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Child Wellness


Stress Busting Strategies: How to PACE your family

Posted on August 17, 2015

Stress Busting StrategiesA new school year is right around the corner, which brings excitement, anticipation, and sometimes, stress. According to the American Psychological Association’s “Stress in America” survey last year, students endured more stress than the average adult throughout the school year at levels significantly higher than experts consider healthy. Parents are not immune to increased stress either, with 83 percent of American adult workers reporting stress at work.

Stress presents in multiple ways, including psychological (worry, intrusive thoughts, unhelpful thinking, irritable or depressed mood, difficulty concentrating), physiological (accelerated heart rate, sweating, body tension), and behavioral (withdrawal or avoidance of anxiety-provoking stimuli, sleep and appetite disturbance, ineffective coping). Short-term stress lasting a day or two is not harmful and can actually be helpful for the mind and body; however, chronic stress can lead to significant problems for children and parents, both at home and at school or work. Specifically, chronic stress can lead to avoidance of anxiety-provoking situations, including kids and teens not wanting to go to school. This can lead to social isolation and additional difficulty with loneliness and depression if left untreated. Chronic stress has also been connected to numerous health problems, such as insomnia, gastrointestinal problems, diabetes, heart disease, obesity, and premature mortality.

Parents ask every year what they can do to help their children more effectively cope with increased stress, and my top recommendation is to PACE themselves and their families:

P stands for Pay Attention.
We often don’t notice stress and anxiety affecting us until we struggle with a headache or stomachache, become overwhelmed with worry, or feel the urge to avoid school and work altogether. It’s important to take a few minutes at different intervals throughout the day to do a quick check-in to see how your body, thoughts, and emotions are doing. For kids, it can be helpful for parents to ask specific “check in” questions about their day, such as, “How did you feel today? What do you think about how your day went today? What did you do today?” These questions encourage kids to elaborate more on emotions, thoughts, and behaviors than the usual, “How was your day?” which generally elicits a one-word response.

A stands for Act in the Moment.
Practice doing one thing at a time. Scientists have proven that multitasking is not nearly as efficient and effective as we’ve come to believe. If you’re working on homework, work. If you’re playing with your kids, play. Try to be a full participant in whatever activity you’re engaging in rather than trying to do too much at once, and this includes worrying while doing other activities. Worries do need to be dealt with, and I recommend scheduling a “worry time” of 15-30 minutes where you just worry. Write out your worries and think about them. Once that time is over, stop and focus in on whatever you have planned next in your day.

C stands for Challenge Unhelpful Thinking.
Try to catch unhelpful thoughts, such as, “This will never get better,” “I can’t do this,” etc. and put these thoughts on trial. What evidence do you have to support them? What evidence suggests that they might not be accurate, realistic or true? If they aren’t true or helpful, talk to a supportive friend or family member and work to find an alternative thought or perspective that is true and helpful.

E stands for Energize.
As much as we’d like to think of ourselves as energizer bunnies in our 21st century society, most of us are not. We’re human, and we can’t give away what we don’t have. If we don’t take time to fill ourselves with rejuvenation and peace, we will not be able to thrive throughout the day. The good news is that we don’t need a weeklong meditation retreat to do this. It can be done in tiny segments throughout a given day – in as little as 10 seconds. Savor a favorite piece of candy. Go for a walk. Listen to your favorite music. Take time to write in a journal. Do something – anything – that you find rejuvenating. Four one-minute intervals in a day can make a surprising difference.

Above all, parents and kids can work together to PACE their families. A group effort makes all the difference.

Tara Kraft, PhD
Tara Kraft, PhD, is with Archway Mental Health Services at CHI St. Alexius Health and at the Medical Plaza - Mandan




Helping Your Overweight Child

Posted on September 4, 2014

Helping Your Overweight ChildAs in the case with adults, obesity in children is rising. Children who are overweight or obese are at greater risk for health problems later in life. There are many reasons for obesity. While its cause is certainly tied to an imbalance of calories, other causes may be genetic, medications, economics, medical problems, too little sleep, stress and lifestyle habits. Here are some strategies to help children achieve and maintain a healthy weight.

