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.


Foundation stories: local grads choose rewarding careers

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By Ryan Damlo, Foundation Executive Director


One of the greatest pleasures of being part of the Tri-County Health Care Foundation is witnessing the difference we can make in the lives of our local communities. Recently, I was fortunate to meet with two local graduates who shared their stories with me. Sada (Thompson) Aschnewitz of New York Mills and Autumn Jahnke of Wadena were able to define their career paths thanks to opportunities given by the Foundation.


Sada’s Storyphoto of Sada, Foundation scholarship winner

As a junior in high school, Sada participated in Tri-County’s summer internship program where she rode in an ambulance, worked in the lab, and collaborated with doctors and nurses.

“The whole staff was open and honest and allowed you to learn and know what a career in the medical field was really like,” she said. “Plus, it allowed me to enter college with a clear path and committed to my goal of becoming a nurse. The summer internship program gave me extra confidence since I had already witnessed some of the clinical skills I was learning in a health care setting.”

In her senior year, Sada received a $1,000 high school scholarship from the TCHC Foundation. “Receiving the scholarship lessened the financial burden, and it showed me that other individuals besides my family believed in me and wanted me to succeed,” she said.

Sada graduated from New York Mills in 2007 and attended Jamestown University for a Bachelor of Science in Nursing. After graduating and getting married to Brad Aschnewitz, she moved to Dickinson, where she worked as a nurse. About five years ago, Sada and Brad moved to Grand Forks so she could enroll at the University of North Dakota to become a family nurse practitioner. She plans to graduate in May 2018.

Because Sada and Brad are both from New York Mills, and with two young children – Mila, 4, and Sage, 1 – they knew they wanted to come home to rural Minnesota.

Sada’s story will come full circle when she joins the Tri-County Health Care team in late 2018.


Foundation scholarship winner, Autumn JahnkeAutumn’s Story

Autumn knew from a young age that she wanted to work in a field that allowed her to help people.

From ninth through 12th grade, she participated in Venture Crew, which teaches basic life support skills and allows the opportunity to go on calls with the EMS team. As a junior, she joined the summer internship program at Tri-County. These two programs showed her many components of a health care facility and helped her confidently decide that nursing was the right path.

Autumn was awarded a $1,000 high school scholarship, as well as the $2,500 Davis Family Nursing scholarship from the Foundation. This scholarship assists students in all levels of nursing to give back to the community, inspire others to pay it forward and encourage qualified individuals to pursue a health care career in nursing. Autumn now attends M State Wadena.

“I am very blessed to have earned these scholarships,” she said. “This brings the value of my education higher considering I don’t have financial aid, and this is helping me get through school. It takes the stress away, and I can focus on classes.”

Autumn plans to graduate in May 2018 and aspires to be hired by Tri-County as a registered nurse.


Every donation counts

Each year, the TCHC Foundation gives out more than $70,000 to community events, grants and scholarships. Stories like Sada’s and Autumn’s show the value in what the Foundation does throughout the year.

Local support like that of Gary and Benda Davis, who created the Davis Family Nursing Scholarship, show that monetary donations can live on forever through a named endowment. Named opportunities within the Tri-County Health Care Foundation begin at $25,000 gifts or higher.

To learn more about leaving a legacy and helping the future of local health care, please contact me at 218-632-8148.


About the author: Ryan Damlo is the Foundation executive director at Tri-County Health Care. He joined TCHC in July of 2017 but has been a part of TCHC for the past two and a half years Foundation executive director head shotserving on the Foundation Board and the TCHC Wadena Clinic advisory committee.

Ryan and his family reside in southwest Wadena, and he is passionate about serving the community. Ryan volunteers with Pack 54 Cub Scouts as Cubmaster, serves as first-vice president of the Wadena Lions, is a board member for the Wadena Redevelopment and Housing Authority, and serves on the Wadena-Deer Creek Community Education advisory board. In his free time, Ryan loves spending time with his family, taking walks, going for bike rides and traveling.

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 do.photo 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 bleedingcontrol.org.


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 deadly.photo 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, www.nfpa.org/publiceducation. © 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.