for pediatric patients where families will be allowed to rejoin their children following surgery.
Minimally invasive procedures Waters said the surgical center will give surgeons the opportunity to perform minimally invasive procedures, making smaller incisions and performing surgeries telescopically. That means less discomfort and a quicker healing time. “We’re all trying to reduce health care costs,” Waters noted. “Surgical centers
have the ability to reduce those costs through copays and deductibles. So that will also be nice for our community.” But the bottom line is continuing to provide quality services in a timely manner to the entire community, Waters emphasized. “This center coincides with what’s going on in other communities. We have the same quality surgeons as in other cities. We just want the same facilities to offer those services in.” And the medical community’s growth won’t necessarily stop with the completion of the surgical center. Prusak outlined SJMC’s plans for a medical park in Baxter. “The lakes area is growing and so is the demand for medical services,” he said. “To meet the long-term needs of the community, we are developing a medical park located close to the major highways and retail outlets so that we can provide services that are convenient and easily accessible.” Examples of future services at the medical park, Prusak said, include a clinic, physician offices and other outpatient medical services.
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The Brainerd Lakes Surgery Center will open this fall in Baxter, providing outpatient surgery services to the community. The surgery center will be located off Highway 371 near the bypass. The facility is a joint venture between the surgical community and St. Joseph’s Medical Center in Brainerd and will offer state-of-the-science technologies. Story/Jenny Kringen-Holmes
Residents of the lakes area will soon have another choice when making health care decisions. The Brainerd Lakes Surgery Center is slated to open this fall in Baxter, providing outpatient, or same day, surgery services to the community. The surgery center, currently being constructed, is located off Highway 371 near the bypass. It will house four operating rooms as well as one procedure room. Dr. Kurt Waters, a physician and facial plastics surgeon at Brainerd Medical Center, is a surgical partner in the facility. Waters explained the facility is a joint ven-
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ture between the surgical community and St. Joseph’s Medical Center in Brainerd. Waters said the facility will offer stateof-the-science technologies in a convenient location. “From a convenience standpoint, it’ll be great for patients,” he said. “It’s our response to the growing needs of our medical staff and our community.” The services to be offered at the surgical center mirror many of those currently offered on a same day surgery level at SJMC, including general surgeries, ophthalmology, ear nose and throat, orthopedics, podiatry, plastics, and urology.
Waters said he hopes the center will expand in the near future to also include pain management and various women’s services. All minimally invasive and outpatient surgical procedures will be done at the surgical center. All invasive procedures that require a hospital stay will remain at SJMC where inpatient and outpatient care, as well as additional technology and support services are available to ensure the patient receives the best possible care. One thing that will be a constant at both sites is that a board-certified anesthesiologist will oversee each case.
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CPAP provides restful nights for sleep apnea sufferers Story and photos/Heidi Lake
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Ahh, the feeling of utter exhaustion. When you’re so tired it takes all your might to even pull the bed sheets back. After sliding into the comfort zone, your head gets lost in your pillow and you can’t help but let out a sigh. We’ve all been there. Suddenly a permeating noise comes out of the lump on the other side of the bed. In and out. In and out. With each breath you lose a little more of that comfort and relaxation you felt when you first climbed into bed. We’ve all been there too. Snoring. About 10 to 30 percent of adults do it, and for some snoring is more serious than just being an annoyance to their bed partner. When Ann Tousignant and her family vacationed together they’d sleep in separate hotel rooms. For as long as she could remember, Tousignant said her family and friends would tease her about snoring so loudly no one within an earshot could sleep. But it wasn’t until about a year and a half ago that Tousignant realized something was wrong. She’d toss and turn all night. She’d go to bed at 8:30 p.m. and have to drag herself to get up at 7 in the morning, never feeling the least bit refreshed. The 49-year-old daycare provider had no energy and was so wornout it was starting to affect her personal and professional life. “Finally, I just got tired of being tired,” she said. So Tousignant met with Dr. Todd Greatens who specializes in sleep and pulmonary medicine at Brainerd Medical Center. Greatens recommended Tousignant undergo a sleep study at Brainerd Lakes Sleep Health Center, BMC’s new sleep center. Before a patient such as Tousignant visits Greatens, a 10-question survey regarding sleeping habits must be done. A patient also has to complete a sleep log, stating when they go to bed and wake up and how many hours they thought they actually slept. At the initial consultation, Greatens goes over the questionnaire and talks with the patient, trying to figure
marketing manager for Weight Watchers International Inc. A study last year of the Amish, a rural people whose culture forgoes the luxuries of modern technology, showed they are far leaner than most Americans as a result of the lifestyle. A study published by the American College of Sports Medicine in Indianapolis concluded that only 4 percent of Amish were obese and 26 percent were overweight, compared to the general population, in which 31 percent registered as obese and 65 percent as overweight. Some of the Amish, who agreed to wear pedometers for the study, walked as many as 18,000 steps — the equivalent of nine miles a day. The work-weight connection is not merely about lack of physical activity. Many workers are spending more time at the office. A survey by the Web classified site Monster.com of more than 17,500 people concluded that 46 percent work about 40 to 50 hours per week and 25 percent said they work 50 hours or more. “We certainly have more stressed
lives, longer work hours for many of us, and less opportunity for being physically active,” said Lawrence J. Cheskin, associate professor at the Johns Hopkins Bloomberg School of Health and director of the Johns Hopkins Weight Management Center in Baltimore. Poor eating habits at work compound the problem. About two-thirds of Americans eat lunch at their desk, while more than 60 percent of workers snack throughout the day, according to a survey last year by the American Dietetic Association and ConAgra Foods, the Omaha, Neb., food conglomerate. Moreover, with a preponderance of both sexes working outside the home, people turn more to prepared foods from groceries or restaurants. Carryout foods in general contain more fat and sugar than home-cooked meals, and often come in larger portions. The office itself is laden with opportunities for eating, from birthday cakes to going-away celebrations. A desk can even become a psycho-
Obstructive Sleep Apnea The Dark Side Of Night
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logical cue for food cravings — like popcorn at the movies, said Thomas Wadden, director of the weight and eating disorders program at the University of Pennsylvania School of Medicine. While businesses frequently request healthier foods in their vending machines, those snacks often cost more and don’t sell as well as the cheaper, more caloric items. “They’re still big candy eaters. They still drink a lot of soda,” said Gary Desenberg, a sales and service manager at A. Kovens Vending, a Pennsylvania company that supplies and stocks vending machines. Some workplaces are trying to become part of the solution.Offices, factories — even sawmills — are hosting aerobics workouts or contracting with groups like Weight Watchers to conduct weight-loss classes. Some employers now distribute pedometers to motivate workers to walk, even if it means taking a bathroom break on another floor to squeeze in some extra steps.
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Sitting is a spreading occupational hazard
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Story/Stacey Hirsh Baltimore Sun
When Paul M. Ribisl needed his secretary to photocopy exams at Wake Forest University 30 years ago, she had to type the questions, walk them to a mimeograph machine, then manually crank out copies. When he needed a letter typed, she would walk to his desk, take shorthand, return to her desk to type the letter, walk it back to him to proofread, then walk back to retype it if there were corrections. Today, however, a copy machine collates, staples and bundles exams in minutes, and Ribisl can type letters and e-mail them to colleagues, saving his secretary all those steps. “You can look at every part of someone’s life and see that the physical drudgery has been taken out of it,” said Ribisl, who now chairs the health and exercise science department at the university in North Carolina. “People are stuck at their desks more.” Along with super-size fries and the TV remote, the workplace has become a cul-
prit in the great American weight gain. A recent study released in the Journal of the American Medical Association concluded that poor diet and lack of exercise could soon surpass tobacco as the leading preventable cause of premature death in the United States. The economy has become dominated by sedentary office work. Technology allows — even requires — workers to remain in a chair all day, staring at a screen. Ever pressed for time, workers seem constantly to be scarfing down junk food on the run or grazing at their desks. Improved technology — from conference calling to instant messaging to Internet-cams — makes communication ever more possible without leaving one’s seat. The result: Gaining weight has become the latest occupational hazard. Americans on average expend about 200 to 300 fewer calories a day than they did 25 years ago — or about 7,000 fewer calories a month, he said. The change
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years ago from manual typewriters to computers, by one estimate, caused the average full-time secretary to gain 5 to 10 pounds a year. “There’s a huge decrease in metabolism that you get when you’re just sitting at your desk all the time,” said Scott Collier, an adviser and instructor in Syracuse University’s exercise science department who directs an exercise program for the university’s staff. Stress from work, many experts say, is also greater, fueled by such things as the push for greater productivity and the threat of outsourcing and downsizing. Stress lowers metabolism, making it tougher to burn calories. And cell phones and e-mail at home and on the road can make work seem omnipresent. “Our work force has become more and more sedentary every single year as technology advances. I think at this point we’re very chair-bound, between the phone and the computer,”said Chris Corcoran, senior
DOCTORS
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out what the underlying problem may be. Overnight sleep studies are done three nights per week at the center. Overnight studies are recommended for most sleep disorder sufferers in order to find out the extent of their problem and how it can be fixed. “We try to know what the problem is before the sleep study,” Greatens said. Of the more than 80 sleep disorders out there, including insomnia, narcolepsy, sleep walking and recurring nightmares, obstructive sleep apnea syndrome is the most common disorder treated at BMC’s sleep clinic. “That’s probably the bread and butter of the lab,” John Wills, sleep lab manager said. Extremely loud snoring, pauses in breathing and falling asleep at inappropriate times are signs of sleep apnea, a potentially life-threatening disorder. Snoring occurs when the muscles in a person’s throat relax too much, narrowing the airway. When air is forced through the narrowed passageway, it results in a snoring sound. For most people the narrowing is not a problem, but
for people with sleep apnea it makes breathing difficult, causing them to stop breathing for a period of time while sleeping. When the brain senses the increased difficulty to breathe, it wakes up just enough to tighten the throat muscles, allowing air to get through effortlessly. Tousignant’s brain had to remind her to breathe 112 times per hour during her sleep study, Greatens said, resulting in her never feeling like she got a good night’s sleep. Before being diagnosed with sleep apnea, Tousignant took a nighttime cold medication to help her sleep at night. “It helped some, but not with the tossing and turning,” she said. “I’d have to drag myself out of bed in the morning. I had no energy whatsoever.” Tousignant admitted when she and Greatens decided a sleep study needed to be done she was nervous, but anxious by the mere thought of sleeping well. Patients arrive at the sleep clinic at 8:30 p.m., change into their pajamas and relax. A sleep technician places sensors on the patient’s head, temple, jaw, neck, chin,
nose, chest and legs to monitor the body and its sleeping habits, such as heart rate, breathing, snoring and leg movement. The sensors transmit information into a control room, manned by sleep technicians all night long. “I thought I would fight with the wires all night, but I couldn’t even tell I had them on,” Tousignant said. The sleep center, part of BMC’s newly completed $9 million expansion project, has a hotel-like feel, with a lounging area, kitchen and four private bedrooms with televisions and attached private bathrooms. The comfortable beds and casual decor gives the sleep center a homey feel, except for the microphone above the bed and the infrared camera attached to the bedroom wall. Although the hardware looks discreet, it plays a major part in the sleep study’s success. For two hours technicians closely monitor each patient, watching them on a small TV screen, listening to their breathing, snoring and studying the information the sensors reveal. When two hours is up, enough information is gathered to determine the
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Patient rooms at Brainerd Lakes Sleep Health Center resemble a hotel room with a private bathroom and television.
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John Wills, sleep lab manager, studied the information gathered during an overnight sleep study. A video camera and microphone are in each sleeping room, allowing sleep technicians to carefully monitor the patient’s sleeping and snoring habits.
