Common questions about urology at TCHC

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By Eric Chapman, D.O.

Urological issues can affect your everyday quality of life, which is why TCHC welcomes three visiting urologists through a partnership with Essentia Health in Brainerd. Drs. Eric Chapman, Scott Wheeler and Bradley Qualey visit four days per month to offer local care.

Sometimes, urological issues are confusing or sensitive, especially in children. To help clarify this topic, Dr. Chapman addressed some common questions related to urology.


A medical doctor explaining urological problems to a patient.Why did you choose the field of urology?

I was interested in a surgical specialty, and urology has a wide spectrum of procedures and allows me to see both male and female patients of all ages.

A lot of what we treat medically and surgically are quality-of-life issues. I enjoy all of those procedures because you have the opportunity to improve someone’s life.


How does the TCHC/Essentia partnership function?

As a team, the three of us rotate at TCHC four days per month on Wednesdays and Thursdays. Because our schedules are spread out, we work together to make sure patients with urgent issues get timely and appropriate care. For example, if a patient sees Dr. Qualey and needs a biopsy, Dr. Wheeler or I could perform the biopsy in a timely manner rather than make that patient wait.

What do you bring to TCHC with this partnership?

We allow patients to receive all of their urological care locally rather than requiring them to drive to Brainerd or St. Cloud. We’re providing surgical care here that wasn’t offered in the past, with the exception of robotic-assisted surgery or surgeries that require post-operative care.


Why is it important to offer urological services for children, especially in a rural area?

If it is available locally, then parents may be more likely to seek care because they don’t have to worry about the travel. It can be difficult with kids, particularly in school, to make appointments in St. Cloud or the Cities. By providing care locally, hopefully more children will be seen.


How common are urological issues in children?

There aren’t many urological emergencies in kids, but we do see many who have a congenital defect in their kidneys or testicles. Bedwetting and urinary tract infections are most common. Most children will outgrow bedwetting, but there can be neurological or anatomical problems that cause bedwetting. If there isn’t a correctable cause, we can offer tips and medicines until they grow out of it.

Little girl with teddy bear visiting doctorWhen should parents seek urological care for their child?

If there is ever testicular pain, bring your child in because it could indicate an emergency. Urinary tract infections in boys or urinary tract infections that are accompanied by a fever are concerning and can be caused by anatomical abnormalities. When it comes to bedwetting, it’s at the parents’ discretion, but typically if they’re 5 or older and continue to wet the bed, we may want to offer treatment.


How do you help a child feel comfortable during a clinic visit?

Sometimes, I leave my white coat in my office and introduce myself by my first name. I try to speak at their level and ask them questions about sports and school. This helps them relax before we start talking about why they’re there.


What should people know about urological issues?

It’s never normal to see blood in your urine. Even if it’s just once and it goes away, that’s never normal. We have had quite a few patients who come in for blood in the urine and they say, “This happened a year ago, but it went away, so I never went in.” It could be due to a serious illness.


What would you say to people who are afraid to seek care because of the sensitive nature?

I empathize with that. I would just want them to know that this is what we’re here for. This is what we do every single day, and we certainly wouldn’t pass judgment for any reason. We’re here for you, and if you can muster up the strength to come in, then you won’t be judged by us.


For more information about urology or a list of the services offered at TCHC, click here.


Photo of Eric Chapman, urologist at TCHCAbout the Author: Eric Chapman, D.O., is a board-certified urologist at Essentia Health in Brainerd and provides urological services at TCHC. In his free time, he enjoys mountain biking, snowboarding and spending time with his son.

Stop the bleeding, save lives

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By Mike Ittner, NR, Paramedic, TCHC Emergency Preparedness Coordinator

Did you know that when injuries occur during emergencies and man-made and natural disasters, major bleeding is the second-leading cause of death?

photo of the TCHC EMS team standing in front of a TCHC ambulanceWith this in mind, TCHC’s Emergency Medical Service (EMS) is joining a national Stop the Bleed campaign to raise awareness and prepare the public for cases of major bleeding.

Free resources

TCHC EMS is championing this campaign in Wadena, Todd and Otter Tail counties by offering free Stop the Bleed kits and free education to anyone in the tri-county area who needs it.

Each Stop the Bleed kit has gloves, absorbent gauze and tourniquets, as well as a flyer containing first aid tips. When we deliver the kit, we will provide free training on how to use the items and the best methods for controlling bleeding. One of our main goals is to put a Stop the Bleed kit wherever there is an AED, but anyone with a need is welcome to request one.

You can make a difference

Victims of a massive bleed can die within five to 10 minutes if it isn’t controlled. Serious bleeding could be caused by a number of incidents, including falls, shop accidents, car crashes and man-made or natural disasters.

One of the core components of the Stop the Bleed campaign is to educate potential bystanders. Despite how quickly emergency responders arrive, witnesses are always the first people at a scene, so their quick action could be the difference between life and death for a victim.

