January 2018

PROUD TO BE A MEMBER OF THE MAYO CLINIC CARE NETWORK

Determinationof Steele

TreatingThumbArthritis

Year inReview

GlaucomaAwareness

Month

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CervicalCancerGiving Back

Hearts GalaFebruary 9

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RECIPIENT OF THE AHA’S STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD

About seven years ago,Jane Urbatsch ofWilliston first noticedsomething in her line ofvision.

That something was like“a great big worm,” shesaid. It would float tothe top of her line ofvision, and then to thebottom; eventually, itstopped floating backand forth and remainedright in the middle ofher vision. “It was a bigworm,” she said, notingthat it was opaque,dense, and you couldn’tsee through it.

What Urbatsch saw ismore commonly knownas a “floater,” a deposit of vitreous humour – theclear gel that fills the space between the lens and theretina – that floats (hence itsname) in a person’s field ofvision.

While it didn’t cause Urbatschany pain, it was certainly a

serious inconvenience. Urbatschloves to read (period westernsare her favorite), so when thefloater remained centrally static, it prevented her fromreading, or pretty much doinganything.

“It was blinding me,” she said.

The floater was only in herright eye, so to do things (likereading), she would close herright eye and focus with herleft. However, coupled withglaucoma and astigmatism,focusing with just her left eyebegan to put a strain on her“poor left eye.”

Floaters are “consolidations ofthe vitreous that occur withage,” explained Mark Raymond,MD, an ophthalmologist withTrinity Regional Eyecare –Western Dakota. As a personages, he said, the vitreous

separates from the retina andforms into clumps, which areperceived in the vision as afloater.

Having floaters is a part of thenatural aging process, Raymondsaid. “We all go through it

sooner or later.” The NationalEye Institute stated on its website that floaters “are morecommon in people who arevery nearsighted, have diabetes,or who have had a cataractoperation.” However, trauma,inflammation, or bleeding ofthe eye can cause prematurefloaters, Raymond added.

The solution for floaters, whichis now available at TrinityRegional Eyecare – WesternDakota, is YAG laser vitreolysis,which breaks up the floaters ina ten-minute, in-office procedure. Recently, TRE –Western Dakota upgraded itstechnology to include YAGlaser vitreolysis.

The procedure is similar to astandard eye exam: a patientwould sit in the chair while thedoctor looks in the eye with a

slit lamp, a biomicroscope.Prominent floaters are identified and obliterated withthe laser.

“You feel nothing,” Urbatschsaid, of the surgery. “It wasamazing.”

As Dr. Raymond noted, thesurgery is not painful andrequires no significant aftercare. The evening after hersurgery, “it was just totally awesome”that she wasable to haveher visionrestored inher right eye.She didn’twaste anytime enjoyingher newsight: shewent onlineand orderedmore booksto read.

“I would recommendthe surgery,”Urbatsch said.“I tell everybodyabout it.”

Trinity Regional Eyecare –Western Dakota acquired thetechnology in September andsince then, Raymond has

performed the procedureon three patients.

“I love it,” Dr. Raymondsaid. “You can’t have happier patients thanJane.”

Over the next month,Urbatsch had additionalsurgeries – also performedby Dr. Raymond – for hercataracts.

“I can see again. It was sonice,” she said. “Why livewith this if you don’t have to?”

A doctor’s referral is not needed for the procedure. To schedule an appointment, call Dr.Raymond’s office at (800) 735-4926 or 572-7641. Trinity Regional

Eyecare – Western Dakota islocated at Trinity CommunityClinic – Western Dakota, 1321West Dakota Parkway,Williston.

a�

Mark Raymond, MD, an ophthalmologist with Trinity Regional Eyecare – Western Dakota, right,demonstrates the technology used to remove eye floaters.

Say Goodbye to Floaters

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Jane Urbatsch doing something she enjoys – reading, something that she couldn’t do when eye floaters blocked hervision in her right eye. A surgical procedure available atTrinity Regional Eyecare-Western Dakota helped to fix this.

“I can see again. It was so nice. Whylive with this if you don’t have to?”

— Jane UrbatschEye Floater Patient

2 • JANUARY 2018 TRINITY HEALTH HEALTHTALK

HealthTalkMarketing DepartmentTrinity Hospital – St. Joseph’s407 3rd Street SEMinot, ND 58701Toll free in ND: (800) 247-1316

Visit our website:trinityhealth.orgJoin us on Facebook:facebook.com/TrinityHealth.ND

Lung Cancer Screening Program

Heidi Bender, FNP-C, a nurse practitionerin Pulmonology and coordinator of theLung Cancer Screening Program, explainedthat the program was launched with the purpose of detecting lung cancer at an earlier stage, to improve the health of high-risk individuals in our region.Consistent with Trinity Health’s mission,the Low-Dose CT Lung Cancer Screening Program demonstrates Trinity’scommitment to futuristic and proactivecontinuous performance improvements,Bender noted.

Prior to low-dose CT lung cancer screening, lung cancer often was detectedthrough chest X-rays, but the cancer oftenwasn’t picked up early enough to make adifference in reducing the death rate,explained Scott Lewis, MD, medical director of Trinity Health’s Radiologydepartment. “They would find cancers, butit was too late.”

The National Lung Screening Trial (NLST)demonstrated that low-dose CT scansreduces the death rate from lung cancer by20 percent by detecting lung cancers early.“That was the first study to show theycould save lives from lung cancer screening,” Lewis said.

Finding lung cancer early is critical becauseit does not often present symptoms untilthe cancer is in its later stages. The mainsymptoms of lung cancer include cough,shortness of breath, blood in sputum,weight loss, and chest pain. Lewis said thatif any of these symptoms are present, it isimportant to see a provider.

Comprehensive Medicine: TraditionalFamily Medicine Returns

Kwanza Devlin, MD, and her colleague,Kimberly Krohn, MD – both are thenewest additions to Trinity Health’s FamilyMedicine team – offer comprehensive careas a way to increase the care a patientreceives, while maintaining a level of continuity.

