Table of Contents Publisher • Tim Bogenschutz Advertising • Susie Alters and Phil Seibel Editor • Sarah Nelson Katzenberger Art Direction/Design • Jan Finger
Knitted Knockers . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Making a difference for women battling breast cancer . . . . . . . . . By Jenny Holmes
What are my joints telling me? . . . . . . . . . . . . . . . . . . . .
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Insights from an orthopedic surgeon . . . . . . . . . . . . . . . . By Dr. Ben Robertson
Coming Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Native of the Brainerd lakes area returns to practice medicine . . . . By Dr. Marie Nelson
Contributing Writers
Brushing up on good dental care . . . . . . . . . . . . . . . . . . .
Sheila Helmberger • Jodie Tweed • Dr. Ben Robertson • Sarah Nelson Katzenberger • Dr. Marie Nelson • Marino Eccher • Jenny Holmes • John Lundy • Patrick Springer
First steps on a new journey . . . . . . . . . . . . . . . . . . . . . .
Health Watch is a quarterly publication of the Brainerd Dispatch.
Ready to roll in Cuyuna Country . . . . . . . . . . . . . . . . . .
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Myths, facts and when to see a dentist . . . . . . . . . . . . . . . By Sheila Helmberger
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Dr. Jessica Tabbatt launches career in podiatric surgery . . By Sarah Nelson Katzenberger
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Cuyuna Lakes Mountain Bike Patrol is there to help . . . . . . . . . . . . By Jodie Tweed Read Health Watch online at www.brainerddispatch.com
Chiropractor helps patients find best approach . . . . . . . . .
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Dr. Thea Feierabend promotes nature’s healing . . . . . . By Sarah Nelson Katzenberger For advertising opportunities call Susie Alters at 218-855-5836. Email your comments to newstips@brainerddispatch.com or write to: Brainerd Dispatch P.O. Box 974 Brainerd, MN 56401
Easy Listening . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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New technology enhances hearing aid experience . . . . By Sarah Nelson Katzenberger
Motorized exoskeleton provides life-changing help . . . . . .
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Paraplegic patients stand & walk . . . . . . . . . . . . . . . . . . . . By Marino Eccher
Meditation technique improves quality of life . . . . . . . . . .
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Enthusiasts see improvements in stress levels and general health . . . . . By John Lundy
Targeted drugs take aim at specific cancers . . . . . . . . . . .
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Kidney cancer victim, Dale Thornton shares his experience . . . . . . By Patrick Springer
Springsteen in the operating room . . . . . . . . . . . . . . . .
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Many surgeons turn up the music . . . . . . . . . . . . . . . . . . . . . By John Lundy
THE End . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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It’s hard to talk about, but it’s best to be prepared . . . . . . . . . . . . . By John Lundy
Kelly Humphrey • kelly.humphrey@brainerddispatch.com
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By JENNY HOLMES Contributing Writer
Knitted KNOCKERS making a DIFFERENCE for women battling breast cancer
When dealing with the seriousness of breast cancer, a little humor is certainly a welcome friend. Perhaps that was the motivation when a group of women formed, and named, the “Knitted Knockers” organization in 2007. While started by a single woman in Maine, the concept and initiative spread
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like wildfire. Today, Knitted Knockers has collected over 5,000 Knockers from volunteer knitters and distributed them, for free, to mastectomy patients in all 50 states. There are now groups in Arizona, Arkansas, California, Florida, Georgia, Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Pennsylvania, Texas, Washington and Wisconsin making and distributing Knitted Knockers.
Marty Peisch of Nisswa first read about it in an online blog. Having been a knitter since she was very young, Peisch said the concept soon became her personal calling. “Both of my grandmothers and a cousin had breast cancer,” Peisch said, noting she saw a unique niche that needed to be filled on a local level. In April she began her own group of the Knitted Knockers in the
Brainerd area. Knitted Knockers are a lightweight, knitted prosthetic breast alternative for women who have had a mastectomy. When placed inside a bra, the knockers take the shape and feel of a real breast. Made with cotton-based yarn and polyfill, Knitted Knockers are said to be lighter and more comfortable than silicone prosthetic breasts. The knitted fabric breathes and prevents the heat rash and discomfort often experienced by women wearing other types of prosthesis. The Knockers are made in a variety of cup sizes for women to choose from, ranging from an A cup all the way up to DD. Each piece has a small hole on the side so women can remove or add polyfill, as well as a knitted nipple on front for a realistic effect. Peisch brought the idea to the Utrinkets store on Laurel Street in Brainerd where she often meets with other knitters to work on projects. “When I brought it up to everyone here, it was kind of like ‘Huh?,’” said Utrinkets owner Kevin Yutrzenka. “But it’s a great concept. And, definitely, we know there’s a need out there.” Yutrzenka and his wife, Kristy, host annual ‘KnitIn’ events at their store every July. They invite knitters of all ages and genders to sit and knit, uninterrupted. The date of the event is the weekend after the week of the Fourth of July. The event times are from noon on Friday to noon on Saturday. Everyone is welcome to attend for an hour or two or stay for the whole 24 hours. The group dedicates that time to making chemo hats for individuals undergoing chemotherapy, as well as prayer shawls and lap blankets for those going through chemo and their families. Collectively, the group of knitters has distributed their labors of love not only locally, but also to the Mayo Clinic, metro-area hospitals and fa-
I’d really like to find other knitters to help. Maybe there’s another weirdo out there that has more time than good sense. Marty Peisch cilities, St. Cloud, Aitkin, Fargo, and a multitude of hospice organizations. Kristy and Kevin said they have participated in cancer-supportive gifts for the eight years they’ve owned their store. What was started as fun time to gather together has evolved into something that has created emotional and personal connections with people battling cancer. “There were just so many times that first year that I cried,” Kristy said. “It’s a really personal thing that everybody is impacted by. And if making something so simple makes someone happy, why not?” The Yutrzenkas and Peisch have witnessed women pay it forward after receiving a knitted gift by coming back to knit for others. “It is a fun time to get together to knit and visit, but it’s also really personal,” Kristy said. Knit-In events continue to grow and gather steam at the Utrinkets store. However, Peisch is really looking for more knitters who want to devote time to exclusively making Knitted Knockers. Dependent on the knitter, the average Knocker takes about two hours to make. Each is tagged with the cup size and the name of the knitter who created the piece. Peisch, herself, said she has easily made over 30 since she started a few months ago, but simply can’t keep up with the demand. “I’d really like to find other knitters to help. May-
be there’s another weirdo out there that has more time than good sense,” she laughed. “It’s just so therapeutic to sit and knit. And you make good friends real fast, too.” Even Kevin Yutrzenka has gotten in on the action and made a Knocker at a recent Open Knitting Day where Marty presented the idea to knitters and crocheters at Utrinkets. “It’s really a nice, small project that’s quick and easy,” he said. “You don’t have to stress about a pattern. It all just falls into place. It’s a quick grab-andgo thing to do.” In 2015, the Knitted Knockers effort morphed into a worldwide program and became Knitted Knockers Charities — a 501(c)3 organization. A website was established to provide information to cancer survivors to connect them to local organizations involved in the initiative. Worldwide, Knitted Knockers has affiliates in the United Kingdom, Australia, South Africa, Mexico, Germany and Finland. Peisch said her local organization is not a 501(c)3 at this point, and all Knockers are made with donated time and materials. There is no charge for Knitted Knockers, and they can be picked up at many local hospitals and through breast cancer survivor groups. To get involved or to learn more about the Knitted Knockers, contact Marty Peisch at 218-820-7149 or email knittedknockersmn@yahoo.com. ■
YOUR CARE TEAM. HELPING YOU LIVE WELL.
Your care team is dedicated to your overall health and well-being. That means they know the ins and outs of your game plan—working alongside their partners to ensure you receive the care you deserve. So, regardless of which team member you see, you can rest assured, your health is in good hands.