The more blood we keep in the body, the better chance a person has of surviving. Our free kits allow bystanders to immediately begin life-saving measures by controlling a bleed until emergency responders arrive. Anyone can save lives if they know what to of the actual stop the bleed kit

Increasing safety

This Stop the Bleed campaign will help us further increase safety for the public, and we hope community members will take advantage of these free kits and training.

I want to give a huge thank you to the local VFW, American Legion, Lions, Elks, St. Helen’s Episcopal Church, First Congregational United Church of Christ Lamson fund and the Tri-County Health Care Foundation, all of whom donated funds to make our Stop the Bleed kits possible.

To request a Stop the Bleed kit, give me a call at 218-631-7464.

Stop the Bleed is a national campaign started by a workgroup of The White House National Security Council.

For more information, visit


photo of Mike Ittner, EMS managerAbout the Author: Mike Ittner, a retired member of the U.S. Armed Forces, is currently the EMS manager. He received his EMT training from Tri-County EMS, completed his paramedic training and has been associated with Tri-County EMS for seven years.

Matthew’s journey with diabetes

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By Matthew Van Bruggen, TCHC Board of Directors


November is American Diabetes Month.

Diabetes is an autoimmune disease that causes your pancreas to reduce or stop producing insulin, a hormone that regulates the amount of glucose in the blood and related blood-sugar levels. I am one of the approximately 3 million Americans who have type 1 diabetes.

There are two types. With type 1, your pancreas shuts down and stops producing insulin. With type 2, your pancreas still functions but doesn’t make enough insulin.

I grew up in Wadena and moved back here in 2004 with my beautiful wife, Shanna. We have four children, all of whom were born at TCHC.

Chance diagnosis

I was a 21-year-old college student at the University of South Dakota when I first learned I had diabetes. Some friends and I went for ice cream, and one of my friends, who had type 1 diabetes, decided to check my blood sugar for fun. My blood sugar turned out to be higher than normal.

I soon learned I also had type 1 diabetes. It was surreal, as I had not had any health problems. I decided that I would make the most of the diagnosis and embrace the lifestyle changes that I would face through education, healthy eating and exercise.

Daily life

My day starts and ends no different than most people. However, in between, it involves checking my blood sugar four to six times a day by pricking my finger and ensuring my blood sugar levels are controlled. I wear an insulin pump, which administers insulin. Based on what I eat, I have to take additional insulin.Close-up Of Person Hands Holding Glucometer At Desk

Living with diabetes is not without challenges. If I don’t take enough insulin, my blood sugar rises and could cause a condition known as ketoacidosis where I can get really sick. If my blood sugar gets too low, I can get lightheaded and shaky.

One thing that helps me control my diabetes is diet. Fortunately, my wife is a trained chef and is passionate about creating healthy recipes for our family that also support a type 1 diabetic lifestyle. We also stay physically active, and combined with diet, these are the two ways I can control my diabetes.

Despite the challenges of diabetes, it’s a disease that you can manage and allows you to live a normal life with lifestyle changes including diet and exercise. The more you do those, the less insulin you’re going to use and the healthier you’ll be.

More awareness, more research

Many autoimmune diseases, not just diabetes, are prevalent in today’s society, which have led to more awareness and more research.

I believe that the research being done will result in a “cure” for type I diabetes in my lifetime. The technology for living with diabetes has improved dramatically since I was diagnosed.

If you receive a diabetes diagnosis, learn as much as possible because it’s going to change your life. You should also understand that it’s not a terminal diagnosis. Both type 1 and 2 are chronic, but they can be managed with lifestyle changes. You can live a very normal life. Just stay positive.

Resources close to home

Tri-County Health Care has come a long way in the past decade with diabetes awareness and the ability to serve our patients. We have a great diabetes education program with knowledgeable educators who are willing to go above and beyond for our patients.

We treat diabetic patients, and if there’s ever a situation where our providers don’t have an answer, they know where to find it. I visited an endocrinologist in Minneapolis for many years but now feel more comfortable treating with Dr. John Pate instead. The care he provides me is exemplary.

Anyone who has diabetes or who is interested in learning more about diabetes is welcome to attend TCHC’s Diabetes Support Group, which meets the third Wednesday of each month at 10 a.m. at the Maslowski Wellness and Research Center in Wadena.

For more information about diabetes, call the TCHC Diabetes Education Department at 218-632-7113 or click here.


Matt and his family posing for a photo by the lake.

Matt with his wife, Shanna, and their four children.

About the Author: Matthew Van Bruggen is married to Shanna, and they have four children, Ava, 11; Jack, 9; Theo, 2; and Vivian, 1. He has served on the TCHC Board of Directors since 2010. He is a practicing attorney, a youth hockey coach and an avid sports fan of the Minnesota Vikings and Minnesota Wild.  He also enjoys spending time with his family and enjoying many of the year-round outdoor activities Minnesota has to offer.

Pregnancy and infant loss: through the lens of a doctor’s practice

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By Beth Helgerson, M.D., OB/GYN


This is a tough subject. Losing a baby, losing a pregnancy – it’s life-changing. Even though it’s not always talked about, it’s very real and very painful to mothers and their families.