Through comprehensive care, Krohn andDevlin can see a patient in their office, atthe patient’s home, in the hospital, or in anursing home. Krohn described this as“patient-centered care,” where the needs ofthe patient are met, regardless of geography or the level of care that is needed. “It’s having a view that patient careis not limited by the boundaries of timeand space.”

It harkens back to the days where youwould call for the doctor, who would cometo your home with his doctor’s bag andtreat what ails you; Devlin and Krohn hopethat this traditional form of familymedicine can return.

“It’s going back to the way things used tobe, when you had your doctor and that wasthe doctor for your family,” Devlin said.“The doctor knew your family inside andout, and they would, if needed to, make ahome visit. If you went to the nursinghome, they would see you there. If you hada baby, they would be there for that. Youdon’t see that very much anymore.”

“After 10 years of being a doctor for someone, you are never the same doctoryou were when you first met them,” Krohnadded, noting that the doctor grows aroundthe patients’ needs while getting to knowthem.

Trinity Regional Eyecare – Western Dakotareceives new equipment through RCGFGrant

The Trinity Health Foundation received agrant from the Rural Community GrantFund to purchase two surgical eye carts forTrinity Community Clinic – WesternDakota, in Williston.

The addition of these carts has proven tobe beneficial as the Ambulatory SurgeryCenter at the clinic has grown significantlywith more eye cases and new surgical services, explained Mark Raymond, MD, anophthalmologist with Trinity RegionalEyecare – Western Dakota. Eye surgeriesperformed include cataracts, corneal transplants, LASIK, glaucoma surgeries,pediatric cases, and floater removal.

These surgical carts assist the providers inoffering patients the best possible care. A surgical cart differs from a surgical tableas the cart includes a specific headrest thathelps keep the patient’s head stable – animportant component, when you consider the small area the surgeon has to work with.

The Heart of an Organization KeepsGiving

Through their fundraising efforts, theTrinity Health Auxiliary Healthy HeartsClub was able to raise $15,000 to purchasecardiac chairs.

A check for $15,000 was presented to C. Etta Tabe, MD, a cardiothoracic surgeonwith Trinity Health, during the HealthyHearts Club’s Hearts Gala on February 10.

These cardiac chairs are used to help getheart patients up and around after surgery,explained Lorrie Antos, RN, BSN, directorof Trinity Health’s Critical Care andWomen’s and Children’s Services.

Early mobilization is started with thepatient soon after surgery. The first step isgetting them into the cardiac chair.

“The chairs are specially designed to makeit easier for them to get up,” Antos said.“The chairs are made in such a way thatyou can position the patient correctly. Theyhelp the patient get well faster. Early mobilization helps prevent pneumonia andcomplications from surgery.”

Patients use the chair the whole time theyare in the Intensive Care Unit.

With the donation from the HealthyHearts Club, three cardiac chairs were purchased, which added to the two chairsTrinity had already.

The Healthy Hearts Club, an extension ofthe Trinity Health Auxiliary, hosts severalfundraisers throughout the year to benefitthe region’s heart patients and the heartprograms at Trinity Health.

TeleSitter Program Helps Ensure PatientSafety

Trinity Health has implemented a new technology that will help keep patientssafer and help to reduce the number offalls and potential injuries during their hospital stay.

The AvaSys® video monitoring system,known as TeleSitter, keeps a watchful eyeover acute care patients in a more practical way.

Nurses typically round on patientsthroughout their shift. “We can have several patients that we try to monitorsimultaneously to care for and preventinjury on a daily basis,” explained KarenZimmerman, RN, vice president and chiefnursing officer with Trinity Health. “Apatient may be at risk for falling, forpulling at IV lines or tubes, or may be a little disoriented and anxious about theirsurroundings.”

With TeleSitter, a technician is able tomonitor a number of patients at the sametime, via the monitoring system, as if thepatients were all in the same room. Theimplementation of TeleSitter is a positivestep toward patient safety, Zimmermansaid. The monitoring system is a safeguardfor patients to prevent falls and injuries.Falls happen when patients try to get out

of bed, walk without assistance, or forgetthey need assistance.

Trinity Physicians Among First To OfferNew Sinus Stent

Trinity Health otolaryngologists Mark Noel,DO, and Rob Thomas, MD, were amongthe first ENT specialists in the nation toemploy a new device that helps keep sinuses open after sinus surgery.

PROPEL® Contour, a product of IntersectENT, Inc., is a dissolvable drug-elutingstent that is placed in the sinuses aftersinus surgery to deliver medication andmechanical support to optimize surgicaloutcomes. The device was recentlyapproved by the Food and DrugAdministration.

Dr. Noel said Trinity Health is one of ahandful of ENT centers in the countryselected to pilot the new stent. He said thedevice is the latest in a line of sinus stentsdesigned to treat the various passages ofthe sinus system.

Trinity Health Receives Recognition forStroke Care Services

Trinity Health was awarded with theStroke Gold Plus Quality AchievementAward, the American Heart Association’shighest award for stroke care, as well as arecertification as an Advanced PrimaryStroke Center from the Joint Commission.

The Get With The Guidelines®-StrokeGold Plus achievement was awarded asTrinity Health met “the most up-to-dateevidence-based treatment guidelines toimprove patient care and outcomes in thecommunities you serve,” according to theAmerican Heart Association.

Jerilyn Alexander, RN, BSN, Stroke andSTEMI Coordinator with Trinity Health,explained that Trinity’s Stroke Center wasreviewed by the Joint Commission inFebruary 2017, using data from 2016. Theissue of recertification was announced inApril 2017. According to the JointCommission’s website, the Certificate ofDistinction for Primary Stroke Centers“recognizes centers that follow the bestpractices for stroke care. Applicants foradvanced certification must meet therequirements for Disease-Specific CareCertification, plus additional, clinically specific requirements and expectations.”

