HealthWatch Magazine - April Issue by Brainerd Dispatch and Echo Journal

Table of Contents

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EDITOR’S COLUMN: Oh, baby! It’s spring by Jodie Tweed FULL-TERM BABIES: Supporting healthy newborns by Jodie Tweed MARCH OF DIMES: Walking for premature babies INFERTILITY:

Battling heartache and hope by Jodie Tweed CHILDBIRTH EDUCATORS: Educating those who educate by Jodie Tweed

On the cover

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FOOD ALLERGIES: Ironton toddler faces struggle by Jennifer Stockinger LYMPHEDEMA:

Incurable, but treatable by Matt Erickson GARDENING FOR NOVICES: Growing your own by Sarah Nelson BLOOD DONORS: Giving the gift of life by Jenny Holmes GOING HOME AGAIN: Caring for your ill parents by Sheila Helmberger Q & A with ... Meet Dr. David Nelson by Jodie Tweed

Who we are Publisher — Tim Bogenschutz Advertising — Sam Swanson Cover design — Cindy Spilman Editor — Jodie Tweed HealthWatch is a quarterly publication of the Brainerd Dispatch. Brainerd Dispatch/Kelly Humphrey

Our cover baby is 2-week-old Kennedi Rae Lyter of Brainerd. She was born March 18.

Read HealthWatch online at www.upnorthhealthwatch.com.

For advertising opportunities call Sam Swanson at (218) 8555841. E-mail your comments to jodie.tweed@brainerd dispatch.com or write to: Jodie Tweed Brainerd Dispatch P.O. Box 974 Brainerd, MN 56401

Brainerd Dispatch/Kelly Humphrey

Jamie and Nikki Lyter, Brainerd, and daughter Teagan, 6, welcomed Kennedi Rae into their family on March 18. This photo was taken when Kennedi was 2 weeks old. Nikki Lyter is the marketing coordinator at the Brainerd Dispatch.

Oh baby, it’s spring! By JODIE TWEED HealthWatch Editor

We hope the cover photo of smiling 2-week-old Kennedi Rae Lyter brought a smile to your face as it did ours. Kennedi is the newest member of the Brainerd Dispatch family, born March 18 to her parents, Jamie and Nikki Lyter. Nikki is the marketing coordinator at the Dispatch and also works behind-the-scenes on this quarterly HealthWatch magazine. Before Kennedi was even born, we asked Nikki if her baby could be our cover model for this edition since many of the stories revolve around childbirth and children. Fortunately, not only did Nikki agree, but Kennedi arrived a little early to make our deadline. And who knew a 2-week-old could smile on cue? What a charmer. When Dispatch staffer DeLynn Howard shared her personal story of trying for more than a decade to conceive a child in the January 2011 edition of HealthWatch, she received an outpouring of

support and touching messages from other women in the lakes area who are struggling with infertility. DeLynn and her husband, Todd, now have a daughter, Isabella, who is nearly 10 months old. But the overwhelming response to DeLynn’s story made us realize what a silent struggle infertility can be for many couples and we felt it was a story that needed to be told here. Infertility treatments can be very costly and more often than not aren’t covered by medical insurance. It can be stressful, too, knowing you’re paying such a large sum of money, up to $20,000 for one cycle, for the possibility of having a child. Since the Brainerd lakes area does not have any fertility clinics, couples also have to drive to the Twin Cities metro area for doctors’ visits, which requires taking time off work. Lakewood Health System in Staples has partnered with Reproductive Medicine Infertility Associates in the Twin Cities to offer some of these reproductive services in Staples to limit the number of trips couples have to make to the Twin Cities. The journey to parenthood isn’t always the easiest route. Some couples, like Scott and Tessa Hall

of Brainerd, have struggled for years with infertility. Tessa will start an infertility support group in Brainerd in May so other area couples going through similar circumstances can connect, share information and support one another. I have personally witnessed the joy and sorrow as close friends and family deal with infertility. My twin nieces, who turn 2 in June, wouldn’t be here without in vitro fertilization, or IVF. I have been there for friends as they’ve gone through unsuccessful rounds of infertility treatments, praying with them that the next round will be “the one.” Speaking of babies, by the time you’re reading this there is a very good chance I’ll be off work on maternity leave with our third daughter, who is due any day now. We’re all very anxious to meet her. Dispatch Staff writer Sarah Nelson will take over the June edition of HealthWatch in my absence, so please pass on any health-related story ideas to her at sarah.nelson@brainerddispatch. com or 855-5879. We hope you enjoy this issue of HealthWatch.

Robb Pastor, director of hospital nursing at Cuyuna Regional Medical Center in Crosby, is shown with the Remote Presence RP-7 robot that allows Abbott Northwestern stroke experts to examine patients at the CRMC emergency room.

24-hour access to stroke care experts now available at Cuyuna Regional Medical Center Patients at Cuyuna Regional Medical Center in Crosby now have 24-hour access to Abbott Northwestern stroke care experts via the Allina Telehealth Network. The Allina Telehealth Network allows Abbott Northwestern stroke neurologists in Minneapolis, from the Noran Neurological Clinic, to provide real-time, around-the-clock neurological assessments via Telehealth equipment placed in CRMC’s emergency department. “This new technology gives our local Emergency Room physician’s immediate access to the specialists at Abbott Northwestern that can assist in making the critical decisions needed for a patient’s timely stroke care,” said Dr. Rob Westin, CRMC’s emergency department medical director. “These enhanced services will allow us to continue providing the quality care the people of our region have come to expect. ” Allina is a leading resource for comprehensive stroke care with 24-hour access to neurologists, interventional neuroradiologists and neurosurgeons. Access to this level of expertise and diagnosis improves timeliness of stroke care, which results in a greater chance for a successful recovery and reduces long-term disability resulting from stroke. “Telehealth will enable more rapid assessment by stroke experts for patients in regional areas, said Maxine Ehlers, CRMC’s patient care administrator. “By doing so, our goal is to improve patient satisfaction and outcomes by allowing patients to receive care close to home, improving quality, and ensuring a well coordinated transfer when more advanced treatment is required.”

Brainerd Dispatch/Steve Kohls

Stacy Anderson and Josh Samler, Little Falls, posed with their 3-day-old daughter, Sophia Nevaeh Samler, who was born March 29 at Essentia Health St. Joseph’s Medical Center in Brainerd. Anderson was induced at 39 weeks pregnancy.

Essentia Health begins campaign for full-term babies By JODIE TWEED HealthWatch Editor

elcome to your last month of pregnancy, when your walk has turned to a waddle and where you’ve got aches and pains in places that never occurred to you before.

While the ending is in sight, many pregnant woman may want their little bundle of joy to arrive sooner, rather than on or after the baby’s estimated due date. More pregnancies are being induced for non-medical reasons for a variety of reasons— perhaps a woman is simply tired of being pregnant or is planning to be in a friend’s wedding and doesn’t want to go beyond her due date. Essentia Health St. Joseph’s Medical Center in Brainerd will soon adopt a new policy to prevent non-medically indicated, or elective, deliveries before 39 weeks.

