Flu vs. flu: what kind do I have?

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By Alison Meyer, APRN, CNP


Right now in Minnesota, the flu season has reached peak numbers, including hospitalizations and deaths. As a result, there have been concerns raised about the flu vaccine and its effectiveness.

One of the common misconceptions I have heard is that the vaccine is given to prevent the stomach flu (gastroenteritis). This is not true as it is only used for preventing influenza.

What’s the difference, you might ask? Despite both being called the flu, influenza and the stomach flu are different viruses.Doctor holding a card with Flu Season., medical concept

The stomach flu is just as its name suggests, an illness that infects your stomach and intestines. Influenza is a respiratory illness. While complications can happen with the stomach flu, influenza is much more likely to cause serious side effects.

Certain symptoms may overlap, but for the most part, they have defining features.


You might have the stomach flu if:

  • You experience nausea, vomiting, stomach pain, diarrhea or low fever
  • Symptoms only last for a day or two

You might have influenza if:

  • You experience high fever, coughing, congestion, body aches or fatigue
  • Symptoms last one week or longer

I’ve also heard other concerns from community members related to influenza and the vaccine.


Is it too late to get a flu shot?

Although flu season has reached its peak in Minnesota, it’s not too late to get vaccinated, as the season could last for many more weeks. Take note, however, that the Sick boy with the flu with thermometer laying in bed and mother hand taking temperature. Mother checking temperature of her sick son who has thermometer in his mouth. vaccine takes a couple weeks to build up your immune system, so you are at risk of encountering an infected individual and catching the virus in that time.  Even so, by getting the vaccine now, you may be able to lessen symptoms and the risk of complications if you should become ill or prevent the virus altogether.


Will I get the flu from the vaccine?

Though you could experience mild side effects such as fever or pain at the injection site, you cannot get influenza from the vaccine. Click here to read a past Tri Living Well blog with more on this subject.


How effective is the vaccine?

The effectiveness of the vaccine changes every year because influenza itself constantly changes. Flu migration patterns across the world are extensively researched each year to estimate which strains of the virus will be most prevalent in the coming season. To ensure the vaccine is readily available before the flu season, it must be manufactured well in advance, which leaves room for the virus to mutate. For this reason, there is a potential for a bad match.

So far this season, the CDC reports that the vaccine is 36 perfect effective at preventing influenza, as noted in its Morbidity and Mortality Weekly Report.

Though this number might seem low, reports by the CDC show that vaccine effectiveness can vary between 40 and 60 percent in seasons where there is a good vaccine/virus match.Young man suffering from the flu with cold and coughing.

There is still enough evidence this season to suggest getting the flu vaccine can be beneficial. Not only are there minimal risks, but any protection is better than no protection at all.


CDC Statistics for the 2017-2018 season:

  • Total hospitalizations in Minnesota as of Feb. 10 are 4,271 compared to 3,738 in the 2016-2017 season.
  • A total of 84 pediatric deaths were reported as of Feb. 10. Among those, only 26 percent of children who were eligible for the vaccine received it.
  • A new study found that vaccination reduced the risk of flu-associated death by 65 percent among healthy children.
  • The median age of those hospitalized in Minnesota is 74.


About the Author: Alison Meyer is an advanced practice registered nurse and certified nurse practitioner at TCHC’s Bertha Clinic. She takes a special interest in pediatrics, women’s health, and health promotion and disease prevention. Alison and her husband, Jeremy, reside in Hewitt and have two children, Elsie and Harrison.

A mother’s love: organ donation saves son’s life

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Today, Feb. 14, is National Organ Donor Day. It’s meant to raise awareness about the lives that can be saved through organ donation. It holds a special place in my heart because last year, I donated a kidney to my son, Mark.

Donate Day - Donate Life Ribbon

A blanket was given to Holly by the University of Minnesota with the donation ribbon and date of the transplant.

Dealing with a disease

Mark was diagnosed with an autoimmune disease called Wegener’s Granulomatosis at the age of 12, which causes inflammation of your blood vessels. He spent nearly a

month at the Minneapolis Children’s Hospital. There, he had IV medications, high doses of steroids, immunosuppressants, multiple procedures, X-rays/scans, blood transfusions and lab tests, as well as visits from more providers and specialists than I could count on my fingers and toes. We were told that we came very close to losing him.

While in the hospital, there was some discussion that Mark may need to start dialysis due to the damage his kidneys received from Wegener’s. However, with time and medications, his kidneys rallied and function improved.

We were told there was a good chance that the damage to his kidneys could lead to the need for a kidney transplant in the future. With any luck, we hoped that day would never come. However, in the spring of 2015, approximately 10 years after his diagnosis, Mark’s nephrologist (kidney specialist) said it was time. He was referred to the University of Minnesota to see if he was a candidate for a kidney transplant.


Finding a donor

For me, there was no question. I wanted my son to have as “normal” of a life as possible and was very hopeful that we could avoid the need for dialysis. So I signed up to be evaluated at the U of M to see if I was a match. The initial transplant evaluation consisted of MULTIPLE blood tests, urine studies, a chest X-ray, EKG, MRI of my kidneys, as well as consulting with my transplant coordinator, social services staff, dieticians, nephrologists and a transplant surgeon.

About a week after the evaluation, I got a call from my transplant coordinator who told me that I was a match! I was excited and, to be honest, scared at the same time! I

A photo of Holly and her son, Mark, as they see each other for the first time after the organ donation transplant procedure.

Holly and her son, Mark, see each other for the first time after the transplant procedure.

was the one who called Mark to let him know that I was a match. He was speechless and surprised, but we were both so relieved.


Working through setbacks

Unfortunately, before the transplant could be scheduled, Mark became ill, and his kidneys failed. He was admitted to St. Cloud Hospital and started on dialysis.