YOUR PILLAGER-STAPLES CARE TEAM SEEING PATIENTS AT OUR PILLAGER & STAPLES CLINICS:
Becky Bennett, PA-C; Arden Beachy, MD; Jody Giza, PA-C; Christine Albrecht, MD; Neil Bratney, Pediatrician
800-525-1033 I 218-894-1515 I lakewoodhealthsystem.com
By DR. BEN ROBERTSON Columnist
What are my joints telling me? Joint pain affects people of all ages, but becomes more common as we get older. The most common cause of joint pain in adults is osteoarthritis (OA). This is also sometimes called degenerative joint disease (DJD) or degenerative arthritis. OA DR. BEN
ROBERTSON
affects 27 million Americans and two of the more common joints affected include the knee joint and hip joint.
In normal joints, a smooth material called cartilage covers the ends of each bone. This provides a gliding surface for joint motion and acts as a cushion as well. The term arthritis refers to joint pain. In OA, this joint pain is the result of the super-smooth cartilage breaking down. As a result, the bones begin to rub together. This causes pain and swelling and difficulty moving the affected joint. Symptoms of osteoarthritis often develop gradually. Many times, people with OA notice pain and stiffness, which is often more noticeable first thing in the morning, or after sitting for a prolonged period of time. Some activities can increase the pain. However, many patients notice that when they are active, their joints actually feel better. OA can lead to other health problems as well. Chronic pain from the arthritis can affect mood and contribute to depression. In addition, knee or hip pain often leads to inactivity, which promotes weight gain and obesity. This, in turn, can worsen heart disease, diabetes and high blood pressure. People with OA also have a 30 percent greater risk of falling and 20 percent greater risk of fracture. Your doctor can commonly diagnose knee and hip arthritis. Your medical history is very important in helping diagnose. Your doctor may ask for a description of your symptoms, including where you feel your joint pain and when your symptoms began. Other important factors include how rapidly your symptoms began and how your symptoms affect your normal daily activities. Physical examination is also very helpful. Your doctor will be examining how well your joint moves. They will also be looking for areas that are painful or swollen. Imaging is also very useful. Often times an X-ray
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is enough to make the diagnosis. Other times an MRI scan can be very helpful. Blood work can be done to rule out other causes of joint pain such as rheumatoid arthritis or Lyme disease. Joint aspiration can also rule out gout or infection as a possible source of pain. Osteoarthritis (OA) is a long-term (chronic) disease. There is not a cure, but there are many ways to manage the symptoms. The goal in treating OA is to control the pain and allow patients to participate in the activities they desire. Sometimes this requires surgery, such as joint replacement. However, many times these goals can be accomplished without surgery. Physical activity is one of the most important ways to manage OA. Low impact aerobic activity is especially
important. Activities such as walking, using the elliptical trainer, biking, swimming and cross-country skiing reduce pain in knee and hip joints. They also improve flexibility, help maintain proper body weight and can improve mood. Strengthening exercises help to build muscle around affected joints. Stretching also improves flexibility and lessens stiffness. Yoga and tai chi can also be very helpful. Weight loss is also an important treatment for OA. Excess weight adds additional stress to weight bearing joints such as the hip and knee. This leads to increased pain and swelling, and can increase the rate at which the joint is damaged. Weight loss can be achieved through diet and exercise. When diet and exercise are not sufficient, there
are other alternatives; which can be discussed with your doctor. Medications can also help manage OA pain. Pain relievers such as Tylenol can help with joint pain. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can help to manage the pain and inflammation. These are available over the counter or with a prescription. Injections can also be very helpful. Corticosteroid injections are powerful pain and anti-inflammatory medications that can be injected directly into the joint. They often provide three to four months of pain relief, and can be repeated. Hyaluronic acid is a protein which naturally occurs in joint fluid. This acts as a lubricant and breaks down in OA. This can be injected and can also provide very good pain relief. When OA of the knee or hip continues to cause pain, despite these interventions, joint replacement is a very good option. Joint replacement involves covering the ends of the bone with metal and plastic (polyethylene) to prevent the bones from rubbing on each other. This eliminates the pain and allows patients to return to their activities. Surgery is now done with only a very short hospital stay. Physical therapy is begun shortly after surgery and continued as an outpatient. Hip replacement can now be done through an anterior approach, which allows us to perform the hip replacement without cutting any muscle. This allows for a faster recovery and less pain. Osteoarthritis is a very common disease. It causes pain and affects people in myriad ways. However, there are many treatments available. It is important to talk with your doctor and work through these treatments so that the symptoms are controlled and you can continue with all of your activities. â– NORTHERN ORTHOPEDICS AND ESSENTIA HEALTH are working together to bring experts to the communities of Crosslake and Pierz. Dr. Benjamin Robertson, orthopedic surgeon, is available to see patients at the Essentia Health Clinic in Crosslake and Dr. Paul Thompson, orthopedic surgeon, will see patients at the Essentia Health Pierz Clinic. Call your local clinic to schedule an appointment. The team of orthopedic specialists is also available in Brainerd at Northern Orthopedics, Ltd., for an appointment call 218-829-7812.
Coming HOME By DR. MARIE NELSON
After a 12-year educational journey, a return home to develop a career and family is the right choice for me. The opportunity to build a medical practice in an area so dear to me as the Brainerd lakes area seems to be too good to be true. Memories of growing up around the lakes and communities were a deciding factor in selecting a location for my career. Many people dream of being able to return home to raise a family and have a career.
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reception to welcome Brainerd lakes native Marie Nelson, M.D., an Obstetrician/Gynecologist who has joined the staff of Cuyuna Regional Medical Center, will be Tuesday, Aug. 4, from 4 to 6 p.m. at Iven’s on the Bay in Brainerd. All women are invited to meet Dr. Nelson and CRMC’s
As my family and I begin settling into the lifestyle that we have missed so much over the years, it is exciting to see familiar faces and know that I have the support of such a great medical system as Cuyuna Regional Medical Center. From the small produce stands to familiar faces at local businesses, there is reassurance and the comfort of a community at every turn. In the coming years, I plan to enjoy lakes and golf courses that I have missed so much while I was away. With a new-found appreciation for the Brainerd lakes area, my family and I are already enjoying our return home and all that the area has to offer. ■
four other obstetrician/gynecologists, enjoy appetizers and beverages, chair massages, and mini manicures and facials. Reservations are requested by calling Jennifer Holmvig at 218-545-4455. Dr. Nelson returned to Minnesota after completing a residency in Obstetrics and Gynecology at Creigh-
ton University Medical Center and Affiliated Hospitals in Omaha, Neb. She earned her Doctor of Medicine at the University of Minnesota Medical School in Minneapolis and Bachelor of Science degree at the University of Notre Dame in Indiana. For an appointment with Dr. Nelson, call 218-546-7462.
Thirty years of helping people live where they most want to live – at home. We’re dedicated to doing whatever it takes to let people live comfortably and safely at home. Just as we’ve done for 30 years. Call or visit us online to learn more.
(218) 829-9238 | (888) 221-5785 | www.gnhomecare.com
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We’ll be there.
By SHEILA HELMBERGER Contributing Writer
Brushing up on GOOD dental care A routine dental checkup can tell your
When to see your dentist
dentist a lot more about you than whether or not you floss regularly. Your dentist might be the first person to know if you are
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o prevent gum disease and other oral health problems, schedule regular dental cleanings and exams. In the meantime, contact your dentist if you notice any signs or symptoms that could suggest oral health problems, such as: • Red, tender or swollen gums • Gums that bleed when you brush or floss • Gums that begin pulling away from your teeth • Loose permanent teeth • Changes in the way your top and bottom teeth align with each other. • Unusual sensitivity to hot and cold • Persistent bad breath or an unusual taste in your mouth
prone to certain types of heart disease or have developed high blood pressure. How much do you really know about why it’s important to floss regularly? And, it sounds a little crazy, but did you know that sugar alone doesn’t really cause cavities? We separate fact from fiction about all of those visits to the dentist with a little help from Baxter-area dentist, Dr. David M. Ude, Lakes Dental Care in Baxter, and information from Mayo Clinic and WebMD MYTH: Flossing is not important. FACT: You need to floss. By not flossing you are missing over a third of the area that needs to be cleaned on your teeth. Brushing alone just doesn’t do the job well enough. Plaque buildups in every area of the tooth — including those you cannot reach. If you want to do the job really well finish with a swish of some mouthwash as well. MYTH: Your dentist is looking for more than cavities and plaque build-up at your appointment. FACT: Your dentist is looking for signs of good oral health when you go in for your visit. He’ll spot any plaque and issues with your gums but they’re also looking for other signs that need to be addressed. During the visit you are likely being screened for signs of oral cancers, lesions and any abscess. MYTH: Tooth decay is caused by eating too much sugar. FACT: Cavities are caused by sugar and acid combined. Ude said for a cavity to form actually requires three factors. Besides the sugar and acid is the amount of time that it is exposed to our teeth. If you eliminate one of the factors you can decrease the risk of getting a cavity. While it is true, if limit your intake of sugar you can cut down on the risk, by decreasing the amount of time it is in your mouth can help fight the formation of cavities as well. This is just one more good reason they remind you to brush and floss twice a day. MYTH: Silver fillings are unsafe. TRUTH: The silver fillings are a mixture of a number of metals including mercury, silver, tin and copper. Some people are concerned about the mercury that the fillings contain. Ude said during the application of the silver on your teeth all of the other elements that are present are pressed out. The American Dental Association supports the use of dental amalgam as safe, reliable and effective. The use of these fillings has been practiced for over 100 years.