Trinity Introduces New Health Screenings

Trinity Health is pleased to provide thecommunity greater access to additionalhealth screenings. Available screeningsinclude: Abdominal Aortic Aneurysm(AAA), Carotid Artery, Coronary ArteryCalcium Scoring, Electrocardiogram(EKG), and Peripheral Artery Disease(PAD). Our imaging technology providesearlier disease detection and promotestimely care.

FirstCare Walk-In Clinic Opens

Calling it a new day in same-day medicine,Trinity Health opened a walk-in clinic atHealth Center – Medical Arts calledFirstCare in September. FirstCare provideshealthcare access on a walk-in basis withno appointments. The walk-in clinic welcomes patients seven days a week withextended hours from 8 a.m. to 8 p.m. onweekdays, and 9 a.m. to 5 p.m. on weekends and holidays.

Thomas M. Warsocki, FACHE, vice president of Physician Network Services atTrinity Health, called the new clinic a significant step in non-emergent care.

continued on page 3

2017 in Review

HEALTHTALK TRINITY HEALTH 3 • JANUARY 2018

“FirstCare gives patients the direct accessibility of walk-in care without compromising quality,” he said. “Patients will have readyaccess to lab, pharmacy, and imaging services in addition to the full range of integrated services available through the Trinity Healthsystem. That’s important to someone who might have a condition that requires a higher level of care.”

Staffing the clinic is a new team of providers committed to providing first-class walk-in care. Marisa Albertson, MD, is a Minot nativewho has practiced Family Medicine in the community for many years. She is joined by nurse practitioners Jessica Fricke, FNP-C, andSandy Storey, FNP-C.

Trinity Health Adds Palliative Medicine Program

Trinity Health has expanded its continuum of care at Trinity Hospital, adding Palliative Medicine to its scope of services. PalliativeMedicine is a program of specialized medical care for people with serious and life-limiting illnesses.

Leading the program are Ann M. Hoff, MD, and Kristy Leier, FNP-C. They work with a team of physicians, nurse practitioners, nurses, social workers, and other specialists to focus on providing relief from the stress and symptoms associated with the serious orlife-limiting illness and to improve quality of life for patients and their families.

2017 in Review continued from page 2

The Trinity CancerCare Center received a donation of $1,000 from El Azteca Restaurant on November 20. During the month of October, theMexican restaurant sold pink chips and salsa to raise funds for theCancerCare Center. Additionally, on October 21, with the assistance ofMinot Stiletto, they held a chip-eating contest, “Eat It Cancer!” that raised$375; those funds were included in the donation to the CancerCare Center. Lilie Nicolas and Griselda Enriquez, with El Azteca, presented the check toShane Jordan, director of the Trinity CancerCare Center; Cody McManigal,donor relations coordinator, and Al Evon, director, both with the TrinityHealth Foundation.

Trinity Hospital – St. Joseph's Same Day Surgery donated blankets to Ward CountyChild Protective and Family Services. Every year, the unit makes blankets to donateto different area organizations.

Giving Back

Patients at Trinity Hospital no longer need to wait for medication after being discharged. Through a new program, patients can receivetheir prescriptions while they are still in the hospital.

“A lot of patients would get discharged, go to the pharmacy, and get their prescription filled before going home,” explained CarolynSeehafer, PharmD, director of Pharmacy Services at Trinity Health.

This new service, which began in July, includes patients receiving their medication the day of discharge, allowing them to go directlyhome. Medications are filled at B&B Pharmacy, located on the ground floor at Health Center – East, and are then delivered directly tothe patient’s hospital room. All medications, including short-term courses of antibiotics or the patient’s first 30-day supply of a prescription, are included, Seehafer says, noting that patients have been “very happy” to have this service available.

Trinity Health’s Speaker’s BureauCall our Community Education Department at 857-5099 to check for available dates and topics.

Medication Delivery Program

Scheels of Minot presented a $1,650 check to the Trinity CancerCare Center.The proceeds represent ticket sales from Scheels’ 3rd annual after-house shop-ping event held November 12. Pictured from left are Beth Feldner, eventscoordinator at Scheels; Al Evon, director of the Trinity Health Foundation;Cody McManigal, the Foundation’s donor relations coordinator; and ShaneJordan, director of the Trinity CancerCare Center.

Students from the National Junior Honor Society at Erik Ramstad Middle Schoolrecently raised $260 for the Trinity CancerCare Center during a “Pink Out,” whenstudents paid $1 or more to wear pink on a particular day. The check was receivedon December 13 by Carol Mohagen and Shane Jordan, with the Trinity CancerCareCenter, and Al Evon and Cody McManigal, with the Trinity Health Foundation. Themoney will go into the CancerCare Center’s Patient Assistance Fund.

FirstCare Walk-In Clinic Now OpenHealth Center – Medical Arts • No Appointments Necessary

4 • JANUARY 2018 TRINITY HEALTH HEALTHTALK

A Determination of Steele

Bruce Steelewalked slowly,but confident-ly, up the quietcul-de-sac innorthwestMinot wherehe makes hishome.

Ten times, upand down thestreet, is theexercise thatSteele needs.Negotiating hiswalker up thesmall drivewayand up thestep into hishome alsohelps aid in hisrecovery,which hascome a longway since hesuffered astroke last year.

On March 25,2017, Steelewas in his bedroom whenhe had hisstroke. “I justfell over,” hesaid.

He crawled from his bedroominto the kitchen and called foran ambulance, which took himto Trinity Hospital, where hestayed for a few days beforebeing transferred to TrinityHealth’s RehabCare Center,located at Trinity Hospital – St.Joseph’s.

Feeling in a Fog

Trinity’s RehabCare Center isan inpatient rehabilitation program dedicated to helpingpeople restore their independence and return to amore productive lifestyle following an illness, injury orsurgery.

Tammy Ferderer, MSW, LCSW,program director for theRehabCare Center, stated thatstroke is the leading diagnosisfor patients admitted toRehabCare.

At first, Steele felt “overwhelmed and depressed”following his admission toRehabCare. “You’re in a fogfrom the stroke. I just wantedto stay in bed and sleep,” hesaid.