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severity of a patient’s sleep apnea. If a certain criteria is met, technicians quietly enter the patient’s room, and wake them up just enough to slip on a continuous positive airway pressure mask or CPAP. CPAP is a machine that delivers air into the airway through a mask worn over the nose. The mask’s airflow creates enough pressure that when a patient inhales their airway stays open, allowing them to breathe easily, without snoring. CPAP is considered the most common and most effective non-surgical treatment for the alleviation of snoring and sleep apnea. Even Greatens and Wills wear CPAP at night. “I used to wake up with bruises from my wife elbowing me,”Wills joked about his loud snoring that accompanied his sleep apnea. “Now it’s a whole new lifestyle. It can change people’s lives.” Tousignant agreed. “It was just like a different me,” she said following her night at the sleep center where she used CPAP for the first time. “I felt very refreshed.” After looking over the test results and discussing options with Greatens the morning after the study, Tousignant was sold on CPAP. She got one the very next
Continuous positive airway pressure mask, or CPAP, is considered the most common and most effective non-surgical treatment for the alleviation of snoring and sleep apnea.
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day. “I was almost anxious to go to bed just to put it on,” she said. Other sleep apnea treatment options include surgery and oral appliances which pull the lower jaw forward, keeping the airway open. Greatens said other sleep disorders can be treated with medication. Sleep apnea affects 14 percent of men and more than 2 percent of women. Obesity, smoking and drinking alcohol can contribute to sleep apnea, which can affect cardiovascular health by causing high blood pressure, heart disease and stroke. Greatens said anyone with sleeping problems is prone to depression as well. “Education is a big part of what we do,” Wills said, encouraging people to learn about and get treated for their sleep disorder early. Tousignant said getting treated for sleep apnea has changed her life. “Don’t drag your feet — if you think you have a (sleeping disorder), get checked,” she said. Other sleep labs are located in Duluth, St. Cloud and the Twin Cities.
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The brain’s other reaction comes through the pituitary gland, which sends signals through the bloodstream instructing the adrenal glands to release the stress hormone cortisol and other steroids. In the right amounts, cortisol helps the body recharge, enhances disease resistance, fights inflammation and improves memory. In excess, however, cortisol promotes the accumulation of abdominal fat, suppresses immunity, shrinks brain cells and impairs memory. Over time, cells become less sensitive to the protective effects of cortisol, and inflammation goes unchecked. Scientists are only now beginning to understand what happens when stress disrupts the delicate interplay between the brain, the endocrine system — the glands and organs that make and release hormones — and the immune system, stimulating the release of compounds that cause inflammation. They’re also beginning to identify ways to stop this inflammation and other stress-related biological effects. “New treatments that teach us ways to relax and cope with daily stress offer great promise in decreasing the risk for many preventable illnesses,” Irwin said. Recent research has identified some of the following ways in which stress influences the course of illnesses linked to viruses, aging or the body’s misguided attack on its own tissues. Physical or mental stress can take an enormous and sometimes deadly toll on the heart. It increases blood pressure, narrows blood vessels and causes blood to become stickier and more likely to clot, increasing the likelihood of a heart attack or stroke. In February, Irwin published a study in the American Journal of Psychiatry showing that stress and depression in heart attack patients increase amounts of chemicals that make certain immune cells sticky and help them travel to artery linings, where they produce inflammation and promote coronary artery disease. A study published last week in the journal Circulation found that mental stress also triggers irregular heartbeats, which can be deadly. Stress can certainly give you butterflies or a stomachache, but chronic stress can trigger flare-ups of irritable bowel syndrome, an intestinal condition that includes cramping, gas, diarrhea and constipation. Women with the condition (who vastly outnumber men) not only have elevated levels of cortisol, but also have exaggerated differences between the higher morning and lower evening levels found in healthy people, Italian researchers reported in 2001. Although stress is no longer believed to cause ulcers (they’re sparked by an infection of the bacterium H. pylori), it can worsen symptoms. HIV-infected gay men who keep their sexual orientation secret get sicker and have shorter life spans than gay men who are more open about their sexuality, a 1996 study found. Closeted gay men tend to be shyer and their nervous systems overreact to stress; as a result, their bodies pump out more stress hormones, which encourage the virus to multiply.
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As a high-level executive for a large computer manufacturer, Dan Bishop was a self-described workaholic who thought he was ably juggling daily demands and corporate pressures. Then he woke up one night with tightness in his chest, barely able to breathe. At first he suspected a heart attack. The tightness quickly passed, but he was frightened enough to see his doctor. The doctor diagnosed an anxiety attack — caused by stress — and told him to “stop being so driven.” “I didn’t know what stress was; I didn’t think I had stress,” said Bishop, now 52, referring to the 1990 diagnosis. As Bishop found, stress can be insidious. The pressures of daily life — jobs, relationships, money, raising children and now, war and terrorism — have become such constant companions that many of us operate with ever-present feelings of pressure, anxiety or burnout. The stress can become so unflagging that many people have accepted it as a standard part of life. Although we may try to ignore its presence, stress doesn’t go away. It just goes to work inside the body. Prolonged stress contributes to many physical and psychological ills. It overrides natural defenses against viruses that cause AIDS, chickenpox and the common cold; encourages the production of inflammatory hormones that drive heart disease, obesity and diabetes; sparks flareups of rheumatoid arthritis and digestive disorders; creates depression and ages the brain. “Numerous studies show that psychological stress can lead to illness, or even death,” said Dr. Michael Irwin, director of the Norman Cousins Center for Psychoneuroimmunology at the University of California, Los Angeles’ Neuropsychiatric Institute. “How we cope with stress and whether or not we get depressed is crucial for our health.” Unchecked stress sends out complex signals that unleash a cascade of activity throughout the body. When someone is confronted with stress — whether physical or psychological — the brain is the first part of the body to respond, reacting in two distinct ways. In one of the reactions, a regulatory part of the brain called the hypothalamus sends signals through sympathetic nerves near the spinal cord to the adrenal glands, commanding them to release the stress hormones epinephrine and norepinephrine (also called adrenaline and noradrenaline). These hormones gird the body for action. They boost heart rate, blood pressure, breathing and blood flow to the muscles and brain, providing an extra surge of energy in times of physical danger. They can also keep athletes, entertainers and others on their toes, keeping them alert and productive when performance counts. But chronic stress opens the floodgates to epinephrine and norepinephrine, regardless of whether there’s a threat, allowing bacteria, viruses or tumors to flourish and making blood more prone to clotting.
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A day in the life of a surgeon
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Pillager Clinic Lakewood Health System’s Pillager Clinic offers you and your family convenient, local health care. Our clinic—home to three board-certified physicians, a physician assistant and nurse practitioner is open Monday-Friday with early clinic hours, starting at 8:00 a.m. on Monday, Thursday and Friday. Physical Therapy services and Occupational Health services are also available onsite. Longbella Drug of Staples provides pharmacy and retail services with a drive thru window.
Wearing special glasses to magnify images, Dr. Ross Bengtson cut through layers of tissue while he made his way to the carotid artery of his patient’s neck, being careful of nerves en route. Story/Jenny Kringen-Holmes Photos/Nels Norquist
Lakewood Health System provides local family practice and specialty care including hospital, care center, senior housing, home care / hospice and transportation services as well as convenient clinic locations in Staples, Motley, Eagle Bend and Browerville. With Lakewood Health System you don’t have to go far, it’s right here.
With a John Mayer CD playing in the background, Dr. Ross Bengtson makes his first incision along a 53-year-old man’s neck, working his way through the layers of tissue to the carotid artery. It’s the first of four surgeries on Bengtson's schedule at St. Joseph’s Medical Center in Brainerd on this Thursday afternoon. The 32-year-old surgeon may look young at
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first glance, but Bengtson’s knowledge and talent far exceed his age. With the consent of Brainerd Medical Center, St. Joseph’s Medical Center and several patients, this reporter followed a local general surgeon during a typical Thursday shift in March. This is just a glimpse into a day in the life of a surgeon.
For an appointment, call 218.746.4550 Pillager Clinic—631 State Hwy 210W, Pillager, MN 56473
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Life after spinal surgery: A 12-year-old’s recovery
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Story/Jennifer Wilson Morris News Service
AMARILLO, Texas — No hospital room compares to your own bedroom — especially when your room has red, orange, yellow and green walls. That’s 12-year-old Wendy Weatherly’s room, and she was glad to return to it. “It was so great,” Wendy said. “There’s nothing like home.” Wendy, a seventh-grader, returned to Amarillo on March 27 after undergoing 13 hours of surgery in Philadelphia to straighten her spine curved by scoliosis. Surgeons removed staples from a previous procedure, then inserted rods into her spine to straighten it. Doctors had hoped that fall’s pioneering procedure would straighten Wendy’s spine without the traditional rods, but Xrays earlier this year showed that her curve was getting worse and she’d need the rods. For now, Wendy is continuing her studies at home as her spine fuses perfectly
straight. “Every day is a little bit better, but every day has its challenges,” Wendy said. She doesn’t remember much about the first few days after surgery. But that didn’t stop her from communicating with family — her fingers remembered sign language, even when a tube in her throat wouldn’t let her talk. “I guess God just provided a way to talk to my parents through sign language,” Wendy said. Family members back in Amarillo also contributed to her recovery, said her mother, Karla Weatherly. When Wendy’s blood count was low, a local blood bank shipped blood that her grandfathers had donated. Four hours after the transfusion started, the 12-year-old felt much better and was ready to watch some television. “She got some very powerful grandfather blood,” Karla Weatherly said.
But Wendy also gets strength from a higher source, the family said. “It comes from God — really it does,” Wendy said. She doesn’t know why all this has happened to her, but Wendy trusts that she’ll find out someday. “(God) has a reason, and he’ll tell me when I get to heaven,” she said. Wendy has also been comforted by the phone calls and cards from people literally around the globe — even from perfect strangers. “It’s such a nice feeling to know that people care,” she said. Wendy will wear her brace — now a psychedelic pink and purple one — for three more months, she said. Her dad, Brent Weatherly, said he’s glad his daughter is home. He is grateful for all of Wendy’s doctors. “I’m glad there’s people like that around,” he said.
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8 a.m. — While many are just arriving for a day’s work, Dr. Ross Bengtson has been at his job for more than an hour already. Bengtson, 32, a physician and surgeon who splits his time between Brainerd Medical Center and St. Joseph’s Medical Center, says he made his first stop of the day at 6:45 a.m. to visit his post-operative patients at SJMC. Now at BMC for a morning of office visits, Bengtson prepares for the full day that lies ahead. Bengtson, a Brainerd resident, has been with BMC/SJMC for nearly one year. He and Dr. Jim Dehen work together at both the clinic and hospital, conferring with one another and assisting when needed on surgical procedures. Much like Dehen, Bengtson is a general surgeon with care levels ranging from vascular and laparoscopic to thoracic and more. 8:15 a.m. — A middle-aged woman meets with Bengtson as a follow-up to a recent diagnosis of endometriosis. After telling him of the pain she experiences in the affected area, Bengtson explains her options, including surgery to remove the growth or to forgo removal and follow-up with a CT scan in another six months, since the growth is benign or non-cancerous. She agrees to follow-up in six months with the scan. 8:25 a.m. — A man shows Bengtson a growth he has had on his elbow for the past year. After examination, Bengtson offers to have the lump removed in the office. “Whack ‘er off there,” the man agrees. Led to one of two procedure rooms in the surgical area of BMC, Bengtson shaves the man’s elbow around the spot to be removed, cleans the area and injects Lidocaine into the growth. He explains he won’t feel any pain, but rather a tugging sensation as it is cut from his arm. Nurse Jan Lambert assists Bengtson, handing him gauze as Bengtson snips out what he explains is a sebaceous cyst or a gland that gets clogged and is unable to secrete therefore causing an enlargement under the skin. The man passes up the opportunity to look at the growth once it’s removed and jokes with Bengtson about passing out at the sight of his own blood once. “That’s why I hate cleaning fish,” Bengtson jokes back. “The blood and guts get me.” 8:50 a.m. — Bengtson is assisted in the procedure room by nurse Jackie Weinhandl for a female patient suffering from hemorrhoids. Back at the nurse’s station, nurse Lambert explains how Bengtson will soon be doing gastric bypass surgeries as well as varicose vein
procedures at SJMC. “We do a lot now,” Now following up on the procedure, the she says, “but we’ll be doing even more in man is in good spirits and said he has the future.” resumed life as normal for the most part. 9 a.m. — Bengtson makes phone calls A small mass has collected at the incision to follow up on patients, giving them site during the recovery process, which is results from lab work and X-rays as well as often typical following this type of procecatches up on paperwork before seeing dure. Bengtson gives the man the option his next patient. to attempt to drain out some of the fluid 9:20 a.m. — A woman with leg and foot with a syringe or to simply wait for the swelling visits with Bengtson. She explains body to reabsorb it. After consideration, she has had the swelling for the past three the man agrees to let Bengtson drain the years but it has gotten progressively fluid. But after attempting, Bengtson worse. After reviewing her medical histo- determines the fluid gathered beneath ry, previous surgeries and examining both the skin is still too thick to be removed at legs and feet, Bengtson explains the possi- this time. He tells the man to come back in ble causes and treatments for the swelling. three weeks if the growth is still apparent. He suggests a pair of good compression 10:05 a.m. — A woman, experiencing stockings as well as coming back for an ultrasound of the legs to rule out any chance of blood clots. 9:30 a.m. — After returning to the nurse’s station, Bengtson dictates his patient’s information and findings from his visit into a tape recorder, a regular practice he does after seeing each patient throughout the day. 9:40 a.m. — Bengtson follows-up with a gentleman who first experienced an abscess by his anal area. The area had been drained but didn’t completely remedy itself resulting in yet another procedure three weeks ago. But at this exam, Bengtson says the man is doing “as expected.” 9:50 a.m. — An older couple visits with Bengtson following the husband’s carotid endarterectomy, a procedure done to open an artery in the neck and allow blood flow following severe narrowing or blockage. The artery had become clogged Thirty-two year old surgeon Ross Bengtson scrubs in before surgery at and led to the man St. Joseph's Medical Center in Brainerd. Bengtson, a Brainerd resident, having a small stroke. has been with SJMC and Brainerd Medical Center for nearly one year.