We’re in the midst of Pregnancy and Infant Loss Awareness Month, a fitting opportunity for me to express thoughts and emotions I’ve seen throughout my practice.

A mother and father holding the hat of a premature baby.There’s not always a reason

Early pregnancy loss is quite common, according to some sources. But we don’t always know when it happens because it might manifest as a late heavy cycle. We aren’t always aware of the reason for early loss, but it’s often due to abnormal chromosome numbers in the fetus.

Mid to late pregnancy loss is far less common. Again, we don’t always have answers. Causes could include abnormal chromosomes, prematurity, genetic/structural makeup, uterine or cervical issues, or poorly controlled medical illness in the mother.

Because we’re not always sure what causes pregnancy loss, it’s important to do everything you can to be healthy if you’re looking forward to motherhood. That might mean taking care of diabetes or hypertension, being in good shape, taking vitamins, maintaining a healthy weight – all before you get pregnant.

Strong support mends broken hearts

Grief is hard enough, but when I talk to women who lose a pregnancy, they share that they feel even worse based on what their friends and other people have said.

People mean well. They don’t mean to cause pain. But phrases such as, “You’ll have another baby” or “Thank goodness you have another baby at home,” contribute to grief. Almost every woman tells me a story of how she was made to feel worse because of well-meaning words, and that stays with her.

If you know someone who has had a pregnancy or infant loss, it’s OK not to say anything. You don’t have to offer advice in hopes of cheering her up. More often than not, it has the opposite effect. It’s OK to simply give her a hug.

If you have experienced a loss and have been hurt by someone’s words, know that there is a place that can help. You can find solace in a support group, where you’ll meet people who are dealing with their own losses. It will show you that you’re not alone, that somebody there has gone through this successfully and wants to help. Lots of candles on dark background

Children are always remembered

While it’s true that time helps with grief, a part of us never lets go of that grief. When I speak to elderly women and ask about their life history, they often want to discuss their own pregnancy and infant losses.

One woman in her 80s described it as always being painful, that it’s been painful for 60 years. Yet, she’s glad that it brings her pain. Not that she enjoys that pain, but it reminds her that her child is never forgotten.

Her sentiments struck me as beautiful and profound. It’s a viewpoint we don’t often hear, and I think it’s important. I’ve shared these thoughts with young women who are experiencing loss right now. While it might not bring them relief, it makes sense to them and, in a way, helps them feel connected to other mothers in their grief and remembrance.

TCHC offers two support groups that might help: Grief Support Group and Parents Who Have Lost a Child Support Group. For more information, call 218-631-5228 or click here.


Beth Helgerson Professional PhotoAbout the Author: Dr. Beth Helgerson specializes in general obstetrics and gynecology, offering women individualized care and surgical procedures. Dr. Helgerson enjoys spending her days off experimenting with new recipes or, even better, finding new restaurants to try. She and her husband have two grown daughters.

Biopsies and 3-D mammography: more accuracy for better outcomes

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3-D Mammography – Dr. Gerald McCullough

The technology used in diagnostic imaging is constantly changing and improving, and TCHC remains at the front of these advancements.

A little over a year ago, we were one of the first in the region to get the capability to perform 3-D mammography. For years, we’ve done 2-D mammography, where the image of a breast is Happy breast cancer survivors supporting each othercompressed into one flat image. With 3-D mammography, we can take a picture of a breast and split it into dozens of 1 mm slices, like a loaf of bread.

This separates each image so you can look at it one slice at a time. If I see a nodule, I can scroll straight to it and see whether or not it has characteristics that are suspicious.

The biggest thing about 3-D mammography is increased accuracy. Sometimes we biopsy areas that are normal because they didn’t look normal, but 3-D allows us a better look at slight changes in the breast so we can reduce the number of false positive biopsies.

When you come in for a mammogram, there are two kinds you might receive. Screening mammograms test a healthy population for disease. It’s been shown that by screening for breast cancer, you increase survival, you increase detection and you promote better health. Diagnostic mammograms are performed if the doctor or the patient feels a lump or if we suspect that something’s not right.A Mammogram image showing left and right breasts.

No matter which type you receive, everyone who gets a mammogram at TCHC gets both a 2-D and 3-D. They are done with the same machine and in the same visit and take five to 10 minutes. The use of this technology, along with regular screening, is very important because you can get a clearer picture of the breast, intervene earlier and have better outcomes.

There may come a day when 3-D mammography becomes standard across the board. The great part is that it is already standard at TCHC so that we can give you more accurate results and peace of mind.

Stereotactic Breast Biopsy – Dr. David Kloss

Sometimes technology comes along and it is a flop (think 3-D TV viewing with those stupid, awkward goggles or think Google glasses).

But once in a while, the engineers get it right, and that new piece of technology REALLY delivers a radically new product or a dramatically better result. Stereotactic breast biopsy is one of those new technologies that REALLY delivered a radically new and improved result!

Nurse with a young woman having a mammogram. Dr. McCullough has described how helpful the 3-D mammography is at picking up very small, subtle changes in the breast. Eight out of 10 times, these little areas are NOT cancerous. But patients and doctors like to know for sure that these mammographic spots are benign (not cancerous).