A full-term pregnancy is counted to 40 weeks and a baby is considered full term between 37 to 42 weeks, but researchers are finding even an extra week or two can make a big difference in the health of an infant. The baby has more time to gain weight; important organs like the brain, lungs and liver, get more time to develop; and the baby becomes more capable of eating and swallowing after birth. Some due dates can be off by a week or two, which means the baby needs even more time to grow. Essentia Health has joined an initiative with the Minnesota Department of Health and March of Dimes to reduce the number of elective inductions before 39 weeks. The hospital has applied for a $5,000 grant from the March of Dimes to create educational materials for pregnant women so they’re aware, even at the beginning of the pregnancy, of the importance of delivering a full-term baby. Jeanette Ruff, nursing director at Essentia Health St. Joseph’s Medical Center Family Birthplace and Pediatrics, said throughout the United States, early induction rates have grown too high. Physicians also get a lot of pressure from their patients to schedule an early induction.

Graphic/March of Dimes

A baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks.

Ruff said research has shown that a first-time mom induced before 39 weeks has a 20 percent greater chance of requiring a C-section than a firsttime mother allowed to go into labor naturally. Babies born by C-section can have more breathing or medical problems than babies born vaginally. In the past, the standard practice was that if the pregnancy reached 37 weeks, then an induction was fine. “As a society, we like to plan,” Ruff said. “Women want to know the date (their baby will be born) and physicians want to make patients happy and the country got carried away.” Ruff said St. Joseph’s softly adopted this new policy during the past year. Each induction scheduled before 39 weeks will soon have to be documented and the physician will have to explain why the mother was being induced. Even adopting a soft policy on inductions before 39 weeks has significantly reduced the number of elective inductions during the past year. There are medical reasons for pregnant women to be induced early, including hypertension, placenta previa and if a mother has diabetes that hasn’t been well managed, for example. These types of medically necessary inductions will continue, said Ruff. Tara Karels, Essentia Health St. Joseph’s Medical Center obstetrical education coordinator, said she and her staff are in the process of adding information about the importance of having fullterm babies as part of the curriculum in the hospital childbirth courses, even in its new course for first-time grandparents so it brings about community awareness.

‘The best incubator is you.’ — JEANETTE RUFF

Brainerd Dispatch/Steve Kohls

Jeanette Ruff (left), nursing director for the Family Birthplace and Pediatrics at Essentia Health’s St. Joseph’s Medical Center in Brainerd, joined coworker Tara Karels, Essentia Health’s obstetrical education coordinator, in the Family Birthplace nursery. The women are part of the team spearheading an Essentia Health campaign against elective inductions before a baby reaches 39 weeks gestation.

Karels noted that elective inductions can mean longer hospital stays for mothers if it takes awhile for the baby to be born. She said inductions can seem more painful, too. When a pregnant mother naturally goes into labor, her body releases oxytocin to start contractions, which also releases endorphins that can counteract the pain. Instead, when a pregnant mother is induced and administered pitocin, a synthetic hormone, to start contractions, it doesn’t cross the blood-brain barrier and doesn’t trigger the release of endorphins. The Minnesota Department of Human Services has adopted payment policy changes in 2011 that will target both the fee-for-service and managedcare sides of the Minnesota Health Care Plans. In the coming months, the DHS is proposing hospitals implement policies related to elective induc-

tions that would start Jan. 1, 2012. Hospitals would be required to submit this data annually. In addition, the DHS is proposing that providers at facilities without policies will be required to submit this data will all deliveries as a condition of provider payment. Ruff said the Essentia Health obstetrics team planned to meet in April to start implementing its stronger policy on early inductions. Ruff said the hospital’s OB staff are on board with the new policy. “Even though it inconveniences us, it’s the right thing to do,” Ruff said of the new policy. “The best incubator is you.” Essentia Health’s C-section rate is about 18-20 percent, far lower than the national C-section of 35 percent. One of the goals of this new policy is to get

those numbers even lower. Stacy Anderson, Little Falls, was induced on March 29, delivering her daughter, Sophia, at 39 weeks. She was due April 1. While her doctor had a concern about how big the baby would be, since her eldest daughter was 10 pounds at birth, Anderson said she was told to wait until 39 weeks. Sophia was born healthy, weighing 7 pounds, 2 ounces. “If I would have gone earlier, she would have been a lot smaller,” Anderson said. “It’s good we didn’t induce early,” added Josh Samler, Sophia’s father. JODIE TWEED may be reached at jodie.tweed@brainerddispatch.com or 855-5858.

Why a full-term pregnancy is so important • In the last six weeks of pregnancy, your baby’s brain adds connections needed for balance, coordination, learning and social functioning. During this time, the size of your baby’s brain almost doubles. • Babies born early have more learning and behavior problems in childhood than babies born at 40 weeks. • Babies born early are more likely to have feeding problems because they can’t coordinate sucking, swallowing and breathing as well as full-term babies. • Babies born early are likely to have breathing problems, like apnea. Apnea is when a baby stops breathing. • Babies born early are more likely to die of sudden infant death syndrome (SIDS). SIDS is when a baby dies suddenly and unexpectedly, often during sleep. — Information provided by the March of Dimes Josh and Amy Duda, along with their son, Kian, 1, are serving as the ambassador family for the Brainerd March for Babies April 30 in Baxter.

March of Dimes walk planned More than 7,600 babies in Minnesota will be born premature this year. Josh and Amy Duda, of Pillager, along with their one-year-old son, Kian, are serving as the ambassador family for the Brainerd March for Babies, Saturday, April 30 at Forestview Middle School in Baxter. March for Babies, the March of Dimes’ largest fundraiser, helps fund lifesaving research and educational programs aimed at helping moms have healthy babies. Last year, the Brainerd event raised $50,000. Kian Duda was born four weeks early in December 2009 at Essentia Health St. Joseph’s Medical Center. Hours later, he took his first helicopter ride — straight to the newborn intensive care unit (NICU) at North Memorial Hospital in Minneapolis. March of Dimes pioneered the concept of specialized care for newborns and pushed for NICUs in hospitals across the country. Within a day and a half, Kian was back at Essentia Health St. Joseph’s Medical Center in Brainerd and Amy was able to hold him for the first time. Like many babies born late preterm, or 34-36 weeks gestation,

Kian suffered from respiratory distress. Babies born late preterm remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice. “Premature birth can be challenging time for any family,” shared Josh and Amy Duda. “The fear of the unknown, rapid decisions that have to be made and complications from a premature birth, it can be overwhelming.” People can show their support by raising money in the March for Babies. Sign up at www.marchforbabies.org and start a team with coworkers, family or friends. March for Babies is April 30 at Forestview Middle School in Baxter. Registration is at 9 a.m. and the walk starts at 10 a.m. Participants will walk outside but the activities will be held in the Forestview cafetorium. Local sponsors for the Brainerd March for Babies are Essentia Health and the Power Loon. The Essentia Health team hopes to have about 200 walkers on its team this year. Last year the entire event had about 500 walkers.

Inf er t ilit y Heartache & hope By Jodie Tweed/HealthWatch Editor

Brainerd Dispatch/Kelly Humphrey

Gretchen and Nick Nelson, rural Brainerd, hope that their recent round of in vitro fertilization was successful and theyâ&#x20AC;&#x2122;ll be having their first baby. The Nelsons have struggled with infertility since they married 3-1/2 years ago.

hen Tessa and Scott Hall decided to buy their home in Northtown, the housing develop-

ment north of Beaver Dam Road in Brainerd, they chose the neighborhood because it was the perfect family-friendly location

for them to raise their future children. Nearly every home has a swingset and childrenâ&#x20AC;&#x2122;s toys in the backyard.