The transplant was scheduled for March 17, 2016, but because Mark had a rough several months leading up to it, where he was hospitalized multiple times with pneumonia and pericarditis, the transplant was cancelled. The U of M Infectious Disease Department checked Mark to be sure he did not have an infection or disease that could cause risks during surgery or possibly even rule him out as a kidney transplant candidate.

Thankfully, he was cleared by the specialist, and we were back on track for the transplant.

In the spring of 2016, Mark’s Wegener’s Granulomatosis came back and attacked his intestines and lungs. After another hospital stay, which consisted of high doses of steroids and Rituxan infusions, Wegener’s went back into remission. The U of M required that Mark be in remission for six months before he could be approved again for the transplant.


A successful ending

Finally, Mark was approved for the kidney transplant. We both repeated the transplant evaluation and were approved. The transplant was scheduled for June 11, 2017.

The transplant went smoothly, and Mark had 2 gallons of urine output by the next morning! (I should explain that Mark did not urinate AT ALL for over a year, so this was

Organ donor recipient, Mark, and his family.

Mark with his wife, Amanda, and their daughter, Mallory.

great news!) The first 24 hours were pretty rough for me, but once we figured out that most of my symptoms were due to the pain medications, they were discontinued,

and I got better.

I was discharged on July 13, and after spending a couple more days with family in the Metro, I felt up to the 2.5-hour car ride home. Mark continued to improve as well and was given the OK to go home much sooner than we anticipated.

Words cannot explain how grateful and honored I am that I was able to do this for Mark. I am so thankful that he has been doing well since the transplant. I am hopeful that my kidney will give him a record number of years before he needs a new one. If the need arose, and if I could do it again, I would not hesitate. After all, he is my child, and we as parents would sacrifice anything for them. They are worth every ounce.


About the Author: Holly Anderson is an LPN at TCHC’s Verndale Clinic. She and her husband, Erick, live in rural Verndale and have two children: Mark, 24, and Kaitlyn, 14. Holly is a proud mother-in-law to Amanda and grandmother to beautiful little Mallory who is 9 months old. She enjoys spending time with her family and friends, listening to music, and the outdoors.

Is your heart healthy?

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By John Haglund, Sonographer


The heart is one of your most important organs, which is why diseases of the heart cause the highest number of deaths in the U.S. each year. Yet, they can be prevented.

In honor of February as Heart Health Month, I’m going to share a little bit about how we at TCHC make sure your heart is as healthy as it can be with a reliable, non-invasive test called an echocardiogram.


What is an echocardiogram?Mother and daughter showing love by making heart shape with hands.

Essentially, it’s an ultrasound of your heart that lets us see a real-time video. It often serves as screening tests and is a great non-invasive way to look at the heart.

Echoes take about 45 minutes to an hour, and my job as a sonographer is to capture many views and measurements of the heart, such as size, thickness and function, for a cardiologist to read and interpret.

We perform echoes on patients age 12 and up. For younger kids, we typically refer them to the Cities where they have dedicated pediatric echo techs.


Why might someone get an echo?

Your provider might order an echo for a number of different reasons. We can use it to see if your heart is the source of certain symptoms, or to assess the health of your heart before and after a surgery.

Here are some specific conditions we might check for with an echo:

  • Heart attack damage
  • Heart murmur
  • Enlarged heart
  • Fluid around the heart
  • Hole in the heart

A common question I get is, “Can you see the arteries in my heart?” No, we can’t, but while we can’t see the arteries themselves, we can measure the movement of the walls of your heart, which can indicate healthy or abnormal arteries.


Patients come first

TCHC is unique in that we offer our patients an echo tech five days a week. So if you come in for a check-up and need an echo, we can typically get you in right away.

Ultrasonography machine used for echocardiogram. Ultrasound imaging used in medicine. Human heart. Four chambers.I also strive to help patients relax during the procedure by taking time to visit with them, as well as to get the best possible images because I know that things I find could affect their care.

One of my patients, Joan Bakken of Wadena, needed an echo to determine if her heart was healthy enough for an upcoming surgery. She needed results quickly, so we were able to expedite them. Joan was appreciative that she could get right in, otherwise, she would have had to drive to the Cities. Though we found she’s not a candidate for surgery at this time, the echo prompted follow-up care that she’s receiving now.

Another patient of mine, Ted Kuperus of Wadena, had an echo to determine the cause of persistent symptoms and received great news that his heart was working normally. His doctors were extremely happy about his results, so now he can move on to evaluate other areas that may be causing those symptoms.

“They made me feel really comfortable and explained what they were doing and what they were looking for,” Ted said. “They got me in right away. We had no problem with any of it. They made it really easy for me, really comfortable.”


Keep heart health top of mind

Your heart is arguably the most important structure in your body. Without your heart, you’re not going to function.

By offering echocardiograms to patients as screening tests, we’re giving them a way to be proactive with their heart.

I see this every day. Patients will say, “Boy, I wish I would have gone in 10 years ago and done an echo test.” We possibly could have detected damage much earlier. And then I have others who came in right away, allowing us to detect abnormalities sooner and have a better chance of saving their heart function.

Proactivity is key when it comes to heart health, as there are many things you can do to prevent heart disease and other conditions.

The American Heart Association and The Heart Foundation offer these resources for keeping your heart healthy:

Answers by Heart Fact Sheets: Lifestyle and Risk Reduction





Photo of John Haglund sitting next to the echo cardiogram machineAbout the Author: John Haglund has 29 years of experience in diagnostic imaging. He started his career as an X-ray technician and then attended an ultrasound program at the University of Wisconsin, where he was trained in both general ultrasound and echocardiograms.