Parents and care givers must be a positive role model for healthy eating and activity habits. Make family-centered changes toward healthy eating. Eat meals together, plan and prepare meals together, and make meal times pleasant and enjoyable. Take part in and encourage fun physical activities such as family bike rides, roller skating or ice skating. Take a positive approach by talking more about healthy choices rather than pointing out wrong choices. Promote a healthy body image. If you complain about your thighs or your latest diet problems, your children will naturally absorb these negative messages and begin to worry about their own body size. Shift your focus from weight to health by focusing on delicious nutrition and fun physical activity rather than the numbers on the scale.

Set healthy limits on screen entertainment like television and video games. Too much screen time can negatively affect sleep habits as well as lead to an inactive lifestyle. Children may also snack more while doing these activities. Television commercials often stimulate false hunger and lead to food cravings. Try active video games such as Wii Fit or Wii Sports. 

Avoid restrictive diets and exercise regimens. Putting children on strict diets can cause anxiety and lead to overeating. A healthy weight for children is about much more than numbers. It is about healthy behaviors, such as enjoying a variety of nutrient-rich foods and a variety of activities for strength, flexibility and aerobic capacity. Allow your child to “grow into” their weight as their height increases.  Compliment your children on lifestyle behaviors (“Great snack choice” or “You really run fast”) rather than on the loss of a pound or two. 

For a healthy weight, children need 60 minutes of daily physical activity. Teach your children games from your youth such as tag, touch football, kickball, or badminton. Find out what your child's interests are. Maybe they would like school sports, karate or hip-hop dance classes. Some children may prefer individual activities like riding bike, walking or playing with a hula-hoop or jump rope. 

If you need specific advice on healthy eating and exercise tips, consult with a registered dietitian.  Simple changes like avoiding sugary beverages, limiting fried foods, and choosing high fiber foods is a great start. Even though “diets” are not recommended for children, it is helpful to have a guideline on food portions and recommended number of servings of various foods that are age appropriate.

Kathy Stewart

Kathy Stewart, LRD, CDE, is a Clinical Dietitian at St. Alexius Food and Nutrition Services





Pain Management


Botox Therapy

Posted on June 3, 2014

According to the National Headache Foundation, migraines occur when blood vessels on the surface of the brain become irritated and start to swell. Pain signals are sent from the swollen blood vessels to the brainstem, where the pain information is processed. Typically, pain of a migraine headache is felt around the sinus and eye or temple area. Pain can also occur in the face, jaw and neck area. More than 37 million people suffer from migraines. The exact cause of migraines is unknown and there is no cure; only medications and proactive measures can curb the symptoms of migraine headaches.

Many people would not associate Botox with migraines; however, Dr. Farhan Tariq, board-certified neurologist at The Clinics of St. Alexius, has been performing the procedure on people with chronic migraines for the past two years. Dr. Tariq states that “Botox therapy injections are for those patients with chronic migraines who have tried various medications for a while with no real result.”

A chronic migraine is a condition in which people experience 15 or more headache days a month, with each headache lasting four hours or more. The Botox treatment is injected under the skin into seven key areas of the head and neck with a small needle. “Patients typically feel little to no discomfort and can start to feel results within two weeks after the treatment.” Dr. Tariq states, “Botox is a preventative medication meaning patients will experience fewer migraines altogether, unlike acute medications that a patient will take as soon as they start to experience a migraine.” Patients return to receive treatments every three to four months and can start to wean off their migraine medications soon after experiencing relief.

Botox therapy is not only for people suffering from chronic migraines. The procedure can also benefit people who have dystonia, a neuromuscular disorder that produces involuntary muscle spasms and contractions primarily in the face, jaw and neck, along with other parts of the body. “What the Botox injections do is greatly reduce the muscle spasms. This can allow the patient to function and live a relatively normal life with little to no pain,” Dr. Tariq explains.

To learn more information on Botox Therapy injections or to make an appointment with Dr. Tariq, call 530-5550 or (877) 530-5550.

Dr. Farhan Tariq is a neurologist for The Clinics of St. Alexius.






Migrating Lower Back Pain

Posted on May 20, 2014

Lower Back PainLumbar spinal stenosis is a condition that results from the narrowing of nerve channels in the lower part of the back. This can cause back and leg pain that can limit your daily function and quality of life.

The most common cause of lumbar spinal stenosis is degeneration of the joints in the spine. This degeneration is a part of the normal aging process. As the joints in our spine degenerate, or become arthritic, they lose their cartilage, and bone spurs can form. Another result of the aging process is the degeneration of our spinal discs and an overgrowth of the ligaments near the spine. All of these forms of degeneration cause the nerve channels to become smaller. The result is pressure on the nerves, which may cause pain.