Brainerd Dispatch/Kelly Humphrey

Tessa and Scott Hall, Brainerd, shown in Tessa’s playroom for her daycare children, have struggled with infertility for six years, and despite the obstacles, they are hopeful that someday they will have a child of their own.

Tessa opened a daycare at their home in 2007, a profession she chose because she not only loves children but thought it would be a way for her to afford staying home with her own someday. Scott works as the ReStore manager for Habitat for Humanity. But six years after they were married, Tessa and Scott are still trying to conceive a child. It makes it even all the more difficult to live in Northtown, where just a couple years ago 10 women on their block were pregnant and due within a three-month time period. They also attend and are active members of Lord of Life Lutheran Church, which has many young families. Tessa said sometimes she struggles watching parents take their young children to Sunday school because she yearns to do that herself. While she loves her daycare children as if they were her own, she said it can be difficult to watch others, like her daycare parents, become pregnant when she is not. Scott said the portable crib set up for naps for one of the daycare children in their bedroom is a constant reminder each day that they don’t have any of their own. They’ve seen fertility specialists who have told them their best chance at having biological children is through in vitro fertilization, or IVF, where a mother’s eggs are removed and then fertilized in a laboratory using sperm from a father, then the embryos are transferred back to the mother’s uterus. Tessa, 28, is suffering from polycystic ovary syndrome and a thyroid condition, along with irregular cycles, while Scott, 31, has a low sperm count. IVF costs an estimated $20,000-$25,000 and the

Brainerd Dispatch/Kelly Humphrey

Scott and Tessa Hall’s parents offered to loan them the money for expensive in vetro fertilization treatments but they turned them down. They hope to figure out a way to pay for IVF, their best hope for conceiving a child.

Halls tried twice to secure financing to undergo the procedure at two separate fertility clinics but they were unsuccessful. It’s a case of bad timing. The first time was when the recession hit in 2008 and banks, even those used by the fertility clinic they were using in the Twin Cities, suddenly stopped giving out loans. The second time, in 2009, the Halls tried to refinance their home but the housing market had crashed and the equity they had built in their house was now gone. “We were at a point where I was so emotional, I was at my lowest point,” said Tessa. Their parents offered to pool their savings to help the couple afford IVF but they turned them down, deciding they couldn’t take their money. They checked out adoption but that, too, can be costly and they wanted to attempt to get pregnant themselves. The Halls have been attending annual conferences for RESOLVE, a national infertility association, for the past two years to not only meet other couples struggling with infertility but to attempt to win a chance at a free IVF treatment. They went through training and now Tessa plans to start a RESOLVE infertility support group in Brainerd in May. It will be a place where other people struggling with infertility can seek support and also information from those going through the same journey toward parenthood. Despite the obstacles, the Halls have faith that they will someday become parents. They are hoping to figure out a plan to afford IVF and in the meantime Tessa is seeing an OB/GYN at Essentia Health St. Joseph’s Medical Center in Brainerd to

help regulate her medical conditions. They both also started taking a herbal fertility supplement and are feeling great; Tessa recently began ovulating on her own, which was a good sign. They both said when they finally do get pregnant, they know that baby is a blessing and they will cherish their child. “We don’t have a game plan but we don’t have the financial resources to do IVF,” Tessa explained. “It’ll happen, definitely.” Nick and Gretchen Nelson live on 160 acres in rural Brainerd, the perfect farm setting to raise their children. Nick grew up not too far away as one of seven children and the Nelsons always knew they’d have a few children. He is an Iraq war veteran having spent 22 months in the war zone before returning home to marry and farm with Gretchen, his high school sweetheart. After trying unsuccessfully to get pregnant for the first year of their marriage, they decided they needed to find out what was wrong. Now married for 3 1/2 years, they still don’t have children of their own — yet. “We thought we’d be having our second child by now,” said Gretchen. “You see people out and they’re pregnant and you wish it was you.” The Nelsons heard about the infertility care program at Lakewood Health System in Staples and decided to start there. Kelly Thompson, a Lakewood nurse practitioner, is responsible for helping to bring infertility care to rural families like the Nelsons. Thompson herself suffered from infertility before conceiving her eldest daughter through IVF. This process required

multiple trips to the Twin Cities for doctor’s appointments, as well as the IVF procedure itself. Thompson helped foster a partnership between Lakewood and Reproductive Medicine Infertility Associates, or RMIA, a Twin Cities fertility clinic. The partnership allows infertility patients to undergo most of their infertility appointments, testing and treatments at Lakewood, including artificial insemination. If a couple needs IVF, they only need to travel to an RMIA clinic three times, once for the initial consultation and the next two appointments for the actual IVF procedure itself. “It’s very limited as to what we have to refer out,” said Thompson. The infertility care program has grown so much that the number of patients have doubled since it began in 2004. Dr. Carol Uhlman, OB/GYN, serves as infertility program director. Thompson emphasized that not all infertility patients need IVF to conceive — IVF is considered the last resort. Thompson said after about a month of testing and monitoring, then she and the staff can recommend a treatment plan, which could mean using intervening medication or giving the couple time to conceive on their own. If donor sperm is needed, Lakewood can help couples utilize sperm banks She said generally patients who are under age 35 and haven’t conceived in one year of trying or patients over 35 who haven’t conceived in six months should come in for infertility testing. She said 30 percent of the time there is a female infertility factor, 30 percent of the time it’s a male infertility factor, 30 percent of the time it’s both and for

10 percent of patients, there’s no explainable reason why they’re having trouble conceiving. “And that’s the frustrating scenario because obviously, if we know the problem we can fix it,” said Thompson. The Nelsons — he’s 25 and she’s 27 — fell into that 10 percent category; there isn’t an answer as to why they’ve had trouble conceiving. “When people say, ‘Oh, you’re young, you’ve got plenty of time,’ they mean well,” said Gretchen. “But we are young and it may take time to get there.” They tried using fertility drugs and also did four rounds of artificial insemination last year but those attempts didn’t work. They decided in December to try IVF. Thompson said couples attempting IVF should plan on costs to be about $25,000. The Nelson utilized a financing plan offered by RMIA, a Fertility Cost Warranty Program, that allowed them to pay $20,000 for three IVF attempts. If those attempts don’t end with them bringing home a baby, then they get their money back. The Nelsons underwent their first IVF attempt in late March where two embryos were implanted and three were frozen for a future attempt. By the time this publication went to print, the Nelsons didn’t know if they were pregnant or not but were hopeful. “It’s a gamble you have to take and you hope,” said Gretchen. “When you want it that bad, you do what you have to do.” Gretchen is a veterinary technician at Lakeland Veterinary Hospital in Baxter while Nick is selfemployed as a farmer. They raise and sell beef and also have a large strawberry patch they tend to in the summer. They took out an interest-free credit card to pay for IVF. “It better be a good strawberry year,” Nick said with a smile. “If not, it better be a good corn year.” But Nick said he and Gretchen always tell each other that no matter what happens in the future, they’ll get through it. “It’s tough, but we’ll make it work,” said Nick. “We haven’t not made it work yet,” added Gretchen. Thompson said Lakewood Health System has about a 30 percent success rate for artificial insemination, or IUI, and an approximate 85 percent success rate for IVF. She said she and her staff carefully monitor their patients and don’t want them to deliver triplets — or become the next “Octomom.” She said success is a singleton pregnancy, twins are a “bonus” and Lakewood strives to avoid multiples higher than that due to the increased tendency for complications. Lakewood has never had a triplet birth. Thompson herself understands the emotional roller coaster of infertility and pregnancy loss. After three years of attempting to get pregnant using IUI, she and her husband now have five children all conceived through IVF, including a 7-yearold son and girls who are 11, 2, and twins born April 7 at Lakewood. “I’ve been down all the discomforts —physically, emotionally, financially,” said Thompson. Thompson said about 15 states in the United States require at least some fertility coverage by health insurance providers and she herself has lobbied at the state Legislature for similar coverage for Minnesota patients. She hopes that some day