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similar blockage in the carotid artery is seen by Bengtson. He explains her blockage consumes about 80 percent of this essential artery, as determined by an ultrasound. Without surgery, Bengtson says she runs an 11 percent risk of a stroke. Once operated on, that risk drops to 5 percent over five years, he tells her. But the elderly woman refuses to have surgical intervention. Bengtson accepts her decision and requests she return in a year to have another ultrasound. “I’ll see you in a year,” he tells her when leaving the room. “You better be here in a year,” she tells him. “Oh, I will be,” he laughs back. 10:14 a.m. — A gentleman with skin cancer is back in Bengtson’s office to have his incision checked where cancerous spots were removed. “Everything looks pretty good from my standpoint,” he tells the man and his wife. The wife asks Bengtson about any lifting restrictions for her husband, to which Bengtson tells her he is free to lift. “Oh good,” she says with a twinkle in her eye, noting some furniture at home she wants moved. But that’s obviously not the news this man wants his wife to hear as he grimaces and tries to convincingly tell her how he can already tell that bending and lifting won’t be good. 10:30 a.m. — Bengtson is called to the procedure room where he meets an older man who had an amputation of his leg below the knee due to diabetes. The man also has skin cancer, with an additional growth on his neck to be removed today. “All I hear about you, young man, is good,” the man says to Bengtson. “Well, wait till I get to tell my side of the story,” Bengtson shoots back. Bengtson examines the Assisted by fellow surgeon Dr. Jim Dehen and Registered Nurse Mary Droogsma, Dr. Ross Bengtson performed a carotid endarterectomy, an operation to unblock his patient's carotid artery, one of two main arteries which run blood from the heart to the brain down either side of the neck.
Dr. James Tuorila, psychologist at the St. Cloud VA Medical Center, leads a posttraumatic stress disorder support group once a week at Brainerd Regional Human Services Center. About 30 people from Operation Desert Storm, Vietnam and World War II meet to discuss different topics related to PTSD. “We discuss how traumatic experiences during war have affected our lives today,” Tuorila said. “Front line units have higher rates of problems depending on what they experienced during their tour of duty.” Tuorila, himself a Korean War veteran, currently has a son serving in Iraq. Tuorila expects him to come back a changed man. “I don’t think anyone can go away to war for a year and come back the same person,” he said. For many veterans, war has changed them for the better, becoming more mature and in touch with their feelings, Tuorila said, but others struggle to rid themselves of the tragedy of war. “The number one issue (dealt with at the PTSD support group) is the transition from being on guard 24 hours a day to not having a rifle or machine gun by your side,” Tuorila said. PTSD is triggered after being involved in
Better get a
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Josh Cameron had no trouble reuniting with his family. The day he returned he was greeted by friends and family at a surprise party, welcoming him home. Hayden Cameron was 10 months old when Josh left and was on the verge of the terrible 2s when he returned. Josh’s fiancee, Dawn Statly, showed Hayden a picture of Josh daily to remind her who he was. “Dawn would show (Hayden) a picture and she’d kiss it,” Josh said. “She wouldn’t let her forget who I was.” The ritual must have worked. Although a little shy at first, Hayden welcomed her dad with open arms when he returned home in March. “Hayden is probably the one thing that has changed the most while I was gone,” Josh said. Josh has been on leave from the Army for the last four weeks, spending time with his family, reconnecting with his “regular” life. He soon plans to go back to work at Crosslake Sheetmetal, something he said he’s definitely ready to do. Sue Cameron is just happy to have her family back together. “If he goes back (to war), we’re all going back with him,” Sue said.
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With a needle smaller than the surgical sutures themselves, it’s easy to see why magnifying glasses and a steady hand are a surgeon’s allies in the operating room.
or witnessing a traumatic act, such as being wounded, seeing someone killed or being a prisoner of war. Symptoms of PTSD include having nightmares, responding to loud or unexpected noises, drinking problems or having anger management issues. Tuorila said no one from Operation Enduring Freedom in Afghanistan or Operation Iraqi Freedom have joined the PTSD support group yet. Col. Vern Anderson, Minnesota state chaplain for the joint forces, said soldiers are well prepared for the transition of returning home after being at war in Iraq. “Reunion (with family members) is more difficult than mobilization,” Anderson said. Before soldiers are sent home, they are briefed about what to expect when reuniting with their families and returning to civilian employment. Many people have trouble reconnecting with their spouses or significant others after being at war for a long period of time. Local church leaders and mental health counselors as well as military support can help ease the transition, Anderson said. “Things might feel awkward, but this is very normal,” he said. “The key is don’t rush things.” ®
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21
Life after war Now the mental, emotional battle starts
CMYK
Story/Heidi Lake Photo/Nels Norquist
We Have Procedures For Problems You Don’t Even Have Yet.
After spending nearly a year in Iraq, Spc. Josh Cameron was welcomed home by his family, including his daughter, Hayden, who was only 10 months old when he left. For many soldiers, reuniting with their families after being at war is harder than leaving them.
Josh Cameron didn’t see his daughter, Hayden, walk for the first time or hear her speak her first word. He even missed her first birthday. On active duty with the Minnesota National Guard’s Company C, 142nd Engineer Battalion, Spc. Cameron, who had never been away from his family for more than a few months at a time during training, found himself stationed at Camp Anaconda near Balad, Iraq, for nearly a year. “We’re a very close-knit family,” said Sue Cameron, Josh’s mother. “I can’t handle the separation.” Sue found herself reading war updates on the Internet three or four times a day while her son was gone, trying to keep up on the latest news from Iraq. E-mails or letters from Josh were few and far between the first few months in Iraq, while camp was still getting set up.
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“I’d have to wait in line four or five hours to use the phone,” Josh said. “The worst part was not hearing from him,” Sue added. As part of an engineering company, Josh didn’t feel like he was in much danger while in Iraq. Except for the occasional mortar, or incoming rounds of enemy fire, Josh said he didn’t see any devastating effects of the war. “We weren’t running through the towns busting down doors or anything like that,” he said. “I never saw any direct fire. If mortar was falling and your tent didn’t move, then don’t worry about it.” A bit of reality set in when Josh Cameron got word a rocket propelled grenade went through a Bradley Fighting Vehicle, killing a fellow Minnesotan and acquaintance of his.
CUYUNA REGIONAL MEDICAL CENTER D EDICATED T O Y OU. E VERY D AY.
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Following a successful procedure, Dr. Ross Bengtson shared the good news with his patient’s wife.
incision site on the man’s amputation and re-bandages the area before helping him move to the exam table where he is laid down on his side so Bengtson can access his neck. Injecting a needle of Lidocaine into the growth area, Bengtson likens the “sting” to a mosquito bite. The man grimaces on the table and when asked if he’s doing all right he replies, “That’s an awful big mosquito.” Bengtson tells him the growth being removed will be sent in to get a biopsy. He also examines two moles on the man’s neck but tells him they are likely benign but to continue to watch both for any changes. 10:57 a.m. — An elderly man partially paralyzed and confined to a wheelchair is Bengtson’s next patient. The man’s tightly fitting shoes had rubbed sores on his small toe, forcing an earlier amputation. Another sore had formed on that foot’s big toe as well which had also been treat-
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ed. Today’s visit was for his re-evaluation. Noting that the sores had improved, Bengtson also offered to write the man a prescription for support socks. Before leaving the room, Bengtson helps the man put his sock and shoe back on, attributing his “expertise” to his work as a nursing assistant in a nursing home while attending college. 11:30 a.m. — Done for the day with appointments at the clinic, Bengtson finishes his paperwork and makes a few calls before heading to SJMC where he is scheduled for four surgeries this afternoon. 12:30 p.m. — Bengtson grabs a quick lunch from the SJMC cafeteria and eats in the surgical staff lounge, visiting with Dr. Hal Leland and other surgical staff. Due to the full schedule of surgeries this afternoon at the hospital, Bengtson explains his first procedure has been pushed
back. 12:55 p.m. — Bengtson arrives in Operating Room 6 with his MP3 player and a set of small speakers, explaining that everything is better with music. The anesthesiologist and several nurses prepare for the surgery, starting IVs on the patient and unfolding blue sheets filled with sterile silver surgical tools. Bengtson uses a black marker to visibly mark the incision site on the now unconscious 53year-old man’s neck. He will be undergoing a carotid endarterectomy, an operation to unblock his carotid artery, one of two main arteries which run blood from the heart to the brain down either side of the neck. 1:02 p.m. — Scrubbed in and ready to begin this delicate surgery, Bengtson helps the operating room staff drape the patient’s body, leaving only an opening at the surgical site.
1:09 p.m. — Wearing special glasses to magnify images, Bengtson makes the first incision into his patient’s neck. Cutting through layers of tissue, he makes his way to the carotid artery being careful of nerves while en route. 1:16 p.m. — Dehen scrubs in and joins Bengtson in the operating room. As a nurse monitors the patient’s vital signs, Bengtson orders medications to be administered through his IV. Once the carotid artery is located, an incision is made into its wall and a shunt, or artificial artery, is placed within that artery. Blood flow will be rerouted through that shunt as Bengtson cleans away the plaque inside the artery’s walls. Once cleaned out, a patch is placed over the incision made in the artery and the shunt is removed. 2:27 p.m. — A small tube is placed near the incision site to allow excess fluids to drain out the neck. With another successful procedure under his belt, Bengtson sews the layers of tissue and skin back together. He estimates he performs about three carotid endarterectomy procedures a month. He says if all goes as planned, this man will be going home tomorrow. 2:41 p.m. — Nurse Patty Fortier removes the breathing apparatus in place during the surgery and calls the man’s name to help him come out of the anesthesia. “Open your eyes,” she tells him. “You’re just waking up.” Bengtson says with this type of procedure he usually stays in the OR until the patient is conscious to ensure he or she didn’t suffer a stroke during surgery, which can be a risk. 2:44 p.m. — The man begins to wake up as he opens his eyes and coughs from the remaining airway tube in his throat. Bengtson asks the man to squeeze his hand and wiggle his toes, which he does successfully, assuring a stroke did not occur. 2:46 p.m. — Bengtson walks to the surgery waiting area, where the man’s wife awaits word on her husband’s condition, and tells her the good news. 2:49 p.m. — A middle-aged woman waits in a room in the same-day surgery area, prepped for a laparoscopic procedure on a hernia. He talks with her briefly answering a few questions, then returns to the staff lounge for a quick break before returning to the OR. Laparoscopy is a surgical technique when a lighted viewing instrument is inserted into the lower abdomen through a small incision allowing for a minimally invasive procedure. 2:55 p.m. — Bengtson is excited for things to come, he explains, as he will soon be doing laparoscopic gastric bypass surgeries at SJMC. He said the hospital is still getting the program set up from pre-operative psychiatric evaluation and nutritionists to support groups following the surgery. “We want to make it as good a program as possible,” he explains, adding the services will be most likely available within the next few months. He said the hospital also offers varicose vein removal procedures which are minimally invasive and growing in popularity amongst those who suffer from the vascular disorder. 3:23 p.m. — Bengtson has just been informed, due to a number of surgeries scheduled, his laparoscopic procedure will be pushed back a couple hours. And with two gallbladder surgeries still scheduled later in the day, Bengtson notes it’s going to be a long day for him. But through it all, he shows his true passion for his career and concedes it’s all in a day’s work in this day in the life of a surgeon.
