When is the pain too much?

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Lorinda wants to help you with pain management.

Pain is a part of life. No one should suffer in silence and solitude. Getting help is the first step toward a life with less pain. Recently, I sat down and thought about my personal and professional feeling on the topic of pain regarding orthopedic health. After some deliberation, I put my thoughts down on paper.

  1. Chronic pain

Ongoing pain can be stifling. If you find yourself suffering from the same old pain every single day, it might be time to make the call. Check-in with yourself. Is your knee pulsing? Do you find it hard to move in certain ways? Don’t suffer in silence. Meet with a professional and figure out what’s going on.

  1. Activity loss

As we get older, we often experience a loss in mobility, but it doesn’t have to be that way. If you’re experiencing trouble gardening or keeping up with the grandkids like you once did, consider seeking orthopedic consultation.

  1. Limited range of motion

Our joints take a lot of abuse. It’s important to keep an eye on our joints as they move. If things don’t feel the same, it’s probably a red flag. This change may be slow and gradual. Aches, pains, and problems doing household chores could be an indicator of joint issues.

  1. Difficulty standing and walking

We definitely take some movements for granted. Every day, most of us get out of bed knowing we will be unhindered. Unfortunately, for some, the simple act of standing can be painful. Struggles with standing and walking shouldn’t be taken lightly. This struggle could be an indicator of more problems to come and should be immediately addressed.

  1. Sprains and soft tissue injuries

Working hard and playing hard sometimes comes with consequences. Sprains are a problem, but in many cases, they don’t require immediate orthopedic intervention. However, if you experience a sprain that doesn’t improve in 48 hours and you’ve tried applying ice and elevation, please schedule an appointment. This kind of pain should be addressed by a professional.

Pain can sometimes be alleviated with simple stretching.

My injuries

I’ve had orthopedic injuries just like anyone else. I ran track in high school and strained my hamstring tendon. My parents got me into physical therapy right away to work on stretching my hamstrings which prevented further injury. I’ve also recovered from other injuries affecting my back. For me, consultation, stretching, yoga, and strength training put me on the road to recovery. During an initial appointment with me, we will work together to find what works best for you.

What to expect during your first visit

A first appointment can be anxiety-inducing, but it doesn’t have to be. In many ways, meeting with Ben Robertson, M.D., or myself isn’t all that different from a regular check-up. During a visit with Dr. Robertson or myself, you should expect us to listen to your story. Getting your perspective on what brought you to us is of great importance. Additionally, we need to know what treatments you have received. We will perform an exam and show you related radiologic images. We will discuss treatment options and outcomes so you can make an informed decision about your care.

About the guest author: Lorinda Zigan, PA-CLorinda Zigan, PA-C, is an expert in pain management and helping people live fuller lives.

Lorinda is passionate about pain management and orthopedic care. Throughout her career, she has helped many people live fuller lives with less pain. In her free time, she enjoys spending time with family. She also enjoys tending to her garden and horses.

If you’re experiencing chronic pain, please consider scheduling an appointment with the Orthopedics team at Tri-County Health Care. Call 218-631-3510 to schedule today!

Pulmonary Rehab: Breathe Easier

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For patients diagnosed with chronic lung conditions such as Chronic Obstructive Pulmonary Disease (COPD), everyday life can be an uphill battle. However, there is hope to manage that diagnosis and it comes in the form of Pulmonary Rehabilitation. Tri-County Health Care’s program helps patients manage their symptoms, complications, oxygen and medications which then reduces hospitalizations and improves quality of life.

Senior sportswoman breathing in fresh air with arm band and headphones outdoors in the parkJackie Mattson, an Exercise Physiologist in the Respiratory Therapy Department at Tri-County Health Care, leads the program and says Pulmonary Rehab can play a vital role in managing chronic breathing problems.

“Our goal is to improve the daily activities in their lives and help our patients learn to manage their diagnosis,” Jackie said.

The Pulmonary Rehab program at Tri-County Health Care combines breathing, exercise and education in order to help patients manage their chronic breathing problems, increase their energy and help reduce breathlessness.

Patients can benefit from Pulmonary Rehab if they have respiratory conditions including: Asthma, COPD, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, Cystic Fibrosis, lung surgeries, Pulmonary Hypertension or other respiratory diseases.