insurance providers do cover fertility treatments for couples who wish to have a child. She noted that one of her clients recently adopted an infant and paid $32,000 in adoption fees, so adoption, which is another option, isn’t inexpensive either. Thompson said couples who are having difficulty getting pregnant should call and make an appointment. “Don’t let costs scare you away,” said Thompson. “Everyone is different. What is right for one couple may not be right for another. I will always be honest — I’m not going to sugarcoat it — if we need to do something different, I’ll be honest with them.” Thompson said couples need to keep in mind that success rates are better the younger you are. “Don’t wait,” said Thompson.

Danell Eggert/Lakewood Health System

Kelly Thompson, nurse practitioner at Lakewood Health System in Staples, helped bring the infertility care program to the hospital in 2004. She is shown pregnant with her twin daughters, whom she gave birth to on April 7. The twins, as well as her three other children, were all conceived through in vitro fertilization.

JODIE TWEED may be reached at jodie.tweed@ brainerddispatch.com or 855-5858.

Educating childbirth educators By JODIE TWEED HealthWatch Editor

BAXTER — Rebecca Fahning, of Grasston, is a lactation counselor and dental hygienist at the Women, Infants and Children, or WIC, nutritional program in Pine County where she mostly works with teenage mothers. Pine County doesn’t have its own hospital, and Fahning said there was a desperate need for an educator to provide childbirth classes as well. The county has one of the highest teen pregnancy rates in Minnesota and is the third poorest county in the state, she said. She applied and received a Statewide Health Improvement Program, or SHIP, grant to be able to attend a special two-day childbirth educator workshop held in late March at the Country Inn and Suites in Baxter. The International Childbirth Education Association workshop was taught by certified professional childbirth educator Tara Karels, who also serves as the obstetrical education coordinator at Essentia Health St. Joseph’s Medical Center in Brainerd. Karels taught childbirth classes for many years at the Brainerd hospital. But as a ICEA professional childbirth educator, she’s able to teach other medical professionals how to teach their own childbirth classes. Fourteen participants traveled from throughout the state to attend the two-day workshop in Baxter. Many of them were obstetrical nurses who either planned to take the next step to become certified childbirth educators through ICEA or simply wanted to become better OB nurses for their patients. Continuing study and an exam were the next steps that participants would need to take to become a certified childbirth educator. Karels showed them how to develop a curriculum on topics like healthy nutrition and lifestyles and relaxation and breathing techniques during labor. She also teaches the stages of pregnancy, labor and delivery, as well as postpartum care. Karels uses many props, like an inflated balloon with a ping pong ball inside to demonstrate how a cervix becomes effaced and dilated during labor, as well as fun ways to get couples engaged in the

Brainerd Dispatch/Jodie Tweed

Tara Karels, a professional childbirth educator through the International Childbirth Education Association, demonstrated how a baby is positioned in the pelvis before delivery, with help from Rebecca Fahning of Grasston. Fahning is a lactation consultant and works with teen mothers in Pine County. Her goal after taking Karels’ childbirth educator workshop in March in Baxter was to return home to teach childbirth classes for teen moms in her county.

Brainerd Dispatch/Jodie Tweed

Margy Gilbertson (left), Pillager, an obstetrics nurse at Essentia Health St. Joseph’s Medical Center in Brainerd, gave a hand massage to Mandy Brodeur, an OB nurse from Essentia Health St. Mary’s Hospital in Detroit Lakes, during a childbirth educator workshop in late March in Baxter.

class. Fahning said she hopes to return to her county to not only provide more prenatal education for teenage mothers, but wants to get fathers and other support persons involved, too. “This has been great,” said Mandi Brodeur, an OB nurse at Essentia Health St. Mary’s Hospital in Detroit Lakes. She attended the workshop with three other OB nurses who teach childbirth classes at the hospital. “I think we’re going to have a

renewed energy and will be changing our programming.” Karels said there is a need to provide training for childbirth educators. As a certified trainer, she has developed a one-day workshop on labor support for OB nurses called, “Mother-Friendly Labor Support for Nurses.” She hopes to offer this workshop to area hospitals in June. JODIE TWEED may be reached at jodie.tweed@brainerddispatch.com or 855-5858.

Brainerd Dispatch/Steve Kohls

Kara Nelson, 2, who has Food Protein-Induced Enterocolitis Syndrome, played recently at her home in rural Ironton.

Ironton toddler struggles with serious food allergies By JENNIFER STOCKINGER Staff Writer

RONTON — There were more sleepless and worrisome nights for Kendall and Brian Nelson than they want to remem-

ber.

Many nights the Ironton couple would wake up to the most horrific sounds of their now nearly 2year-old daughter Kara screaming in her crib. Often she would be covered with vomit. But it didn’t stop there. Kara, who was then under the age of 1, would continuously throw up until she was so dehydrated and weak that she would be left with a blank stare on her face. “It would be like a volcano erupted,” said Kendall. “She was so miserable and we’d be up all night. Her cry was just horrible. She also had many

burned diaper rashes and eczema that were really bad.” When Kara’s vomiting episodes all started, the Nelsons would bring her to the emergency room and the doctors thought she just had the flu and was dehydrated. It wasn’t until the family attended a fire department event when Kara had a more extreme vomit event. “We could tell that she wasn’t herself,” said Kendall. “We were used to her spitting up so we always had extra clothes, but never anything this severe. She started to vomit and we’d clean it up and we’d do this over and over again until she went into shock.” The Nelsons brought her to the ER that night and were told that Kara probably had a case of the flu and possibly a sensitivity to foods. “They thought maybe her tummy wasn’t ready for solids yet, so they told us to take a two-week

break from foods,” said Kendall. “Two weeks later rice cereal was tried again, only to have the exact same shock-like reaction after vomiting.” That night she had another vomiting episode and the next day, the Nelsons took her to Brian’s family physician, Dr. Kara Maucieri of the Cuyuna Regional Medical Center in Crosby, because they thought Kara may have celiac disease, a disease that runs in Brian’s family. “While sitting in her office, she was researching some websites when she came upon a disease called FPIES,” said Kendall. “We read it and Kara had all the classic symptoms, we were like ‘oh my gosh.’” Kara was 8 months at the time and was referred to a pediatric gastroenterologist. The Nelsons said the first specialist they saw wasn’t helpful and they struggled for months as Kara’s symptoms continued. When she was 9-11 months,