Fifteen years ago, a small area in the breast that needed a biopsy to prove it was benign required a big, expensive operation; this resulted in a large scar, pain and time away from work.

For the last 18 months, the specialists at TCHC have been using the latest in computer technology combined with the newest mammogram machine to biopsy these tiny little areas. Rather than a trip through same-day surgery with a large scar, these biopsies are completed through a 3 mm (1/5 of an inch) incision under local anesthesia. The ENTIRE biopsy takes 15 minutes. The patients can drive themselves home!

Most often, these biopsies are benign and then the patient has the satisfaction of knowing that everything is OK! In the less common event that the biopsy returns suspicious or cancerous cells, I can sit down and talk to the patient and family members to discuss the current options of surgical management. This usually includes a “lumpectomy” (otherwise known as breast conserving therapy), sentinel lymph node biopsy (another minimally invasive biopsy technique) and then followed by radiation therapy.

With the help of this new, minimally invasive technology, the doctors at TCHC can deliver quicker, more effective care to you. We still deliver good ol’ fashioned hometown care, but with this new technology, the patient is even BETTER cared for!



About Dr. McCullough: Dr. McCullough is a radiologist at Wadena Clinic. He graduated from the University of Minnesota School of Medicine in Minneapolis and completed his residency at the University of Minnesota. In his spare time, he enjoys fishing and deer hunting.

About Dr. Kloss: 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.

Fire Prevention Week: when the smoke alarm sounds

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Consider this scenario: It’s 2 a.m. You and your family are fast asleep when you awaken to the smoke alarm sounding and the smell of smoke. What do you do? If you and your family don’t have a fire escape plan in place, it could jeopardize your safety or even prove of a wood framed home with heavy fire showing on floor number 3

In a typical home fire, you may have as little as one to two minutes to escape safely from the time the smoke alarm sounds. That’s why home escape planning is so critical in a fire situation. It ensures that everyone in the household knows how to use that small window of time wisely.

This year’s Fire Prevention Week theme, “Every Second Counts: Plan 2 Ways Out,” works to better educate the public about the critical importance of developing a home escape plan and practicing it. Fire Prevention Week is October 8-14, 2017.

In support of Fire Prevention Week, Tri-County Health Care encourages all families to develop a plan together and practice it.

Safety Tips

  • MAKE a home escape plan. Draw a map of your home showing all doors and windows. Discuss the plan with everyone in your home.
  • KNOW at least two ways out of every room, if possible. Make sure all doors and windows leading outside open easily.
  • HAVE an outside meeting place (like a tree, light pole or mailbox) a safe distance from the home where everyone should meet.
  • PRACTICE your home fire drill at night and during the day with everyone in your home, twice a year.
  • PRACTICE using different ways out.
  • TEACH children how to escape on their own in case you can’t help them.
  • CLOSE doors behind you as you leave.

If the Alarm Sounds

  • If the smoke alarm sounds, GET OUT AND STAY OUT. Never go back inside for people or pets.
  • If you have to escape through smoke, GET LOW AND GO under the smoke to your way out.
  • CALL the fire department from outside your home.

safety tips for having Halloween jack lanternsHalloween Fire Safety Tips

Halloween is a fun and spooky time of year for kids, and it’s just around the corner. Make trick-or-treating safe for your little monsters with a few easy safety tips.

  • When choosing a costume, stay away from long trailing fabric. If your child is wearing a mask, make sure the eye holes are large enough so he or she can see.
  • Provide children with flashlights to carry for lighting or glow sticks as part of their costume.
  • Dried flowers, cornstalks and crepe paper catch fire easily. Keep all decorations away from open flames and other heat sources like light bulbs and heaters.
  • Use a battery-operated candle or glow-stick in jack-o’-lanterns. If you use a real candle, use extreme caution. Make sure children are watched at all times when candles are lit. When lighting candles inside jack-o’-lanterns, use long, fireplace-style matches or a utility lighter. Be sure to place lit pumpkins well away from anything that can burn and far enough out of the way of trick-or-treaters, doorsteps, walkways and yards.
  • Remember to keep exits clear of decorations so nothing blocks escape routes.
  • Make sure all smoke alarms in the home are working.
  • Tell children to stay away from open flames, including jack-o’-lanterns with candles in them. Be sure they know how to stop, drop and roll if their clothing catches fire.


Reproduced from NFPA’s website, © NFPA

Ann’s breast cancer journey: early detection is key

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By Jessica Sly, Communications Specialist


One year. That’s how long Ann Immonen has been on her breast cancer journey. It taught her much about her own strength and the strength of family and friends. It also taught her that early detection is key to breast cancer survival.

A picture of Ann with her Coworkers

Ann and her TCHC co-workers.

Late in October 2016, Ann went in for her annual mammogram, utilizing the new 3-D technology at TCHC. Just a year earlier, she had been cleared with a normal mammogram. This one, however, revealed concerning lumps that doctors determined needed further investigation.

Following a diagnostic ultrasound on Oct. 31 and needle-guided biopsy on Nov. 9, the diagnosis came back positive. She had breast cancer.