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—Mayoclinic.org
MYTH: Bad breath is a sign of gum disease. FACT: Bad breath is a sign of the presence of unhealthy bacteria. When you brush your teeth it is a good practice to brush your tongue too as a regular part of your dental care. If you notice that your breath smells bad regularly it can be a sign of a periodontal problem or an abscess or cavity. MYTH: Gum disease only happens to older people. FACT: Unfortunately, Ude said there are a lot of younger people that deal with it as well. If you have poor dental health anyone can develop gum disease. MYTH: Other health conditions can be diagnosed during a dental appointment. FACT: True. Your dentist may recommend a visit to your regular physician if conditions such as high blood pressure, slow or poor healing from a dental procedure is noted, or certain types of periodontal sores are noticed at a dental appointment. MYTH: White teeth mean your teeth are healthier. FACT: Not true. The natural color of our teeth is different from person to person. Over the years teeth can develop stains from the things we eat and drink also, like coffee and wine. Even though your teeth may be perfectly healthy they can have a slight discolored appearance. On the flip side, Ude said you can go to the
store and use all of the whitening products that are available but you will still have cavities. Just because someone has a nice, bright white smile doesn’t mean that they have healthy teeth. MYTH: Brushing bleeding gums is really bad. FACT: No. Brushing is good not only for your teeth and tongue, but also your gums. If you have bleeding gums when you brush make sure to let your dentist know at your appointment but some bleeding isn’t uncommon. It’s important to keep the tissue around your gums as clean as the rest of your mouth and you can do this by regularly brushing and flossing them. If your gums are sensitive make sure not to brush them too hard. MYTH: Using an aspirin on a toothache will take care of the pain. FACT:. Ude said sometimes the use of aspirin can lead to burns on the tissue of the gums. Aspirin typically works when it enters the bloodstream and not in this type of situation. MYTH: Bleaching your teeth is dangerous. FACT: It is not. Bleaching teeth is a way to remove any external stains and this will leave you with a nice, bright smile. The bleaching materials on the market and used at your dentist today are completely safe. ■
By SARAH NELSON KATZENBERGER Editor
First steps on a NEW journey ulcerations before they become complicated.” believes she has the best of Tabbatt said it’s important to watch for open sores and both worlds. any new skin conditions and A northern Minnesota nato not waste time trying to detive, Tabbatt returned to the cide if it’s worth a visit to the lakes area in July to launch doctor. “Just get it checked out her career in podiatric surgery right away,” she said. “Unfortuwith Essentia Health in Brainnately people often wait until erd. Tabbatt will see patients it’s too late.” with a wide range of issues inUnchecked foot conditions DR. JESSICA cluding disorders affecting the can lead to serious infection TABBATT foot, ankle and lower leg. and, in extreme cases, ampuTabbatt said it wasn’t a lifetation. long interest in feet that led her to her Tabbatt said she enjoys the excitechoice in specialty. ment that comes with surgery but also “I really wasn’t sure what I wanted to the relationships that come with patient pursue,” Tabbatt recalled. care. Diabetic patients see their physiShe said it was a lecture she attended cians often, sometimes on a weekly bawhile in medical school with a podiatric sis. “You really do build a better relationsurgeon that really introduced her to the ship with them,” she said. “The goal is idea of making podiatry her career path. really to have to see them less often.” Tabbatt said she likes the idea of mixing In addition to her excitement in startprimary care with surgery. ing her career at Essentia, Tabbatt said “It really keeps you on your toes,” she she is excited to be home again. said. “I love both aspects. They really “I’m excited to use the cabin and compliment each other well.” not have to sit in traffic at the end of Tabbatt said a lot of people don’t re- the weekend,” she joked. “We’re really alize how important proper foot care is. looking forward to the change of pace “Our feet take us everywhere,” she and enjoying all that the Brainerd lakes said. “Without proper care, foot and area has to offer.” ankle conditions can be debilitating and With her move from the Twin Cities, prevent us from being able work or take Tabbatt said she expects to bring all that part in activities we enjoy.” she’s learned in her training to the lakes Tabbatt sees patients of all ages and area, noting many people are forced to stages of foot disorder but noted that drive a long way in order to see a podiaearly intervention is often the key to trist, particularly one that specializes in keeping feet healthy and preventing working with diabetic patients. long-term disability. “People shouldn’t need to drive to the Tabbatt said she has taken special cities just to see a specialist,” she said. interest in seeing patients with diabetes “I expect to bring everything I do in the who are often at a higher risk for foot in- cities up to Brainerd.” fection and ulcer due to peripheral neuTabbatt joins the podiatry team at Esropathy, which is decreased sensation in sentia that includes Dr. Daniel Ryan and the feet. Nurse Practitioner Melissa Erickson. “It “The most important things some- really takes a team effort to keep people one with diabetes can do to take care healthy,” Tabbatt said. To schedule an appointment with Dr. of their feet is to do daily foot checks,” Tabbatt said. “This helps catch sores and Tabbatt call 218-828-2880. ■ Dr. Jessica Tabbatt genuinely
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By JODIE TWEED Contributing Writer
Ready to Roll in Cuyuna Country Mountain bike enthusiasts are a hearty bunch, but sometimes even the toughest rider can run into a medical emergency while out on the trails. Fortunately for riders in the Cuyuna Country State Recreational Area, emergency help may be closer than they think. The Cuyuna Lakes Mountain Bike Patrol is a volunteer-based group trained to administer first-aid to riders within the Cuyuna Country SRA. Several crewmembers work as emergency personnel, including Darrell Dwire, bike patrol director, who is a paramedic at Cuyuna Regional Medical Center in Crosby. CRMC has provided some bikes for the EMS staff to use while out riding as part of the bike patrol. CRMC also provides first-aid training for dedicated volunteer bike patrol members, as well as medical supplies that they can carry on their bikes to help other riders in need of help. Dwire said the bike patrol has six EMS bike patrol members and about six other volunteers who have gone through the training program. The bike patrol is always looking for new members, especially those who already enjoy riding out on the trails, anyway. The bike patrol can provide prospective members with medical training, and there isn’t a specific amount of time when members should be out monitoring the 25-miles of single-track trails. There are special events that the bike patrol members provide support
Kelly Humphrey • kelly.humphrey@brainerddispatch.com
Cuyuna Lakes Mountain Bike Patrol members Tim Nelson (front), Josh Boudreaux, Darrell Dwire and Kelly Ziegler ride along a trail at the Pennington Mine access.