Kara didn’t gain any weight, which was concerning, so the couple went to see an allergist in St. Cloud. The doctor there finally diagnosed Kara with FPIES. According to the Children’s Hospital of Philadelphia for FPIES — Food Protein-Induced Enterocolitis Syndrome — it is a condition that affects infants and young children and is a nonImmunoglobulin E mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea, which normally occur about two hours after food is consumed. The most common FPIES triggers are cow’s milk and soy. However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley. Kendall had to stop nursing and Kara was put on a few different formulas that soon led to the family purchasing a prescribed amino-based formula that cost $2,200 a month. The family’s insurance paid for the formula, but they had to switch insurance after Brian got a new job with the City of Deerwood. They made an appeal with the insurance company to pay for the formula and in mid-April, the family found out the insurance would pay for it. The treatment for FPIES was for Kara to slowly add new foods to her diet to see what she could eat without getting sick. She started out eating bananas, corn and Kix cereal. Today she can eat about 20 foods, which includes pork, beef, chicken, green beans, carrots, potatoes, strawberries, apples, eggs and tomatoes. “Each week we try a new food,” Brian said. “We give her a new food and then we have to wait to see how she reacts. It usually takes about two hours after she has eaten a food to see if she’ll have a reaction. Some foods take a few days to see if they’ll work for her and other foods may take two weeks. “Her worst reactions were to rice and oats.” The Nelsons said it’s a relief to know what is wrong with Kara, but each day is a challenge. They plan everything they do around her and they have to be sensitive when making meals for themselves and their older daughter Brenna, who’ll be 4 in May, who can eat anything they want. Kendall said most of the time they’ll eat things that Kara can eat to make it easier, but there are always times when something comes up, such as a birthday party and she can’t have the cupcakes. “We had a terrible scare about a

Brainerd Dispatch/Steve Kohls

Kendall Nelson lifted daughter Kara, 2, to give her a kiss at their home in rural Ironton. Kara has Food Protein-Induced Enterocolitis Syndrome and the family has to be careful about what Kara eats.

month ago during the night,” said Kendall. “It was almost a year since she’s had such a big reaction. We don’t know what she got into. It was a big reminder to us to be careful. Kara knows what she can’t have and she’s really good about it. When she wants something we’re having, but she can’t have it we’ll tell her you can’t have it because it is ‘owie on your tummy.’ “We’re in survival mode from day to day, sometimes it’s hour to hour. We pack her lunch for daycare and no one else is allowed to feed her. We watch her like a hawk. She can’t have most snack foods, but we eat a lot of freeze dried snacks and we have to read every label. Grocery trips take a long time. Usually I’ll go twice, once just for Kara and the other time for us.” A few fast food chains have made special items for Kara so she can eat out sometimes. The Nelsons said children have outgrown FPIES, but it’s unclear yet whether their daughter will. The Nelsons are grateful for all the support there is with FPIES, especially since it’s a rare disease. The Nelsons find a lot of support through the social networks, like Facebook and blogs and the Children’s Hospital of Philadelphia. The Nelsons hope the hospital foundation’s nonprofit organization called FPIES United Family Fund geared for research and education will find a cure for the syndrome. To learn more about FPIES and to donate to the fund go to http://giving.

chop.edu/site/TR?pg=fund&fr_id=10 30&pxfid=6824 or to read the Nelson’s story from their words go to http://www.fpiesofourlives.blogspot. com/.

JENNIFER STOCKINGER may be reached at jennifer.stockinger@brainerddispatch.com or 855-5851.

Lymphedema: incurable but treatable

Brainerd Dispatch/Steve Kohls

Pam Miller, certified lymphedema therapist at Essentia Health’s St. Joseph’s Medical Center’s Outpatient Rehabilitation, massaged the leg lymphedema sufferer Bill Albrecht. Albrecht has suffered from lymphedema, which cause swelling in his legs due to fluid backup, for at least 15 years but wasn’t diagnosed until recently. Miller said Albrecht’s progress has been remarkable since she started therapy. By MATT ERICKSON Staff Writer

n the 20 years he worked as an over-theroad trucker, Bill Albrecht of Brainerd put on 1.8 million miles traveling to 48

states and through Canada. As fulfilling as that work was, he also figures it had an unhealthy effect on his body and was one of the factors that led to his suffering of lymphedema, which caused severe swelling in his legs. “I have had problems for years,” the 68-year-old Albrecht said. “It had been years, 15 years or so, that I had swelling. I figured it was from sitting in a truck all those hours every day. For years in the truck I had this huge pillow to keep my legs elevated at night, and it would start all over in the morning.”

The problem was that no one, not Albrecht or his doctor, knew exactly what the problem was. To alleviate his symptoms, Albrecht spent years taking water pills to temporarily reduce the swelling in his legs, which he figured got up to 19 or 20 inches in diameter around his calves. Though the water pills provided temporary relief, the swelling always returned. Over time, he said, the problems with his legs left him almost immobile. That all changed in February of 2010, when Albrecht was referred to specialists at Essentia Health St. Joseph’s Medical Center’s Outpatient Rehabilitation on South Sixth Street, which confirmed a diagnosis of lymphedema. That’s when he got on a program to manage the effects of lymphedema. “When he first started he could hardly walk into here,” said Pam Miller, certified lymphedema therapist at Essentia Health St. Joseph’s Medical Center’s Outpatient Rehabilitation. “He had to

walk with a walker.” While most people are probably familiar with lymph nodes and the lymphatic system, few understand its function within the body. The body’s lymphatic system is part of the immune and circulatory system and works to remove fluid from the body. Lymphedema occurs when the system is unable to remove fluid because of a blockage, resulting in a buildup of lymph fluid usually in the arms or legs. If not treated, over time the fluid can become hard, the skin becomes tight and open sores are common, Miller said. The causes of lymphedema are many. It can be present at birth, as a result of surgery, a lymphatic anomaly or from poor veins. And in many cases, most people don’t know they have it, Miller said. It’s been in just the past two years that Miller and another certified lymphedema therapist, Peg Borders, have started a treatment program for people suffering from lymphedema.

“I firmly believe there’s many, many, many people out there who have lymphedema that can be helped and they just don’t realize they can have treatment,” Miller said. “And I do feel the medical community isn’t quite aware of what is out there. Education. We need to educate the public and the doctors.” Albrecht was one of Miller’s first patients, coming in twice a week for therapy that included treating the skin and gently massaging his legs to open the lymphatic system and to drain the fluid. Now Albrecht uses a pump at home for his therapy sessions. He also uses compression stockings to help keep his lymphatic system working. Miller compares treating lymphedema to an ice jam on a river — it does no good to try to push more ice through without first opening up the source of the jam. Albrecht recalls his swelling was so bad that if his legs were bumped the skin would break, draining the fluid that had built up. He couldn’t walk, meaning his 82-year-old neighbor took care of his garden. He used a wheelchair to get around his house. “There was just so much I couldn’t do. It’s just so much better now,” Albrecht said about the therapy to remove fluid from his legs. He can now walk and he’s planning to get to work on his garden as soon as the weather cooperates. For every patient, the goal is to get them to do therapy at home using a pump like Albrecht does, Miller said. “We want them to be able to do that because it’s a life-long thing they will have to deal with,” Miller said. “That’s very hard for a lot of people to actual-

Brainerd Dispatch/Steve Kohls

While a pump massaged one of Robert Curo’s legs during a therapy session for lymphedema at Essentia Health’s St. Joseph’s Medical Center’s Outpatient Rehabilitation, Peg Borders, certified lymphedema therapist, rolled a compression wrap on Curo’s other leg. The lymphedema therapy program started in Brainerd in 2009.

ly deal with that portion, that it’s not going to be cured.” Albrecht can attest to the benefits of the therapy and he called Miller his “certified angel.” Miller said most rewarding for her is seeing the instantaneous results in patients after therapy

sessions. “It’s made a world a difference for me, I know,” Albrecht said. MATT ERICKSON may be reached at matt.erickson@brainerddispatch.com or 855-5857.