“Maybe because of my health care background, I really never cried about my diagnosis,” she said. “I was just thankful for the early detection because they have come a long way with breast cancer treatment.”

Then came a choice: to undergo a mastectomy or not. The knowledge of her medical history helped her decide. When Ann’s mother was diagnosed with breast cancer, she chose a single mastectomy but experienced recurrence in her other breast. So Ann opted for a bilateral mastectomy.

Chemotherapy began the first week of January. Because of debilitating side effects – nausea, fatigue, hair loss – Ann was unable to work, but she is grateful for the amazing cancer care program at TCHC, which allowed her to receive chemo right in her hometown of Wadena.

Though wigs were an option, she chose instead to sport a fantastic array of hats and made sure to be open with her family about the changes.

“I was never uncomfortable not having hair. I loved hats and I wore them well, but I felt I needed to tell my grandchildren,” she said. “One of my grandsons told his mom, ‘Grandma took some medicine, and her hair popped out!’

Breast Cancer - Ann Ringing Bell

Ann ringing the bell after treatment.

“That’s what you do this for at this age,” she added. “You do it for your children and your grandchildren. They were amazing.”

Radiation started in May and continued through June, again causing more side effects. Finally, two weeks after the 25-day radiation treatment, Ann returned to work.

“It was amazing to be back around people again,” she said. “And I have gotten stronger and stronger and stronger.”

She will continue chemotherapy every three weeks through December, but the aggressive part of the medication is over, meaning her energy and her hair have returned.

Ann credits the support of her family, friends, church members and coworkers with keeping her spirits high.

“Faith, family and friends with a positive attitude can get you through anything,” Ann said. “That’s my motto.”

As she reflects on the past year and looks forward to the end of treatment, Ann’s message to other women is that screenings matter.

“The biggest thing is early detection,” she said. “It’s amazing how when you sit at a table with maybe six ladies, three have had biopsies and two of us were positive. It happens to people every day, but the biggest thing I can say is early detection.”


Ann with her Family at the Relay for Life.

About Ann: Ann Immonen and her husband, Eldon, live in Wadena and have two daughters and two grandchildren. She began working at Tri-County Hospital 39 years ago as an LPN. Over the years, she has worn different hats within Tri-County. Following a Type 1 diabetes diagnosis about five years ago, she transitioned to a part-time float nurse position in the Wadena Clinic.

What’s your risk of ovarian cancer?

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By Jennifer Arnhold, M.D.

As the fifth-leading cause of cancer deaths in women, ovarian cancer is an aggressive disease, and because of a lack of reliable screening, it often isn’t caught until later stages. This is why September is recognized as Ovarian Cancer Awareness Month.

Digital medical illustration: Perspective x-ray view of human ovum with tumor. Anatomically correct. Isolated on black.According to estimates from the American Cancer Society, about 22,440 women in the U.S. will be diagnosed with ovarian cancer in 2017, and about 14,080 will die from it.

Your lifetime risk of ovarian cancer without a gene mutation is about 1 in 75, and your lifetime chance of dying from it is about 1 in 100. Women with certain genetic mutations and a strong family history of breast and reproductive cancer are most at risk.

There is hope, however. Over the past 20 years, the diagnosis rate in women has been gradually declining. Prevention is the key to continuing this trend.

The exam

When a woman comes in for her annual physical or with ovarian concerns, her provider would take a thorough family history and possibly a pap smear (note that pap smears are not needed every year). A speculum exam to look at the vagina and cervix and a pelvic exam to feel the ovaries and uterus are also conducted.

If abnormal lumps on the ovaries are found, we order imaging such as a pelvic ultrasound or CT scan. A blood test that measures CA 125 might also be needed. CA 125 is a protein that collects in high concentration in tumor cells, especially ovarian cancer cells.

The blood test doesn’t provide a diagnosis, but if the numbers are elevated to a certain point, combined with abnormal imaging, it might lead us to believe that a tumor is cancerous.

Most of the time, tumors are benign, and that can be address and monitored. But if cancer is suspected, then patients are referred to a GYN oncologist.

If a woman who is done with childbearing undergoes a hysterectomy or other gynecological surgery, the recommendation is to remove the fallopian tubes at the same time. Fallopian tubes carry eggs from the ovaries to the uterus.

It is thought that the origin of ovarian cancer could be in the Fallopian tubes. Removing the tubes can significantly reduce your risk of ovarian cancer over your lifetime, and it doesn’t add any increased risk or complexity to the surgery.

Why is it so hard to detect?

Ovarian cancer begins as tiny fluid- or air-filled sacs on the ovary that can’t be picked up with imaging, and they’re impossible for a doctor to feel during a pelvic exam. The cancer also doesn’t show up in blood tests and doesn’t have obvious symptoms.Woman with menstrual pain is holding her aching belly - body pain concept.

These symptoms might include:

  • Changes in appetite
  • A feeling of early fullness
  • Changes in bowel or bladder habits
  • Generalized pain
  • Pelvic discomfort
  • Fatigue

Prevention is key.