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Cuyuna Lakes
Mountain Bike Patrol provides help to bikers out in the rugged terrain
Cuyuna Country State Recreational Area of
Kelly Ziegler (left), Darrell Dwire, Josh Boudreaux and Tim Nelson, members of the Cuyuna Lakes Mountain Bike Patrol, are seen here at the Pennington Mine access with a specialized litter basket with one wheel that is used to get injured riders off rough terrain. Kelly Humphrey • kelly.humphrey@brainerddispatch.com
safe and having a good time on the trails. The volunteer bike crew helps with trail maintenance and runs mountain biking events in Cuyuna Country SRA. There are about 75 bike crew members, Hautala said, but they hope to continue to add more crew members within the next few years. “We have many different groups working together to make Cuyuna happen,” Hautala explained. “All these groups are collaborating to make it the best destination it can be.” Cuyuna Country SRA, which opened five years ago, currently has 25 miles of single track and construction on an additional three-and-a-half miles are expected yet this year. The Minnesota State Legislature allocated $600,000 to the trails system in Legacy funds. Hautala said the master plan is that one day there will be 75 miles of single-track mountain bike trails within the recreation area. Single track is safer for mountain bike riders, since everyone is traveling in the same direction. “The long-term goal is to have three days of riding without ever repeating a trail,” Hautala explained. “The reason we want to do that is to make it a destination, not just a day trip.” Hautala said Cuyuna Country SRA is ranked among the top 20 mountain biking trails in the world — no small feat. The more trails within the trails system, the more people who trek to the Cuyuna Range for mountain biking, which creates a huge economic impact for the community. Dwire said with the popularity of fat tire bike riding in the winter, he is hop-
ing to get some fat tire bikes for the ambulance staff so the EMS staff can go out and patrol during the winter. If you’re interested in learning how to become a trained member of Cuyuna Lakes Mountain Bike Patrol, contact Dwire at ddwire@cuyunamed.org. The
Cuyuna Lakes Mountain Bike Crew is also looking for more volunteers. They meet at 7 p.m. the first Thursday of each month at Hallett Community Center in Crosby. ■ JODIE TWEED is a freelance writer/editor who lives in Pequot Lakes.
Your Home, Our Care Knute Nelson Home Care offers personalized care in the comfort of a client’s home: 24-Hour Skilled Nursing Care Physical, Occupational & Speech Therapy Wound Care • Medication Reconciliation IV Therapy • Pediatric Care Ostomy and Catheter Care • Home Health Aide Homemaking We accept most other insurance plans and self-pay. Medicare Certified
15175 Edgewood Drive, Suite 160 • Baxter, MN 56425 P:218-454-1542 • F:218-454-1541
www.knutenelson.org • facebook.com/knutenelson
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for, but ultimately, they simply have to enjoy mountain biking and helping others. “The patrollers are passionate about biking. They’re advocates for the trail,” Dwire said of the bike patrol team. The team includes both male and female riders. “It’s a real, unique opportunity that the Cuyuna Lakes area has been given with the construction of the bike trails. They are one of the greatest in the state, and they’re getting bigger. It’s cool to be part of that.” Dwire said bike patrol members often find themselves helping lost riders find their way, assisting with bike repairs and handing out bandages, rather than responding to serious medical emergencies. “Most of these guys are pretty tough,” Dwire said of mountain bike riders. “There are a lot of abrasions, and we’ll hand out Band-Aids and bleeding controls. A big part of the job is being an advocate for the trails and community.” If a serious emergency did occur out in the 800-acre recreation area, riders should call 911. There are EMS access points listed on the trail maps. Dwire said the Crosby and Ironton fire departments have specialized litter rescue baskets on one wheel equipped to get injured riders off the rugged trails. Bike patrol members aren’t the only riders voluntarily manning the mountain bike trails. Aaron Hautala, president of the Cuyuna Lakes Mountain Bike Crew Chapter of the International Mountain Bicycling Association, said the bike patrol and members of his bike crew work together as advocates and stewards of the recreational area to make sure everyone is
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By SARAH NELSON KATZENBERGER Editor
Chiropractor WORKS TO HELP Dr. Thea Feierabend has always known she wanted to help heal people. Growing up in a family that practiced holistic medicine, Feierabend has seen first hand the benefits of treating illness and injury the most natural way possible. “We didn’t make many trips to the doctor,” she said. “That’s really kind of how I kind of decided to go into chiropractic care.” In 2012, the one-time medical laboratory technician set out in a completely new direction in life. She launched her career as a chiropractor. Feierabend said she has always had an interest in medicine and just wanted to do more with her career. “I wanted to be more of a provider and treat people to help them find healing,” she said. Feierabend said her journey into chiropractics wasn’t a completely straightforward decision. She actually considered becoming a dental hygienist, a physician’s assistant or a doctor before going to school for chiropractics. “Something just wasn’t clicking,” she said. A friend she knew from her undergraduate studies was attending chiropractic school, and their experience helped Feierabend find her way into chiropractics. “It was everything I grew up with and a doctor all wrapped into one,” she said. “It was just perfect.” Opening an office in Brainerd, called Lone Oak Chiropractic, Feierabend has made a conscious effort to be a distinctive kind of chiropractor. “I have a lot of people come in and they’re just tired of the whole come in, get adjusted, go home, come back again a few days later,” she said. “They want something a little different.” Along with chiropractic treatment, Feierabend uses acupuncture, massage and nutritional response testing to help her patients find healing. She said while many people shy away from acupuncture because of a fear of needles, Feierabend said they are nothing to be afraid of and can be helpful in treating many kinds of ailments including lower back pain, headache, sinus trouble, allergies, stress and gastrointestinal issues. “A lot of people call and wonder, ‘Can it help me?’ and I always say, ‘Well, it can’t make anything worse,” Feierabend said, noting that everyone is different so individual treatment varies. “I do see great results,” she said. “It’s really fun to do.” Feierabend makes the use of essential oils a regular part of her patient treatment. Her go-to blend before doing a back or neck adjustment is
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Dr. Thea Feierabend discusses the many methods of treatment she uses with patients at Lone Oak Chiropractic in Brainerd. Feierabend treats patients of all ages and stages in life. Kelly Humphrey • kelly.humphrey@brainerddispatch.com
patients find nature’s best healing peppermint, eucalyptus and clove, or others depending on what her patients prefer. Feierabend credits her upbringing with her knowledge of essential oils and their use in chiropractic care. ”There’s so many and there’s so many ways to use them,” she said. “People get very overwhelmed and they’re really not that scary and not that hard to use.” Feierabend said essential oils can be used to treat many ailments that might normally result in a visit to the doctor’s office. For the common cold Feierabend said it’s a good idea to go to the chiropractor and get adjusted as soon as symptoms start. “It can help boost that immune system right away,” she said. For ear infection, Feierabend said to never drop oils directly into the ear but using basil, purification (a blended oil from essential oil company Young Living) and tea tree can be massaged around the ear and down the neck. Feierabend said mullein garlic can be dropped directly into the ear. “Garlic is antiviral, anti-bacterial. It’s very soothing,” she said. For persistent fever, Feierabend said until a child is age 3 she recommends lemon along the spine and the bottom of the feet. After age 3, peppermint oil can be used directly on the bottom of the feet or with coconut oil as a rub used on the upper chest. “Peppermint is really good but it can be harsh on the respiratory system in young children,” she noted. In addition to oils, Feierabend said apple cider vinegar is often helpful in fighting fever and other infection. In can be ingested directly, but since the taste is not very kid-friendly, Feierabend said it can be used in the bath as an alternative. For gastrointestinal issues Feierabend recommends peppermint oil in adults and a blended oil called DiGize. “You can dilute it and rub it right on their tummy and bottoms of the feet,” she said. “That’s a great one.”