Leland’s story: hope and healing after a serious injury

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By Jessica Sly, Communications Specialist


The date was Feb. 6, 2017. Carpenter Leland Elgin was hard at work cutting a piece of flooring on a table saw. Just as he reached the end, the piece kicked back toward the blade, taking his left hand with it. His thumb and three fingers were severed.Leland working with physical therapy to regain strength from his hand injury

“I looked at my hand and everything was just dangling there,” he recalled. “I must’ve gone into shock right away because I just kept on walking right to the ambulance and got in.”

The emergency department physician at TCHC determined that Leland needed extensive surgical intervention, so he was airlifted to North Memorial in the Cities. A nearly 10-hour surgery connected Leland’s digits back to his hand, transferring veins and nerves from other parts of his body to restore feeling in his fingers.

“It’s unreal what they can do,” he said. Unfortunately, his index finger was too damaged and couldn’t be saved.

Within the first month and a half following his accident, Leland had six surgeries, and then he was ready to start physical therapy.

Because Leland lives near Bertha and Eagle Bend, he chose rehabilitation at TCHC’s Bertha Physical Therapy Clinic with Travis Rasinski, DPT. They started with mobilization in his fingers to loosen the scar tissue and kept his hand wrapped to reduce swelling.

“They wanted to get it limbered up because everything was stiff. Nothing worked,” Leland said. “When we first started, Travis was just trying to get everything moving. It’s kind of weird because you can hear it breaking loose every so often, but Travis loves it.”

Leland working with Rehab to restore function in his hand after a serious injury.Travis worked manually with each finger and coached Leland through exercises such as picking up objects, turning keys and working with weights.

After three months, Leland returned to work. It helped to keep him occupied, as well as contributed to the healing process. “I was going crazy sitting at home,” he said. “At first, it was a little tough. It seemed like a lot harder work. It’s just overcompensating for what you can’t do with that hand and figuring out different ways to do things. You get used to it.”

A surgery scheduled in September was meant to connect Leland’s tendons to return independent movement to his fingers. Unfortunately, it wasn’t successful.

Leland resumed physical therapy, where Travis used ultrasound to soften the new scar tissue and worked to loosen the joints in each finger. He also stabilized Leland’s right shoulder to compensate for the extra use.

After months of work, they restored the movement in his elbow and wrist and got some range of motion back in his first knuckles. However, his grip strength and functional capacity will never go back to normal.

“It’s a unique case for sure. You forget what you take for granted,” Travis said. “Leland’s a highly motivated, hard-working patient.”Leland Elgin and physical therapist, Travis Rasinksi

Leland credits his incredible surgeons and Travis’ hard work with getting him to where he is today in terms of functionality.

It’s been almost exactly a year since the accident, and throughout that time, Leland has experienced a range of triumphs and setbacks, both physically and emotionally. But he’s not letting it keep him down.

“At first I kinda thought, ‘Oh, great.’ Then I realized it is what it is, and I’ve just got to do the best I can with it,” he said, and he had the same message for others who may be experiencing physical difficulties. “Push as hard as you can. Do as much as you can do. Something will come around. Something will work out. It’s just figuring out different ways to do it.”



Photo of Jessica Sly, the author for this blog post.About the Author: Jessica Sly has been working as a communication specialist at TCHC since May 2017. A Wadena native, she graduated from the University of Northwestern – St. Paul in 2012 with a degree in English with a writing concentration. She is a word nerd, lover of all things Disney, self-proclaimed crazy cat lady and devoted Minnesota Vikings fan (SKOL).

Battling the Wadena County opioid epidemic

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By Jessica Sly, Communications Specialist


If you look at the news these days, the odds are you’ll find something related to opioids and addiction. Opioids are a national problem that trickles down through every community, no matter how large or small, including those served by Tri-County Health Care. Health care organizations across the U.S. are joining the fight to stop this epidemic, starting with reducing opioid prescriptions Prescription bottle for Oxycodone tablets and pills on wooden table for opioid epidemic illustration.for pain relief, and TCHC considers this cause an extremely important priority.


What are opioids?

The National Institute on Drug Abuse describes opioids as drugs that interact with an individual’s nerve cells, resulting in pain relief and euphoria. Opioids include the illegal drug heroin, synthetic drugs such as fentanyl, and legal prescription pain relievers including oxycodone, hydrocodone (Vicodin), codeine, morphine and more.


How dangerous are they?

Generally, opioids are safe as prescribed pain relievers if taken for a short time, but if used in a larger quantity or not taken as directed, they can cause addiction. Regular use as a result of addiction can lead to an overdose or death. Fortunately, if discovered right away, an overdose can be treated.

Nationwide, 66 percent of all drug overdose deaths are attributed to opioids, and 40 percent involve a prescription opioid. An average of 115 Americans die every day from opioid overdoses while 46 people die every day from prescription opioid overdoses. These numbers continue to rise each year.


Why are opioids a large problem locally?

The Centers for Disease Control and Prevention reports that opioid prescription rates tend to be greater in rural areas where diabetes, arthritis, disability and suicide are common; in counties with high populations of white residents; and in areas with elevated poverty, unemployment and uninsured rates.

With a combination of many of these characteristics, Wadena County has a higher opioid prescription rate than other areas that have more favorable socioeconomic conditions.

However, because of the small, close-knit nature of TCHC’s service area, law enforcement and pharmacies are able to partner to track and work against opioid abuse.


What is Tri-County Health Care doing to reduce the rate of opioid prescriptions?

The first step to solving the opioid epidemic is changing the way that providers manage pain, for instance, using intervention radiology, rehab and non-opioid medications instead of opioids.