Growing a (novice) garden By SARAH NELSON Staff Writer

Gardening is in my blood. Well, theoretically it should be. My grandfather had an incredible backyard vegetable garden and, as a kid, I spent many summer days helping him pick carrots and tomatoes and countless heads of lettuce. My grandpa was a chemist by trade and now as an adult I am growing more convinced that he had developed some laboratory concoction to better his veggies because they were always perfect. Green thumbs like his make home gardening kind of intimidating— especially when you live in a region that is frozen solid for 5-6 months out of the year. Last spring I decided to test my genetic gardening predisposition and grow my own veggies. There is something extra fresh about produce that goes straight from the garden to the dinner table, plus, summer harvest can last through the winter months, saving a bundle on the grocery bill. It was a lot of work and a lot of dirt, but the first few buds that broke through the ground made it all worth it. Before I planted, I did a little research on optimal growing for northern Minnesota. I did some things right, a few things wrong, but by the time summer was at its peak, I had a pretty decent garden. Just ask my friends and neighbors who inherited piles of my fast-growing spinach and rapidly multiplying green beans. Start indoors: Growing season in Minnesota starts when the ground thaws and nighttime temperatures are warm enough to not freeze the fragile seeds beneath the ground. Last year, with some late snow coming the first week of May, there was a brief scare for my outdoor garden seedlings. Thankfully the frost was mild, but inclement weather could potentially damage young plants. To avoid the early demise of delicate plants, it’s a good idea to start your garden indoors. I planted the bulk of my seeds in individual biodegradable planters about a month before the ground was warm enough to plant outside. My sun porch gets

Brainerd Dispatch/Kelly Humphrey

Seedlings were transplanted from smaller containers to larger ones at Landsburg Landscape Nursery to give them room to grow.

at least eight hours of direct sunlight providing enough warmth and light to sprout some healthy plants weeks before I transplanted them outdoors. Make sure you pay attention to the number of seeds to plant in a particular space. Vegetables like beans, onions and tomatoes tend to play the survival of the fittest game and require three or more seeds and the one that grows the fastest wins. I found that it was a little painful to pluck the weaker seedlings, but thinning is for the greater good. You’ll forget all about the doomed plants as soon as you see the fruit of your labor. Maximize your space: One of my biggest deterrents of home gardening was the size of my yard. I live in town, so growing rows of produce that extend into the horizon isn’t an option. I built a raised bed and re-purposed two other planter boxes giving us approximately 90 square feet of space, which I used every inch of. • Interplanting crops that grow fast with slower growing crops can help generate optimal crop yield by the slower yielding crops helping to stabilize the soil, and mixing produce types will help create some advantageous biodiversity. Just don’t intercrop with produce that will compete for sunlight and space. • Plant in wide rows instead of a single file — you’ll achieve a higher yield and reduce the risk of tangled roots and deformed veggies. No one wants to eat carrots that look like actual fingers. • Grow up. Plant vertically. You can save some space by growing produce like melons, cucumbers, and gourds vertically and grow other crops on ground level. Plus, it makes your garden look really lush when you have melons and tomatoes hanging over your ground-level crops. Don’t overplant: This was my big mistake. I got

a little too ambitious about the variety of produce my garden would yield. I planted spinach, green beans, snap peas, lettuce, green onions, red onions, zucchini, cucumbers, tomatoes, and peppers. That doesn’t even count the herb variety housed on my porch. It was fun, but it got a little overwhelming and sadly I ended up having to give away or throw out a painful amount of veggies. Plant vegetables you know you’re going to enjoy or will be able to share. Over-planting forces your crops to compete for space and nutrients and result in under-grown crops, or in my case, out of control zucchini. I didn’t even know zucchini could grow to be three feet long. I could have entered the county fair with those giants. Go green: When I started plotting out my garden plans, I had this brilliant idea that I was going to grow bell peppers. In Minnesota. My little pepper pot yielded a whopping two red bell peppers. They were so cute I had a hard time even eating them. For all the love and hard work I put into those pepper plants, I was pretty disappointed with my results. For this year, note: peppers are hard, if not impossible, to grow in Minnesota. Green veggies are hearty and tough. They tend to survive frost and do just fine if summer drags it feet a little. If you’re feeling a little hesitant about the idea of a home produce aisle, there’s nothing like a garden of lettuce or green beans to up your confidence. The one exception to the green rule: Don’t plant avocados. Even in the most welcoming summer climates, an avocado seed takes ten years to yield fruit. SARAH NELSON may be reached at sarah.nelson@brainerd dispatch.com or 855-5879.

Tips from the pros

Brainerd Dispatch/Kelly Humphrey

Vegetable seeds in packets await the chance to grow in area gardens.

Need a little more convincing? Jaci Forsberg of Landsburg Landscape Nursery in Brainerd shared her insight on planting a successful backyard vegetable garden. • “Start of small, especially if you don’t quite know what you’re doing.” Forsberg said it’s a good idea to remember to take on only what you can handle. “I lot of people are turning to raised bed gardening,” she said. “It’s really slick and it cuts back on weeding.” • Invest in good soil. “We have such terrible soil around here,” Forsberg said. She recommends an organiccompost mix. “If you start off with good soil you shouldn’t have to fertilize as much.” Forsberg also said to make sure you have the pH balance of your soil tested every year. • Don’t forget the basics. Weeding, watering, and fertilizing are essential to gardening success.

Landsburg Nursery offers gardening classes every Saturday during the month of April and June. For more information call (218) 829-5519 or visit their website: www.landsburgnursery.com.

For the rest of us... If growing your own vegetable garden sounds more traumatizing than exciting, don’t worry, you can still benefit from homegrown produce without the effort. Community-Supported Agriculture shares provide partnership between area farmers and the consumers who eat their veggies. Members support the farm operations and in return receive a weekly produce share through the growing season. For information on CSA shares in your area, visit the Minnesota Department of Agriculture’s Minnesota Grown at: http://www3. mda.state.mn.us/mngrown/home.aspx.

