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Youngest sibling Julia is a cardiac device specialist with a company that does atrial fibrillation ablation (a heart procedure) with cardiologists and cardiac surgeons across Minnesota, Wisconsin and the Dakotas.

As a family tradition, you might say it goes back to Daniel’s father, who was a dentist in the small town of Dowagiac, Mich. From that, Daniel said, he got his first “inkling” into medicine.

“Then,” he said, “I worked as an orderly in the operating room in a rural hospital in Michigan as an undergraduate, and then got hooked into the whole rural general surgery thing.”

Daniel graduated from the University of Michigan, then went to medical school at Wayne State University in Detroit, where he also did his residency. “That included the Detroit Receiving hospital,” he said, “which is the main trauma hospital in Detroit. At that time, we’d average, like, six gunshot wounds a day. So, very busy, and you really learned how to operate.”

That was where Daniel met his wife and Mark’s mother, Norita.

Mark’s path to surgical practice started with shadowing his father during his early teens.

“You just see the pros and cons of being a doctor in a small town,” he said, “not having quite as many resources, so a little bit more of it falling on you, but also the rewards of helping your community. That really stuck with me throughout undergrad and training, in terms of leading me back this way.”

After graduating from the University of North Dakota, Mark went on to medical school at the University of Minnesota, Twin Cities, a residency at Hennepin County Medical Center and, most recently, a one-year fellowship in Texas, focusing on minimally invasive and bariatric surgery.

“I knew, going into college, I was interested in medicine, and probably something surgical,” he said. “It’s a nice blend of being a doctor and still having an opportunity to work with your hands. I appreciated that combination.”

Both father and son do what Mark described as “head-to-toe, general surgery,” including thyroid, parathyroid, lung, abdomen, skin, soft tissue, breast, colorectal, hernia and gallbladder surgery – pretty much everything except neuro-, vascular and orthopedic surgery.

Meanwhile, Daniel has been increasingly practicing bariatric surgery, seeing about 4,900 gastric bypass patients since 2000.

“We’re one of the handful of Centers for Excellence for bariatric surgery in the state,” he said. “Basically, the insurance companies will only let those be done in a few, select places, because of the high risk some patients have. We’ve had BMIs of, like, 99, in really extreme cases.”

A normal body mass index (BMI) is between about 18.5 and 25, with the risk of diabetes, hypertension, sleep apnea and death increasing the farther above that range it goes.

Daniel said a study shows that for an obese person with diabetes, bariatric surgery can add an average of nine-anda-half years to their life expectancy.

As possibly the only rural hospital with a Centers for Excellence designation in bariatric surgery, the Park Rapids practice has pulled in patients from throughout northern Minnesota and eastern North Dakota. “Only about 14% of the (patients) would be in what you would call our service area,” said Daniel. “Everyone else is outside of that.”

It’s been a boon, not only for Essentia’s practice and the local hospital, but also for their patients, he said.

Mark’s training also emphasized bariatrics, but it’s the minimally invasive part that’s bringing change to the area’s healthcare system.

He explained it as, “rather than making a big incision, making small incisions with a camera and instruments.”

Daniel said he thinks of it as “rather than a big incision, having three, four, or five half-inch to one-inch incisions that you can work through little ports, so you have a lot less incisional pain and less problems with hernia and organ infections, and much faster recovery.”

Basic laparoscopy has been around for a while, but the new wrinkle has to do with robotics. Daniel said laparoscopic robots provide “very good visualization and really precise manipulation, working corners that you otherwise would find difficult.”

He said he’s in the process of picking up these robotic procedures, in which Mark is already certified.

After more than 30 years of practice, Daniel still feels he chose right. “In a practice like this, you’re really a major component of patients’ healthcare,” he said.

“It’s an exciting time to build on the surgery program that’s been here,” said Mark. “There are certainly challenges with providing excellent surgical care in a small community, where you don’t have as many resources, but that’s part of the fun. Figuring out how we can continue to provide care with more technological advances that tend to favor bigger cities, and being able to come back to where I’m from and continue to build on that, has been a lot of fun.”

Robin Fish can be reached at rfish@parkrapidsenterprise. com.

What did the tree do when it went on sabbatical? It took a leaf of absence, of course.

Tree humor is fun, but what’s happened to trees this winter is certainly no laughing matter. Wet, heavy snow, followed by cold temperatures, left many branches bent and broken since mid-December. Will trees and shrubs recover?

Co-worker Joe Zeleznik, North Dakota State University Extension forester, described the situation in a recent article.

He said: “The blizzard in mid-December was especially bad, starting with a thick layer of ice. After that came the heavy wet snow. Finally, the light fluffy snow came and eventually the storm moved on.”

“How are the trees doing with all these challenges?” Zeleznik asks. “Most trees are doing fine,” he says, “While others sustained a good deal of damage.”

Zeleznik points out that trees that hold their leaves into winter have been most affected, and ironwood and Ponderosa pines in his own yard are still bent from the extra weight of ice and snow. Spruce trees fared better, he notes.

BY

KINZLER Gardening Columnist

I’ve noticed the same in our own yard. Some trees and shrubs are unaffected, while the branches of other types are completely bent out of shape. Our evergreen columnar arborvitae, whose branches form an upright column, are now splayed apart, looking more like a haphazard mess than its normal, tailored shape.

Zeleznik continues “I’ve been debating what to do. Should I knock off the snow and ice from my trees? Would pruning out the deformed branches be a good approach?” He reminds us that “do nothing” is always a management option; it just has its own set of consequences.

“I don’t know if the leader on our pine tree will straighten out next year, if I remove the snow. The stem could be permanently kinked. If I cut out the bent-over leader, I worry that multiple leaders will form, creating a structural nightmare in which connections are weak and more susceptible to future breaking.”

Zeleznik observed that many multi-stemmed arborvitaes and junipers were badly affected, which is what I’ve found in our own yard. He says recovery is possible, though it will likely take several years.

Zeleznik suggests drawing the stems back together and supporting them with a strap or flexible material such as a bungee cord. Wait, though, until temperatures are warmer, in the 30s when stems are flexible.

He says arborvitae and other multi-trunked types will need support for one to two years as they put on new wood underneath the bark. The extra rings in the trunk will give the tree strength and stiffness.

Zeleznik emphasizes that support straps should be flexible, providing support without digging into the stems. Check straps every three or four months to be sure they’re not choking the stems, and loosen as needed.

Beyond that, Zeleznik says all we can do is wait, and hope we don’t get more super-heavy snow and ice.

I totally concur that binding together the branches of arborvitae does work.

As a college student, I worked at the home of NDSU professor Neal Holland during summer break. A duty one spring was to bind together the stems of columnar arborvitae, which had become splayed outward during winter. The material of choice at the time was old nylon stockings, which worked perfectly.

The arborvitae regained their structure and were still standing tall many decades later.

Deciduous (leafy) shrubs that are flattened by snow and ice are better able to rebound than evergreens. Many such shrubs in our own yard have lost their rounded shapes. Instead, branches of spirea, nine- bark and others have fallen under the weight of heavy snow, laying at unnatural angles.

Luckily, the entire shrub can be pruned all the way back to six inches above ground level before spring growth starts, and new, sturdy branches will quickly form, returning most shrubs to their original shapes.

Unfortunately, this method doesn’t work for evergreen shrubs.

As Zeleznik pointed out, only time will tell the full extent of this winter’s damage.

Don Kinzler, a lifelong gardener, is the horticulturist with North Dakota State University Extension for Cass County. Readers can reach him at donald.kinzler@ndsu.edu.