Opioid Crisis Newspaper Headline. Newspaper is on a DeskTCHC is currently working with CHI St. Gabriel’s in Little Falls to learn how to develop an opioid management program in Wadena. This program will address opioid use for chronic non-cancer pain management and develop consistent standards of practice for opioid management.

Phase one of the program will focus on expanding services to patients while phase two will focus on developing collaborative community partnerships including law enforcement.

To help fund this program, TCHC recently received a $39,213 grant through the Minnesota Rural Hospital Planning and Transition Grant Program. TCHC will match the funds received.

Included in the program is the addition of a dedicated registered nurse case manager. The case manager will meet with patients to develop an individualized plan of care that meets evidence-based practices and helps patients achieve their opioid management goals.


By the numbers

  • Every day, emergency departments treat more than 1,000 individuals for not using prescription opioids as directed.
  • Overdose deaths from prescription opioids between 1999 and 2014 were the highest among those age 25 to 54.
  • One in four patients that receive long-term opioid therapy in a primary care setting battles opioid addiction.
  • In 2012, more than 255 million opioid prescriptions were written, with a rate of 81.3 prescriptions per 100 persons.
  • By 2016, the national opioid prescribing rate had declined to 214 million, with a rate of 66.5 prescriptions per 100 persons.
  • In 2016, opioid overdose deaths were five times higher than in 1999.
  • Those most at risk of overdose due to prolonged use acquire opioids in multiple ways: their own prescription, 27 percent; free from friends or relatives, 26 percent; bought from friends or relatives, 23 percent; or bought from drug dealers, 15 percent.

Statistics from the Centers for Disease Control and Prevention


Photo of Jessica Sly, the author for this blog post.

About the Author: Jessica Sly has been working as a communication specialist at TCHC since May 2017. A Wadena native, she graduated from the University of Northwestern – St. Paul in 2012 with a degree in English with a writing concentration. She is a word nerd, lover of all things Disney, self-proclaimed crazy cat lady and devoted Minnesota Vikings fan (SKOL).

HPV: a vaccine to prevent cancer

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By Jennifer Arnhold, M.D., GYN, Embrace Women’s Health Clinic


If you could get a vaccine that prevented cancer, would you? Well, you can, and it’s available right now.

Human papillomavirus (HPV) is a common virus that has the potential to cause multiple cancers and other conditions, such as genital warts and cervical dysplasia.

HPV is spread through sexual transmission and can infect most males and females in their lifetimes. In fact, 1 in 4 people in the United States is infected with HPV, according to the Centers for Disease Control and Prevention (CDC). Each year, about 14 million people become infected, including teens. In most cases, people don’t suffer symptoms, and the virus clears on its own.Child receiving HPV vaccine at shoulder

However, if the virus worsens, the consequences could be severe. Along with genital warts or cervical dysplasia, it can cause mouth, throat, cervical, vaginal, vulvar, penile and anal cancer. Alarmingly, 2 in 3 people will get genital warts after any kind of genital contact with an infected individual, and regarding cervical cancer, 30 women are diagnosed and 11 women die from it each day.

The good news is that HPV can be prevented. A vaccine exists that is extremely effective at reducing the prevalence of HPV, therefore reducing the risk of these conditions and cancers.

The CDC recommends that children should get the vaccine starting at age 11, and it can be given through the age of 21 in males and 26 in females. It’s not a yearly vaccine. Rather, it’s given in an effective series of three.

The reason for vaccinating so young is we want to vaccinate before sexual activity begins because it’s more effective if you’ve never been exposed to HPV. Plus, it will help the child develop a sufficient immune system.


What prevents you from being vaccinated?

One of the reasons why parents might choose not to vaccinate their children is a general thought that, overall, vaccines are unsafe. However, many years of extensive research have shown these claims to be unfounded.

Diverse group of teenage friends hang out outside together at a local park or school campus.Because sexual transmission is how HPV is spread, it can be hard for many parents of young children to wrap their head around having to discuss this subject.

It may be uncomfortable, but regardless how the virus is spread, the fact is that the vaccine is a reliable method of prevention. Think about this: Of the more than 30,000 annual cases of HPV-caused cancer in the U.S., the vaccine can prevent about 28,000 cases.

I think this is one of the greatest arguments for getting the HPV vaccine. Not only that, but it decreases the need for anxiety-provoking procedures such as pap smears or colposcopies. In my mind, it’s an absolute win-win. And for parents, it can be a huge benefit your kids later in their lives. A little bit of prevention now can make a big impact later.

Ask your provider if your child is ready for the vaccine.

photo of doctor Jennifer Arnhold


About the Author: Jennifer Arnhold, M.D., enjoys spoiling her son, Ty, and poodle, Andy. Her hobbies include cooking, yoga and reading. She graduated from medical school in 2000 and performs gynecology and gynecological surgery at Tri-County Health Care in Wadena. You can also see her for outpatient appointments at Embrace Women’s Health Clinic in Baxter.

Verti-“go” away!

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You’re lying in bed awaiting the buzz of your alarm. When it finally sounds, you peel back the comforter, drape your legs over the side and sit up.

Bam! Your eyes start spinning, the room whirls and you feel as though you might topple over. In a few moments, the abrupt sensation fades, but the sense of unease remains.


When the world keeps spinning

If you’ve experienced this scenario or others like it, you might have what’s called benign paroxysmal positional vertigo or, simply put, positional vertigo. It’s caused when tiny, gravity-sensing Vertigo - Head Positioning 1crystals in your ear break loose and fall into the canals of your inner ear, which control your balance. These crystals start interrupting signals and send the wrong input to your brain, making you hypersensitive to movement.

Symptoms include dizziness associated with movement, nausea, vomiting, loss of balance and the feeling that your surroundings are spinning. It can occur at any age but is more common in adults older than 40. Though symptoms typically don’t last too long for each episode, they can hit you hard and fast.