For headaches she recommends lavender. For sleep issues she said a blend called Peace and Calming as well as lavender and cedarwood. Feierabend sees patients of all ages and actually recommends parents bring their children in at a young age. “With all their running and falling and jumping around, it’s a good idea, just for general maintenance to (have them adjusted),” she said. “We can keep them healthy as they grow older.” Feierabend sees children from infancy and often helps desperate parents find simple solutions to colic, constipation and bedwetting. “Kids are so easy and they love it. They just have so much fun in here,” she said. “And they respond so well.” As far as using supplements for children, Feierabend recommends a probiotic, Vitamin D and a fish oil. “They’re great to keep the immune system up and fish oil helps with brain development,” she said. Feierabend said she isn’t opposed to seeing a medical doctor when necessary. With her own 16-month-
old son, she makes time for well-child check-ups and when acute illnesses make it necessary. “I’m still a parent,” she said. “I may have grown up a certain way and know all these things but when it comes to my kid, my response is still, ‘What do I do?’” Feierabend said she does a lot of chiropractics with her son who has never had so much as an ear infection or an over the counter drug, much less prescription medicine. “It doesn’t mean I wouldn’t take him in,” she said. “I just try to do all my own things before hand.” Feierabend makes herself readily available to her patients by phone, email and Facebook. “I don’t mind answering questions,” she said. “I really want to be able to help people find what they are looking for.” Feierabend said she really believes working on the spine can create a healing environment and allow the human body to heal themselves as they were intended to do. “I don’t cure anything necessarily — I don’t cure headache, I don’t cure back pain,” she said. “I help your body to get to the point where it can heal itself.” For an appointment with Dr. Feierabend call 4543015. ■
Kelly Humphrey • kelly.humphrey@brainerddispatch.com
Dr. Thea Feierabend uses a separate treatment room for administering essential oil treatments. She uses essential oils to assist in treatment of everything from the common cold to constipation.
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By SARAH NELSON KATZENBERGER Editor
Easy listening
New technology enhances hearing aid experience Brad Carlson
Brad Carlson has had trouble with his hear-
discusses the
ing for as long as he can remember. “I was born that way, probably,” he said. Carlson said he really started to notice his hearing impairment in both of his ears as an eighth grader when he failed his standard hearing test. Carlson, who would not disclose his age but said he is “old enough to need hearing aids,” said he’s lived his entire life with his poor hearing. Until now. “I’m brand new,” he said. “I’m telling everyone about it.” In March 2015, Carlson visited Dr. Whitnea Engelbrecht, an audiologist with Essentia Health in Brainerd. Engelbrecht introduced Carlson to a tiny inner-ear device that he said has changed his life. Carlson’s hearing aid, made by Resound, pairs with an app on his iPhone and allows him control the volume level, frequency, speech focus and background noise he hears with his hearing aid. It allows him to personalize settings based on location. The technology even uses Carlson’s iPhones GPS to remember locations he has preselected and automatically adjusts his hearing aid’s setting accordingly. “When I go home, it knows I’m home and the settings change on their own,” Carlson said. Carlson can also take phone calls, listen to music, watch movies and access all audio and video functions on his phone directly through his hearing aids. “Some people don’t like their hearing aids — I love mine,” he said. Carlson said he’s a gadget guy and while the adjustment period required came with a learning curve he enjoyed the experimentation. “I had no other options until now,” he said. “They couldn’t fix it. I was just kind of stuck.” Engelbrecht said the hearing aid Carlson uses has been out for a few years, but the Bluetooth technology that pairs the device directly with iPhone is new and is particularly new to the Brainerd lakes area. “We’re not seeing everybody doing them,” she said. “We want to get the word out — what is new out there for hearing aid products and technology.” Engelbrecht said while Bluetooth technology had existed for some time, it previously required an additional device to pair with a phone, or other Bluetooth compatible technology. The Resound hearing aid that Carlson uses is made specifically for use with iPhone 5 or better. The device also pairs with iPad and iPod devices.
benefits of his new Resound hearing aids and their enhanced technology controlled from his iPhone. Steve Kohls • steve.kohls@ brainerddispatch.com
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I hear more birds. I had no idea there were so many birds in the world.
Carlson’s tiny hearing aids are barely visible when in use but provide vast improvement to Carlson’s damaged natural hearing. Steve Kohls • steve. kohls@brainerddispatch.com
Brad Carlson
just so we can monitor changes down the road.” Engelbrecht said pricing is often an inhibitor for people in need of a hearing aid. Pricing differs and depends on insurance coverage. “Some help and some don’t,” Engelbrecht said. Programs like the Sertoma Club and the Lions Club help with cost assistance in situations where the hearing aid is a need and patients cannot afford the cost. Carlson warned those in the market for a new hearing aid against third party distributors because they tend to charge far more for the device. “You see these big ads and they suck you in,” he said. “Go shop around. Go see two or three people at least.” Carlson said he discovered Essentia Health carries hearing aids through a customer. “Whitnea is cool,” he said. “She talks loud, but that’s OK — she’s used to talking to older people.” Carlson noted that Essentia Health provides unlimited battery supplies. “These are expensive,” he said, jokingly. “I’m careful with my usage because I like Essentia.” Carlson said he is still getting used to his hearing aids, but is happy with his decision to finally make the investment after a lifetime of feeling like he was always missing something. “I hear more birds. I had no idea there were so many birds in the world,” he said.
Carlson is hopeful that after a lifetime of poor hearing the use of his new hearing aids will help him regain some
of his lost hearing. “Can I get all of it back — I think I can,” he said. ■
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Engelbrecht said as patients learn about the new technology and test it for themselves, the response has been very positive. “It doesn’t matter what type of hearing loss you have, anybody could wear these hearing aids,” she said. “If you want a hearing aid that is sleek, small and nobody would see it or even if you need a hearing aid because of a profound hearing loss — you could still take advantage of all of the made for Apple devices.” Engelbrecht noted that the hearing aids can still be used without pairing with iPhone, allowing for better hearing regardless. “You’d still be getting the most upto-date technology,” she said. “It’s worth it to take advantage of that.” Engelbrecht said she sees patients of all ages and levels of hearing loss. “Anybody can have a hearing loss,” she said. The most common contributors to hearing loss are family history, noise exposure and age. Damage often becomes noticeable when a person reaches their 30s and more so in their 50s. Patients tend to be older and often more resistant to the idea of their own hearing loss. “When family and friends start to question their hearing it’s time to come in and get a baseline exam,” she said. “If you’re not noticing any hearing loss, then after the age of 50 get a baseline
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By MARINO ECCHER St. Paul Pioneer Press
Motorized EXOSKELETON helps ST. PAUL — A few false starts, a whir of motors and Evans Bille was off and walking down the hospital hallway. It might not have been remarkable for most people — except Bille hasn’t had the use of his legs for nearly a year. The White Bear Lake 22-year-old was leaning on a deck railing last August when the railing gave way. The fall left him with much of his spine fused and no feeling from the chest down. That’s still the case, but he’s one of a small group
of paraplegic patients at Regions Hospital who are trying a new motorized exoskeleton that lets them stand upright and, with no small effort, walk. The device, called ReWalk, is made by a Massachusetts company. It was approved last summer by the U.S. Food and Drug Administration — the only one of its kind cleared for use in the home or in public. Those who have used it see life-changing potential in ways great and small — even as they struggle to convince their insurers to cover the considerable price tag. “That feeling of all of a sudden being six feet tall
again,” Bille said, “is surreal.” He’s one of three Regions patients who spent a few hours working with the device Wednesday. It most closely resembles a pair of robotic legs. Motors strap to the outside of the patient’s thighs and calves, with a battery pack and a computer in the back. It’s controlled by a wristwatch. The motors move the legs as the patient uses crutches to balance. Invented by Amit Goffer, an Israeli man who is quadriplegic, the device is still rare — there are just 74 private users worldwide. The company is currently looking for hospital to partner with and run clinics to give patients a look at it.
Jean Pieri • St. Paul Pioneer Press
Ms. Wheelchair Minnesota, Angelique Lele, gets up with her ReWalk device at a
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monthly exoskeleton clinic July 15 at Regions Hospital in St. Paul. Greta Wolf (left), a physical therapist, helps. Lele was paralyzed a few years ago after falling off a trapeze.
paraplegic patients stand & walk offers a handful of health benefits. It builds bone strength, which atrophies when limbs don’t bear weight. It’s a form of aerobic exercise. It alleviates sitting sores and cuts down on intestinal and bowel issues that crop up in patients who can’t stand. Moreover, he said, it can offer a huge psychological lift to people who had to cope with a sudden and harsh change when they were injured. “I believe the mental benefits from it cannot be overstated,” he said. Collier sees it as a way to regain the freedom to do things as simple as reaching the oil dipstick in his car to as meaningful as dancing at his daughter’s wedding. “It gets to be real hard on a person, that you want to do this and you can’t do this,” he said.