The symptoms of lumbar spinal stenosis include lower back pain, leg pain, leg weakness and leg numbness or tingling. In more severe cases, patients may experience a loss of bowel or bladder control and/or the inability to walk. In most instances, symptoms of spinal stenosis are worse when walking. Symptoms often improve or resolve when the patient sits or lies down. Additionally, a person's symptoms may improve when they lean forward as they walk, such as leaning over a grocery cart. The most common scenario is the ability to walk short distances followed by the need to stop and rest due to leg pain. After a short rest period, a short period of walking is usually able to be resumed.

Most cases of lumbar spinal stenosis gradually worsen with time. People with spinal stenosis may notice a gradual decrease in the distance they can walk and increase in pain. If untreated, these symptoms can result in progressive weakness, loss of function of the legs and loss of bowel and bladder control. If this occurs, medical attention should be sought immediately.

To determine if someone has lumbar spinal stenosis, a medical provider obtains a complete medical history and performs a physical examination. Specific tests, such as x-rays, MRI's or CT scans may be helpful to provide additional information.

The treatment for lumbar spinal stenosis depends on the severity of the symptoms and the results of an evaluation. For mild or moderate spinal stenosis, medications may be recommended to help reduce inflammation of nerves. Physical therapy can improve strength and flexibility. Cortisone injections in the lumbar spine can be used to reduce pain and inflammation around nerve tissue.

Surgery may be an option for those who do not improve with non-surgical treatment. Surgery may also help if the symptoms are severe, or result in the loss of bowel or bladder control or cause severe weakness in the legs.

Lori KlabundeLori Klabunde is a Physician Assistant and graduate of The University of North Dakota’s PA program. She is currently employed at St. Alexius’ Pain Clinic.





Anterior Approach to Hip Replacement

Posted on April 1, 2014

Hip SurgeryJoint replacement surgeons are increasingly using the anterior approach to hip replacement surgery in an attempt to improve outcomes and patient satisfaction. 

The anterior approach to total hip replacement is becoming more popular because it can be less invasive, hospital stays can be shorter, and recovery and rehabilitation tend to be quicker for patients. Over the past 10 years, there have been several new and less invasive approaches to hip replacement surgery. The anterior approach is one of these “minimally invasive” procedures.  

In the anterior approach, an orthopedic surgeon accesses the hip joint through the front of the body and between the hip muscles that help hold the hip joint in place. Smaller incisions are possible with this procedure versus traditional hip surgery. In addition, the minimal disturbance of the muscle also allows for a quicker recovery and rehabilitation. In traditional hip replacement surgery, an incision of eight to 10 inches is made beside or behind the hip joint. The surgeon must go through muscle and detach the muscles from the hip joint. With the anterior approach, the surgeon goes between the muscles, rather than through the muscles, so detachment is not required.

Another benefit of leaving the muscles intact is that the joint is more stable, thus reducing the chance of hip dislocation, one of the risks of hip replacement surgery. Most total hip replacement patients whose surgeries were done with an anterior approach are able to bear full weight soon after this surgery which means progression to return to normal activities occurs rapidly.

If you are considering joint replacement surgery, it is important to be in the best physical condition possible prior to surgery. It is imperative that patients considering joint replacement surgery consider weight loss prior to undergoing joint replacement. Obesity is a major complicating factor in recovery from joint replacement surgery. Obesity delays wound healing, increases risk of pulmonary complications and infection. Patients of normal weight will recover much quicker and faster and with fewer complications than the overweight patient. 

Total hip replacements involve replacement of the joint’s cartilage and bone with implants. The ball (femoral head) is at the top of the long thigh bone called the femur. The ball fits inside the hip socket (acetabulum) which is on the pelvic bone side.  

In healthy hip joints, cartilage covers the surfaces of the bones and enables the ball and socket to work smoothly. With arthritis, the cartilage surfaces degenerate, leading to pain and decreased mobility. In total hip replacement, the surgeon smoothes out the hip socket and removes damaged cartilage and any debris.

A cup-shaped implant is secured into the socket. The ball at the top of the leg bone is trimmed away and a metal stem is placed inside the leg bone and secured there. A ball (metal or ceramic) is placed at the top of the stem and then a smooth, sturdy plastic, metal or ceramic piece is placed inside the cup-shaped implant. This creates a new hip joint that moves smoothly.