The staff, however, came in towake him up every morning,insisting that he carry on andfollow through with his therapy. “They were very conscientious and accommodating,” Steele said,but while being positive, theyweren’t sympathetic enough toallow Steele to wallow in hismalady. Steele reckoned that ifthat were the case, he wouldn’thave gotten nearly as far. Thestaff didn’t coddle him; theymade him work toward hisrecovery.

“If I was going to feel sorry formyself, I had to do it on myown,” he said.

And he did.

An interdisciplinary team workswith RehabCare patients. Thestaff at RehabCare includerehabilitation nursing staff,physical therapists,

occupational therapists, speech-language pathology andaudiology therapists, psychiatricand psychological services, pastoral care, medical social services, and nutritional services.

“Everyone was so positive, so supportive,” he said. Thatencouragement, he adds, “wasenough for me. I just decided ifI did things halfway, I’m cheating myself. I committed tothe program and took it serious.”

Initially, Steele was to stay atRehabCare for three weeks,“but they thought it would dome good – and it did,” if hestayed another week so theycould get him to the level ofrecovery where he could gohome. That program includedsessions with physical therapy, occupational therapy, andspeech therapy, the latter ofwhich taught him how to swallow again. “You’re like achild learning how to ride a tricycle. You’re almost like achild,” Steele said.

Throughout his treatment andthe repetition involved, hereceived incremental gains, ashis body began to rememberhow to do things most take forgranted: picking up a pencil,getting dressed, the basics.

The exercises that he wastaught “translates so well intothe real world,” Steele said, noting that he can see how thethings he learned in RehabCarecarry over into daily living.“They know what they’redoing. They know their business; I can’t say enoughabout them.”

Each day was important as hegot into a rhythm, learning toregain his old self by re-learningthings he could do before.

“The confusion is gone; theawkwardness is still there,” hesaid. “RehabCare gives youdaily rewards and constantencouragement from the staff.“The whole program is full of

triumphs. It keeps yougoing. It kept me going.”

Being Cut Loose

About a week before hewas discharged, a homevisit was performed toascertain his living conditions. His rugs wereremoved to eliminateany tripping hazards and furniture was rearrangedto accommodate Steeleand his walker.

On April 25, 2017, “theycut me loose” and Steelereturned home.

For the next six weeks,Steele participated inTrinity’s HomeHealth/Hospice program; the HomeHealth agency caters topatients who are homebound and have askilled need for either anurse or a therapist(physical, occupational,or speech).

Home Health staffinclude social workers, aswell as certified nursingassistants to help withbathing and personalcares; it does not provide

custodial care, such as homemaking, making meals, orcleaning homes, but HomeHealth can assist patients ingetting Meals on Wheels orLifeLine. Social workers canhelp them access communityresources, help with financialconcerns, and long range planning.

Patients who require HomeHealth may have had surgery,where they are using awheelchair, walker, or crutchesto get around. So, in lieu ofmaking numerous trips to theclinic, Home Health acts as theeyes and ears for the provider.

Twice a week, staff from TrinityHome Health visited Steele athis home for therapy sessions.These sessions continued forfour to six weeks after he camehome; once he completed this,he graduated to outpatienttherapy sessions. Patients participate in the Home Healthprogram anywhere from one tothree months, depending on thehealth of the patient.

The first six months of recoveryfollowing a stroke are crucial,said Gus Kruse, OTR/L, anoccupational therapist withTrinity Home Health/Hospice,who worked with Steele.“That’s when you get most ofyour return. The biggest gains happen in the first six monthsafter having a stroke. The brainis more into getting everythingback and reconnecting thosesignals.”

According to the American Speech-Language-HearingAssociation (ASHA), a strokemay cause physical difficulties,particularly in the arm, leg andface on one side of the body;cognitive problems; and/orspeech and language problems.These impairments canimprove over time as the brainheals. Recovery is based on theseverity and location of thestroke, plus the will and abilityof the patient to work on getting back on track.

“He’d been busting his butt toget as much back as possible,”Kruse said. “It’s quite a process.”

While the staff at RehabCarewere helpful to Steele, it isSteele himself who is instrumental in his progress.

“Bruce is doing wonderful,”Kruse said in last June, as theyescaped from the growing summer heat in Steele’s home.He credited Steele’s recovery topure motivation and determination “If he wasn’tmotivated, he wouldn’t bedoing as well. He’s come a longways already.” If Bruce doesn’tcontinue on his own, a personwon’t succeed.

Therapy “is a two way street,”Kruse said. The four hours ofHome Health therapy thatSteele did weekly is notenough, and the care must continue at home.

While at home, Steele did tasksthat can help promote dexterityin his fingers, as well as “creating the wiring” in his righthand. A pail of toy plasticblocks sits by his kitchen table.With his left hand, he willreach into the pail, fish out ablock, and then attach it toanother block. He leans againsthis kitchen counter and doesexercises: knee bends, leg lifts,and squats.

“I’ll come over here and do 20minutes, a half hour,” he said.

While watching television,Steele does his block exercises,stringing beads, cutting paper,or typing on his computer.

“Without him being determined and working on allhis activities, including dressing,bathing, cutting up paper andworking on his hand, he wouldnot be doing as good as he isdoing,” Kruse said.

If Steele sat on his couchwatching television and wasn’tdoing anything, he felt “uncomfortable,” he said. “It’simportant to keep busy.”

Keeping busy helped Steelemove closer and closer to hisoverall goal: freedom from hiswalker.

“The day I get rid of this” – hemotioned toward this walker –“and get a cane, I’ll be sohappy,” he said. “I’ll celebrate itevery year.”

Steele is feeling “very goodnow,” not just physically, but emotionally and mentally. “I’mvery optimistic,” he said, as heneared the end of his therapy.

As Steele appeared to be progressing just fine, that dayshould be soon coming.

Participation in Trinity Health’sHome Health Agency is usually recommended by yourprovider. If you feel you qualify, please speak to your physician.For more information, pleasecall 857-5082.