He’s trying to convince his insurance company to see things the same way. The device costs $70,000 per unit, and the insurer thus far has refused to cover it on the grounds that it isn’t a necessity. Bille is in the same position, having fought similar battles over other mobility and therapy devices. He and Lele both have funding pages set up with GoFundMe.com to help defer medical expenses. “How can a group look at your paperwork,” Collier said, “and say it’s not a medical necessity when at the end of the day, they get up and walk out to their cars?” ■ The Pioneer Press is a media partner of Forum News Service.
Jean Pieri • St. Paul Pioneer Press
Lina Alsauskaite (right), a ReWalk clinical training manager, readjusts a ReWalk device in between patients at Regions Hospital in St. Paul. The ReWalk system — a device that fits outside the patient’s legs — powers the hip and knee movement to allow them to stand and walk.
“The goal is to bring more access,” said Lina Alsauskaite, the company’s clinical training manager in the Midwest. This month’s clinic was the third at Regions — the only hospital in Minnesota to use the device so far. Bille, the first patient to strap it on back in April, can now motor through the corridors with some proficiency — aided by an upper body sculpted by sports and carpentry. For Angelique Lele, the reigning “Ms. Wheelchair Minnesota, Wednesday was the first try. She was paralyzed in the legs three years ago in a fall from a trapeze. By the time her physical therapists
got her strapped into the ReWalk, she joked she was ready for a map. When she stood up for the first time, she issued an audible “whoa.” It’s “so funny,” she said, “what you forget.” It was the first time, too, for Scott Collier, a Montgomery, Minn., farmer who was paralyzed a year and a half ago when heavy equipment collapsed on him as he changed a tire. The session left him sweaty, exhausted and satisfied. “It was nice standing up, stretching your legs and looking eye to eye with everyone,” he said. Dr. Steven Jackson, a spinal cord specialist at Regions, said the device
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By JOHN LUNDY Forum News Service
Enthusiasts say MEDITATION The class
DULUTH — My feet are flat on the floor,
helped me
could in an office chair within a claustro-
observe the emotions, accept and let go. I have also been much more focused at work, my digestion and overall health has been much better, and I have been sleeping better than I have in years. Jennie Krech, Duluth
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and I’ve made myself as comfortable as I phobically cramped medical office. As instructed, my eyes are closed. It’s shortly after the beginning of a busy work shift. My mind is focused on what’s coming next. After I get back to the office, I’ve got a phone interview and then a face-to-face interview with a senator scheduled. And Elizabeth Zuber is telling me to think about my breathing. I invite you to just notice right now how you’re breathing. She speaks slowly in a calm, steady voice. And there is no right way or wrong way to do this. It’s your own personal experience of how you’re breathing. Zuber is introducing me to Mindfulness-Based Stress Reduction, a technique she has taught at Essentia Health for 13 years. Formerly the hospice volunteer coordinator for St. Mary’s hospice, Zuber and some colleagues had studied the methods developed in the 1970s by Jon Kabat-Zinn of the University of Massachusetts Medical School. Mindfulness simply means “paying attention in a particular way,” Zuber explains. She first learned about it from Dr. Steven Kuross, an oncologist/hematologist at the Essentia Health Cancer Center who remains ardently enthused about mindfulness. “I developed a meditation practice, and it had such a profound effect on my life,” Kuross said in a telephone interview. “It just profoundly changed how I live for the better.” Kabat-Zinn was a researcher and a Buddhist practitioner when he developed his ideas, Kuross explained. “Buddhism is now a religion, but it wasn’t really founded as a religion,” Kuross said. “When the Buddha achieved enlightenment, he realized what he learned was applicable to all humans.”
‘EVERYONE CAN RELATE’
Mindfulness also could be described as heartfulness or awareness, he said. It’s meditation by another name. “If you advertised ‘take a meditation class,’ people wouldn’t respond very well,” Kuross said. “But if you said, ‘How about stress reduction?’ Everyone can relate to that.” It works, say people who have taken Zuber’s class
at Essentia Health. “It’s the only thing I can attribute to my improving health,” said Jennie Krech, 45, of Duluth. Krech was in the midst of a health crisis when she took the class from late January through late March of this year, she said. She also learned that her ex-husband was getting remarried, and the news reopened some old wounds. “The class helped me observe the emotions, accept and let go,” she wrote in an email. “I have also been much more focused at work, my digestion and overall health has been much better, and I have been sleeping better than I have in years.”
THE CLASSES
Zuber teaches two eight-week Mindfulness-Based Stress Reduction classes each year and also offers an abridged version, a four-week stress class, through Essentia Health’s Wellness Program. The classes are experiential, with some lecture each week, Zuber said. Each session has its own focus, such as breath and body work or mindful communication and mindful consumption. Students are often referred from hospital departments, such as the Cancer Center or internal medicine or by psychologists, she said. Because students may not know what they’re getting into, she starts with an orientation class and an application form. “My sense is people have to have a readiness to look at themselves and to do the work,” Zuber said. “If they want somebody else to fix them, this is probably not the program for them.”
THE CARTOONIST
Like Krech, Chris Monroe finds mindfulness helps her sleep. “In the middle of the night when you wake up and your mind is worrying ... mindfulness has given me the tools to work for better sleep,” she said. Monroe, cartoonist and author of children’s books (“Violet Days,” “Monkey With a Tool Belt”), took the class about three years ago, she said, when she was experiencing some health issues. She knew stress was hard on her health, and she was looking for ways to counter that. “I was really searching ... to eliminate stress without resorting to medication,” said Monroe, 53, who lives in the Observation Hill neighborhood. Unlike her sometimes cynical alter ego in “Violet Days,” Monroe is all in when it comes to the process. She’s so pleased with the results that Monroe said she thinks everyone should try it, even people who aren’t feeling particularly stressed out.
improves health, quality of life THE WIGGLING PUPPY People who took the class talk about help they’ve gotten from images they were encouraged to visualize. For Monroe, it’s images of thoughts as clouds. “If this cloud is getting your attention because it’s negative and scary, you just have another cloud bump it along,” she said. “Actually visualizing that has helped me so much.” Krech was struck by a visual image of her mind being like a wiggling puppy. As a puppy can be trained to obey and stay calm, so you can your mind, Krech said. “It wants to think, but sometimes it overthinks,” she said. “Until we learn to train our brain, it will keep spinning.” Linda Nervick, who took the class earlier this year, said it taught her to appreciate the moment. If it’s the start of a busy day and she’s taking a shower, she takes time to appreciate the warm water and scented soap. “(Zuber) changed my life within 10 minutes of the first class,” said Nervick, 51, who lives in the Hillside neighborhood. “My life just clicked.” Nervick, self-employed as owner of a public relations and marketing firm, said the class helped her realize a source of stress in her life was one of her clients. She had the confidence to make the difficult financial decision to end her relationship with that client. “I feel healthy; I sleep well,” Nervick said. “(In the past) I would find myself on a Sunday night so stressed out. Now I listen to KUMD jazz on Sunday night and I celebrate Sunday night.” Zuber’s soft, calm voice continues. And on your next exhale I want you to soften your shoulders and let your chest be open almost as though your skin, muscle and tissue are just melting. ... And your breath is becoming deeper. ... Just notice with curiosity how often your mind, or perhaps your body or sounds want to pull you away. And just gently escort yourself back to the in breath coming in and the out breath going out. ... Feeling the breath with your senses as it enters, feeling the sensation in your body as it expands and contracts. Letting go of the thinking mind and moving more into the senses. ... And switching your attention to the out breath. Making that one or two seconds longer than the in breath. ... Begin to wiggle your fingers and your toes and gently transition yourself back. Let your eyes flutter open on the next out breath. My guided, three-minute mini-meditation has come to a close. “So that’s what it’s like to be a human being rather than a human doer,” Zuber concludes. But I’m new at this, and I’d have to admit that I hadn’t completely let go of thinking about those later assignments. I also was thinking about the parking meter outside, which hadn’t responded when I plugged it with three quarters before coming in.