Blood donors providing the gift of life By JENNY HOLMES HealthWatch correspondent

What started out as a dare to an 18-year-old boy has now evolved into the story of a 56-year-old man who recently donated his 88th pint of blood to the American Red Cross. Rick Janssen of Baxter earned and collected his 11th gallon card at the March 2011 Red Cross Blood Drive at Heritage Assembly of God Church in Baxter and says there is “no end in sight” to his service through blood donation. While his motivation as a man is many-fold, back on Jan. 18, 1973, it was a dare from a coworker and incentive to get a few paid hours away from work that got his blood pumping. “Back then, if you were working, your employer had to pay you while you were giving blood,” Janssen recalled with a chuckle. “So I thought, ‘Cool! It’s a good way to get paid for working and donating blood.’ But I also did it because my mom did it and she was encouraging me to do it. She was the goal I was shooting for — to catch her and pass her.” Catch and pass he did, right around the eightgallon mark. And the rest is history. Recalling that day 38 years ago, Janssen said it was really a piece of cake. “I thought it went so smooth. There was nothing to it. And they kept saying, ‘You could be saving three lives.’ That really says something to me. That means a lot. For an hour of my time, I’d give every day for that.” However, American Red Cross stipulations only allow donors to give every 56 days. So in lieu of every day, Janssen settles for donating four or five times each year and has driven up to 30 miles to make his donation. And if that dedication doesn’t already speak volumes, Janssen and wife, Connie, commonly invite the visiting Red Cross workers from each local multi-day blood drive to their home for dinner. “It’s a great way to meet people from different towns,” he said, adding the last time they hosted a gathering, 13 people attended. “I’m looking forward to hopefully getting 30 over next time.” While he says it isn’t his sole motivation for donating, Janssen noted an even greater appreciation for fellow blood donors after his wife underwent a stem cell transplant 10 years ago. “My wife likes to think we got a break on blood because I’m a donor,” he joked. “She’s been in and out of remission four times and the stem cell surgery was her last ditch effort to put it in remission again. And it worked. That gift of life means so much to me.”

Brainerd Dispatch/Steve Kohls

April Berg, of the American Red Cross, shared a laugh with longtime blood donor Rick Janssen, Baxter, as he prepared to give his 88th pint of blood at the March American Red Cross Blood Drive in Baxter. Janssen has been donating blood since he was 18.

Brainerd Dispatch/Steve Kohls

LaVae Wenzel has donated about 12.5 gallons of blood, making her one of the top blood donors in the Brainerd lakes area.

Having gone from a dare to a passion, Janssen anticipates giving for a long time to come. “I enjoy it. I won’t quit until they tell me I can no longer give for some reason. Really, there’s no end in sight.” According to the American Red Cross, only three out of every 100 people in America donate blood, and every two seconds someone receives a unit of blood. For 20 years, Dee Severson has coordinated the local chapter of the American Red Cross, soliciting new donors and making calls to the ‘regulars.’ “They hear my voice and they don’t even ask who it is. They just say, ‘Okay, Dee. When do you need us?’ The need is always there. That’s what the Red Cross puts on their posters and it’s very, very true.” Severson noted the generosity of blood donors in the lakes area, citing the record turnout at the March “Battle of the Badges” blood drive in Baxter.

Brainerd Dispatch/Steve Kohls

Mary Bradley (top left) of the American Red Cross prepared to get a blood donation from Tom Peters at the March American Red Cross Blood Drive. Peters has donated 71 units of blood. Jan Smelter (above), American Red Cross, prepared to get a blood donation from long-time donor Marvin Erdman. Erdman has donated 80 units of blood. Brainerd Dispatch/Kelly Humphrey

Cheryl Norwood (left) had her blood drawn by phlebotomist April Berg during the March Red Cross blood drive.

“People in Brainerd are so giving,” Severson said. “We had a wonderful turnout at our March drive. Our goal was 741 units of blood but we topped off at 872. We were so swamped the whole time and it was wonderful!” Despite the fact she has now donated over 12 gallons, or 100 pints, of blood to date, LaVae Wenzel considers that to be just a number and certainly not the motivation behind her giving spirit. “I first started in 1972,” Wenzel said. “I guess I was kind of asked to give the first time and after that it just seemed like the right thing to do. I always feel good after I donate.” Now retired, Wenzel worked for the Rosemount-Apple Valley School District for 16 years and made a point of participating in blood drives four times annually. After moving to the area, she would often drive distances to ensure she kept up on a regular donation schedule. Having a B-positive blood type, Wenzel has often been specifically contacted as a direct match for many in need of blood. And after her husband required six pints of blood in a transfusion several years

ago, Wenzel felt compelled to give back on behalf of both of them. “If you put 12.5 gallons out, that’s quite a bit,” Wenzel laughed. “I don’t know. I just gave when they wanted me to give.” Cheryl Norwood of Baxter is quickly approaching the eight-gallon mark. Giving since the age of 16, Norwood was also encouraged by her parents to give blood and has passed the tradition down to her eldest son who also donates when he can. “I feel it’s important to give wherever there’s a need,” Norwood commented. “Everyday there are men and women in the military who give of their lives. The least I can do is give blood. What’s an hour’s time in comparison? I’ll continue giving as long as I can. It’s such a small thing to do and it doesn’t cost much; just a little time.” To learn more about donating blood through the American Red Cross, visit www.redcrossblood.org. JENNY HOLMES is a former reporter with the Brainerd Dispatch and owner of Silver Bullet Communications. She lives in Nisswa with her husband, two children and dogs.