The program is personalized to fit an individual patient’s needs, but it often consists of 16 sessions across 8 weeks. Each session has an educational component to it, and Tri-County Health Care utilizes their medical experts across multiple fields to help patients.

“We have our patients meet with diabetes prevention, pharmacists, nutritionists and other experts to help provide education on how to best manage their condition,” Jackie said. “We want to make sure our patients have access to this information to help them succeed in our Active senior woman exercising on treadmill during pulmonary rehab sessionsprogram and enhance their quality of life.”

Patients also benefit from learning techniques that will help them gain more control of their breathing and avoid feeling out of breath while being physically active or under stress. These techniques can include yoga breathing or pursed-lip breathing.

Exercise is also a focus of the program. It helps to not only build stamina and flexibility but also strengthens muscles used to breathe. This in turn makes performing everyday tasks easier.

The Respiratory Therapy team uses a variety of exercise equipment such as a treadmill or stationary bike. They monitor heart rates, blood pressure and oxygen levels during exercise and might recommend medication to help keep airways clear and open. Tri-County Health Care also utilizes certain exercises and equipment to help patients with mobility issues benefit from the program.

For more information on how Pulmonary Rehab can be beneficial for you, talk to your provider or call our Respiratory Therapy Department at 218-631-7479.

A BIG help for those with Parkinson’s

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Parkinson’s disease is a devastating disorder that can hinder a person’s movements and ability to complete activities of daily living. Symptoms start gradually, sometimes beginning with a barely noticeable tremor in one hand.

Over time, symptoms can worsen as the disease progresses. There is no cure, but some treatment can help to ease symptoms and slow the onset.

One such treatment includes a rehabilitation program called LSVT BIG. Last year, Tri-County Health Care added this program to its list of rehab services.

Because the disease can cause slower and smaller movements, the goal of the LSVT BIG program is to train people how to use their body “normally” by learning how to make bigger movements.

Parkinson's BIG program“In the BIG program, we’re really trying to amplify things and make things bigger. I say the word ‘big’ probably 10,000 times throughout our session,” said Trenda Hoemberg, LSVT-certified physical therapist. “Sometimes they get a shuffling gait pattern, so we really encourage them to make it bigger. So it seems a little bit larger to them than it typically would for an individual who doesn’t have Parkinson’s.”


Putting it into practice

A few years ago, Barb Maninga of Menahga began to experience tremors in her left arm and hand. She went to see a specialist in Fargo who concluded that she was in the early stages of Parkinson’s disease. She began medication and was encouraged to go through the BIG program.

Barb was pleased to learn that a nursing home in Menahga offered the program, giving her easy and convenient access. She finished that program with success.

At a recent appointment, Barb’s daughter asked the specialist if she should think about doing the program again. The answer was yes. In fact, Barb said her specialist recommended that she go through the program every so often to help as the disease progresses.

Though Menahga no longer offered the program, she was excited to learn that Tri-County Health Care had recently added the program, so she made an appointment with Trenda in the spring.

“Barb’s really high functioning. So it was really fun because I had to get creative because she was doing so well,” Trenda said. “We were trying to think about things at home that were harder for her. She talked about how holding a coffee cup in the morning was a little bit harder. When she walks and gets tired, that left leg gets a little bit weaker and lags behind. So we really focused on some of the walking and balancing aspects with her.”

Because Barb is regularly active and loves to garden, Trenda also made a point to work with her outside so that she was exposed to uneven terrain.

“It was a lot of fun with Trenda. She’s so happy,” Barb said. “We had a lot of fun doing all of the exercises.”

“She was so much fun,” Trenda echoed. “You can have those patients who are really ready to thrive and go for it, and she was just a ball to work with. She was all for being creative and ‘Ooh, what are we going to do today?’”

Now that Barb is done with her second round of the BIG program, she is benefiting from the positive effects. “I was doing those exercises already at home. I do them every morning,” she said. “(The BIG program) was the best thing that I’ve done to keep my exercise going. This program was really, really good.”


Providing a better outcomeParkinson Program - Photo of Barb & Trenda smiling and standing next to each other.

Each person who goes through the BIG program starts with the same eight base exercises. “Then we usually pick a few things and add exercises depending on what tasks they’re struggling with,” Trenda said. “Maybe it’s dressing, maybe it’s walking, maybe it’s balance.”