■ Studies on meditation give varied results
D
ULUTH — When Dr. Steven Kuross first told Elizabeth Zuber about Mindfulness-Based Stress Reduction, he noted that its effectiveness is evidence-based, she said. Zuber cites research she says validates that effectiveness. Studies, based on 30-45 minutes of daily meditation, show reduced stress, increased productivity, enhanced relationships and increased sensations of joy and peace, Zuber said. Sara Lazar, a neuroscientist at Massachusetts General Hospital and Harvard Medical School, used brain scans to compare a control group with people who practiced meditation. In a “TEDx Talk,” she reported that 50-year-olds who practice meditation didn’t experience the same shrinkage of their prefrontal cortex as those in the control group. That shrinkage is the phenomena that makes it harder for us to figure things out and to remember things, she said.
Perhaps my distraction on the first try is not unusual. Mindfulness is a discipline, Kuross said. “It does take time,” he said. “It’s often very frustrating at first.” That’s because you’re becoming aware of what’s really going on in your thoughts, he explained. “The saying is you open the door and you get what’s outside,” Kuross said. “So when you start to meditate, you open the door and you get what’s there, and it’s
In a 2004 study published in the Journal of Psychosomatic Research, a German research team analyzed previous studies and cautiously concluded: “These results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems.” A similar analysis by a team from Johns Hopkins University, about meditation but not specifically about MBSR, was published last year in the Journal of the American Medical Association. It found “moderate evidence” of improved anxiety, depression and pain; “low evidence” of improved stress/ distress and mental health-related quality of life; and “low evidence or no effect or insufficient evidence of any effect” on positive mood, attention, substance use, eating habits, sleep and weight. The Johns Hopkins researchers also said they found no evidence that meditation was better than “active treatment,” such as drugs, exercise and other behavioral therapies. But from looking at the studies within that study, “It appears that mindfulness had the best reviews,” Zuber said. often a lot of crap.” But the choice to do that is worth making, according to Zuber, a choice to “wake up and be a participant in our own life” instead of living half asleep. Before leaving, I ask Zuber if it’s difficult to practice meditation in the context of a busy day. “Well, if you practice it, it becomes easier,” she says. “It becomes who you are. You then become a human being doing stuff.” ■
By PATRICK SPRINGER Forum News Service
Targeted drugs PINPOINT cancers MOORHEAD — Dale Thornton began taking a small white pill as part of his battle with kidney cancer. Within a few weeks he could sleep lying flat on his back, something he hadn’t been able to do for months because of pain. “So I knew good things were happening inside,” he said. It took him six weeks to wean himself from morphine. Luckily, tests had determined that Thornton, a retired financial aid director at Concordia College, was a good candidate for Afinitor, a drug to treat advanced kidney cancer that blocks a protein that controls other proteins that trigger cancer cells to grow. He’s participating in a cancer research trial at Sanford Health’s Roger Maris Cancer Center in Fargo and is one of a growing number of patients whose cancer is being treated by drugs targeted by genetic markers. The targeted drugs, designed to pinpoint specific forms of cancer, are enabled by a growing body of research into molecular and genetic changes in cells that cause cancer. They offer hope--albeit an often costly one--in cases where conventional chemotherapy hasn’t been effective. Afinitor, besides checking the growth of targeted cancer cells, also inhibits the growth of blood vessels that feed the tumor, and can restrict the cells from getting nutrients. Thornton began taking Afinitor early this year to control kidney cancer that originated nine years ago as bladder cancer. His bladder cancer had disappeared for years, but his doctor became concerned about his kidneys two years ago when red flags appeared in test results during a routine check-up. One kidney, stricken with cancer, looked like a shriveled prune. After surgery, rounds of radiation and chemotherapy failed to eliminate three tumors on sites where the cancer had spread. His oncologist mentioned the possibility of the research trial involving Afinitor and asked if he was interested. “I said, “Sure, why not?’ “ Thornton said. At the time, his kidney function was not good enough to participate, but his oncologist kept watch on his condition and enrolled him in the study once his health made him eligible. Luckily, Thornton had genetic markers that matched an available targeted drug to treat kidney cancer. The only problem, and it was sizable: Targeted drug therapies are expensive. Afinitor reportedly has a wholesale cost of $7,500 for a 28-day supply. Even with health coverage through Medicare and
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supplemental insurance, Thornton couldn’t afford the medication. Fortunately, the pharmacy at the cancer center applied for a grant, and he was accepted. “In the absence of that grant, I’d be in deep trouble,” said Thornton, who started taking Afinitor in January. “If I had to pay for it, it would be such that I couldn’t do it. I would endanger the financial future of my wife.” Despite the steep financial cost, a major advantage of targeted cancer therapies is they produce fewer side effects than conventional chemotherapy. Thornton’s experience with the drug so far as been encouraging--scans show one of his three tumor sites has disappeared. “That makes everybody happy, including my wife,” he said. Because doctors aren’t allowed to comment on patients in clinical trials, Thornton’s oncologist, Dr. Anu Gaba, can’t comment on his case. But Thornton said she’s been pleased with early results of the drug. After he was able to wean himself from morphine, he asked, “Isn’t that what you expected?” “She said she didn’t know what to expect, it’s a research thing,” he said. Targeted cancer drugs and drugs that enhance the body’s immune system to fight malignancies are two promising areas of cancer treatment enabled by research advances, Gaba said. Both are examples, she added, of the emerging trend of more personalized cancer prevention, diagnosis and treatments made possible by genomic medicine. In the future, samples of patients’ DNA from blood and tissues increasingly are being “biobanked” and can be available to guide treatments for a growing number of cancers, something Sanford is piloting in its internal medicine clinics in Sioux Falls, S.D., and will bring to Fargo, said Dr. David Pearce, president of Sanford Research. “We’ll be biobanking everybody here,” he said. Roger Maris Cancer Center, where Gaba serves as medical director, has been banking blood and tumor samples for about a year for genetic analysis, she said. Targeted cancer drugs can cause fewer side effects than chemotherapy because they act more directly on the tumors. Even so, side effects of Afinitor, the drug Thornton is taking, can include breathing problems, delayed wound healing and might make patients more prone to infections. Fatigue has been the biggest side effect Thornton has noticed, but he said overall he is doing much better on the drug than without it, and his doctors are closely monitoring his organ function. He’s able to travel and feels comfortable enough to work in his garden, something he wasn’t able to do for a time. “The reality is I feel much better than eight months ago,” he said. “My quality of life has improved considerably.” ■
Dale Thornton is feeling more like getting back into doing some gardening in his Moorhead backyard after some drug treatments to battle his cancer tumors and his pain is greatly reduced. Dave Wallis • Forum News Service
By JOHN LUNDY Forum News Service
Sponge ... Scalpel .... Springsteen Many surgeons don’t stop the music while operating DULUTH — When Dr. Mark Monte operates on a patient, chances are The Boss is singing along. “I’m a huge Springsteen fan,” the Duluth general surgeon said. “I probably have on my MP3 player any recording Springsteen has ever made.” Like many surgeons, Monte takes his musical tastes into the operating room with him. Picking the music is a perk of being the surgeon, said Monte, who has practiced at St. Luke’s hospital since 1997. But it’s also to the benefit of everyone involved. “Good studies have been (showing) that appropriately selected music in the operating room can help,” Monte said. One such study was conducted in the mid-1990s by a team led by Karen Allen, a research scientist at the State University of New York at Buffalo, and published in the Journal of the American Medical Association. The 50 surgeons who volunteered were studied while performing a stressful task. Allen’s team found that the surgeons performed “significantly better” when listening to music they chose than when no music was on at all. But music can benefit patients as well as operating teams, said Mark Johnson, cath lab manager at Essentia Health-St. Mary’s Medical Center. “The more pleasant and relaxed the patient’s environment is when they’re inducing that anesthesia, the vastly better experience the patient is going to have,” said Johnson, whose division is responsible for vascular surgery “from head to toe” as well as the electronic side of heart procedures, such as installing a pacemaker. When patients are going to be awake during the procedure, the staff seeks to accommodate their musical tastes, Johnson said. “We’ve had some things that we can get close to, but we can’t quite duplicate,” Johnson said. “We don’t have a big repertoire of CDs.” Dr. David Fogarty also defers to the patient’s