Going home ... again “untreatable.” We looked at one another and thought of a different word: Unbelievable. Life as we know it can change in a day. It hapMy mother is the kind that had warm cookies pens all the time. ready after school and good-tasting hot meals on About this time last year a doctor with a bad the table every night. My own kids should be so bedside manner and a cell phone in his hand lucky. pulled aside the curtain to my father’s room at a She had one daughter and I relished in every Duluth hospital, frowned, and said, “There’s nothbit of the mother-daughter attention. As an adult I ing we can do, Steve. It’s not good. Sorry.” Then he have called her weekly for advice about her grandpointed to the phone and said, “I really have to babies, my ineptness in the kitchen and just to take this,” and was gone. Granted, talk about nothing special for an hour at another doctor had already delivered the a crack. biggest blow: They’d found cancer. It was My mother is already extraordinary to advanced. us. We’d all noticed my father hadn’t For almost five years her blood has been feeling up to par so when my spent nearly as much time out of her phone beeped on a Sunday on our way body as in it. She has logged around 500 to the Civic Center to watch my son’s hours hooked up to machines while her hockey game with a text message that blood slowly snakes through tubes out of said, “Dad is ready to go to the hospital,” and then back into her body. Ask any I knew it might not turn out well. dialysis patient about the process. They A few hours later, waiting for him to will tell you about the dreaded needles return from additional tests I saw a file and the too-frequent, lengthy procedure on the desk in his room. My 68-year-old they endure that leaves them tired, weak father’s name was printed on it and on and recovering the remainder of the day. the line after ‘diagnosis’ someone had And another March brought big handwritten “Cancer — Everywhere.” changes to our lives. That evening, surrounded by my It was a hard decision but my mother mother, his children, our spouses and has left her home and moved into an eight grandchildren from middle-school assisted living facility. It is bright and age to college, my father talked about nice. The staff is kind but it isn’t her Sheila Helmberger, who lost her father last year, said she feels what he’d like to happen with family home, so on weekends when it’s possible blessed and looks forward to celebrating Mother’s Day with her land my parents owned. And then, in we take turns bringing her home to the typical dad fashion, seeing the somber mother and family. place my father built for their retirefaces of his grandchildren, he asked if ment. Finding a suitable place to live was much Their home in the country meant dial-up they’d like to order pizza. Making a face he said, “I Internet and only sketchy cell phone service. Texts like looking for a good school for our children. We never like the food in these hospitals anyway.” asked about the staff to resident ratio, when and were somewhat reliable. Between the two I got A nurse explained my father’s options for his what they served for meals, and what they offered highlights of sporting events, helped register for care. There was no real prediction on how long he for enrichment. Most importantly we asked if we might have but their best guess was weeks. Before this year’s classes and watched Family Access like were all welcome to come and go as often as we a hawk, which meant I was able to nag from she finished he said, “I’m going home.” We never wanted. another city. A half dozen deer came nightly to expected anything different. I am “geographically blessed,” as well as slightsteal from the bird feeders in my parents’ yard. I For the next six weeks my brothers and I manly “career-challenged” and am able to make the photographed them with my phone and showed aged some creative scheduling, doing our best to trek one or two days a week. At one point in my the pictures to my dad. make sure someone was always at my parents’. husband’s career coming home meant an eightMy husband and I weighed his own experience My father’s tumors were in critical areas, includhour drive. I’m so glad it doesn’t now. Some days I losing his mother a few years before – a late night ing close to his heart, and three times a week my take her to dialysis or other appointments. Some phone call from an emergency room with no hope mother needed to get to Grand Rapids for dialysis days we shop and go out for lunch. Almost always of a goodbye — to losing my father little by little. treatments. One of us would go with her and one of us talks the other into dessert. someone would stay behind with our dad. Spouses Neither seemed better than the other. She lives within city limits now and has a cell It’s exactly 90 minutes from my parents’ drivechipped in and grandchildren with driver’s licensphone. We’re at her fingertips. She and I still way to my own. I bought Miranda Lambert’s CD es were useful, too. One of my mother’s brothers speak daily about topics such as her grandchiland played “The House that Built Me” at least helped out frequently. It was a good team. We dren and my ineptness in the kitchen. Last winter once a trip. were all able to spend time with my dad. Hospice My father passed away a year ago on March 20. my brother took her to dialysis, then braved a blizcame once a week and then more often. zard so she could be at her granddaughter’s wedSometimes, when it was just our parents and us We were all there. ding. March is over. It is nearly Mother’s Day. kids, it all felt weirdly familiar. A few weeks ago, 11 months after my father’s This year, more than ever, I am so very blessed The day it was announced pitchers and catchpassing we found ourselves in the same hospital to both be one and to have one. ers were reporting to camp for the Twins, my dad in another waiting room. We were told similar reached for the remote and turned off the televinews, a little more politely, about my mother. SHEILA HELMBERGER lives in Baxter and contributes to sion. Outside of his window his favorite season Doctors used words like “mass” and “suspicious,” was arriving. then followed them later with “probable” and several publications. By SHEILA HELMBERGER HealthWatch Correspondent

As painful as it was to be with my father, none of us could fathom being anywhere else. One morning he stayed in bed. “I think I’ll take the day off.” he said quietly. “What do you think?” I nodded. Chairs for us were moved beside his bed. My brothers and I split our weeks between their home and our own. While my brothers strategically used up vacation days and other leave I realized what a blessing it was to freelance and still make my deadlines.

Q and A with ... Dr. David Nelson How long have you been providing interventional pain therapy at Essentia Health St. Joseph’s Medical Center? I have been seeing patients in Brainerd for about a month now, on Mondays. I appreciate the opportunity to serve another community and help patients get some relief from their pain. It has been great coming to Essentia Health St. Joseph’s Medical Center. The staff and patients here are wonderful to work with. Can you tell us more about your employment and educational background? I received my medical degree from the University of Minnesota. I did my residency and fellowship training in anesthesia and pain management at the University of Minnesota and the Mayo Clinic. I have been caring for patients at Essentia Health in Duluth for about eight years. I worked in the Twin Cities prior to that. What’s the difference between chronic and acute pain? Chronic pain tends to outlast the duration that you would expect from an injury. In this situation, there are actual changes that occur in the nervous system — the spinal cord and brain. It’s a real disease with long-term problems that involve changes occurring in the patient’s anatomy, chemistry and nerve tissues. There also seems to be some genetic component to chronic pain. The patients that I see in my practice at St. Joseph’s are typically those in more acute or sub-acute pain. Often the patient has experienced pain for months, and frequently we can find the particular source for their pain. Many of these patients have problems with degenerative changes in their spine. What are some of the common causes of pain in the patients you see? For the majority of patients I see, the pain originates in the spine. The pain is often caused by degenerative changes in the disks between the vertebra or the small joints in the spine, called the facet joints. Sometimes I treat pain in the hips and knees that is also caused by degenerative changes. I can also help patients who have nerve entrapment syndromes, where pain is caused by a nerve in the arm or groin, for example, that gets trapped

in scar tissue after surgery. In many of these cases we can pinpoint the source of the pain, so it’s less likely that these problems will result in a general, chronic pain problem. What kinds of treatments and therapies do you provide? We provide interventional pain therapies, which often involve spinal injections. These injections go into various parts of the spine to help localize the source of the pain and hopefully, make it better. We use various medications, including local anesthetics and steroids. We can also use heat and chemical processes to destroy specific nerves that are causing pain. What is it like to get an injection? Typically, the process is pretty quick. Patients are admitted, and I speak with them about the nature and location of their pain. We review various imaging studies, and discuss what kind of spinal injection would be most beneficial. Many times we get referrals from a patient’s family physician or orthopedic surgeon requesting a specific kind of injection. If that hasn’t already happened, I work with the patient to come up with a treatment plan. The injections themselves only take a few minutes and many times the patient doesn’t even have to change into a hospital gown. We use imaging, called fluoroscopy, to see precisely where the injections are placed. That’s the standard of care — to use imaging during these kinds of injections. The care doesn’t end with the injection, however. It’s very important to get patients into a physical therapy or exercise program. We put a lot of emphasis on strengthening the core and spinal support muscles, so patients can have more long-term relief of their back pain. What kind of outcomes can patients often experience? In the majority of cases, we are able to find the source of the pain in the spine. I would say that occurs 60-70 percent of the time. That means we have a reasonable chance of giving patients some long-term pain relief. If we can reduce the pain by 75 percent for six or more months, that is a positive outcome. Many patients do have to come back for additional injections, but we are careful to monitor the amount of medication

patients receive. We are pretty conservative and judicious when it comes to the number of injections we believe a patient should receive. As I mentioned before, we want to work closely with the physical rehab staff to make sure patients are getting active and staying mobile once their pain lessens. This will reduce the chance that they need to come back for further injections. What is the most common area for pain that you treat? The lower back is the most common problem area for my patients. Can you suggest any tips for preventing pain, particularly in the back? It’s important to maintain a proper weight and to keep yourself fit. In particular, it’s a good idea to strengthen the muscles that support the spine. Also, be careful when lifting heavy objects. Pay attention to using good body mechanics to keep your back healthy as long as possible. — Jodie Tweed, HealthWatch editor

Dr. David Nelson is an Essentia Health interventional pain specialist.

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