It’s Not Too Late… Look Your Best This Summer! Try it! What do you have to lose?
822-3302 • 2301 Excelsior Road North, Baxter, MN 56401
Kathy, Micha, Steve, Cassie, Michele
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CR 66 Crosslake, MN seasonal allergy symptoms? 218-692-2502 or 800-595-7312 ... Mon-Fri 9-5:30; Sat 9-1 we have a complete line pharmacy@crosslake.net of cold/allergy products!
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19
CMYK
Following a successful procedure, Dr. Ross Bengtson shared the good news with his patient’s wife.
incision site on the man’s amputation and re-bandages the area before helping him move to the exam table where he is laid down on his side so Bengtson can access his neck. Injecting a needle of Lidocaine into the growth area, Bengtson likens the “sting” to a mosquito bite. The man grimaces on the table and when asked if he’s doing all right he replies, “That’s an awful big mosquito.” Bengtson tells him the growth being removed will be sent in to get a biopsy. He also examines two moles on the man’s neck but tells him they are likely benign but to continue to watch both for any changes. 10:57 a.m. — An elderly man partially paralyzed and confined to a wheelchair is Bengtson’s next patient. The man’s tightly fitting shoes had rubbed sores on his small toe, forcing an earlier amputation. Another sore had formed on that foot’s big toe as well which had also been treat-
18
ed. Today’s visit was for his re-evaluation. Noting that the sores had improved, Bengtson also offered to write the man a prescription for support socks. Before leaving the room, Bengtson helps the man put his sock and shoe back on, attributing his “expertise” to his work as a nursing assistant in a nursing home while attending college. 11:30 a.m. — Done for the day with appointments at the clinic, Bengtson finishes his paperwork and makes a few calls before heading to SJMC where he is scheduled for four surgeries this afternoon. 12:30 p.m. — Bengtson grabs a quick lunch from the SJMC cafeteria and eats in the surgical staff lounge, visiting with Dr. Hal Leland and other surgical staff. Due to the full schedule of surgeries this afternoon at the hospital, Bengtson explains his first procedure has been pushed
back. 12:55 p.m. — Bengtson arrives in Operating Room 6 with his MP3 player and a set of small speakers, explaining that everything is better with music. The anesthesiologist and several nurses prepare for the surgery, starting IVs on the patient and unfolding blue sheets filled with sterile silver surgical tools. Bengtson uses a black marker to visibly mark the incision site on the now unconscious 53year-old man’s neck. He will be undergoing a carotid endarterectomy, an operation to unblock his carotid artery, one of two main arteries which run blood from the heart to the brain down either side of the neck. 1:02 p.m. — Scrubbed in and ready to begin this delicate surgery, Bengtson helps the operating room staff drape the patient’s body, leaving only an opening at the surgical site.
1:09 p.m. — Wearing special glasses to magnify images, Bengtson makes the first incision into his patient’s neck. Cutting through layers of tissue, he makes his way to the carotid artery being careful of nerves while en route. 1:16 p.m. — Dehen scrubs in and joins Bengtson in the operating room. As a nurse monitors the patient’s vital signs, Bengtson orders medications to be administered through his IV. Once the carotid artery is located, an incision is made into its wall and a shunt, or artificial artery, is placed within that artery. Blood flow will be rerouted through that shunt as Bengtson cleans away the plaque inside the artery’s walls. Once cleaned out, a patch is placed over the incision made in the artery and the shunt is removed. 2:27 p.m. — A small tube is placed near the incision site to allow excess fluids to drain out the neck. With another successful procedure under his belt, Bengtson sews the layers of tissue and skin back together. He estimates he performs about three carotid endarterectomy procedures a month. He says if all goes as planned, this man will be going home tomorrow. 2:41 p.m. — Nurse Patty Fortier removes the breathing apparatus in place during the surgery and calls the man’s name to help him come out of the anesthesia. “Open your eyes,” she tells him. “You’re just waking up.” Bengtson says with this type of procedure he usually stays in the OR until the patient is conscious to ensure he or she didn’t suffer a stroke during surgery, which can be a risk. 2:44 p.m. — The man begins to wake up as he opens his eyes and coughs from the remaining airway tube in his throat. Bengtson asks the man to squeeze his hand and wiggle his toes, which he does successfully, assuring a stroke did not occur. 2:46 p.m. — Bengtson walks to the surgery waiting area, where the man’s wife awaits word on her husband’s condition, and tells her the good news. 2:49 p.m. — A middle-aged woman waits in a room in the same-day surgery area, prepped for a laparoscopic procedure on a hernia. He talks with her briefly answering a few questions, then returns to the staff lounge for a quick break before returning to the OR. Laparoscopy is a surgical technique when a lighted viewing instrument is inserted into the lower abdomen through a small incision allowing for a minimally invasive procedure. 2:55 p.m. — Bengtson is excited for things to come, he explains, as he will soon be doing laparoscopic gastric bypass surgeries at SJMC. He said the hospital is still getting the program set up from pre-operative psychiatric evaluation and nutritionists to support groups following the surgery. “We want to make it as good a program as possible,” he explains, adding the services will be most likely available within the next few months. He said the hospital also offers varicose vein removal procedures which are minimally invasive and growing in popularity amongst those who suffer from the vascular disorder. 3:23 p.m. — Bengtson has just been informed, due to a number of surgeries scheduled, his laparoscopic procedure will be pushed back a couple hours. And with two gallbladder surgeries still scheduled later in the day, Bengtson notes it’s going to be a long day for him. But through it all, he shows his true passion for his career and concedes it’s all in a day’s work in this day in the life of a surgeon.
It’s Not Too Late… Look Your Best This Summer! Try it! What do you have to lose?
822-3302 • 2301 Excelsior Road North, Baxter, MN 56401
Kathy, Micha, Steve, Cassie, Michele
“Your Hometown Pharmacy Team” Private Consultations • Gifts • Cards • Toys • Clothing Kodak Film Developing • Dry Cleaning Service Questions about your cold or
Ask Us
CR 66 Crosslake, MN seasonal allergy symptoms? 218-692-2502 or 800-595-7312 ... Mon-Fri 9-5:30; Sat 9-1 we have a complete line pharmacy@crosslake.net of cold/allergy products!
Ask Us
19
Life after war Now the mental, emotional battle starts
CMYK
Story/Heidi Lake Photo/Nels Norquist
We Have Procedures For Problems You Don’t Even Have Yet.
After spending nearly a year in Iraq, Spc. Josh Cameron was welcomed home by his family, including his daughter, Hayden, who was only 10 months old when he left. For many soldiers, reuniting with their families after being at war is harder than leaving them.
Josh Cameron didn’t see his daughter, Hayden, walk for the first time or hear her speak her first word. He even missed her first birthday. On active duty with the Minnesota National Guard’s Company C, 142nd Engineer Battalion, Spc. Cameron, who had never been away from his family for more than a few months at a time during training, found himself stationed at Camp Anaconda near Balad, Iraq, for nearly a year. “We’re a very close-knit family,” said Sue Cameron, Josh’s mother. “I can’t handle the separation.” Sue found herself reading war updates on the Internet three or four times a day while her son was gone, trying to keep up on the latest news from Iraq. E-mails or letters from Josh were few and far between the first few months in Iraq, while camp was still getting set up.
20
“I’d have to wait in line four or five hours to use the phone,” Josh said. “The worst part was not hearing from him,” Sue added. As part of an engineering company, Josh didn’t feel like he was in much danger while in Iraq. Except for the occasional mortar, or incoming rounds of enemy fire, Josh said he didn’t see any devastating effects of the war. “We weren’t running through the towns busting down doors or anything like that,” he said. “I never saw any direct fire. If mortar was falling and your tent didn’t move, then don’t worry about it.” A bit of reality set in when Josh Cameron got word a rocket propelled grenade went through a Bradley Fighting Vehicle, killing a fellow Minnesotan and acquaintance of his.
CUYUNA REGIONAL MEDICAL CENTER D EDICATED T O Y OU. E VERY D AY.
17
CMYK
similar blockage in the carotid artery is seen by Bengtson. He explains her blockage consumes about 80 percent of this essential artery, as determined by an ultrasound. Without surgery, Bengtson says she runs an 11 percent risk of a stroke. Once operated on, that risk drops to 5 percent over five years, he tells her. But the elderly woman refuses to have surgical intervention. Bengtson accepts her decision and requests she return in a year to have another ultrasound. “I’ll see you in a year,” he tells her when leaving the room. “You better be here in a year,” she tells him. “Oh, I will be,” he laughs back. 10:14 a.m. — A gentleman with skin cancer is back in Bengtson’s office to have his incision checked where cancerous spots were removed. “Everything looks pretty good from my standpoint,” he tells the man and his wife. The wife asks Bengtson about any lifting restrictions for her husband, to which Bengtson tells her he is free to lift. “Oh good,” she says with a twinkle in her eye, noting some furniture at home she wants moved. But that’s obviously not the news this man wants his wife to hear as he grimaces and tries to convincingly tell her how he can already tell that bending and lifting won’t be good. 10:30 a.m. — Bengtson is called to the procedure room where he meets an older man who had an amputation of his leg below the knee due to diabetes. The man also has skin cancer, with an additional growth on his neck to be removed today. “All I hear about you, young man, is good,” the man says to Bengtson. “Well, wait till I get to tell my side of the story,” Bengtson shoots back. Bengtson examines the Assisted by fellow surgeon Dr. Jim Dehen and Registered Nurse Mary Droogsma, Dr. Ross Bengtson performed a carotid endarterectomy, an operation to unblock his patient's carotid artery, one of two main arteries which run blood from the heart to the brain down either side of the neck.
Dr. James Tuorila, psychologist at the St. Cloud VA Medical Center, leads a posttraumatic stress disorder support group once a week at Brainerd Regional Human Services Center. About 30 people from Operation Desert Storm, Vietnam and World War II meet to discuss different topics related to PTSD. “We discuss how traumatic experiences during war have affected our lives today,” Tuorila said. “Front line units have higher rates of problems depending on what they experienced during their tour of duty.” Tuorila, himself a Korean War veteran, currently has a son serving in Iraq. Tuorila expects him to come back a changed man. “I don’t think anyone can go away to war for a year and come back the same person,” he said. For many veterans, war has changed them for the better, becoming more mature and in touch with their feelings, Tuorila said, but others struggle to rid themselves of the tragedy of war. “The number one issue (dealt with at the PTSD support group) is the transition from being on guard 24 hours a day to not having a rifle or machine gun by your side,” Tuorila said. PTSD is triggered after being involved in
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Josh Cameron had no trouble reuniting with his family. The day he returned he was greeted by friends and family at a surprise party, welcoming him home. Hayden Cameron was 10 months old when Josh left and was on the verge of the terrible 2s when he returned. Josh’s fiancee, Dawn Statly, showed Hayden a picture of Josh daily to remind her who he was. “Dawn would show (Hayden) a picture and she’d kiss it,” Josh said. “She wouldn’t let her forget who I was.” The ritual must have worked. Although a little shy at first, Hayden welcomed her dad with open arms when he returned home in March. “Hayden is probably the one thing that has changed the most while I was gone,” Josh said. Josh has been on leave from the Army for the last four weeks, spending time with his family, reconnecting with his “regular” life. He soon plans to go back to work at Crosslake Sheetmetal, something he said he’s definitely ready to do. Sue Cameron is just happy to have her family back together. “If he goes back (to war), we’re all going back with him,” Sue said.