Not all hip replacement patients are eligible for the anterior approach. A surgeon familiar with this approach will assess a patient’s suitability for this surgery. The type of hip replacement will depend on the patient’s history, a thorough examination of the patient, the quality of the bone and pre-existing deformities. With any type of joint replacement surgery, patients need to find a surgeon with experience who can help the patient make the best possible decision about surgery, treatment and rehabilitation.

Dr. Timothy BoppDr. Timothy Bopp is a board certified orthopedic surgeon with The Bone & Joint Center. Dr. Bopp specializes in reconstructive surgery of the hip and knee.





Health and Wellness


Tips for Safe Snow Shoveling

Posted on November 19, 2014

Tips for Safe Snow ShovelingIt is winter here in the Midwest, which usually means cold temperatures and yes … snow. While shoveling snow can be good exercise, it also can be a very dangerous activity for some people. Every winter people injure themselves from shoveling snow. These injuries range from aches and strains to fatal heart attacks. Shoveling increases the work demands on the heart by quickly increasing heart rate and blood pressure. Furthermore, cold air makes it harder to work and breathe, which adds extra strain on the heart and body. It can also put us at risk for hypothermia (decreased body temperature) if we are not dressed properly.

Before you pick up the shovel, please consider the following tips:

  • You are at increased risk for a heart attack if you have a history of heart disease, have already had a heart attack, have high blood pressure or high cholesterol, you smoke or you are inactive. If this is the case then talk to your health care provider before you shovel.
  • Drink plenty of water as dehydration can happen with exertion in cold weather.
  • Avoid nicotine and caffeine before you start. These are stimulants that can cause blood vessels to constrict and place extra stress on the heart.
  • Warm up and gently stretch the muscles in your arms, legs and back. Warm muscles work better and are less prone to injury.
  • Dress warmly and in layers. If you get too warm you can remove layers as required.
  • Take care of and protect your back. If possible, push the snow rather than lift it. Keep your back as straight as you can, and bend at the knees and lift with your legs. Do not bend at the waist, avoid twisting and don’t throw the snow over your shoulder. Pick up smaller loads of snow at a time, keep the load close to your body and point your feet in the direction the snow will be thrown.
  • If possible, clear off the snow as soon as it stops falling. Fresh snow is lightest. If you expect more than a couple of inches to fall, try to clear off a couple of inches at a time even if it is still snowing.
  • Listen to your body. It is very important to go slow and take breaks. If you are tired or experience any pain, stop. If you are experiencing signs of a heart attack, such as chest pain or pressure, pain that radiates to the jaw, between the shoulders or down the arm, sweating, nausea, dizziness and/or shortness of breath, seek medical help immediately. Keep a cell phone in your pocket in case of an emergency. If you don’t have a cell phone but your car has a keyless entry, carry the remote/keys with you and hit the panic button if you need to get someone’s attention and assistance.
  • If you are healthy and able, remember your neighbor who may not be, and take time to clear their steps and walkway. An act of kindness is never wasted.

Sandy Tschosik is a registered nurse and has her Bachelors of Nursing from the University of Manitoba, Canada.  She is the community health services coordinator at CHI St. Alexius Health.





Beginning to Heal After a Breast Cancer Diagnosis

Beginning to Heal After a Breast Cancer DiagnosisIt is scary enough for some people to go through the screening process that could detect breast cancer; anticipating the process and the results can create anxiety. Learning that your test results have detected cancer can change a person’s life dramatically enough to put them on a path of mixed emotions. Knowing what to expect during the diagnosis process and letting one’s self express the common emotions that go along with a diagnosis can play an important role in treating breast cancer.

If a radiologist discovers something suspicious while reading the images of a breast cancer screening exam, or if a person is experiencing symptoms of breast cancer, a doctor will want to perform tests to confirm or deny a cancer diagnosis. Keep in mind, abnormalities on an image or having a symptom of breast cancer does not necessarily mean a person has cancer. Many suspicious findings on an image and/or symptoms can be non-cancerous. In the event that a breast cancer diagnosis is confirmed, additional tests are used to determine how the breast cancer progressed, or at what stage a person’s cancer is.