Andrew Krueger • Forum News Service
wishes if the patient is going to be awake — with an exception. “I’ll let the patient pick whatever they want to listen to as long as it’s not country,” said Fogarty, an orthopedic surgeon at St. Luke’s hospital for the past five years. “I tell them my hand is less steady if I have country music on.” Fogarty, who grew up in the ‘80s, said his tastes run to alternative: performers such as The Clash, Nirvana, Social Distortion and Maynard James Keenan. Other members of the team generally set up the mu-
sic in accordance with his tastes, Fogarty said. Music can lighten the load for an operating team, particularly if the surgery takes four or five hours, Fogarty said. But it’s not always appropriate. “Sometimes, you get into cases that are either pretty technical or a little more tense,” he said. “So I want some quiet, so I can concentrate more closely.” When he’s working, Fogarty often is concentrating so much that he doesn’t hear the music anyway, he said. The surgery always takes precedence over the music, Monte said. “The first rule we all swear to is: First, do no harm,” he said. “So (the music) can’t interfere with the operation.” Monte, who grew up in New York, could be said to have an obsession with Springsteen’s music. He has been to 33 of the rocker’s concerts, he said. He’s also a big fan of U2 and “anything Motown.” The latter, he said “is amusing to the surgical techs who are half my age.” Monte will listen to Christmas music around the holidays, he said. He doesn’t listen to hip-hop. “Cardiac surgeons and vascular surgeons, for whatever reason, they tend toward classical music,” Monte said. “I like a little classical music, but eight hours of the Boston Symphony is a little bit much.” Both Monte and Fogarty said they also have colleagues who prefer country music. Dr. Christopher Heck, a cardiovascular surgeon at Essentia Health-St. Mary’s Medical Center, likes rock ‘n’ roll — Counting Crows, Neil Young and the Beatles, among others. No heavy metal, rap or head-banging music, he said. “Music helps people to relax,” Heck said. “It helps alleviate stress.” A lengthy procedure with no music can become tedious, Monte said. But there might be something that’s even worse than no music. “If you pump in music that the surgeon doesn’t like, nobody has a good day,” he said. ■
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By JOHN LUNDY Forum News Service
THE END — it’s good to be prepared DULUTH — As an oncologist, Dr. Jonathan Sande is used to conversations about death. It’s a subject that dominates his time even more now as he helps develop an advance care planning program for Essentia Health’s Twin Ports facilities. Yet when it’s personal, it’s still not easy to discuss. “I can tell you from my experiences with my parents that even for health care professionals, it’s hard to have this type of conversation with family members,” Sande said. It’s an unassailable fact: We’re all going to die. Health care and legal professionals agree that resolving matters before a health crisis or deteriorating mental capabilities occur can save family members and loved ones untold grief. “I see so many clients that come in that miss the boat on it, and it’s cost a lot of money, and it’s caused a lot of frustration,” said Greg Gilbert, a Duluth attorney whose specialties include estate planning. “It caused a lot of conflict.” Gilbert, who is a former city councilor, helps hundreds of clients with estate planning. He always asks if they’d like to fill out a Minnesota Health Care Directive while they’re at it, he said.
USER-FRIENDLY FORM
The form, which in the past might have been called a living will and also might be known as an advance directive, is simple enough so that a lawyer’s help isn’t necessarily required, Gilbert said. It’s divided into two parts. The first allows you to designate an “agent” — and alternative agents — who will make health care decisions if you are unable to decide or speak for yourself. “Your spouse may be the worst choice,” Sande said. “Your agent ideally would be someone who is solid, who can make decisions in tough times, who won’t be paralyzed by emotions.” The second is devoted to your health care instructions on issues such as when you want, or don’t want, life-prolonging treatment. Sue Schettle, CEO of the Twin Cities Medical Society, offered a sample issue: “If you were unable to eat and you had to rely on a feeding tube, is that something you would want to do or not want to do?” You can fill out the part designating an agent and not answer the treatment questions or vice versa, said Patty Minogue, ER department case manager for St. Luke’s hospital. She recommends filling out the whole form. “Make sure that people know what you want,” Minogue said. “And that you choose the person that is most likely going to act on what it is that you want.”
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THE NEXT STEP
Every state has a health care directive, but they vary from state to state, Gilbert said. In Minnesota, your form becomes a legal document if you have it witnessed or notarized. But the rules are different in other states. “If a person changes states, they’ll want to check the laws for the new state,” he said. So your form is completed and notarized or witnessed. What do you do with it? “Don’t have it in your safety deposit box or your attorney’s office,” Minogue said. You want it quickly available when you’re brought into the emergency room at 3 a.m., Gilbert said. If you live in the Duluth area, you should bring your form to both hospital systems and ask to have it scanned in, Gilbert and Minogue said. Your doctor’s office should have a copy as well. If your church has a parish nurse, give a copy to him or her, Minogue said. If you’re on the road a lot, keep a copy in your glove compartment, Gilbert suggested. Both also said you should take a fresh look at your form from time to time to see if you want to make changes. Minogue does so with her own form every year at tax time, she said. “You’re already doing that stuff that you don’t want to do anyway,” she explained. In about 25 years of having a form, she has revised hers three or four times, Minogue said. Hospitals will follow wishes expressed in your most recent document.
TALK ABOUT IT
But it’s not just about filling out a form. “For us, an advance directive is the end product,” Sande said. “Our goal is to help the patients and their loved ones understand, reflect upon, discuss their goals of care for future health conditions that they might have.” Filling out the document is better than nothing, Sande said, but it’s much more valuable to talk through the options. He cited a study in which patients and their designated agents — placed in separate rooms and given identical scenarios — reached the same conclusion less than 50 percent of the time. Agreed Heather Opsahl, executive director of the Lake Superior Medical Society: “It’s not all about a document. You don’t necessarily have to have a document. It’s more of the conversation with the loved ones. I’ve gone through that with my mom.” Gilbert has done that, too, he said, traveling to Michigan earlier this year to discuss health care directives with his parents, who are in their 80s. It’s not just a conversation for the middle-aged and elderly among us, said Ben Wolfe, retired program manager of Grief Support services at Essentia Health-St. Mary’s Medical Center. “When you’re 16, you’ve got that driver’s license.
More and more kids are saying we want to be organ and tissue donors,” Wolfe said. “Having had even that conversation is important.”
‘HONORING CHOICES’
But that doesn’t mean we do it. Gilbert compared it to flossing: We agree with our dentist that we should do it, but that doesn’t always mean it happens. In fact, an electronic medical records system across the Essentia Health System revealed that about 25 percent of patients have some sort of advance directive, Sande said. That’s about the national average, he said. Efforts are under way to change that. The Twin Cities Medical Society began developing “Honoring Choices” in 2008, Schettle said. Modeled after a program developed in La Crosse, Wis., it brings together hospitals, insurance companies and other health care organizations in a uniform effort to help people with end-of-life planning, she said. “What we’re trying to do is normalize the conversation, change a culture,” she said. Sande is heading a similar effort at Essentia Health with Sandee Carlson, program coordinator for advanced-care planning. “We’re trying to create a program where these kinds of conversation that result in creation of a living will or advance directive becomes a standard part of your care,” Sande said. Although it has started in Essentia’s Twin Ports facilities, plans are to expand to the health system’s East Region and perhaps systemwide he said. Regionally, a group has been working for 14 years to advocate for advance planning in northeast Minnesota, Wolfe said. Three years ago, they approached the Lake Superior Medical Society, which now is spearheading an organization known as Advance Care PlanningNortheast Minnesota. “We are the last section in Minnesota not doing this, so it’s a big deal,” Opsahl said. “We’re trying very hard to get some funding. ... Our idea is to mimic exactly what’s going on in Honoring Choices (in the Twin Cities).” The hope is to develop a pool of volunteers who would be available to help people with advance care planning, Opsahl said. It might seem like a morbid topic, but experts say it’s not really about dying. “This is about living,” Sande said. “We’re all going to die; this is about living the best that we can.” ■
TO LEARN MORE
• Learn more about Advance Care PlanningNortheast Minnesota at lsmedsoc.org. • Learn more about Healthy Choices Minnesota and download a Minnesota Health Care Directive form at honoringchoices.org.
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