Minot man fights way back from stroke, with help from Trinity Health staff

As part of his Home Health-based physical therapy, Bruce Steelewalks up and down his street ten times under the supervision of Gus Kruse, OTR/L, an occupational therapist with Trinity’s HomeHealth. Steele suffered a stroke in March and “is doing wonderful,”Kruse says, crediting Steele’s motivation as a factor toward his recovery.

HEALTHTALK TRINITY HEALTH 5 • JANUARY 2018

Cancer of the cervix, the lowerpart of the uterus (womb), isthe second-most commoncause of female-specific cancer – breast cancer is themost common – and it can be detected through recommended screenings.

The American Cancer Societyestimates that in 2017, about12,820 new cases of invasivecervical cancer would be diagnosed and about 4,210women would die from it.

Cervical cancer is also preventable.

Like mammograms and self-breast exams with breastcancer, David Amsbury, DO, anOB/GYN with Trinity Health,said that staying up to datewith Pap smears and followingrecommended guidelines isintegral to prevent cervical cancer.

“Cervical cancer is somethingthat no woman should have todie from,” Dr.Amsbury said.

Early vaccination,along with regularPap smears and HPV testing whenrecommended, isnow the best way toprevent cervical cancer, theFoundation forWomen’s Cancersaid.

The Papanicolaoutest, known more

commonly as aPap smear, is amethod of cervical screeningused to detectpotentially pre-cancerousand cancerousprocesses in thecervix. TheFoundation forWomen’s Cancerstates that sinceits inception inthe 1940s, thePap smear hasreduced deathsfrom cervicalcancer by morethan 70 percent.“It is hoped withwide-spread vaccination andimproved screening strategies,fewer and fewer women will beaffected by cervical cancer andpre-cancers in the future,” theorganization stated on its website.” It added that cervicalcancer was once one of the

most commoncauses of cancer deathfor Americanwomen.

Since 2012,the AmericanCancerSociety recommendsthat cervicalcancerscreenings,such as Pap

smears, should first be performed at the age of 21.The previous guideline was 18years of age, but, as MargaretNordell, MD, an OB/GYN withTrinity Health, stated, youngwomen who were still goingthrough the maturation processwould be tested and given false positives, leading to unnecessary surgeries.

After the first Pap smear,women are encouraged to getone every three years betweenthe ages of 21 to 29, unless recommended otherwise.

From the ages of 30 to 65, thetesting would be done everythree years or every five years if combined with HPV testing.From the age of 65, recommendations suggestagainst screening for thosewomen who are not at a high

risk for cervical cancer.

“High risk, in general, refersto people who have had ahistory of abnormal Papsmears or multiple sex partners, as that is how youget exposed to HPV. Thoseare your two high riskgroups,” Dr, Amsbury said.

“If you get the HPV vaccine at a younger age,theoretically, you are protecting yourself from cervical cancer later in life,”Dr. Amsbury said. “You arenow vaccinated against thosehigh risk strains of HPV.”

The vaccine is calledGardasil, a routine HPV vaccination for all 11-12-year old girls. Gardisilis recommended by theCenters for Disease Controland Prevention (CDC), theAdvisory Committee onImmunization Practices, andthe North DakotaDepartment of Health.

Catch-up vaccination is also recommended for femalesages 13 to 18, and for adults19 to 26 who were not previously vaccinated.

Amsbury recommends that,if you are a younger person,the Gardasil vaccine shouldbe discussed with a physician.

According to the CDC, riskfactors for cervical cancerinclude smoking, having HIVor another condition thatmakes it hard for your bodyto fight off health problems,using birth control pills for a

long time (five or more years),having given birth to three ormore children, or having several sexual partners.

“HPV virus causes the most ofthese cervical problems,” saidDr. Nordell. It wasn’t until the1980s that HPV was identifiedin cervical cancer tissue, implicating it in virtually allcervical cancers. “We don’tknow how the HPV virus is outthere, but the way to take careof cervical cancer is to get aPap smear and treat it accordingly.”

As cervical cancer progresses,symptoms can include vaginalbleeding after intercourse,between periods, or aftermenopause; watery, bloodyvaginal discharge; and pelvicpain or painful intercourse.

Depending on its stage, treatment for cervical cancercan vary.

Trinity Health’s obstetrics andgynecological providers dealwith the surgical care ofwomen and their children during pregnancy, childbirth,and the postnatal period. For more information, visit: http://trinityhealth.org/gynecology.

Trinity Health’s staff ofOB/GYNs are available to helpwith all of your gynecologicalneeds.

David Amsbury, DO, is basedat Health Center – MedicalArts, and can be reached at 857-7385.

Heather Bedell, MD, TimBedell, MD, and JenniferJohnson, MD, are based atHealth Center – Medical Arts,and can be reached at 857-7397.

Lori Dockter, PA-C, is based atHealth Center – Medical Arts,and can be reached at 857-5050.

David Billings, MD, is based atHealth Center – Town &Country, and can be reached at857-7394.

Jessie Fauntleroy, MD, MargaretNordell, MD, and CarolSchaffner, MD, are based atHealth Center – Town &Country, Suite 102, and can bereached at 857-5703.

Join us onfacebook.com/TrinityHealth.ND

David Amsbury, DO

Cervical Cancer can be Prevented

6 • JANUARY 2018 TRINITY HEALTH HEALTHTALK

Hand Procedure Worthy of a Thumbs UpNew CMC Sling Procedure Effective in Treating Thumb ArthritisArthritis is mostoften associatedwith hips andknees, but handscan be just asvulnerable tothe painfuleffects of jointdisease.

Blendi Cumani,MD, a specialistin hand, wrist,and upper limbsurgery, sayshand arthritiscan stem frommany factorssuch as an old sprain or fracture, orsimply wear and tear over years of usage.

“People reach a certain age and they startto feel some aches and pains,” Dr. Cumaninoted. “Most people ignore the pain andcontinue doing whatever it is they’ve beendoing with their hands over many years,but they really shouldn’t ignore the pain.”