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With a needle smaller than the surgical sutures themselves, it’s easy to see why magnifying glasses and a steady hand are a surgeon’s allies in the operating room.
or witnessing a traumatic act, such as being wounded, seeing someone killed or being a prisoner of war. Symptoms of PTSD include having nightmares, responding to loud or unexpected noises, drinking problems or having anger management issues. Tuorila said no one from Operation Enduring Freedom in Afghanistan or Operation Iraqi Freedom have joined the PTSD support group yet. Col. Vern Anderson, Minnesota state chaplain for the joint forces, said soldiers are well prepared for the transition of returning home after being at war in Iraq. “Reunion (with family members) is more difficult than mobilization,” Anderson said. Before soldiers are sent home, they are briefed about what to expect when reuniting with their families and returning to civilian employment. Many people have trouble reconnecting with their spouses or significant others after being at war for a long period of time. Local church leaders and mental health counselors as well as military support can help ease the transition, Anderson said. “Things might feel awkward, but this is very normal,” he said. “The key is don’t rush things.” ®
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Life after spinal surgery: A 12-year-old’s recovery
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Story/Jennifer Wilson Morris News Service
AMARILLO, Texas — No hospital room compares to your own bedroom — especially when your room has red, orange, yellow and green walls. That’s 12-year-old Wendy Weatherly’s room, and she was glad to return to it. “It was so great,” Wendy said. “There’s nothing like home.” Wendy, a seventh-grader, returned to Amarillo on March 27 after undergoing 13 hours of surgery in Philadelphia to straighten her spine curved by scoliosis. Surgeons removed staples from a previous procedure, then inserted rods into her spine to straighten it. Doctors had hoped that fall’s pioneering procedure would straighten Wendy’s spine without the traditional rods, but Xrays earlier this year showed that her curve was getting worse and she’d need the rods. For now, Wendy is continuing her studies at home as her spine fuses perfectly
straight. “Every day is a little bit better, but every day has its challenges,” Wendy said. She doesn’t remember much about the first few days after surgery. But that didn’t stop her from communicating with family — her fingers remembered sign language, even when a tube in her throat wouldn’t let her talk. “I guess God just provided a way to talk to my parents through sign language,” Wendy said. Family members back in Amarillo also contributed to her recovery, said her mother, Karla Weatherly. When Wendy’s blood count was low, a local blood bank shipped blood that her grandfathers had donated. Four hours after the transfusion started, the 12-year-old felt much better and was ready to watch some television. “She got some very powerful grandfather blood,” Karla Weatherly said.
But Wendy also gets strength from a higher source, the family said. “It comes from God — really it does,” Wendy said. She doesn’t know why all this has happened to her, but Wendy trusts that she’ll find out someday. “(God) has a reason, and he’ll tell me when I get to heaven,” she said. Wendy has also been comforted by the phone calls and cards from people literally around the globe — even from perfect strangers. “It’s such a nice feeling to know that people care,” she said. Wendy will wear her brace — now a psychedelic pink and purple one — for three more months, she said. Her dad, Brent Weatherly, said he’s glad his daughter is home. He is grateful for all of Wendy’s doctors. “I’m glad there’s people like that around,” he said.
SLEEP YOUR BEST, BE YOUR BEST.
Feeling tired? Do you catch yourself yawning during the day? You’re not alone. One in every seven people suffers from a sleep ailment. But now there’s help. Introducing the Brainerd Lakes Sleep Health Center. With the comfort of an upscale hotel and the latest sleep assessment practices, Dr. Greatens and his staff treat sleep apnea, narcolepsy and many other conditions that can prevent you or someone you love from getting the deep, rejuvenating sleep a body needs. Stop yawning and start sleeping. Call (218) 855-5479 or 1-800-277-8262 to schedule a consultation.
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Todd M. Greatens, M.D.
John Wills, RPSGT
Director
Sleep Lab Manager
www.brainerdclinic.com • 2024 South Sixth Street
8 a.m. — While many are just arriving for a day’s work, Dr. Ross Bengtson has been at his job for more than an hour already. Bengtson, 32, a physician and surgeon who splits his time between Brainerd Medical Center and St. Joseph’s Medical Center, says he made his first stop of the day at 6:45 a.m. to visit his post-operative patients at SJMC. Now at BMC for a morning of office visits, Bengtson prepares for the full day that lies ahead. Bengtson, a Brainerd resident, has been with BMC/SJMC for nearly one year. He and Dr. Jim Dehen work together at both the clinic and hospital, conferring with one another and assisting when needed on surgical procedures. Much like Dehen, Bengtson is a general surgeon with care levels ranging from vascular and laparoscopic to thoracic and more. 8:15 a.m. — A middle-aged woman meets with Bengtson as a follow-up to a recent diagnosis of endometriosis. After telling him of the pain she experiences in the affected area, Bengtson explains her options, including surgery to remove the growth or to forgo removal and follow-up with a CT scan in another six months, since the growth is benign or non-cancerous. She agrees to follow-up in six months with the scan. 8:25 a.m. — A man shows Bengtson a growth he has had on his elbow for the past year. After examination, Bengtson offers to have the lump removed in the office. “Whack ‘er off there,” the man agrees. Led to one of two procedure rooms in the surgical area of BMC, Bengtson shaves the man’s elbow around the spot to be removed, cleans the area and injects Lidocaine into the growth. He explains he won’t feel any pain, but rather a tugging sensation as it is cut from his arm. Nurse Jan Lambert assists Bengtson, handing him gauze as Bengtson snips out what he explains is a sebaceous cyst or a gland that gets clogged and is unable to secrete therefore causing an enlargement under the skin. The man passes up the opportunity to look at the growth once it’s removed and jokes with Bengtson about passing out at the sight of his own blood once. “That’s why I hate cleaning fish,” Bengtson jokes back. “The blood and guts get me.” 8:50 a.m. — Bengtson is assisted in the procedure room by nurse Jackie Weinhandl for a female patient suffering from hemorrhoids. Back at the nurse’s station, nurse Lambert explains how Bengtson will soon be doing gastric bypass surgeries as well as varicose vein
procedures at SJMC. “We do a lot now,” Now following up on the procedure, the she says, “but we’ll be doing even more in man is in good spirits and said he has the future.” resumed life as normal for the most part. 9 a.m. — Bengtson makes phone calls A small mass has collected at the incision to follow up on patients, giving them site during the recovery process, which is results from lab work and X-rays as well as often typical following this type of procecatches up on paperwork before seeing dure. Bengtson gives the man the option his next patient. to attempt to drain out some of the fluid 9:20 a.m. — A woman with leg and foot with a syringe or to simply wait for the swelling visits with Bengtson. She explains body to reabsorb it. After consideration, she has had the swelling for the past three the man agrees to let Bengtson drain the years but it has gotten progressively fluid. But after attempting, Bengtson worse. After reviewing her medical histo- determines the fluid gathered beneath ry, previous surgeries and examining both the skin is still too thick to be removed at legs and feet, Bengtson explains the possi- this time. He tells the man to come back in ble causes and treatments for the swelling. three weeks if the growth is still apparent. He suggests a pair of good compression 10:05 a.m. — A woman, experiencing stockings as well as coming back for an ultrasound of the legs to rule out any chance of blood clots. 9:30 a.m. — After returning to the nurse’s station, Bengtson dictates his patient’s information and findings from his visit into a tape recorder, a regular practice he does after seeing each patient throughout the day. 9:40 a.m. — Bengtson follows-up with a gentleman who first experienced an abscess by his anal area. The area had been drained but didn’t completely remedy itself resulting in yet another procedure three weeks ago. But at this exam, Bengtson says the man is doing “as expected.” 9:50 a.m. — An older couple visits with Bengtson following the husband’s carotid endarterectomy, a procedure done to open an artery in the neck and allow blood flow following severe narrowing or blockage. The artery had become clogged Thirty-two year old surgeon Ross Bengtson scrubs in before surgery at and led to the man St. Joseph's Medical Center in Brainerd. Bengtson, a Brainerd resident, having a small stroke. has been with SJMC and Brainerd Medical Center for nearly one year.
15
A day in the life of a surgeon
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Pillager Clinic Lakewood Health System’s Pillager Clinic offers you and your family convenient, local health care. Our clinic—home to three board-certified physicians, a physician assistant and nurse practitioner is open Monday-Friday with early clinic hours, starting at 8:00 a.m. on Monday, Thursday and Friday. Physical Therapy services and Occupational Health services are also available onsite. Longbella Drug of Staples provides pharmacy and retail services with a drive thru window.
Wearing special glasses to magnify images, Dr. Ross Bengtson cut through layers of tissue while he made his way to the carotid artery of his patient’s neck, being careful of nerves en route. Story/Jenny Kringen-Holmes Photos/Nels Norquist
Lakewood Health System provides local family practice and specialty care including hospital, care center, senior housing, home care / hospice and transportation services as well as convenient clinic locations in Staples, Motley, Eagle Bend and Browerville. With Lakewood Health System you don’t have to go far, it’s right here.
With a John Mayer CD playing in the background, Dr. Ross Bengtson makes his first incision along a 53-year-old man’s neck, working his way through the layers of tissue to the carotid artery. It’s the first of four surgeries on Bengtson's schedule at St. Joseph’s Medical Center in Brainerd on this Thursday afternoon. The 32-year-old surgeon may look young at
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first glance, but Bengtson’s knowledge and talent far exceed his age. With the consent of Brainerd Medical Center, St. Joseph’s Medical Center and several patients, this reporter followed a local general surgeon during a typical Thursday shift in March. This is just a glimpse into a day in the life of a surgeon.
For an appointment, call 218.746.4550 Pillager Clinic—631 State Hwy 210W, Pillager, MN 56473
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As a high-level executive for a large computer manufacturer, Dan Bishop was a self-described workaholic who thought he was ably juggling daily demands and corporate pressures. Then he woke up one night with tightness in his chest, barely able to breathe. At first he suspected a heart attack. The tightness quickly passed, but he was frightened enough to see his doctor. The doctor diagnosed an anxiety attack — caused by stress — and told him to “stop being so driven.” “I didn’t know what stress was; I didn’t think I had stress,” said Bishop, now 52, referring to the 1990 diagnosis. As Bishop found, stress can be insidious. The pressures of daily life — jobs, relationships, money, raising children and now, war and terrorism — have become such constant companions that many of us operate with ever-present feelings of pressure, anxiety or burnout. The stress can become so unflagging that many people have accepted it as a standard part of life. Although we may try to ignore its presence, stress doesn’t go away. It just goes to work inside the body. Prolonged stress contributes to many physical and psychological ills. It overrides natural defenses against viruses that cause AIDS, chickenpox and the common cold; encourages the production of inflammatory hormones that drive heart disease, obesity and diabetes; sparks flareups of rheumatoid arthritis and digestive disorders; creates depression and ages the brain. “Numerous studies show that psychological stress can lead to illness, or even death,” said Dr. Michael Irwin, director of the Norman Cousins Center for Psychoneuroimmunology at the University of California, Los Angeles’ Neuropsychiatric Institute. “How we cope with stress and whether or not we get depressed is crucial for our health.” Unchecked stress sends out complex signals that unleash a cascade of activity throughout the body. When someone is confronted with stress — whether physical or psychological — the brain is the first part of the body to respond, reacting in two distinct ways. In one of the reactions, a regulatory part of the brain called the hypothalamus sends signals through sympathetic nerves near the spinal cord to the adrenal glands, commanding them to release the stress hormones epinephrine and norepinephrine (also called adrenaline and noradrenaline). These hormones gird the body for action. They boost heart rate, blood pressure, breathing and blood flow to the muscles and brain, providing an extra surge of energy in times of physical danger. They can also keep athletes, entertainers and others on their toes, keeping them alert and productive when performance counts. But chronic stress opens the floodgates to epinephrine and norepinephrine, regardless of whether there’s a threat, allowing bacteria, viruses or tumors to flourish and making blood more prone to clotting.