There are a variety of tests to help a physician determine if cancer is detected in the breast(s). One of the most commonly-used tests is a biopsy. During a biopsy, a sample of the abnormal area is removed by a needle. The tissue is sent to a pathologist who studies it under a microscope. There are different methods of performing a biopsy; a physician determines which method is most appropriate. Having a biopsy is not a comfortable procedure. Therefore, a local anesthetic may be used to numb the area. Other diagnostic tools used are magnetic resonance imaging (MRI) and ultrasound. Both are painless procedures. An MRI creates strong magnetic fields and radiowaves and an ultrasound uses sound waves to create images of the breasts.

It is important that a breast cancer diagnosis does not prevent a patient from acknowledging their other health needs. People don’t just heal physically. Considering the healing components of one’s emotional health is a crucial part of breast cancer treatment. It is normal for a breast cancer patient to feel a variety of upsetting emotions. To begin with, a person may greatly consider their own mortality or that their diagnosis may have negative effects on their family, friends and career. These thoughts can cause an enormous amount of stress, anxiety and depression. Addressing those emotional concerns is very important in the entire treatment process.

It is a good idea to seek out professional help when experiencing those strong emotions. A primary care provider offers talk therapy that can make a big difference in changing how one thinks about a breast cancer diagnosis. Understanding those thoughts and concerns are a normal part of dealing with the diagnosis. Relying on good friends and family for support is equally as important; patients need others for strength and comfort. They should consider cancer support groups, church or spiritual groups or online support communities. Hearing from and talking to others going through the same experience is a good way to communicate one’s fears and struggles. Almost everyone who is diagnosed with cancer could use some type of support, depending on individual personalities.

The beginning of a cancer journey can turn one’s world upside down, but understanding what to expect and taking care of the emotional needs experienced during this time is a healthy way to start that journey.

Denise McDonough, MDDenise McDonough, MD, is a family physician with St. Alexius Mandan Clinic - North. She has a special interest in women’s health.





Be Prepared For Flu Season

Posted on September 23, 2014

Be Prepared For Flu SeasonIt is easy to get frightened by the infections that have made headlines lately; like the Ebola virus in West Africa or the new enterovirus D68 that is making its way across the Midwest. While the spread of these infections is worrisome, the infection that kills most people in the US each and every year is still influenza and its complication, pneumonia. Influenza alone infects around 60 million people annually in the US and has claimed the lives of thousands of Americans each year; but has rarely made the headlines. Over 200,000 people each year are hospitalized due to the influenza virus, and of course many more are absent from school and work.

This highly contagious virus affects respiratory systems. Symptoms vary from fever, cough, and malaise, to pneumonia and respiratory failure. Seasonal influenza is known to aggravate any underlying illnesses such as congestive heart failure and chronic obstructive pulmonary disease. It can trigger heart attack or stroke in the elderly.  Influenza can also lead to superimposed bacterial pneumonia including Staphylococcal or Pneumococcal pneumonia. Fortunately, we can substantially decrease our risk of influenza infection simply by getting vaccinated.  Influenza vaccine is still the single, most important tool to prevent this infection. Anyone six months and older should receive a yearly influenza vaccine. Numerous studies have repeatedly shown benefits in all age groups from infants and children to healthy adults and the elderly.

However, not all who receive the vaccine receive the same benefit.  The vaccines seem to work the best for the healthiest. The elderly and people with multiple medical conditions might not develop immunity as well with the vaccine. Also, babies who are less than six months old are too young to receive the vaccine. This is a problem because the very old and the very young are particularly vulnerable to influenza.  Therefore, getting as many people as possible vaccinated around them to gain "herd" immunity in our community is important. When enough people in the population get vaccinated, it is less likely that the most vulnerable will come into contact and become infected with the influenza virus.

In the case of infants, studies have shown that the vaccination of their mothers while still pregnant reduces the chance of their babies being hospitalized for influenza by 92%.  In the case of nursing home residents, studies have shown that vaccinating more nursing home staff results in the reduction in hospitalization and even deaths of their patients during flu season.  More and more healthcare institutions, and even laws in some states, have made yearly influenza vaccine mandatory for healthcare workers to protect their patients, especially the most vulnerable ones who are less likely to respond to the vaccine themselves.