Because there isn’t a reliable screening test for ovarian cancer, annual physicals with pelvic exams are extremely important.

You should also be aware of your body, paying attention to how you feel and noting any symptoms you might exhibit.

If you experience symptoms or have concerns, don’t wait to seek a professional assessment, and don’t be afraid to come in. It’s easy to rationalize pain as no big deal. The best way to know for sure is to see your doctor.

For more about ovarian cancer, click here.


photo of doctor Jennifer Arnhold

Dr. Jennifer Arnhold

About the Author: Jennifer Arnhold, M.D., lives in the Brainerd Lakes Area and enjoys spoiling her son, Ty, and poodle, Andy. 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.


Let’s talk lice: Q&A with a school nurse

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By Guest Blogger Amy Yglesias, Wadena-Deer Creek Elementary School Nurse

A four year old boy scratching his  itchy scalp from head lice

Let’s face it. Lice are gross, they’re inconvenient, and there’s a real possibility that your child could come home one day with a scalp infested with them.

But don’t worry! Aside from the “yuck!” factor, a case of lice isn’t all bad news. The symptoms are mild, and reliable treatment exists. You may even be able to ward them off.

Here are some quick tips and common questions to put your mind at ease:

What is the best way to prevent lice?

Lice are spread by head-to-head contact, so avoid touching your head to others. One way we do this all the time is for pictures. Be careful when taking those selfies with others! Also, do not share combs, brushes, hair ties, helmets or hats with others. Lice DO NOT jump or fly to another person.

What are signs of lice to watch out for?

Parents should watch their children for itching of the head and neck.

What causes/attracts lice?

Lice have no preference over which head they land on, clean or dirty. They are attracted to our specific body temperature and humidity of the human scalp. Anybody can get lice.

Are lice harmful?

Lice do not carry disease and do not pose a significant health risk.

If your child’s classmate has lice, what should you do?

Check your child’s hair frequently. Remind your child to avoid head-to-head contact. The smell of tea tree oil has been known to repel lice. Put a couple drops in hair detangler or a water bottle and spritz hair. Also, lice do not like the smell of coconut. There are over-the-counter preventive items you can buy.Mother using a comb in child's hair to look for head lice

What should parents do if they find out their child has lice?

Do not freak out. It will be OK.

Check all family members/people that live in your house. Treat everyone who has lice all at the same time.

Decide which treatment you will use. There are prescription, over the counter and natural treatments. Some people chose to go to a lice clinic to be treated. If needed, your doctor could help you decide which treatment is best for you. Click here for the Center for Disease Control and Prevention treatment guidelines.

Follow the product directions carefully. With most products, you will need to treat again in seven to 10 days. Removing the nits, or eggs, is an important part of the treatment of lice. Continue checking the head and combing hair daily for two weeks. If all nits within 1/4 inch of the scalp are not removed, some may hatch and your child will get lice again.

Wash clothing worn in the last three days, bedding and towels in hot water and dry in a hot dryer for at least 20 minutes before using again.

Stuffed animals, backpacks and other cloth items can be put in a plastic bag for two weeks. Vacuum carpets, upholstered furniture, mattresses and seats in the car thoroughly.

Is there anything else you think parents should know about lice?

If your child gets lice, it is not the end of the world and certainly nothing to be ashamed of. It can happen to any family.


family photo of the author of the blog story with her family.

Amy and her family.

About the Author: Amy Yglesias is the school nurse at Wadena-Deer Creek Elementary School. She has been a licensed practical nurse for 18 years and just started her fourth year at the school. Before that, she worked at the TCHC Wadena Clinic. Yglesias is married and has two daughters, a sixth grader and a third grader, and a spoiled mini schnauzer named Princess.

When sports injuries strike, TCHC is there

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By Sarah Maninga, TCHC Certified Athletic Trainer


The fall sports season is well under way, and with that comes the risk of injuries associated with athletes.

As an athletic trainer, I am trained in evaluating injuries and make suggestions for the next step after injuries happen. This can include immediate care on the sidelines or a visit to sports A nurse applying a bandage to the inured knee of a female volleyball sports player.medicine, ReadyCare or the emergency department.


The right care, right away

When an injury happens at a sporting event, an athletic trainer is typically the first to run out onto the field or the first person to meet the athlete after they walk off the field. We see a wide variety of injuries ranging from bloody noses to broken bones.

When an athlete is down on the field or the court, the first thing we do is determine the extent of the injury. From there, we decide if we need more medical responders such as an ambulance. If we decide it does not require an ambulance, we can move the athlete to the sidelines and begin an evaluation.

This includes:

  • History (location of pain, peripheral symptoms, mechanism of injury, associated sounds and symptoms, history of injury)
  • Palpation (bony alignment, joint alignment, swelling, painful areas, deficit in muscles or tendons)
  • Joint and muscle function (range of motion, weight-bearing status)

After we go through the evaluation, we need to decide how to manage the injury. This can include putting a bag of ice on a sprained ankle, splinting a broken wrist or having the parents bring the athlete to the emergency department.