Joanne Lynk of Wadena knows exactly what that’s like. A couple months ago, she began experiencing positional vertigo symptoms. They were triggered by tilting her head back too far, sitting up after lying down or rolling over from her left side. She endured about a month of this until it gradually worsened.

“I would tilt my head back to put eye drops in, and that’s when it would hit so hard,” she said. “The room would just totally spin. I couldn’t sit still while upright. I would sway back and forth, side to side.”

After a particularly strong spell in the morning, Lynk visited ReadyCare at Tri-County Health Care, where she was given medication to stabilize her system and referred to Tri Rehab Services if her symptoms continued.

Lynk tried the medication but didn’t see results, so she decided to try rehab.


A fast solution

In physical therapy, positional vertigo is treated by gently moving the head through a variety of positions to coax the crystals into another part of your ear. This non-invasive treatment takes about 15 minutes, and for the rest of the day, patients are instructed not to bend over or lie down so that the crystals have a chance to stay in place. By the next day, most people feel back to normal.

Resting after vertigo treatment“Positional vertigo is one of the easiest things we can treat with physical therapy, and we can treat it so quickly,” said Tim Sly, physical therapist. “Usually with one to two treatments, it’s gone.”

However, not all vertigo is positional vertigo and could be caused by other factors, such as medications, brain injuries or blows to the head, so it’s important to have it diagnosed properly.

“If you’re dizzy all day long even when you’re not moving, that’s not positional vertigo,” Sly explained. “Positional vertigo is usually just brought on by certain movements. It comes in spells and goes away quickly.”

Following her first treatment, Lynk experienced immediate, positive results and was astonished to find her dizziness had vanished.

“I left there, and about a half hour later, I was thinking, ‘This is the most clear-headed I have felt in a long time. Have I just always been a little dizzy all the time?’” she recalled. “The next morning, I felt just as clear-headed and awesome as I did after the treatment. It was just amazing.”

Positional vertigo is incredibly common, and the physical therapists and physical therapist assistants at Tri Rehab Services want everyone to know that there is a fast solution, that you don’t have to endure this any longer.

“I see people almost every other week with vertigo. The key is not to suffer for months thinking it will go away,” Sly said. “Get to therapy because we can fix positional vertigo quickly and get you back to feeling your best.”

For more information or to see if physical therapy is right for you, click here or call 218-631-7475.

Benefits of exercising during pregnancy

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By Dawn Dahlgren-Roemmich, Certified Nurse Midwife


As a baby grows throughout a pregnancy, it’s beneficial for both mom and baby to find the optimal fetal position. This means that your baby is lined up correctly in your pelvis to promote an easier and more efficient birth. In order to move the baby, we need to move the mother. To achieve optimal fetal positioning, the mother needs to actively stretch and exercise during the prenatal timeframe and continue this into her labor and birth process.

Small group of early 30's pregnant women doing Pilates.They are sitting in a row,leaning over one leg with one elbow on the floor.Other arm is stretched over head and eyes are closed. The woman in focus is wearing blue sweat pant and red sleeveless tank top.

Exercise during pregnancy can include low-impact exercises like stretching, yoga, aerobics, walking and swimming. Partaking in these exercises for 20 to 30 minutes a day can help reduce backaches, constipation, bloating and swelling. It can also help prevent gestational diabetes; increase your energy; improve your mood and posture; and promote muscle tone, strength and endurance.


How to avoid injury

During pregnancy, your body makes a hormone called relaxin, which can cause the ligaments that support your joints to relax. This can put your joints at an increased risk of injury. Your center of gravity also shifts during pregnancy due to the extra weight gain, placing more stress on your joints and muscles. You may be more likely to lose your balance.

Your need for oxygen also increases when you are pregnant. As your belly grows, you can become short of breath, which can affect your ability to do strenuous exercise.

To decrease your risk of injury, avoid high-impact exercises, and make sure that you are doing exercises that are safe for pregnant women. Drink plenty of water before, during and after your workout to avoid dehydration. If you feel dizzy or fatigued, which are signs of dehydration, sit down and drink cool water.Pregnant woman exercising by walking and carrying a bottle of water.

Avoid standing or lying flat on your back for prolonged periods of time. When you lie on your back, your uterus presses on a large vein that returns blood to the heart. Standing motionless can cause blood to pool in your legs and feet. Both of these positions can decrease the amount of blood returning to your heart and may cause your blood pressure to decrease for a short time.

Do not exercise if you experience any of the following conditions until you have checked with your provider:

  • Vaginal bleeding
  • Feeling dizzy or faint
  • Shortness of breath before starting exercise
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Regular, painful contractions of the uterus
  • Fluid leaking from the vagina


You have options

Here at Tri-County Health Care, we offer two great low-impact exercise programs that are safe for pregnant mothers at no cost to you: Prenatal Yoga and Tri Aquatics Moms Course. I would highly recommend both classes to assist you with fetal positioning.

exercising pregnant moms in a warm water therapy pool.Prenatal Yoga is a weekly class at TCHC designed to reduce stress and anxiety while increasing your strength and flexibility. Tri Aquatics Moms Course is a quarterly class that educates expecting mothers on fitness including low-impact aerobic exercise with stretching, strengthening and range of motion activities for the entire body. Exercises are done in a warm water pool which helps to provide a reduction of pain associated with the later stages of pregnancy for expecting moms.

We also have a great rehabilitation department that can assist you with learning exercises that are safe for pregnant women and that can alleviate the discomforts of pregnancy. Click here to learn more about Tri Rehab Services.

To sign up for Prenatal Yoga or Tri Aquatics Moms Course, click here.

For more information about Midwifery Services, click here.