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severity of a patient’s sleep apnea. If a certain criteria is met, technicians quietly enter the patient’s room, and wake them up just enough to slip on a continuous positive airway pressure mask or CPAP. CPAP is a machine that delivers air into the airway through a mask worn over the nose. The mask’s airflow creates enough pressure that when a patient inhales their airway stays open, allowing them to breathe easily, without snoring. CPAP is considered the most common and most effective non-surgical treatment for the alleviation of snoring and sleep apnea. Even Greatens and Wills wear CPAP at night. “I used to wake up with bruises from my wife elbowing me,”Wills joked about his loud snoring that accompanied his sleep apnea. “Now it’s a whole new lifestyle. It can change people’s lives.” Tousignant agreed. “It was just like a different me,” she said following her night at the sleep center where she used CPAP for the first time. “I felt very refreshed.” After looking over the test results and discussing options with Greatens the morning after the study, Tousignant was sold on CPAP. She got one the very next
Continuous positive airway pressure mask, or CPAP, is considered the most common and most effective non-surgical treatment for the alleviation of snoring and sleep apnea.
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day. “I was almost anxious to go to bed just to put it on,” she said. Other sleep apnea treatment options include surgery and oral appliances which pull the lower jaw forward, keeping the airway open. Greatens said other sleep disorders can be treated with medication. Sleep apnea affects 14 percent of men and more than 2 percent of women. Obesity, smoking and drinking alcohol can contribute to sleep apnea, which can affect cardiovascular health by causing high blood pressure, heart disease and stroke. Greatens said anyone with sleeping problems is prone to depression as well. “Education is a big part of what we do,” Wills said, encouraging people to learn about and get treated for their sleep disorder early. Tousignant said getting treated for sleep apnea has changed her life. “Don’t drag your feet — if you think you have a (sleeping disorder), get checked,” she said. Other sleep labs are located in Duluth, St. Cloud and the Twin Cities.
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The brain’s other reaction comes through the pituitary gland, which sends signals through the bloodstream instructing the adrenal glands to release the stress hormone cortisol and other steroids. In the right amounts, cortisol helps the body recharge, enhances disease resistance, fights inflammation and improves memory. In excess, however, cortisol promotes the accumulation of abdominal fat, suppresses immunity, shrinks brain cells and impairs memory. Over time, cells become less sensitive to the protective effects of cortisol, and inflammation goes unchecked. Scientists are only now beginning to understand what happens when stress disrupts the delicate interplay between the brain, the endocrine system — the glands and organs that make and release hormones — and the immune system, stimulating the release of compounds that cause inflammation. They’re also beginning to identify ways to stop this inflammation and other stress-related biological effects. “New treatments that teach us ways to relax and cope with daily stress offer great promise in decreasing the risk for many preventable illnesses,” Irwin said. Recent research has identified some of the following ways in which stress influences the course of illnesses linked to viruses, aging or the body’s misguided attack on its own tissues. Physical or mental stress can take an enormous and sometimes deadly toll on the heart. It increases blood pressure, narrows blood vessels and causes blood to become stickier and more likely to clot, increasing the likelihood of a heart attack or stroke. In February, Irwin published a study in the American Journal of Psychiatry showing that stress and depression in heart attack patients increase amounts of chemicals that make certain immune cells sticky and help them travel to artery linings, where they produce inflammation and promote coronary artery disease. A study published last week in the journal Circulation found that mental stress also triggers irregular heartbeats, which can be deadly. Stress can certainly give you butterflies or a stomachache, but chronic stress can trigger flare-ups of irritable bowel syndrome, an intestinal condition that includes cramping, gas, diarrhea and constipation. Women with the condition (who vastly outnumber men) not only have elevated levels of cortisol, but also have exaggerated differences between the higher morning and lower evening levels found in healthy people, Italian researchers reported in 2001. Although stress is no longer believed to cause ulcers (they’re sparked by an infection of the bacterium H. pylori), it can worsen symptoms. HIV-infected gay men who keep their sexual orientation secret get sicker and have shorter life spans than gay men who are more open about their sexuality, a 1996 study found. Closeted gay men tend to be shyer and their nervous systems overreact to stress; as a result, their bodies pump out more stress hormones, which encourage the virus to multiply.
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Sitting is a spreading occupational hazard
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Story/Stacey Hirsh Baltimore Sun
When Paul M. Ribisl needed his secretary to photocopy exams at Wake Forest University 30 years ago, she had to type the questions, walk them to a mimeograph machine, then manually crank out copies. When he needed a letter typed, she would walk to his desk, take shorthand, return to her desk to type the letter, walk it back to him to proofread, then walk back to retype it if there were corrections. Today, however, a copy machine collates, staples and bundles exams in minutes, and Ribisl can type letters and e-mail them to colleagues, saving his secretary all those steps. “You can look at every part of someone’s life and see that the physical drudgery has been taken out of it,” said Ribisl, who now chairs the health and exercise science department at the university in North Carolina. “People are stuck at their desks more.” Along with super-size fries and the TV remote, the workplace has become a cul-
prit in the great American weight gain. A recent study released in the Journal of the American Medical Association concluded that poor diet and lack of exercise could soon surpass tobacco as the leading preventable cause of premature death in the United States. The economy has become dominated by sedentary office work. Technology allows — even requires — workers to remain in a chair all day, staring at a screen. Ever pressed for time, workers seem constantly to be scarfing down junk food on the run or grazing at their desks. Improved technology — from conference calling to instant messaging to Internet-cams — makes communication ever more possible without leaving one’s seat. The result: Gaining weight has become the latest occupational hazard. Americans on average expend about 200 to 300 fewer calories a day than they did 25 years ago — or about 7,000 fewer calories a month, he said. The change
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years ago from manual typewriters to computers, by one estimate, caused the average full-time secretary to gain 5 to 10 pounds a year. “There’s a huge decrease in metabolism that you get when you’re just sitting at your desk all the time,” said Scott Collier, an adviser and instructor in Syracuse University’s exercise science department who directs an exercise program for the university’s staff. Stress from work, many experts say, is also greater, fueled by such things as the push for greater productivity and the threat of outsourcing and downsizing. Stress lowers metabolism, making it tougher to burn calories. And cell phones and e-mail at home and on the road can make work seem omnipresent. “Our work force has become more and more sedentary every single year as technology advances. I think at this point we’re very chair-bound, between the phone and the computer,”said Chris Corcoran, senior
DOCTORS
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out what the underlying problem may be. Overnight sleep studies are done three nights per week at the center. Overnight studies are recommended for most sleep disorder sufferers in order to find out the extent of their problem and how it can be fixed. “We try to know what the problem is before the sleep study,” Greatens said. Of the more than 80 sleep disorders out there, including insomnia, narcolepsy, sleep walking and recurring nightmares, obstructive sleep apnea syndrome is the most common disorder treated at BMC’s sleep clinic. “That’s probably the bread and butter of the lab,” John Wills, sleep lab manager said. Extremely loud snoring, pauses in breathing and falling asleep at inappropriate times are signs of sleep apnea, a potentially life-threatening disorder. Snoring occurs when the muscles in a person’s throat relax too much, narrowing the airway. When air is forced through the narrowed passageway, it results in a snoring sound. For most people the narrowing is not a problem, but
for people with sleep apnea it makes breathing difficult, causing them to stop breathing for a period of time while sleeping. When the brain senses the increased difficulty to breathe, it wakes up just enough to tighten the throat muscles, allowing air to get through effortlessly. Tousignant’s brain had to remind her to breathe 112 times per hour during her sleep study, Greatens said, resulting in her never feeling like she got a good night’s sleep. Before being diagnosed with sleep apnea, Tousignant took a nighttime cold medication to help her sleep at night. “It helped some, but not with the tossing and turning,” she said. “I’d have to drag myself out of bed in the morning. I had no energy whatsoever.” Tousignant admitted when she and Greatens decided a sleep study needed to be done she was nervous, but anxious by the mere thought of sleeping well. Patients arrive at the sleep clinic at 8:30 p.m., change into their pajamas and relax. A sleep technician places sensors on the patient’s head, temple, jaw, neck, chin,
nose, chest and legs to monitor the body and its sleeping habits, such as heart rate, breathing, snoring and leg movement. The sensors transmit information into a control room, manned by sleep technicians all night long. “I thought I would fight with the wires all night, but I couldn’t even tell I had them on,” Tousignant said. The sleep center, part of BMC’s newly completed $9 million expansion project, has a hotel-like feel, with a lounging area, kitchen and four private bedrooms with televisions and attached private bathrooms. The comfortable beds and casual decor gives the sleep center a homey feel, except for the microphone above the bed and the infrared camera attached to the bedroom wall. Although the hardware looks discreet, it plays a major part in the sleep study’s success. For two hours technicians closely monitor each patient, watching them on a small TV screen, listening to their breathing, snoring and studying the information the sensors reveal. When two hours is up, enough information is gathered to determine the
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Patient rooms at Brainerd Lakes Sleep Health Center resemble a hotel room with a private bathroom and television.
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John Wills, sleep lab manager, studied the information gathered during an overnight sleep study. A video camera and microphone are in each sleeping room, allowing sleep technicians to carefully monitor the patient’s sleeping and snoring habits.
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CPAP provides restful nights for sleep apnea sufferers Story and photos/Heidi Lake
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Ahh, the feeling of utter exhaustion. When you’re so tired it takes all your might to even pull the bed sheets back. After sliding into the comfort zone, your head gets lost in your pillow and you can’t help but let out a sigh. We’ve all been there. Suddenly a permeating noise comes out of the lump on the other side of the bed. In and out. In and out. With each breath you lose a little more of that comfort and relaxation you felt when you first climbed into bed. We’ve all been there too. Snoring. About 10 to 30 percent of adults do it, and for some snoring is more serious than just being an annoyance to their bed partner. When Ann Tousignant and her family vacationed together they’d sleep in separate hotel rooms. For as long as she could remember, Tousignant said her family and friends would tease her about snoring so loudly no one within an earshot could sleep. But it wasn’t until about a year and a half ago that Tousignant realized something was wrong. She’d toss and turn all night. She’d go to bed at 8:30 p.m. and have to drag herself to get up at 7 in the morning, never feeling the least bit refreshed. The 49-year-old daycare provider had no energy and was so wornout it was starting to affect her personal and professional life. “Finally, I just got tired of being tired,” she said. So Tousignant met with Dr. Todd Greatens who specializes in sleep and pulmonary medicine at Brainerd Medical Center. Greatens recommended Tousignant undergo a sleep study at Brainerd Lakes Sleep Health Center, BMC’s new sleep center. Before a patient such as Tousignant visits Greatens, a 10-question survey regarding sleeping habits must be done. A patient also has to complete a sleep log, stating when they go to bed and wake up and how many hours they thought they actually slept. At the initial consultation, Greatens goes over the questionnaire and talks with the patient, trying to figure
marketing manager for Weight Watchers International Inc. A study last year of the Amish, a rural people whose culture forgoes the luxuries of modern technology, showed they are far leaner than most Americans as a result of the lifestyle. A study published by the American College of Sports Medicine in Indianapolis concluded that only 4 percent of Amish were obese and 26 percent were overweight, compared to the general population, in which 31 percent registered as obese and 65 percent as overweight. Some of the Amish, who agreed to wear pedometers for the study, walked as many as 18,000 steps — the equivalent of nine miles a day. The work-weight connection is not merely about lack of physical activity. Many workers are spending more time at the office. A survey by the Web classified site Monster.com of more than 17,500 people concluded that 46 percent work about 40 to 50 hours per week and 25 percent said they work 50 hours or more. “We certainly have more stressed
lives, longer work hours for many of us, and less opportunity for being physically active,” said Lawrence J. Cheskin, associate professor at the Johns Hopkins Bloomberg School of Health and director of the Johns Hopkins Weight Management Center in Baltimore. Poor eating habits at work compound the problem. About two-thirds of Americans eat lunch at their desk, while more than 60 percent of workers snack throughout the day, according to a survey last year by the American Dietetic Association and ConAgra Foods, the Omaha, Neb., food conglomerate. Moreover, with a preponderance of both sexes working outside the home, people turn more to prepared foods from groceries or restaurants. Carryout foods in general contain more fat and sugar than home-cooked meals, and often come in larger portions. The office itself is laden with opportunities for eating, from birthday cakes to going-away celebrations. A desk can even become a psycho-
Obstructive Sleep Apnea The Dark Side Of Night
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logical cue for food cravings — like popcorn at the movies, said Thomas Wadden, director of the weight and eating disorders program at the University of Pennsylvania School of Medicine. While businesses frequently request healthier foods in their vending machines, those snacks often cost more and don’t sell as well as the cheaper, more caloric items. “They’re still big candy eaters. They still drink a lot of soda,” said Gary Desenberg, a sales and service manager at A. Kovens Vending, a Pennsylvania company that supplies and stocks vending machines. Some workplaces are trying to become part of the solution.Offices, factories — even sawmills — are hosting aerobics workouts or contracting with groups like Weight Watchers to conduct weight-loss classes. Some employers now distribute pedometers to motivate workers to walk, even if it means taking a bathroom break on another floor to squeeze in some extra steps.