Care choices

So how do you choose where to take your child athlete when he or she gets hurt? It mostly depends on the injury, and you have multiple options to choose from.


Sports medicine. TCHC offers a Sports Medicine Clinic Monday through Friday from 8 to 9 a.m. at the Wadena Clinic. It is also offered at the Henning Clinic Monday through Friday byYoung injured boy playing the sport of basketball holding an ice bag on his head. appointment. This service includes a free sports injury evaluation by one of TCHC’s medical providers. All student athletes from elementary to high school are eligible.

This is a great option for overuse injuries such as tendinitis and for non-emergency acute injuries such as joint sprains and muscle strains.

If the medical provider determines that there needs to be additional testing or services after the evaluation, then fees for those services will be charged at that time.


ReadyCare is a walk-in clinic offered by TCHC. It is open Monday through Thursday from 8:30 a.m. to 7 p.m., Friday from 8:30 a.m. to 4:30 p.m., and Saturday from 8 a.m. to noon. This is a great option for a variety of illnesses and sports injuries including:

  • Minor lacerations
  • Minor traumas
  • Muscle aches and pains
  • Skin rashes/infections
  • Sprains
  • Strains


The emergency department is a 24-hour service open seven days a week. The emergency department is for more serious injuries such as broken bones or dislocations, but it is also an option when everything else is closed and an injury or illness can’t wait until the next day.



Photo of Sarah with her family.About the Author: Sarah Maninga has been an athletic trainer at TCHC since January 2015. She works with athletes at three area schools: Wadena Deer Creek, Sebeka and Menahga. During her time off, she enjoys spending her time with her husband on their small farm and doing anything that involves being outside, especially hunting and running.

Could abnormal posture be the source of your pain?

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By Erin Boesl, Physical Therapist, Henning Physical Therapy Clinic


The human body is asymmetrical. Our internal organs and bodily systems – neurological, respiratory, circulatory, muscular and vision – are not the same on the left side of the body as they are on the right. Even with this asymmetry, we create balance in how we move.

But sometimes, we can develop postural imbalances. Posture is the way our body is positioned when sitting or standing. Abnormal posture can develop at a young age or through daily, occupational and repetitive work.

Physical Therapist works with a patient on leg exercises.People also often overuse the dominant side of their body. Over time, this can lead to chronic muscle overuse or underuse, inflammation and pain. The pain then leads to other impairments and functional limitations, so we might not be able to complete daily activities.

Physical therapy is a great solution to posture imbalance.

We can perform an evaluation and develop a personalized treatment plan to suit your needs.

One of my patients, Jessica Strege, came to me with a pinched nerve in her neck and shoulder, as well as some chronic back pain. I discovered that most of her pain came from abnormal posture that actually stemmed from her diaphragm and pelvis.

Over six weeks, we used exercises to turn on and turn off certain muscles to improve her alignment. When muscles are in the correct resting position, they can begin strengthening more efficiently. After her treatment ended, Jessica said she no longer has pain every day like she did before.

If you have daily pain or postural imbalances, a physical therapist could help you find relief.


The following are some examples of imbalances or habits that might indicate bad posture.



  • Asymmetry of the head and face. This means that one side doesn’t mirror the other side.
  • You can turn your head farther to one side.
  • One shoulder is higher than the other (typically left).Physical Therapist works with patient on leg exercises.
  • One shoulder blade protrudes more.
  • You can raise one arm higher than the other.
  • You can reach behind your back farther with one arm.
  • Your ribs protrude more in the front on one side (typically left).
  • Your chest expands more on one side when you breathe.
  • One side of your pelvis is higher.
  • One leg appears longer.
  • One foot turns out more than the other when standing or walking.
  • Your trunk can rotate more to one side than the other.
  • You have scoliosis with a right rib hump.
  • You have overdeveloped back or calf muscles on one side.


Faulty habits:

  • Sleeping on one side.
  • Always crossing legs one way while sitting.
  • Putting more weight on one leg when standing (typically right).
  • Turning your head to one side when reading.
  • Always holding a baby on one side.


Do you identify with any of these? If the answer is yes, now would be a great time for you to make an appointment with a physical therapist to see how we could help. Tri-County Health Care has rehab clinics in Henning, 218-548-5580; Bertha, 218-924-2250; and Wadena, 218-631-7475.

For more information, click here.


Erin with her family posing for a family photo.

Erin and her family.

About the Author: Erin Boesl, Doctor of Physical Therapy, has completed training with the Postural Restoration Institute. She can perform a specialized postural assessment and develop an appropriate treatment plan tailored to your postural asymmetry and dysfunction. Erin has worked for Tri-County Health care for 12 years, most currently at the Henning Physical Therapy Clinic. She is also a wife and mother of four children and resides in Parkers Prairie with her family.

Help your child deal with stress at school

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By Jill Wilkens, Physician Assistant


School in the tri-county area is almost back in session. As you prepare to send your children off to class, this might be a good time to take a step back to evaluate the school-year schedule. Is your Bored and fed boy up doing his homeworkchild in sports? Do they take part in after school activities? How much homework might their new teachers assign? Do they have good friends at school?