Dawn with her family posing for a family photo. About the Author: Dawn Dahlgren-Roemmich is board certified by the American College of Nurse-Midwives and takes a special interest in integrative medicine and water birth. She became a certified nurse midwife to empower women and to make the journey of pregnancy to birth a joyous event for the family. She and her husband have three daughters and one son. They also have a bunny, two border collies, three horses and a pony.

Winter blues or something more?

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By Rhoda Rees, FNP

Embrace Women’s Health Clinic, Baxter


It happens every year. The cold sets in, daylight grows shorter and snow flurries fly. Naturally, this change in seasons is commonly followed by a case of the winter blues. That’s completely normal. But what if your melancholy mood is more serious than it appears?Silhouette of sad teenage girl looking out the window on a cold autumn day

Depression is a prevalent issue in our society, and sometimes, it comes with a seasonal element. Seasonal affective disorder (SAD) is a type of depression that occurs when fall and winter arrive and then resolves in the spring and summer. Left untreated, this cycle can recur every year, repeating over and over.


How do I tell the difference between SAD and winter blues?

Symptoms of winter blues are typically short-lived. Everyone is allowed a little slump during the winter doldrums, but if you feel down and out for longer than two weeks, your affliction may be more serious.

SAD symptoms include:

  • Irritability
  • Sleep problems
  • Change in appetite
  • Fatigue
  • Loss of energy
  • No interest in activities
  • Feelings of guilt or worthlessness
  • Thoughts of suicide

You might also be more at risk for SAD if you’ve experienced any form of depression or mood disorder in the past or if you have a family history of the disorder.

If you think you might be suffering from SAD, it’s important that you make an appointment to see your provider. An assessment, questionnaire and family history will help determine your diagnosis.


Can it be treated?

Treatment depends on severity. For a mild case, and if you are willing to change habits, then lifestyle alterations can be a solution. This includes a healthy diet, regular exercise and an adequate amount of sleep.

Melting snowman on the warm rainy day in the middle of January winter weather.Pursuing outside activities during the day can also be a major help. They get you out and moving around, which is a benefit to serotonin, your happy hormone. You also get a good dose of fresh air and natural light to help keep your internal clock in check.

You may experience barriers at first, so what’s it going to take to get you outside? If you aren’t motivated to try full-on exercise, would you go for a walk? Then maybe you could take it a step further by cross-country skiing or ice skating. The key is finding something outside that you would be willing to pursue.

For more severe cases of SAD, depression medication may be needed. Another option is light therapy. This involves a special red light that gives off UV rays to replenish your vitamin D supply, which decreases your risk of health conditions. Using light therapy for even one hour a day can improve symptoms. You could also ask your provider about vitamin D supplements.

Hundreds of patients every year come in with SAD, so if you receive this diagnosis, you are among a large group who have gone before you and emerged successfully. By being proactive, you and your provider can identify your barriers and develop a treatment plan to reduce symptoms and help you enjoy the winter.


About the Author: Rhoda Rees is a family nurse practitioner at Embrace Women’s Health Clinic in Baxter. She is board certified through the American Nurses Credentialing Center. Women’s health is her specialty and her passion, and she loves helping patients make educated decisions that positively impact their health.

Blend coconut and almonds in tasty holiday treats

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By Shelby Hunke, Registered Dietitian


Coconut and almonds are two staples in today’s household, whether using them to cook with, snack on or enrich your beauty regime. Coconut is rich in fiber, calcium and magnesium, and almonds are full of protein, iron and vitamin E. Together, they pack quite a wallop.

Let’s take it up a notch and add this healthy combo to something sweet and sugary in celebration of the holidays. Here are a couple recipes from two of my favorite health food magazines.

Merry Christmas and Happy New Year!


Coconut Almond PizzellesYoung woman holding Italian cookies

Today’s Dietitian Magazine Nov. 2017 issue

Serves 30


3 large eggs

1/2 cup granulated sugar

1/2 cup coconut oil, melted and cooled

1 1/2 tsp. anise extract

1 tsp. vanilla extract

1 cup almond flour

1 cup all-purpose flour

2 tsp. baking powder

1/8 tsp. ground cinnamon



Lightly oil or coat the pizzelle iron with nonstick cooking spray and plug it in to preheat.

Combine eggs and sugar in a medium bowl and beat on medium speed or whisk by hand until well blended. Add the coconut oil, anise and vanilla and beat until blended. Scrape down the sides of the bowl if necessary.

In a separate bowl, whisk together the almond flour, flour, baking powder and cinnamon.

At a slow speed, gradually beat the flour mixture into the liquid mixture until just combined.

Place one heaping teaspoon at a time in the center of each of the grids of the pizzelle iron and clamp the handles together with the handle clamp.

Cook for about 40 seconds until the cookie is lightly browned. Remove with a spatula and transfer to a wire rack to cool.


Nutrition per serving (1 cookie): Calories 90; Total Fat 6 g; Sat. Fat 3.5 g; Cholesterol 25 mg; Sodium 8 mg; Total Carbohydrate 8 g; Dietary Fiber 1 g; Sugars 4 g; Protein 2 g


For the full article, click here.


Coconut Almond Truffles

Developed by Noora Mousa, RDNchocolate truffles sprinkled with cocoa powder close-up on the table. horizontal

Food & Nutrition Magazine Nov./Dec. 2017 issue


Servings: 14



1/3 cup raw almonds

1 cup dark chocolate morsels

1 cup shredded sweetened coconut

1/2 cup (120 milliliters) canned coconut milk

1/4 cup unsweetened cocoa powder


To read or print the full Coconut Almond Truffles recipe, click here.