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Local doctors team up to open outpatient surgical center
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The Brainerd Lakes Surgery Center will open this fall in Baxter, providing outpatient surgery services to the community. The surgery center will be located off Highway 371 near the bypass. The facility is a joint venture between the surgical community and St. Joseph’s Medical Center in Brainerd and will offer state-of-the-science technologies. Story/Jenny Kringen-Holmes
Residents of the lakes area will soon have another choice when making health care decisions. The Brainerd Lakes Surgery Center is slated to open this fall in Baxter, providing outpatient, or same day, surgery services to the community. The surgery center, currently being constructed, is located off Highway 371 near the bypass. It will house four operating rooms as well as one procedure room. Dr. Kurt Waters, a physician and facial plastics surgeon at Brainerd Medical Center, is a surgical partner in the facility. Waters explained the facility is a joint ven-
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ture between the surgical community and St. Joseph’s Medical Center in Brainerd. Waters said the facility will offer stateof-the-science technologies in a convenient location. “From a convenience standpoint, it’ll be great for patients,” he said. “It’s our response to the growing needs of our medical staff and our community.” The services to be offered at the surgical center mirror many of those currently offered on a same day surgery level at SJMC, including general surgeries, ophthalmology, ear nose and throat, orthopedics, podiatry, plastics, and urology.
Waters said he hopes the center will expand in the near future to also include pain management and various women’s services. All minimally invasive and outpatient surgical procedures will be done at the surgical center. All invasive procedures that require a hospital stay will remain at SJMC where inpatient and outpatient care, as well as additional technology and support services are available to ensure the patient receives the best possible care. One thing that will be a constant at both sites is that a board-certified anesthesiologist will oversee each case.
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A job well done The fact that Botox injections are now the No. 1 non-surgical cosmetic procedure in the United States proves the drug is getting and giving not only the aesthetic, but also the medical results people are seeking. Carissa Peterson’s story has especially reinforced Elieff’s confidence in this often controversial drug. Elieff said he treats several patients with conditions similar to Peterson’s, but says her case was one of his first and remains one of his favorite success stories. “It’s something people need to know about,” Peterson added. “Had I not discovered (Botox) I’d be miserable. If something can help you, you don’t really have to be ashamed of it.” Not only is Peterson free of shame, she’s also ready to show off what has been hidden under bulky shirts for too long, noting she will be wearing a strapless black dress to prom this spring. “It has changed my self-esteem and confidence,” Peterson said. “Getting stuck for 15 minutes can change the rest of your life.”
What is Botox? Botulinium Toxin, or Botox, was discovered by accident at a Belgian picnic in 1895 when 34 people ate sausages contaminated with a lethal substance (later known as Botulism) and, subsequently, three died. Botulism is defined as an anaerobic, spore-forming bacteria that, under the right conditions, can germinate and create toxins. After being isolated, purified and experimented with by scientists, the first batch of toxin for human use was prepared in 1979. The Botox procedure has been widely used and is considered a safe, effective way of treating aging skin. Previously approved for the treatment of lazy eye and eye spasms, Botox was approved by the Food and Drug Administration for the treatment of frown lines between the eyes, also known as glabellar lines, in 2002.
expression lines. The constant contractions of those muscles result in wrinkles. Botox blocks the impulses from the nerves to the facial muscles thereby relaxing them, resulting in a smooth, unwrinkled look. What does it cost? Each treatment can cost anywhere between $100 and $800, or more, depending on the affected area to be treated and the units of Botox used.
Where is Botox available? Any authorized health care professional can administer Botox, including dermatologists, plastic surgeons and other cosmetic physicians. Local providers include Dr. Kurt Waters at Facial Plastics at Brainerd Medical Center; Dr. Daniel Elieff of Midwest Clinic of Dermatology, Laser and Cosmetic Surgery in St. Cloud; and Midsota Plastic and Reconstructive How does it work? The Botox procedure works by Surgeons with physician services weakening facial muscles related to offered at St. Joseph’s Medical Center.
Centers of excellence The decision to open an ambulatory surgery center has been a long time in the making. Waters said he and several other surgeons decided to pursue the opportunity with the support of SJMC. “Obviously there are communities where hospitals and doctors compete, but that’s not the case here,” Waters said. Thomas K. Prusak, SJMC president, said, “SJMC and the physicians are very excited about the future of the ambulatory surgery center and the development of a medical park to meet the current and future needs of the community.” Prusak said the development of the surgical center will enable SJMC and the physicians to develop two centers of excellence for the area. “It was more patient driven than anything,” Waters explained. “This center will provide convenient, easy access and will continue to uphold patient privacy.” Along with the operating and procedure rooms, the center will provide patient care suites where the patient and their family will begin the process and prepare for surgery. The family will also be allowed to wait in that suite until their loved one is returned from recovery.
There will also be a refreshment center for families to utilize and a children’s play area. Waters also noted a separate recovery area for pediatric patients where families will be allowed to rejoin their children following surgery.
Minimally invasive procedures Waters said the surgical center will give surgeons the opportunity to perform minimally invasive procedures, making smaller incisions and performing surgeries telescopically. That means less discomfort and a quicker healing time. “We’re all trying to reduce health care costs,” Waters noted. “Surgical centers
have the ability to reduce those costs through copays and deductibles. So that will also be nice for our community.” But the bottom line is continuing to provide quality services in a timely manner to the entire community, Waters emphasized. “This center coincides with what’s going on in other communities. We have the same quality surgeons as in other cities. We just want the same facilities to offer those services in.” And the medical community’s growth won’t necessarily stop with the completion of the surgical center. Prusak outlined SJMC’s plans for a medical park in Baxter. “The lakes area is growing and so is the demand for medical services,” he said. “To meet the long-term needs of the community, we are developing a medical park located close to the major highways and retail outlets so that we can provide services that are convenient and easily accessible.” Examples of future services at the medical park, Prusak said, include a clinic, physician offices and other outpatient medical services.
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Midwifery
Before . . . . . . and after
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After getting Botox injected in her forehead, Tracy Blumberg was unable to use the muscles that move her eyebrows. The Botox procedure weakens facial muscles that are related to expression lines. Botox works by blocking the impulses from the nerves to the facial muscles, relaxing them. The result is a smooth, unwrinkled look. Brian and Shelly Crenna of Royalton welcomed the newest addition to their family, Levi Thomas Crenna, at CentraCare clinic in Long Prairie. The Crenna’s used the midwifery program during their pregnancy, but when a Cesarean Section was needed, a doctor was called in to perform the procedure.
A parent’s alternative to hospital birthing
Story and photos/Heidi Lake
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LONG PRAIRIE — With teary eyes you clutch your coach’s hand. Sweat beads gather on your brow and you can’t help but smile at the thought of your child being born. Having a baby is the happiest day of many people’s lives. Although known for being rather painful, giving birth in a calm and relaxing atmosphere could help ease the stress of the laboring situation.
The other side of Botox While Botox has provided relief to those suffering with chronic disorders, the drug has gained popularity mostly for its cosmetic contributions. Hollywood stars have helped launch this drug into superstardom. According to the Cosmetic Surgery Times publication, more than 2 million Botox procedures were done in the United States during 2003 alone. And Elieff predicts that number will double after the turn of 2004. Elieff explained Botox temporarily paralyzes muscles at the injection site disabling the individual to create the lines caused when raising their eyebrows, squinting or frowning. Botox is used by many newscasters, actors and politicians “to eliminate those facial miscues people can see,” he added. Tracy Blumberg, a 28-year-old St. Cloud woman, began having regular Botox injections about two years ago after being told she had hyperanimation of her facial muscles. Without being consciously aware, Blumberg would excessively squint or frown, giving those around her miscues about her temperament. “People would think I was mad when I wasn’t,” she said. Elieff suggested Blumberg try Botox to
prevent her facial muscles from contracting. “I’d heard a lot of good things about it,” Blumberg said. “So, I tried it. And I loved it.” And now, she admits, she’s hooked. Results, which typically take about 72 hours to appear, last between two to three months before another treatment is necessary. “It doesn’t hurt at all,” Blumberg said. “The first sensation, when the needle goes in, feels like a pin prick. And you can feel the Botox being injected into the muscles. But it’s just so quick. I love Botox. It’s my best friend.” An admitted Botox user himself for the past 10 years, Elieff said the three most popular areas where Botox is injected into the face include the forehead; the glabellar, or area between the eyes; and on the outside of either eye where lines, nicknamed crow’s feet, develop. The number of necessary injections per session to treat lines depends on the muscles and areas being treated as well as the individual, but usually range from five to seven. “It’s just super, super dramatic stuff,” Elieff said, adding each Botox session in the facial area is done in a matter of min-
utes with affects to be seen for months. Other areas that can be injected for cosmetic purposes include the tip of the nose, drooped lower lips, in aging neck muscles and, believe it or not, to sagging breasts to provide more lift. When opening his practice eight years ago, Elieff said only a couple viles of Botox were kept in stock. Now, his clinic keeps a couple dozen in the refrigerator for their continually growing client base. While approximately 90 percent of his Botox clients are female, Elieff said more men are catching on to the craze. The average Botox users at this St. Cloud clinic are women in their mid-30s to mid-40s who are concerned with reducing the signs of aging. “One thing we see a lot of is the people who come in for Botox don’t want to create a stroked-out, paralyzed face,” Elieff said. “They want to retain some motion of the facial muscles, but soften the wrinkles and lines.” Elieff stressed the importance of a good overall familiarity with the anatomy when administering Botox. If injected into the wrong place, Botox can cause stroke-like affects, including paralysis of limbs and facial muscles as well as drooping eyelids.
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ST. CLOUD — All Carissa Peterson wanted to do was live a normal life — a life where this bubbly 17-year-old could be free to wear clothes of her choice without a constant feeling of self-consciousness. Instead, the Sartell High School student was forced to wear sweatshirts and dark tops to hide an embarrassing excessive sweating condition, also known as hyperhydrosis. That is, until she learned about the medical uses for the increasingly popular drug, Botox. It was the eighth grade when Carissa Peterson realized her excessive sweating wasn’t normal. “It’s not something you really talk to your friends about,” the blond-haired, blue-eyed girl said. But after literally being drenched in sweat during stationary activities from watching movies to sitting in class, Peterson said she’d had enough. “All I wanted to do was be able to wear a little blue T-shirt,” she commented, adding the sweating condition forced her to hide under bulky sweatshirts and dark colors. Her involvement in the Sartell Sabres Dance Team was even affected as her sweat glands were kicked into an even higher gear when active and sweat was vis-
ibly obvious on costumes. “Literally, every shirt she bought before this was based on the excess sweating,” said mom Cindy Peterson. “I started worrying about her wearing sweatshirts all the time. And I knew (the sweating) wasn’t caused by her being hot.” Cindy contacted Carissa’s pediatrician who diagnosed the hyperhydrosis and prescribed her a heavy duty antiperspirant. Carissa even tried an electronic device that, when applied, would send a series of painful shocks into her arm. But nothing seemed to help. Until one day, paging through a Seventeen magazine, Carissa says she came across an article regarding the use of Botox to treat conditions like hers. After consulting her pediatrician on the information she read, Peterson was referred to the Midwest Clinic of Dermatology Laser and Cosmetic Surgery in St. Cloud. Dr. Daniel Elieff, owner of the eightyear-old private practice with offices in St. Cloud and Alexandria, gave this young girl hope that with the use of Botox, the sweat production could be controlled. For the last two years Peterson has undergone Botox injections every three to
four months. Each session entails approximately 20 to 30 punctures into each armpit. Once injected, the Botox partially paralyzes the muscle that is to blame for putting pressure on the sweat glands and causing them to contract. Each injection is done with a 30 gauge needle, smaller in diameter than an insulin syringe, to minimize invasion and discomfort. Lying flat on an exam table while each injection is made, Peterson takes each poke and prod in stride. “You just have to tell yourself that it’s not that bad,” she said, likening it to repeated pricks with a safety pin. “But it’s totally worth it.” Each injection is superficial, Elieff said, explaining the small needle penetrates the dermis, or second layer of the skin. Because the treatments have proven clinical benefits, each of Peterson’s visits are covered under her family’s health insurance policy. Other medical purposes for Botox have included treating lazy or crossed eyes, headaches, club foot disorder and even for Peterson’s cousin who has cerebral palsy and finds relief from chronic muscle tension with help from the powerful drug.