Each week, BIG patients rotate between Trenda in physical therapy and Caitlyn Wolter, OTR/L, in occupational therapy. Caitlyn works on everyday activities such as getting dressed or handwriting while Trenda works on movement and balance. They collaborate in order to meet all of the patient’s needs.

The earlier a Parkinson’s patient can take the BIG program, the better, but Trenda said that people can join at any time in their diagnosis. The exercises can be modified to fit those who are high or low functioning by offering ways to do the exercises while standing, sitting, or lying down.

Trenda stressed that patients need to be completely dedicated to the program because it is a large time commitment. Typically, it requires patients to attend rehab four times a week for four weeks while also keeping up with assigned exercises at home. But the benefits are worth the effort.

“I think the program definitely provides a better outcome on life, helping with some of those daily routines that are a little bit harder,” Trenda said. “It’s not going to stop the progression, but it can definitely help slow it down a little bit or help to make life a little easier for anyone who is dealing with Parkinson’s.”

Wadena Rehabilitation also offers LSVT LOUD, led by Meghan Current-Cary, MS/CCC-SLP, which focuses on helping people whose speech is affected by Parkinson’s. The BIG and LOUD programs are typically not taken at the same time as they both require four-week commitments.

Referrals to the BIG or LOUD programs can come from primary care providers or specialists. People with Parkinson’s who think they may benefit from these programs should make an appointment with their provider to talk about their options.

Family leans on faith after tragic farm accident

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Brittany Springer likes to be prepared. Living on a farm, she knows that accidents can happen, so she makes sure to have emergency plans in place for a variety of scenarios.

But nothing could have prepared her for the severe injury her daughter would sustain on Aug. 22, 2016.


Savhannah feeding a baby goat on the farm.An unforeseen accident

It was a day like any other day. Five-year-old Savhannah was following her father, Stephen, around the farm, eager to help him out with chores. Up next was cutting the hay. She trailed him to the tractor, but he wasn’t aware that the gear was in reverse when he started up the machine.

The tractor kicked back. The hitch struck Savhannah. It ripped open her stomach from her chest down to the top of her left leg. Stephen immediately rushed to her side.

“He had to put her insides back in her before he could pick her up,” Brittany recalled. “He came running to barn where I was. I grabbed her and said, ‘You call 911. We’re going to start driving.’”

The Springers live in a rural area near Henning and knew time was precious, so after calling 911, they grabbed their other young children, Gracie and Peter, and raced away to meet the ambulance.

“We literally maxed out the speed that our van would go,” Brittany said. “Henning police had been following us and trying to catch us.”

They met the Tri-County Health Care ambulance just outside of Deer Creek and handed Savhannah over to Renee Miller and Cole Lugert, paramedics. Savhannah’s wounds were so severe that they called for more help before transporting her to the hospital.

“Then it was a flurry,” Brittany said.“We got to hospital. They took her in. I was, I guess, checking in. You don’t realize how hard it is to remember phone numbers or addresses under so much stress.”

The emergency room was a whirlwind of activity as countless medical personnel fought to stabilize Savhannah’s tiny body.

The tractor hitch had cut into her stomach and colon and broken her pelvis and collarbone. Veins and arteries were severed in her left leg, resulting in the most blood loss. Her body began to go into shock, which made her legs swell and cut off the circulation. Emergency department staff made full-length cuts on both thighs and both calves to relieve the pressure.Savhannah in the hospital after the farm accident.

They got her stable enough to transport her to Hennepin County Medical Center where a team of surgeons – including trauma, vascular, orthopedic and pediatric – set to work. The surgeons repaired the damage as best as they could, using mesh to replace the tissue that had been lost to close her wounds.


Starting to heal

Savhannah stayed for one month in the intensive care unit. Stephen needed to work during that time, so Brittany stayed with Savhannah and her siblings.

When Savhannah finally got to go home, the recovery process began. It has been a long and difficult road. Along with hundreds of hours of physical therapy, she has had 21 surgeries and is due to have another in the next couple months.

“It’s one of those things that you wish it was over but it probably won’t ever be,” Brittany said.