This year, the trivalent vaccine will contain the H1N1 strain, the H3N2 strain and the influenza B strain similar to one from 2013-2014 influenza  season. The Quadrivalent vaccine will contain an additional influenza B strain. The CDC recommends getting influenza vaccine as soon as the vaccine arrives, preferably by October, since peak influenza activity can start anytime from October until March. Remember, it takes two weeks for your body to develop immunity after the vaccine is given. Research has shown this immunity starts to wane after six months in the elderly, but likely lasts longer if you are young and healthy.  Getting your yearly vaccine by October should provide adequate protection until the end of flu season.
Influenza vaccine now comes in many variations. The inactivated intramuscular or intradermal flu vaccines are appropriate for most people. The live attenuated intranasal vaccine is designed to be used by healthy individuals between the ages of two and 49.  A high dose influenza vaccine is available to enhance the vaccine response for people 65 years and older.  A recombinant inactivated vaccine, trivalent (RIV3), contains no egg protein, and can be used for people who have severe allergic reactions to eggs.

In addition to getting vaccinated, we should frequently wash our hands with soap and water or hand sanitizer, and cover our noses and mouths when we cough or sneeze.  While seemingly simple, these are ways we can prevent the spread of infection, influenza or other respiratory illnesses. The fall season is here. Getting a yearly influenza vaccine not only protects against the flu, it also protects anyone you come in contact with, parents, grandparents, children, or a best friend's newborn. Consult with a doctor or pharmacist about which variation of the vaccine is right for you.

Dr. Supha Arthurs

Dr. Supha Arthurs is an infectious disease specialist with The Clinics of St. Alexius. She is board-certified by the American Board of Internal Medicine in the subspecialty of infectious disease. Dr. Arthurs is a member of Infectious Diseases Society of America and North Dakota Medical Association.




The Scoop on Sugar

Posted on May 27, 2014

Scoop on SugarSugar is a simple carbohydrate that the body uses for energy. Some foods naturally contain sugar such as fruits, vegetables and dairy products. These foods also contain essential vitamins and minerals that the body needs. However “added sugar’’ such as the sugar and syrups added to food during processing, preparing, or at the table, are nothing more than added calories with little to no nutritional value. To reduce the risk of developing health problems, it is imperative that we limit our daily consumption of added sugars.

Although guidelines for daily limits of sugar vary, the American Heart Association (AHA) suggests limiting added sugar consumption to:

  • 4 teaspoons per day for preschoolers.
  • 3 teaspoons per day for children age 4 to 8.
  • 5 to 8 teaspoons per day for preteen and teens.
  • 6 teaspoons per day for women.
  • 9 teaspoons per day for men.

Do you know how much added sugar Americans eat or drink on a daily basis? It may shock you. According to the AHA:

  • Children as young as 1 to 3 years consume approximately 12 teaspoons per day.
  • Children age 4 to 8 average 21 teaspoons per day.
  • Teens age 14 to 18 average 25 teaspoons per day for girls and 34 teaspoons per day for boys .
  • Women and men age 19 and older consume approximately 18 and 25 teaspoons per day respectively.

In general the average American consumes about 22.2 teaspoons or 355 calories of added sugar a day which greatly surpasses the recommended daily amount. Consuming too many sugary foods and beverages can negatively affect your health. It can fill you up and cause you to miss out on healthier foods containing essential nutrients, vitamins and minerals. Furthermore, a diet high in added sugar may increase the risk of developing tooth decay, obesity, type 2 diabetes, high blood pressure, elevated triglycerides and heart disease. A recent article published online in Journal for the American Medical Association (JAMA) Internal Medicine, showed that the risk of dying from heart disease becomes elevated once added sugars surpass 15% of daily calories (this would be equivalent to drinking one 20 ounce soda/day in a 2000 calorie/day diet).

Reducing the amount of added sugar in our diet can benefit health. Here are some tips to help you become sugar savvy:

  • Read food labels carefully. The amount of sugar is listed in grams (g). There are 4 grams per teaspoon and 4 calories per gram. So if the label says it contains 20 grams of sugar that is equivalent to 5 teaspoons and 80 calories from sugar. Keep in mind that this includes both natural and added sugar and this is why a cup of low fat milk may say 13 grams of sugar per cup. Therefore it is also important to identify added sugars in the ingredient list. Sugar goes by many different names. Look for ingredients that end in “ose” such as fructose, dextrose or maltose, any type of syrup, and honey. Ingredients are listed in order of decreasing weight. So if sugar in any form is listed as one of the first few ingredients, the product is likely high in added sugar. Food labels will be changing in the future and one of the new features will be a line for "added sugars" to help distinguish between natural sugars in food compared to the sugars that are added during processing.
  • Limit desserts and sweets. Choose fresh fruit instead or canned fruits in water. When baking substitute sugar with equal amounts of unsweetened applesauce or only use half the amount of sugar the recipe calls for. Use vanilla or almond extracts for flavor. Cut back on the amount of sugar you add to cereals or coffee. Use zero calorie sweeteners in moderation.
  • Rethink your drink. Sugary beverages are a major source of added sugar in the American diet. A regular 20 oz soda could contain 16 to 18 teaspoons of sugar! Would you eat 16 teaspoons of sugar? Consider switching to low calorie beverages ~ better yet, drink more water! Sports drinks also contain a lot of sugar and can benefit high performance athletes. However, for most adults and children, water and a healthy snack is a better option to replenish fluids and energy during or after exercise. Consider cutting back on sugary coffee drinks. The best beverages for children are plain, low fat milk and water. Limit 100% fruit juice to 4 to 6 ounces per day – it is better to eat the whole fruit and get the fiber.
  • Snack smarter. Instead of cookies and pastries, snack on fruits and vegetables, low fat cheese with whole grain crackers or an apple with peanut butter. When faced with a choice, choose the food that gives more nutritional bang for your buck!

Sugary foods and beverages should be a once in a while treat or something we consume on a special occasion. Unfortunately, they have become the daily norm. Please do your health a favor and try to cut down on the amount of added sugar in your diet because when it comes to sugar, less is more.

Sandy Tschosik is a registered nurse and has her Bachelors of Nursing from the University of Manitoba, Canada.  She currently is the St. Alexius community health services coordinator.





Staying Safe in the Sun

Posted on April 14, 2014

Staying Safe in the SunThe skin is the largest organ of the body and has several important functions. It covers and protects the internal organs from injury, acts as a barrier to bacteria, helps to control body temperature and permits the sensations of pain, temperature and touch. One of the most important ways to take care of the skin is to protect it from the sun.

Skin cancer is the most common of all cancers. The three major types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. Basal and squamous cell skin cancers are mainly found on parts of the body exposed to the sun such as the neck, face, ears and hands. They seldom spread to other parts of the body and are highly curable. According to the American Cancer Society (ACS), more than 3.5 million basal and squamous cell skin cancers are diagnosed in the United States each year.

Melanoma accounts for a small percentage of skin cancers; however, it is more serious and causes the most skin cancer deaths. Melanoma can occur anywhere on the body, in an existing mole or even on skin that has not been exposed to the sun. The most common site where melanoma occurs in men is on the back, chest and face. In women, melanoma most often develops on the legs. Melanoma can spread and be fatal if not detected and treated early. The ACS estimates that 76,100 new cases of melanoma will be diagnosed in 2014.

Risk factors for developing skin cancer include:

  • Unprotected and/or excessive exposure to the sun and other sources of ultraviolet radiation, such as tanning beds and lamps.
  • Having naturally blonde or red hair with fair skin that freckles or burns easily from the sun.
  • Multiple or abnormal moles.
  • Personal or family history of skin cancer.
  • History of sunburns in early life.
  • Occupational exposures to certain substances such as coal tar or arsenic.
  • Certain autoimmune diseases, such as lupus or a medical condition that weakens the immune system.

Skin cancer can be prevented. The best way to lower your risk of developing skin cancer is to practice sun safety:

  • Avoid direct sun exposure between 10 a.m. and 4 p.m. when the sun’s rays are strongest.
  • Wear protective clothing to cover exposed skin and a wide brimmed hat to shade the neck, ears and face.
  • Wear sunscreen year round even on cloudy days. Use sunscreen with an SPF of at least 30 that provides both UVA and UVB protection, and apply generously on all exposed skin including tips of ears, neck and lips. Apply 30 minutes before outdoor activities, and reapply every two hours or more often if sweating or swimming.
  • Wear sunglasses that block both UVA and UVB rays.
  • Avoid tanning beds/lamps.

Early detection of skin cancer is crucial for successful treatment. Therefore, it is important to be familiar with the skin you are in. On a monthly basis with the help of mirrors, check your skin from head to toe, and identify any changes to moles, freckles and birthmarks or the presence of any new “spots.”

Report the following changes or findings to your medical provider:

  • A flat, firm, pale area or any small, raised, red or pink, pearly bumps.
  • Firm red lumps or rough, crusty areas that become itchy or tender.
  • A sore that bleeds, heals and then returns.
  • Moles that change in shape, color, size or texture, or become painful or start to bleed.