The answers to these questions can all impact your child’s resistance to stress.

Though stress is usually attributed to adults or teenagers, children are also susceptible to stress, especially during school. Anything from being overwhelmed with homework, to not understanding something, to experiencing problems with friends or classmates could trigger stress. Your child could also pick up on situations at home that could cause them stress.

Keep an eye out for the warning signs. Your child may become more irritable, act out or change their normal behavior. They may cry more easily.

Always be open and eager to listen to your children, and encourage them so that they are comfortable coming to you if they feel stressed. Make sure your child knows that you’re available to help, whether it’s with homework or with friend trouble.

Here are some other ways to help your child deal with stress:

  1. Make sure they keep to a routine, such as going to bed and waking up at the same time.
  2. Set aside time for homework each day.
  3. Schedule family time.
  4. Have playtime built into their everyday routine.

With the increase of homework and the added pressure of responsibilities earlier in a child’s life, playtime is beneficial. Sometimes kids just need to be kids. You could also use playtime to make learning more fun.Kids playing outside on a jungle gym during recess.

In general, I recommend that kids try to get at least 30-60 minutes of activity or exercise daily. This goes hand in hand with limiting screen time, which is important to enforce with children in this day and age.

Getting enough exercise works in tandem with getting enough sleep to keep children functioning at their best. During the school year, most children should get at least 10 hours of sleep at night, but depending on the child, that number can vary from nine to 12 hours.

Paying attention to the amount of sleep, physical activity and playtime that a child gets is key to keeping their stress levels low.

Have a great school year!



About the Author: Jill Wilkens is a physician assistant at the Tri-County Health Care Wadena Clinic. A native of Long Prairie, Jill previously worked at the New Ulm Medical Center and has been in Wadena since 2011. She and her husband, Shayne, have two children and a Cavalier King Charles Spaniel.


Tips for healthy back-to-school lunches

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By Shelby Hunke, Registered Dietitian


We’ve all heard breakfast is the most important meal of the day. But for growing children, all meals are important, especially when you want them to function at their best both physically and mentally at school. healthy lunch box example

While school food services provide nutritious meals for children, some like to pack their own lunch. If you have a picky eater or a child who chooses to have a “cold” lunch, here are some tips for healthy back-to-school lunches.


Put your kid in the chef’s role

Sit down with your child once per week and help them plan their lunches. They are more likely to eat food when they have a say in the choices.

Focus on the recommendations and include foods from each food group: milk, meats, grains and vegetables/fruits. It’s okay to include a small sweet or snack item.

Make a checklist or spreadsheet of foods your child is willing to eat from each food group.


Choose nutrient-dense foods

Even in small amounts, nutrient-dense foods have a lot of nutrition. Examples are whole-grain breads or wraps, colorful fruits and vegetables and low-fat dairy such as yogurt, string cheese or low-fat milk.


Focus on “eye”-ppetizing foods

Kids and adults alike eat with our eyes first. Kids especially are attracted to colorful foods and fun packaging. Buy a lunch box, Tupperware and disposable silverware with their favorite character or color. Have fun with shapes and sizes by cutting out their sandwiches, fruit or vegetables with a cookie cutter.


School lunch box for kids. Cooking. Keep the food safe

If you are packing perishable food in your child’s lunch, remember to include an ice pack or two to reduce the risk of food poisoning.

It’s also important to invest in a well-insulated lunch box. Refrigeration is usually unavailable at school, so packing shelf-stable foods is important: trail mix, granola bars, bagels, baby carrots, whole fruit, dried fruit, single-serve applesauce or whole grain crackers.


Prevent boredom

Some kids could eat the same lunch for two weeks straight, while others get bored and need some variety. To help ensure their lunch doesn’t go to waste, try these strategies:

Celebrate special days: Plan a lunch menu around a special date or event. For example, pack an all-red lunch on Valentine’s Day.

Pack extra: Use peer pressure to your advantage by packing extra “ants on a log” or hummus dip for your child to share with their friends.

Have trendy lunch supplies: Kids will be excited to eat their lunch when it’s packed in a “cool” lunch box or includes stickers on plastic baggies.


Pinwheel lunch recipes

All recipes should start with a whole-wheat wrap of choice. Roll and cut after assembly.

  • Turkey and apple: Base layer of mustard and/or mayo topped with grated cheddar cheese, turkey breast, apple slices and lettuce.
  • Hawaiian Pizza: Base layer of spaghetti or marinara sauce topped with grated mozzarella cheese, Canadian bacon and pineapple chunks.
  • Southwestern: Base layer of cream cheese topped with salsa, black beans, sliced black olives and strips of red bell pepper.
  • Veggie Lover: Base layer of hummus topped with mixture of vegetables, such as grated carrots, sliced cucumber, lettuce and pepper strips.
  • Turkey and Pesto: Base layer of pesto topped with turkey breast, cucumber slices and lettuce.


Sources: and


Shelby with her husband, Paul, and their children, Madison and Jackson.

About 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 two kids, Madison and Jackson. In her spare time, she enjoys family time, running with her dog, Bela, and cooking!