The nurse-midwifery program at CentraCare clinic in Long Prairie prides itself at putting the comfort and wellbeing of moms and their families first. “I want to help people be healthy and have healthy babies,” said Ruth Wingeier, Long Prairie’s certified nurse-midwife. Two large birthing suites resemble hotel rooms, complete with a couch and night stand. Medical equipment is hidden behind pictures on the wall, making the rooms feel inviting. “We try to keep moms from being afraid (of giving birth) because it tends to make labor take longer,” Wingeier said. “The rooms are calm, relaxed and comfortable.” Wingeier said she averages 11 or 12 deliveries per month, and the interest in midwife-aided births seems to be on the rise, with more than 20 babies born under Wingeier’s care in the month of March. Long Prairie’s clinic will soon be hiring a second midwife and will possibly add another birthing suite, due to the continued popularity of midwife-assisted births. The birthing suites have private bathrooms with whirlpool bathtubs allowing expectant mothers to labor, or actually give birth in the water.
Wingeier said about one-third of her expecting patients choose to give birth under water, an option first offered at Long Prairie three years ago. “(The water) helps moms relax and is more calming for the baby,” she said. Babies are in water while in the womb, and to be born under water eases their transition of entering the world and breathing on their own, Wingeier said. CentraCare clinic in Long Prairie, having one of the oldest midwifery programs in Minnesota, even makes house calls. Wingeier said women who have had no complications during their pregnancy, or have many children and are prone to having quick, easy labors often opt to give birth at home, with the assistance of a midwife. “Some people just don’t like all the intervention they get at a hospital,” Wingeier said. Others just like the feeling of getting personalized health care. Debbie Sauer, 42, on the verge of having her eighth baby, used a midwife while having all but two of her children. “(Midwives) are less routine than doctors,” Sauer said. “They give you options and respect your wishes. I feel more con-
fident in their care.” Wingeier said she educates women and encourages them to make their own decisions during pregnancy, often times using alternative methods such as herbs and nutrition instead of medication. “Midwives attract people who want alternative methods,” Wingeier said. Shelly Crenna wanted to give birth to her second child at home, but her husband, Brian, wasn’t comfortable with the idea. So the Royalton couple decided to compromise and use Long Prairie’s midwifery program. “I wanted a home birth because hospitals scare me,” Shelly Crenna said. “I wanted something more personable (than a doctor’s office).” Fifteen days overdue, weighing in at 10 pounds, 6 ounces, Levi Thomas Crenna entered the world via Cesarean Section. Each mom under midwives care has a consulting physician in case of complications. If a C-section is required, if pregnant with multiples, or if there are other risk factors, the doctor is called in and the midwife assists during the birthing process. “Sometimes you just need two sets of hands,” Wingeier said.
Introducing…
Previous page photo: Tracy Blumberg, 28, has received Botox treatments in her forehead and between her eyes for the past two years. The St. Cloud resident said the procedure has become “addictive.” Dr. Daniel Elieff of Midwest Clinic of Dermatology Laser and Cosmetic Surgery in St. Cloud, administered Botox injections in Carissa Peterson’s underarm area. Peterson, 17, suffers from hyperhydrosis, or excessive sweating, and found Botox helps control the condition.
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Appointments with a midwife at CentraCare clinic are 20-30 minutes long, giving Wingeier and her patients plenty of time to talk and get to know one another, something both Wingeier and her patients enjoy. “Right now I’m delivering the daughters I delivered,” Wingeier said with a smile. With a bachelor’s degree in nursing and a master’s in nurse-midwifery, Wingeier spends much of her day providing prenatal, postpartum and newborn care, and also provides routine gynecological care. Wingeier is on call 24-hours a day and rarely has time to catch her breath between laboring and birthing patients as well as doing regular patient checkups. She gets calls in the middle of the night, regardless of weekends or holidays. But with more than 20 years experience as a midwife, Wingeier said helping women stay comfortable while giving birth to healthy babies makes it all worth while.
Ruth Wingeier, certified nurse-midwife at CentraCare clinic in Long Prairie, checked Sheila McCoy’s baby for problems following a car accident the previous night.
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What lives in your mouth
The medical field never ceases to amaze me. Even right here in the Brainerd lakes area, medical professionals perform what I call miracles every single day. To go to work and cure someone of a plaguing disease or illness or to save lives through emergency surgery, is something my mind can hardly grasp. For many in the medical profession, this is everyday life. This issue of HealthWatch follows the amazing acts performed at local
Any first-grader can tell you that if you don’t brush your teeth, creepy sugar “bugs” will take over and cause cavities. But not all of the bugs, or microbes, in the mouth actually affect oral health. And not all of them are bad. A vast and diverse community of microscopic organisms — including viruses, bacteria, fungi and protozoa — thrive in the mouth, scientists are learning. Some of them may play important roles in preserving health and causing diseases, says Dr. David Relman, an associate professor of microbiology at Stanford University. “We already know so much about so many disease-causing agents that it tends to give you the feeling that there is no reason to be going out and trying to find others,” he says. But the causes of many diseases remain unknown — and the mouth appears to be a good place to look for clues. “We are increasingly becoming aware of the connection between the oral cavity and the body,” says Donna Mager, a researcher at the Forsyth Institute, an
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hospitals and clinics, from the heroics of a surgeon, to delivering babies, to curing sleep disorders. To the doctors, nurses, paramedics and everyone who has a hand in medically improving the lives of others, don’t take your job for granted. You truly are miracle workers.
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Heidi Lake, Editor
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plaque deposits on teeth, is probably caused by several organisms, but no one has identified all the microbes responsible for this common disorder. Some microbes found in the mouth may even contribute to disease in other parts of the body, such as the heart, although those links are still tenuous. Mager is trying to identify possibly precancerous changes in the mouth’s bacteria colony. About half of all people diagnosed with oral cancer die within five years because the disease is detected at advanced stages. But if scientists could find clues that disease could develop — based on changes in bacteria — they might be able to intervene earlier, she says. “We are tracking the changes in those colonization patterns,” says Mager, whose research is in collaboration with the Dana Farber Cancer Institute. “Hopefully, we will be able to predict which people will develop cancer.”
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independent research center in Boston. “Whatever grows in the oral cavity could have an impact on what happens to the body.” Research by Relman and Mager is helping to advance this notion. In his lab, Relman samples the region in the mouth called the subgingival crevice, the deep space between the gum and tooth. So far, scientists have found more than 500 bacterial strains or microbes in this area, and Relman has identified 37 others. Other mouth microbes have yet to be identified, he believes. Ultimately, researchers want to better understand the patterns and prevalence of particular microbes and what those patterns suggest about a person’s health. “I think it’s fair to say that the vast majority of members of the oral microbial flora are not disease-causing agents. They may be necessary or important for maintaining health,” he says. “Some small subset may be involved in disease.” Gum disease, in which gums become inflamed, red and swollen because of
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’Brain pacemaker’ helps Parkinson’s patients’ muscle control
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Story/William Hathaway Hartford Courant
Photo/Tom Brown
Parkinson’s disease can lock up William programmer controls the high-frequency overnight. Doctors must tinker, someStanziano’s muscles so quickly, he says it electrical signals, which in Stanziano’s case times for months, with the strength of the feels like a crowbar thrust into a gearbox. are sent to each side of the subthalamus, electric pulses and the dosages of “Sometimes I walk into a Dunkin’ an area of the brain involved in move- dopamine-replacing medicine to get the Donuts and can’t walk out,” said ment. best results. Although doctors can adjust Stanziano, who may have to wait patiently The hardware costs $25,000. The tech- the strength of the pulse with the handfor hours until medication kicks in and nology is similar to cardiac pacemakers, held programmer, patients can only turn loosens his limbs enough to get home. used to regulate the heart, and vagus the pulse generators on or off. Four months ago, the 51-year-old nerve stimulation, used to control epilepFor Stanziano, the results have been Wolcott man went to the University of sy. mixed since he received his brain paceConnecticut Health Center, where docAlthough deep brain stimulation has led maker last November. He no longer has tors implanted a “brain pacemaker” — to a few spectacular successes in unlock- the residual Parkinson’s symptoms when electrodes placed deep he is in his “on,” or more inside his brain that are functional, state. designed to short-circuit However, when he is in the errant signals that can the “off” state, his condiimmobilize him. tion is as bad as before The procedure, known the operation, he said. as deep brain stimulation, Doctors can’t explain is one of many promising why the technology treatments that uses elecsometimes doesn’t work, tricity to treat ailing minds. because they don’t fully For Stanziano, deep understand why it works brain stimulation is at all. designed to compensate Some researchers sugfor the death of brain cells gest electrical stimulation that produce the neuroaffects the release of spetransmitter dopamine, cific neurotransmitters essential for many muscle that compensate for the movements. The death of lack of dopamine, while dopamine-producing cells others have argued that is caused by Parkinson’s electrical pulses reset disease. abnormal electrical sigStanziano’s medication nals in the brain. had stopped preventing Scientists have known the muscular lockup that for more than 70 years his doctors call the “off” Bill Stanziano wears a "brain pacemaker" and pulse generators in his chest, which help that modifying electrical state, a period when mus- provide deep brain stimulation to help his muscles stay loose, thereby counteracting impulses in the brain can cles are not functioning. the effects of Parkinson's disease. Dr. J. Antonelle de Marcaida, at right, adjusts the have therapeutic beneThe advanced stage of his electrical signals to the pulse generators. fits, said Dr. Sara H. disease and his relative Lisanby, associate profesgood health made Stanziano eligible to ing the frozen gaits and ending the debili- sor of clinical psychiatry and medical receive a brain pacemaker. People with tating tremors of Parkinson’s patients, it director of Columbia University’s depresmilder forms of Parkinson’s, dementia does not cure the disease, said Dr. J. sion center. patients and those in ill health are not eli- Antonelle “Toni” de Marcaida, director of Deep brain stimulation is an indirect gible for the procedure, which carries a the movement disorders program at descendant of some of those early treatslight risk of internal bleeding or infection. UConn. ments, she said. After more than a decade of successful “There is no real evidence that it is The earliest use, in electric shock theratrials, deep brain stimulation has now neuro-protective,” she said. py, has been condemned for the pain and entered the mainstream of Parkinson’s And it doesn’t work for everyone, side effects such as memory loss that it treatment. Deep brain stimulation although in trials eight of 10 Parkinson’s afflicted upon patients with mental illness. requires two separate operations — one patients have shown improvement that However, in the past two decades, sciento implant electrodes deep into the has lasted more than five years, de tists have rehabilitated the procedure, and patient’s brain, and a second to implant Marcaida said. today, targeted electrical convulsive theratwo hockey-puck-size pulse generators on Stanziano also now realizes that deep py “remains the most effective treatment both sides of the chest. A hand-held pulse brain stimulation does not work for depression, period,” Lisanby said.
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