Hunke FamilyAbout the Author: Shelby Hunke is a registered dietitian working at Tri-County Health Care in the hospital and clinic. She has a degree in exercise science and a passion for helping patients live a healthy lifestyle. She lives in Wadena with her husband, Paul, and three kids, Madison, Jackson and Conor. In her spare time, she enjoys family time, running and the outdoors!

When the holidays get you down

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By Andrea Craig, Psychiatric Mental Health Nurse Practitioner


The holidays aren’t always the most wonderful time of the year. In fact, many people I have seen in my practice over the years feel particularly disheartened or resentful of the holidays.

There’s no right way to feel during this time of year, but the pressure to feel joy and happiness can be especially discouraging. Many factors contribute to these emotions, such as finances, loneliness, and grief, but there are solutions for each of these.


For those on a budgetFrustrated dad looking at receipts and bills during Christmas time

One of the biggest causes of depression around the holidays that I see is finances. In today’s consumer-centric world, there’s heavy pressure on people to spend lots of money and to buy lots of gifts. As a result, many people feel guilty for not being able to afford gifts, parents and grandparents especially.

Despite what mainstream society wants us to think, I believe that there’s more to the holidays than giving and receiving gifts, and this time of year can be enjoyed without spending heaps of money.

If you don’t have the funds to buy gifts, first try giving the gift of time. Make a point to spend time with people. In fact, this gift may be more cherished than a new toy in the long run.

Here are some other ideas to keep the holiday expenses low:

  • Drive around town to look at lights.
  • Bake cookies.
  • Watch a movie on TV and have a cup of hot chocolate.
  • Play a board game while listening to Christmas music.
  • Only do stocking stuffers.
  • Go skating or sledding.
  • Get involved in community events, such as visiting Santa Claus or lighting ceremonies.
  • Find creative projects to make with materials found around the house.
  • Buy a few inexpensive gifts and play a game when opening them.
  • Write friends and family a personalized letter instead of getting gifts.
  • Give handmade gifts.
  • Sell old toys or clothes in order to buy new ones.
  • Volunteer for others in need.


A Caucasian woman is indoors in her living room. There is a Christmas tree in the background.

For those who are lonely

Another cause of sadness around the holidays is not having anyone to spend time with. This is especially difficult if you see other people celebrating together.

Because it’s supposed to be such a happy time of year, if you don’t feel any of that joy due to loneliness, it intensifies your negative feelings.

If you’re feeling up to it, try some of these methods to combat loneliness:

  • See what’s available in the community in terms of activities or celebrations.
  • Get involved in a local church. Even if you don’t share the faith, churches can offer other solutions in terms of companionship and feeling involved.
  • Seek out others around you who are in a similar circumstance. Though it may not feel like it, there are many others who are experiencing what you are.
  • Volunteer. This can take your mind off of loneliness by focusing on the needs of others.


For those who are grieving

Sometimes, the holidays bring up past feelings of grief or intensify new ones. This is especially hard during the first year and the first holiday.

A Depressed adult male looks out a window past christmas decorations with christmas lights in the background.Instead of trying to suppress thoughts of your loved one during the holidays, I encourage you to embrace those thoughts.

Try starting a new tradition in memory of that person. For instance, purchase an ornament in honor of that person to hang on the tree. Share stories about them to make them a special part of the holiday. Include their favorite foods in the holiday menu.

This might make you feel guilty about enjoying the holiday without your loved one. I just want you to know that it’s OK to celebrate the holiday and to feel happiness. But it’s also OK if you don’t feel like celebrating.

For those spending time with a grieving individual, ask how you can best support them, and try to make things less stressful, perhaps by taking care of the meal or hosting. Some people would feel better by not participating in the holiday at all, and that’s OK. It’s just important to give this individual the chance to say yes or no.


About the Author: Andrea Craig works in behavioral health at Tri-County Health Care and is board certified as a psychiatric mental health nurse practitioner. She is a graduate of the College of St. Scholastica in Duluth.

Why should you get the flu vaccine?

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By Ben Hess, M.D., Chief Medical Officer


As we look ahead to peak influenza season in Minnesota, now is a good time to consider getting your annual flu vaccine. The vaccine is absolutely safe and can protect you from contracting the virus and suffering severe symptoms that can put you down and out for one to two weeks.


Cold and Flu Season Street SignAbout this year’s vaccine

This year’s vaccine contains four strains of influenza, including H1N1 or swine flu. The strains included in the vaccine change every year based on extensive research and well-documented flu migration patterns in other parts of the world.

On average, about once every seven years, there is a bad match or the virus changes from the time of production to when flu season actually arrives. This is why the vaccine is not very effective some years.

In the U.S., the peak flu season is approximately November to February. However, in Minnesota, the peak is from January to February. The virus typically affects coastal states and large metro areas first, which is why I recommend that snowbirds and those who travel get their vaccinations early.

Check out this map that shows the steady progression of the virus.


Feeling sick after getting the vaccine?

One argument I commonly hear for why people opt out of the flu vaccine is they are worried they will get the flu from the vaccine. Here are some important things to consider:

Dead virus. The flu vaccine that we give here at TCHC is a dead virus. You would never get the flu from this vaccine.

Delayed effect. The vaccine takes about two weeks to become fully effective. It is possible to contract the flu in this time period, which is why it’s important to get the vaccine early.Sick woman sneezing to tissue. Medicine, hot beverage and dirty paper towels in front. Girl caught cold. Cough syrup and handkerchiefs on table. Very ill person feeling bad and having fever.

Specific strains. The vaccine contains specific strains of the flu that researchers believe will be most prevalent during the current season. It is possible to contract a strain that is not included in the vaccine.

No response. A certain percentage of people simply don’t respond to the vaccine. The reasons are unclear, and because the vaccine changes every year, it is hard to research.