Dr. Cumani says he’s noticed a rise latelyin the number of patients complaining ofhand arthritis, especially osteoarthritis ofthe thumb, the most common form ofhand arthritis. It usually occurs in the jointat the base of the thumb, called the carpometacarpal joint, or CMC. It’s thejoint that allows you to move your thumbinto your palm, a motion called opposition.

“It’s where the metacarpal bone of thethumb attaches to the trapezium bone ofthe wrist,” Dr. Cumani explained. “Overtime, you can start to develop a breakdown of the cartilage that cushionsthe ends of the bones and the underlyingbone itself. It can be very painful.”

Women are three times more likely thanmen to develop arthritis in the CMC jointdue to certain anatomical differences andhormonal factors. Diagnosis isn’t difficult,according to Dr. Cumani. “It can be ruledin or out with just a simple X-ray. Oncewe have a diagnosis, there are several conservative remedies we can try, depending on the patient’s age and theextent of the disease.”

Dr. Cumani stressed it’s important toaddress any form of hand arthritis as soonas you notice symptoms of pain or limitedmovement. “There are supportive measures we can prescribe – splints,braces, and cortisone shots,that can helpslow the diseaseprogression andpromote healing. Weeven have custom bracesthat our handtherapists construct out ofplastic thatmold to theshape of yourhand.”

Patients withadvanced disease who don’t get relief fromconservative treatments do have multiplesurgical options available to them. A number of procedures that address thumbarthritis involve partial or completeremoval of the diseased bone and tissue onboth sides of the wrist and thumb joint.The issue then becomes how to stabilizethe thumb when the wrist bone isn’t available to serve as a base of support.Hand procedures have advanced in recentyears to address this issue. One techniquecalls for running a tendon from the wristto the thumb joint. But this can result in

some loss of wrist movement.Dr. Cumani prefers a methodthat secures the thumb withoutcompromising wrist function.

“Instead of taking a tendonfrom the wrist we use something called a CMC sling.It’s like a little rope that tethersthe base of the thumb to the base of the index finger, creating a suspension thatrelieves the pain while preserving the thumb’s movement and flexibility,” heexplained.

The procedure has been available only three years or so,but already the sling methodappears to be showing promisein terms of long-term

outcomes, pain relief, and patientsatisfaction.

Whatever the health issue, if it involveshands it’s best to consult a hand and wrist

specialist,accordingto Dr.Cumani.“The handcontains somanystructures,not justbone andtendon,but bloodvessels,nerves, andsoft tissues.How youtackle one

problem is going to affect another. Thehand is finicky; it’s designed to work asperfect machine on its own. There’s not alot of room for error.”

To consult with one of Trinity Health’shand and wrist specialists, Blendi Cumani,MD, or Daniel Williams, MD, call theHand and Wrist Surgery Department at857-7301. Their offices are located atHealth Center – Medical Arts, 400Burdick Expressway East, Minot.

Blendi Cumani, MD Daniel Williams, MD

A drive to put turkeys on the tables of less fortunate families this holiday season has raised a record sum.

The Trinity Health Foundation launched its sixth annual turkeydrive in late October in partnership with KHRT’s Horn of Plentycampaign. The goal was to raise $6,750 – enough to purchase upto 450 turkeys or 150 full gift boxes for families in the region.

Foundation Director Al Evon says the campaign ended November30, and the numbers indicate the drive far exceeded its goal.

“This year,TrinityHealthFoundationreceived$8,210,which is thehighestamount ofdonations inour historyof conductingthe TurkeyDrive for theHorn of

Plenty,” Evon said. “We are truly blessed by the many people whodonated generously and, in many cases, sacrificially to supportfamilies in our area.”

Evon says donations came from employees within Trinity’s systemas well as from nursing students and others in the community.“The outpouring of compassion and support was amazing,” Evonadded. “Many families will be blessed when they receive the gift boxes.”

The turkeys and food items were distributed along with giftboxes to families in the community just before Christmas.

Volunteers helped to put together the food and gift baskets for the Horn of Plenty onDecember 6.

Horn of Plenty Turkey Drive Exceeds Goal

Cody McManigal, donor relations coordinator with the TrinityHealth Foundation, far left, and Al Evon, director of the TrinityHealth Foundation, second from right, stand with Horn ofPlenty organizers Don Leavitt, second from left, and RoyLeavitt, far right.

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HEALTHTALK TRINITY HEALTH 7 • JANUARY 2018

Glaucoma is a disorderleading to progressivedamage to the opticnerve. The optic nerveis the part of the eyethat carries the imagewe see to the brain, soan important part ofthe vision. When damage to the opticnerve occurs, blindspots develop. Theseblind spots usually goundetected until theoptic nerve is significantly damaged.The damage is nonreversible.

“Early detection and treatmentby your optical provider arethe keys to preventing opticnerve damage and blindnessfrom glaucoma,” said EvelyneKindy, MD, an ophthalmologistwith Trinity Regional Eyecare –Minot Center.

Glaucoma is a problem of public health significance. Inthe United States, the overallprevalence for adults over 40years is estimated to be 2 percent. That means it isaffecting over 2 million peoplein the country. Based on datafrom the Baltimore Eye Survey,about half of those people arenot even aware they have thedisease. In the United States,more than 7 million office visits occur per year for theprimary purpose of monitoringpatients with glaucoma andpatients at risk for developingglaucoma. Glaucoma of alltypes is one of the leadingcauses of legal blindness in theUnited States.

Glaucoma is caused by ananomaly of the drainage systemof the eye. There is a constantsmall amount of fluid that isproduced while an equalamount flows out of the eyethrough a microscopic drainagesystems. Because the eye is aclosed system, if the drainage isblocked, the excessive fluidcannot flow out of the eye andthere is a buildup of pressurethat causes optic nerve damage.

There are different types ofglaucoma. The most commontype – and the most commonform in the United States – iswhat is defined as chronic

open glaucoma.The risk ofdevelopingchronicopen angleglaucomaincreaseswith age.Treatmentis necessaryto preventfurther lossof vision.This is thetype of

glaucoma that has no symptoms in the early stage.Vision remains normal formany years. As the optic nervebecomes more damaged, blankspots began to appear in thefield of vision. Typically, thepatient is not aware the deficitin the day-to-day activity untilthe nerve is significantly damaged.