Savhannah’s legs have been the slowest to heal. The bottom half of her right leg is noticeably thinner than the other, and her foot turns inward. Brittany described Savhannah as being their little vet on the farm, so it was hard for her to be unable to move.

“At first, she had lost so much muscle mass and recovering, she couldn’t move or do anything,” Brittany said, “but she would still try to wheel her wheelchair outside as much as she could.”


Savhannah poses for a dance picture with a friend after her farm accident.Moving forward

This year is Savhannah’s first year back at dance, something she loves to do, but her season will be cut short with another surgery.

“She’s doing surprisingly well,” Brittany said. “She’s resilient. She has bad days, but for the most part, she hasn’t let it stop her.”

Brittany said Savhannah’s readjustment to working on the farm has gone smoothly. She doesn’t fear the equipment and is eager to continue helping out and tending to the animals.

“Me on the other hand, that’s a different story,” Brittany said. “I thought I was fine until we left the hospital. It triggered everything, and I had a lot of PTSD that I had to work through.”

Savhannah, Gracie and Peter now have another sibling in Paisley and will welcome one more in January.

Though only 3 and 1 at the time, Gracie and Peter often surprise their parents with what they remember. For instance, Gracie noticed a pair of shorts Brittany pulled out for the summer and commented that they were the shorts she was wearing when Savhannah was bleeding.

The entire family continues to work through the lasting effects of the accident, but Brittany said their strong faith is what has allowed them to persevere.

“I want to stress that really God had his hand in the entire situation and lined everything up perfectly,” she said. “I couldn’t imagine going through it without God to lean on. My husband was hysterical. The kids were in the back seat, crying. I’m sitting there holding my child that’s bleeding to death. What else do I have?”

Many community members and friends stepped up to help the Springers with farm work and with their children. In turn, they said they were blessed to reach out to encourage others with their story and testimony.Springer Family on the farm

“We did a lot of praying and a lot of trusting,” Brittany said. “There were positive things that came out of the accident. We met such incredible people through that journey. There were people that would send us letters that our faith in the situation made them give their life to Christ because if we could have faith through that, they could too. That was a big blessing.”

Getting back up at Henning Physical Therapy Clinic

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By Jessica Sly, Communications Specialist


Vietnam veteran William “Bill” Pedrow struggled for years with physical ailments, specifically a crippling stiffness. Last year, he decided to take action. As a disabled veteran, Bill consulted with a veterans clinic in Alexandria, and they helped him arrange for physical therapy.Bill Pedrow received physical therapy at the Henning Physical Therapy Clinic.

“They were going to send me to the Wadena hospital, and we said, ‘Well, geez, we think the Wadena hospital has a clinic right there in Henning, the town I’m right outside of,’” Bill said. “They took care of it all. And it’s a small setting so you felt comfortable coming in.”

Bill went to Henning Physical Therapy Clinic where he saw Tyler Wegscheid, DPT. Tyler determined that Bill suffered from stiffness that severely limited his mobility.

“I couldn’t even get down on the floor and get back up,” Bill said.

“Bill presented with extremely tight muscles and soft tissues throughout his lower extremities,” Tyler explained. “His joint mobility and flexibility in his legs were very limited, which impaired his ability to perform various activities of daily living. He also presented with weakness throughout some of the major muscle groups in his lower extremities. It likely was wear and tear from working construction and possibly from his military experience.”

Bill Pedrow received physical therapy at the Henning Physical Therapy Clinic.Tyler created a treatment plan to loosen Bill’s body, starting with his legs and back.

Tyler explained that they performed rigorous stretching techniques on Bill’s muscles and surrounding soft tissues, applying heat in order to help them stretch more efficiently. They alternated stretching with manual therapy techniques for restoring normal range of motion.

Even though winter was in full swing and snow covered the ground, Bill wore his shorts to treatment because he knew he’d have to work hard.

“They’d get me sweating. Tyler would put me on that darn balance ball doing squats,” Bill said, laughing. He was quick to add that he learned how important a physical therapist is for rehabilitation. “But believe me, it’s not going to be easy. You gotta really work.”

Each week, Tyler gave Bill exercises to complete at home to advance his rehab while at appointments.

“He gave me all the tools I needed to really keep myself limber at home. The thing is, he could tell if you were doing them or not,” Bill confessed. “He gave you exercises and he could tell when you came in whether or not you did the stretches just by the improvement that there was.”