Already infected. The flu has an incubation period of up to four days. If you were already infected with the flu before you get the vaccine, then the vaccine will be ineffective.

Immune response. It is possible to have an immune response to the vaccine, which can give you muscle aches and pains or a mild fever for two to three days. This is reassuring because it means your immune system is responding to the vaccine and you are likely more protected from the flu.


Influenza – a serious illness

Influenza is extremely contagious and is spread through droplets when people talk, sneeze or cough. Typical symptoms last about one week and include high fever, muscle aches, upper respiratory infection and fatigue. Most people will experience weakness and fatigue for another one to two weeks after the actual illness.

Those most at risk are the elderly, people with weakened immune systems and children, especially infants younger than 6 months old because they can’t be vaccinated.

Flu vaccine calendar noteTo a certain extent, the younger you are, the more severe your reaction will be. Most symptoms that come from the flu are caused by your immune system, so the healthier your immune system, the potentially more severe your symptoms will be.

If you come down with the flu, your best course of action is to stay home from work or school, drink plenty of fluids, get lots of rest, and take anti-inflammatory medications such as Ibuprofen or Aleve.

The flu is also a fairly significant cause of mortality in the U.S. From the 1976-1977 season to 2006-2007 season, flu-associated deaths ranged from as low as 3,000 to as high as 49,000 annually, according to the CDC’s Morbidity and Mortality Weekly Report.

Because the severity of the virus is unpredictable, I highly recommend getting the vaccine as soon as is convenient for you. By doing so, you potentially avoid illness for yourself while ultimately preventing the spread to vulnerable individuals.


For additional information about influenza, visit www.cdc.gov.


About the Author: A board-certified family practitioner and Chief Medical Officer at Tri-County Health Care, Ben Hess, M.D., was inspired to study medicine because he wanted to make a difference in people’s lives every day. While not at work, Hess enjoys hunting, fishing, bowling and listening to public radio. He and his wife have three daughters and make their home in Verndale.Dr. Hess

What in the world is GERD Awareness Month?

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By David Kloss, M.D., FACS

Gastroesophageal reflux disease (GERD) Vector graphic illustration.

Did you know that November is GERD Awareness Month? What in the world is that?! Is that like “left-handed Great Aunt Awareness Month”?? Did Hallmark cards make this up? Or perhaps the florists invented GERD Awareness Month, hoping you’d send roses to your best friend who has been complaining bitterly over the lunch hour about their reflux.

Well, I’m not buying a GERD card from Hallmark, and I haven’t seen a sign in front of the florist’s shop yet.

“GERD,” or acid reflux, acid indigestion and esophagitis, is a common problem in America. Thirty to 40 MILLION people suffer from acid reflux. To me, every DAY is GERD awareness. I see three or four GERD patients a day in my surgical practice. So why is it such a big deal?

People who suffer nighttime reflux can’t sleep flat in bed. Spouses have to listen to their partner coughing or vomiting all night long from acid regurgitation. People can’t enjoy a mild salsa on their taco because they get acid reflux. People who have had acid reflux for 20 years might have narrowing at the end of their esophagus from the acid burning their throat and can’t swallow a piece of steak or chicken.

GERD - Linx Patient visiting with the doctor.How many of you reading this are nodding your heads “yes”? Perhaps you know someone who suffers from these issues or you have acid reflux yourself! Many Americans are already taking Prilosec or Zantac (have you seen the commercials on TV?). The antacid pharmaceutical business brings in BIG money!

There certainly are other medical issues that are perhaps more serious and have more life-threatening consequences, but constant acid reflux, or GERD, is no joke. It can cause a narrowing of the esophagus as I mentioned above, it can (rarely) cause cancer, the pills can upset your metabolism and cause thinning of your bones and increases the risk of kidney injury. Acid reflux can cause asthma and/or constant coughing. The burning sensation in the esophagus can cause chest pain, mimicking a heart attack or gallbladder issues. The constant vomiting, food coming back up or burning can interfere with work.

So GERD Awareness Month is also the month where I can make you aware that YOU DON’T HAVE TO SUFFER! A fairly new surgery called LINX is very successful CURING reflux, not just “putting a Band-Aid” over the symptoms like the pills do.GERD - LINX Quarter comparison of the size of the device used to cure acid reflux.

At Tri-County Health Care, we have performed 18 LINX surgeries in the last year, and 100 percent of our patients are off their heartburn pills. The patients are eating Mexican food and sleeping flat in bed with their spouse again! This surgery is highly effective and has significantly fewer side effects than the old Nissen fundoplication surgery that was done 30 years ago. With LINX, we can fix the associated hiatal hernia and put in a small magnetic device to prevent acid reflux. This is all done telescopically with no big incisions and no extended downtime from work. It is outpatient surgery!

So come talk to me now that you are “aware” that November is GERD Awareness Month. I can explain how we evaluate acid reflux, we can go over the symptoms you are having, and we can see if you might be a candidate to cure your acid indigestion!


For more information on LINX or to schedule a consultation, call 218-631-7581 or visit TCHC.org/LINX.


GERD/LINX surgeon, David Kloss.About the Author: Dr. Kloss is a board-certified general surgeon at Tri-County Health Care. In his free time, Dr. Kloss is an avid marathon runner. His race résumé includes the Marine Corps Marathon in Washington, D.C., as well as marathons in Dublin, Ireland; Paris, France; and Pittsburgh. He also ran the Twin Cities Marathon for the Leukemia and Lymphoma Society and the New York City marathon for the American Cancer Society. Dr. Kloss also earned Ironman status, having completed the Madison, Wisconsin, Ironman race in 2014. All this running helps Dr. Kloss control his weight so he can eat cookies WHENEVER he wants.