The second type of glaucoma isthe closed angle glaucoma.“This is a true eye emergency,”Dr. Kindy said. “Some eyes areformed with the iris very closeto the drainage angles. The iriscan eventually be pushed forward, blocking the drainagechannel completely leading toan acute increase of theintraocular pressure.”Symptoms are very dramaticfor the patient with blurredvision, severe eye pain,headaches, halos around lights,and nausea and vomiting.

“Your ocular provider considersmany kinds of information to evaluate your risk of developing glaucoma,” Dr. Kindy said. The mostimportant risk factors includes:

• Age

• Elevated eye pressure

• Family history of glaucoma

• African or Hispanic ancestry

• Being significantly farsightedor near-sided

• Past eye injury

• Thinner central cornea thickness

• Systemic health problemsincluding vascular disease,diabetes, or migraineheadaches

• Pre-existing thinning of theoptic nerve

The eye provider will look atall these factors before deciding whether you needtreatment or should be closelymonitored as a potential glaucoma patient. If the risk ofdeveloping glaucoma is higherthan normal, you will mostlikely need to have regular examinations to detect earlysigns of damage on the opticnerve.

“We detect glaucoma, by doingregular eye examinations,” Dr.Kindy said. “Glaucoma screenings that just evaluatepressure is not sufficient todetermine if glaucoma is present.”

During the glaucoma evaluation, your eye providerwill measure the intraocularpressure. “We will look at thedrainage angle of the eye bydoing a gonioscopy and willevaluate if there is any opticnerve damage with ophthalmoscopy. Some ancillary tests in the office willbe obtained as a field of visionand topic nerve ultrasound.Photography of the optic nervecan be obtained if needed.”

Early detection and treatmentare the keys to prevent blindness, Dr. Kindy said. “As arule, damage caused by glaucoma cannot be reversed.The modalities of treatmentinclude eye drops, laser surgery,and surgery in the operatingroom to lower the eye pressure. Other modalities oftreatment also include iStentassociated with cataractsurgery.”

With any type of glaucomaperiodic examinations are veryimportant to prevent visualloss. “For some reason, glaucoma can progress without warning. Therefore,adjustments to your treatmentmay be necessary from time totime,” Dr. Kindy said.

Most of the glaucoma usuallyis controlled with eye dropstaken daily. The main purposeof the topical medication is tolower the eye pressure. It isimportant to be consistentwith the treatment as the glaucoma medication can

preserve vision. All medicationscan have side effects or caninteract with other medications. Therefore it isimportant that you make a listof your medications that youtake regularly and share thislist with each doctor you see.

Laser surgery treatment maybe also recommended for different types of glaucoma. Inopen angle glaucoma, trabeculoplasty is performed bythe ophthalmologist to helpcontrol the eye pressure. In theclosed angle glaucoma, iridotomy treatment is performed to improve the flowof aqueous fluid to the drain.

Surgical procedure done in theoperating room is usually anoutpatient procedure whenother modalities of treatmenthave failed. iStents can also beconsidered at the time ofcataract surgery.

Treatment for glaucomarequires a close teamworkbetween the patient and thedoctor. “As the medication isprescribed by your eyeprovider, the patient is stillresponsible to follow theinstructions and use the eyedrops,” Dr. Kindy said. “Whenthe medication is taken regularly, typically you canexpect a visit with your eyeprovider every six months.”

People at any age with symptoms of or risk for glaucoma should be schedulingan eye exam. “An adult with no symptoms with risk factor foreye disease should have a complete screening at age 40,”Dr. Kindy said. “Adults at age65 years or older should have acomplete eye exam every oneto two years based on theirmedical condition.”

To schedule an exam, callTrinity Regional Eyecare –Minot Center, at 852-3937.Trinity Regional Eyecare –Minot Center is located atHealth Center – Plaza 16,2815-16th Street Southwest,Minot. In addition to theMinot Center, exams can alsobe made at our regional centersin Devils Lake (662-4085) andWilliston (572-7641).

Fixed Wing Service Launched in WillistonA new air ambulance has got off theground in Williston. Trinity Health haslaunched a regional fixed wing emergencytransport service out of Williston that willbe an extension of its Minot-basedNorthStar Criticair helicopter and airplaneservices. The Williston service was up andrunning December 13.

Lorrie Antos, Director of Critical CareServices, said the new transport is calledNorthStar Criticair Fixed Wing Willistonand is available 24-hours-a-day, seven-days-a-week, to provide medicaltransport for patients from Williston andsurrounding communities.

“We’re excited to provide this extension ofour NorthStar Criticair service,” she said.“There’s been a need for reliable air transport out of Williston. We feel very fortunate and privileged to be part ofWilliston’s medical community, and we’recommitted to doing all we can to give thevery best care to patients.”

Each NorthStar Fixed Wing Williston mission will be staffed by a dedicatedflight crew consisting of a pilot, paramedic

and critical care nurse,who will be on call 24/7.“We’ll fly to any receiving facility,” saidAntos. “Typically, itwould be a specializedfacility outside of theregion.”

The aircraft is equippedto fly pediatric and adultmissions, including high-risk labor/deliverypatients. “Our criticalcare helicopter out of Minot will continueto provide transport for neonatal missions,and the helicopter will serve the region asit has since 1992 with critical care transport and rescue,” Antos added.

As is the case with its Minot-based rotorand fixed wing services, Trinity Health iscollaborating with Executive Air TaxiCorp. to provide aircraft, pilots, and maintenance expertise. The aircraft, a King Air 90, is equipped with state-of-the-art instrumentation to ensurethat clinical teams can provide exceptionalcare for patients. In addition, the cabin is

large enough to accommodate a patient’sfamily member, if appropriate for the situation.