Tyler added, “Bill was very motivated to improve his physical health and was compliant with his home exercise program, which were two very important keys to his success.”

After three months, Tyler determined that Bill had improved enough to discontinue treatment.

“When he let me go, he said he was fairly pleased at the amount of improvement, but it took a lot of stretching,” Bill said. “Both my wife and myself really think the world of Tyler. We really think he did a good job for me. When I came in here, I was so stiff. If I got down on the floor, I could not get back up again. I had to have something to get me up. So he got me on the road there.

“The people here are very, very easy to work with,” he continued. “That makes you feel good coming. You don’t like to go to a place where you don’t feel welcome. It always felt good.”

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

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By Jessica Sly, Communications Specialist


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

Concussions: An Athletic Trainer’s Perspective

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Concussions, type it into Google© and you will end up with 14,500,000 results and all those articles can leave you with your head spinning in hundreds of different directions. Many of us hear about concussions daily and probably see something about them on the national news almost every night. If you have a child who plays sports you may be wondering if you should continue to let them play. I’m here to tell you that yes concussions can be scary, but that doesn’t mean we should wrap our children in bubble wrap and sit them on the couch.

So, what exactly is a concussion? A concussion is a mild traumatic brain injury. It occurs when direct and indirect forces are applied to the skull that result in the brain either rapidly accelerating or decelerating. This causes impairment of the brains functions.

The symptoms of a concussion can vary and all of them do not need to be present for you to be diagnosed with a concussion. Symptoms include a loss of consciousness, headache, nausea, vomiting, dizziness, poor balance, sensitivity to light, ringing in ears and sensitivity to noise, blurred vision, poor concentration, memory problems, drowsiness, fatigue, sadness, depression, irritability and neck pain.

A word of caution here: NO concussion is the same. If someone you know gets a concussion, don’t diagnosis yourself with their symptoms. People will react differently to them and there’s no set timeline saying how long a concussion will last.

One of the biggest things I think people forget is that concussions don’t just happen in sports. They can happen doing almost anything. Yes, anything! Sure, they are more likely in sports; however, you could be walking out to get your mail and get a concussion because you slipped on the ice and hit your head. You could be heading out to do your favorite winter activity like ice fishing and get a concussion because you slipped and bumped your head on the ground. Anyone can get a concussion.

So what do we do about concussions? In the sports medicine world, if we suspect a concussion in an athlete we remove them from the game and do a sideline assessment. This consists of rating symptoms on a scale of 0 to 6, immediate memory questions, concentration exercises, an eye/pupil exam and motor and balance exercises. We also check to ensure that all cranial nerves are functioning during this time. Once an athlete is diagnosed with a concussion they can’t return to play until they are symptom free and they have completed the “Return to Play” protocol. The “Return to Play” protocol lasts four days with each day consisting of the athlete gradually getting a little more into practice. The student athlete must remain symptom free through this protocol and if they don’t, then they go back and start over once symptom free again.

It is hard for anyone to completely prevent a concussion, but there are things we can do. We can make sure football and hockey players have up-to-date helmets and that our athletes/children are learning proper hitting and tackling techniques. We can educate coaches, parents and athletes about concussions, their symptoms and the importance of early diagnosis. If a concussion goes undiagnosed or an athlete returns to play before it is resolved it can have long-term effects, including post-concussion syndrome or second impact syndrome. Individuals with post-concussion syndrome can have concussion symptoms that persist for more than three months. Second impact syndrome is when a patient receives a second concussion before the first one is resolved.

Yes, concussions can be scary. That is why parents and coaches need to be aware of concussions, what the symptoms are, understand they can happen to anyone and know if you suspect a concussion to make sure the individual sees a health care professional as soon as possible. Early diagnosis will help the student athlete get back to the sport they love and help an adult get back to their daily activities sooner.

Bubble wrap not necessary.


About the author:

4x5 Maninga Sarah
Sarah Maninga has been the Athletic Trainer at Tri-County Health Care since January 2015. Her services are contracted with the Wadena Deer Creek and Sebeka schools. When she is not busy at the schools, she enjoys spending time with her husband on their small farm near Menahga and doing anything that involves the outdoors.