The Williston service is the first geographicexpansion of NorthStar Criticair, whichwas established by Trinity Health in 1992as a critical care helicopter and wasexpanded in 2015 to include fixed wingcapability. Mark Chilson, NorthStar’s leadparamedic, will oversee the Williston service, which will be dispatched byTrinity’s Direct and Dispatch communication center in Minot.

An extension of the Minot-based NorthStar Criticair helicopter and airplaneservice has launched in Williston. The NorthStar Criticair Fixed WingWilliston will join the NorthStar Criticair airplane service, pictured here.

Evelyne Kindy, MD

January is Glaucoma Awareness Month

8 • JANUARY 2018 TRINITY HEALTH HEALTHTALK

C A L E N D A RPrepared Childbirth ClassesLearn about exercise and breathing techniques, labor/delivery,newborn care, newborn feedings, etc. Enrollment is limited.

SATURDAYSJanuary 6, February 3, March 10, April 7, and May 59 a.m.-4 p.m., in the Prepared Childbirth Classroom, HealthCenter – Riverside Education Center, 1900 8th Ave. SE.

Breastfeeding BasicsJanuary 10, February 14, March 14 and April 11Offered by Laureen Klein, RN, BSN. Meets from 7-9 p.m.,Health Center – Riverside Education Center, 1900 8th Ave. SE.

These classes are offered free of charge as part of Trinity’scommunity benefit mission, but registration is typicallyrequired. To sign up for classes go online at http://trinityhealth.org/familybirth_registration or call 857-5640.

Family Birth Center ToursExpectant mothers are invited to attend a formal grouptour/education/Q&A session at Trinity Hospital’s Family Birth Center. This opportunity allows every expectant motherto hear and see valuable information in a relaxed environment. We will also provide information on self-care,infant safety, and what to expect during your delivery. See trinityhealth.org/familybirth_SVS or call 857-5380 for adetailed schedule.

For the latest updates, check online at trinityhealth.org

C O M M U N I T Y

Mobile Mammogram ScheduleJanuary 3........................Premier HealthCare, Devils Lake, 662-8662

January 8 .................................St. Luke’s Hospital, Crosby, 965-6349

January 10 ....................................Cognizant, 420-3598 (Joan Bailey)

January 22 ...........Trinity Community Clinic – New Town, 628-2990

January 23.......................................................Tioga Clinic, 664-3368

January 24 ...Kenmare Community Hospital, 385-4296 (Sherry/Kris)

January 29....Northland Community Health Center, Rolla, 477-3111

January 30 .................Trinity Community Clinic – Mohall, 756-6841

January 31 Northland Community Health Center, Rolette, 246-3391

Calendar of EventsJanuary 24-26 — Trinity Health will be among the exhibitors atthe KMOT Ag Expo, which will be held January 24-26 at theNorth Dakota State Fair Center, in Minot. There, we will offerlow-cost health screenings, which include cholesterol screenings,and free blood pressure checks.

January 30 — Keys to Diabetes Success, Budget Tips withDiabetes, 5:30 pm, Trinity Health Community Conference Center,Town & Country Center.

HEARTS GALAFEBRUARY 9The Trinity Health Auxiliary Healthy Hearts Clubwill host a Hearts Gala on Friday, February 9 at theHoliday Inn Riverside. The event begins at 6:30p.m. with a social followed by a buffet dinner andentertainment from Midwest Dueling Pianos.

The Healthy Hearts Club has hosted the fundraisersince 2015. “Every year the Gala changes and itgrows, but our mission remains the same,” saidSherry Maragos, event coordinator. That mission isto bring awareness to heart disease, the leadingcause of death in the United States.

According to the American Heart Association,more than 800,000 Americans die of heart disease (including coronary heart disease, hypertension, and stroke) each year. “Manyof us don’t realize just how many people are affected by heart disease,” Maragos said. “The Gala is an opportunity for us to bringthe disease to the forefront and help people in our community suffering from it.”

Tickets to the event are $75 each and can be purchased online at www.trinityhealth.org/auxiliarygala or at the Trinity HospitalGift Shop. For $500, you can reserve a table of eight (a $100 savings!). Call Sherry Maragos at 857-5221 to reserve your table orfor more information about the event.

GalaHearts

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FUNDRAISER FOR THE HEARTFEBRUARY 9, 2018 • 6:30 PMHOLIDAY INN RIVERSIDE

FEATURING MIDWEST DUELING PIANOS FOOD • FUN • PRIZES

$75 - TICKET $500 - TABLE OF EIGHT

TO PURCHASE TICKETS, CALL SHERRY MARAGOS AT (701) 857-5221OR VISIT WWW.TRINITYHEALTH.ORG/AUXILIARYGALA

T R I N I T Y H E A LT H H E A LT H Y H E A R T S C L U B

Accutane Can Help You Say Goodbye to AcneSixty million people in the United States have acne.

Now, those who suffer from acne now have an easier way to betreated, without stepping foot in a dermatologist’s office. RyanSiewert, MD, a family medicine physician at Trinity CommunityClinic – Western Dakota, can prescribe Isotretinoin, also knownas Accutane, to help with acne.

Accutane is a daily pill which is normally taken for four to sixmonths.

“When you’re done with the treatment course, your acneimproves to the point where you don’t need to be on anythingany longer,” he said, noting that by the course’s end, your “acnewill ideally be where you want it to be.”

Acne vulgaris, or more commonly known (and feared byteenagers everywhere) as acne, is caused when hair follicles areclogged with dead skin cells and oil from the skin. Genes, hormones, infections, diet, smoking, and stress have all been saidto be contributing factors for acne.

Siewert said that through this prescription, patients would not needto travel far to see a dermatologist,thus allowing patients with acneissues to be treated sooner.

“Accutane is one of the most effective, if not the most effective,for acne treatment,” Siewert added.

To make an appointment with Dr. Siewert, please call the TrinityCommunity Clinic – WesternDakota, at 572-7711. TrinityCommunity Clinic – Western Dakotais located at 1321 West DakotaParkway, in Williston.

Ryan Siewert, MD