May is Melanoma and Skin Cancer Awareness Month.  As we look forward to the warmth of summer, remember to stay safe in the sun while having fun!

Sandy TschosikSandy Tschosik is a registered nurse and has her Bachelors of Nursing from the University of Manitoba, Canada.  She currently is the St. Alexius community health services coordinator.





Sleep Deprivation Can Make You Sick

Posted on April 9, 2014

Sleep Deprivation Can Make You sickAs a busy working wife and mother, I realize that sleep is the last thing on my “to do” list. I know that I am not alone in this 24/7 society. I am not sure we all realize by not making sleep a priority, we are literally making ourselves sick. Sleeping less than the suggested 7-9 hours each night can dramatically increase the risk of long-term health issues including a shortened life expectancy. The chronic medical conditions associated with sleep deprivation are obesity, diabetes, hypertension and cancer.

Recent data suggests that people who sleep less than four hours are 73 percent more likely to be obese, and those who sleep an average of five hours have a 50 percent greater risk of being obese. Surprisingly, people who got six hours of sleep dropped their risk of obesity to 23 percent.

Insufficient sleep is associated with decreased leptin and ghrelin levels. These hormones are responsible for telling our brain that it has enough food. The decrease in hormones can result in food cravings even after adequate caloric intake and can produce a feeling of decrease energy.

A study done at the University of Chicago revealed that a lack of slow wave sleep can decrease the body’s sensitivity to insulin. This phenomenon can increase the risk of Type 2 diabetes.

Heart Disease
According to data from Harvard University’s Nurse Health Study, participants who slept for five to six hours were at a greater risk for cardiac disease. Sleep deprivation has been linked to an increase in cortisol, also known as the “stress hormone”. This increase in cortisol in people with existing hypertension can cause an increase in blood pressure the day following shortened sleep time. Increased cortisol levels over time can also increase one’s chances of experiencing a sudden cardiac event. One study showed that sleeping too few hours increased the risk of heart disease in women.

It was previously stated that a lack of quality sleep time can cause a shift in hormone levels. Melatonin is a hormone that is produce by the brain during sleep. This hormone is important in cleaning up free radicals in the body, so it is safe to say that the decrease in Melatonin could decrease the body’s ability to fight cancer.

According to a study published in “Cancer” in October 2010, there is a link between sleep time and colon polyps. Upon review of the sleep patterns of study participants, the data shows a higher rate of polyps in people who reported less than six hours of sleep (29 percent) than in those who state they slept more than seven hours per night (22 percent).

Karla Smith

Karla Smith, BS, RRT, RPSGT, is the coordinator of St. Alexius’ Sleep Center.






Burn Calories While You Work

Posted on February 27, 2014

Regular exercise is one of the most important things you can do to improve your overall health and quality of life. According to the Centers for Disease Control and Prevention (CDC), adults need at least two hours and 30 minutes of moderate to intense aerobic activity per week as well as muscle-strengthening activities that work all major muscle groups at least two days per week.  Unfortunately, the reality is many of us do not get the recommended amount of physical activity.  Why? The number one reason reported is that we just don’t have time. 

Many of us spend 40 or more hours a week at work and have family commitments that can make it difficult to find the time to exercise. So why not exercise while you are at work? Below are some activities you can do to fit some exercise into your work day.

• IBurn Calories While You Workf able, walk or bike to work. If you drive, park at the far end of the parking lot to get some extra steps into your day.
• Take the stairs versus the elevator whenever possible.
• Walk over to someone’s office instead of calling, texting or emailing them.
• Turn coffee breaks into fitness breaks. Take a brisk walk, or take this time to do some stretching.
• If practical, rather than sit and meet with someone, schedule a “walking” meeting. Problem-solve while doing laps in the hallways, or better yet, go for a walk and brainstorm outdoors if weather permits.
• If you sit at a desk, remind yourself to get up. Standing burns more calories than sitting. Stand or pace during a phone call, or stand while having a discussion with someone.
• Turn your office space into a mini-gym.  Keep dumbbells or resistance bands under the desk and work those biceps while talking on the phone or in between meetings.
• Replace the office chair with an exercise ball. This can help to improve your balance and posture and tone abdominal or other or core muscles. The ball can also be utilized for wall squats or other exercises throughout the day.
• If you have exercise equipment at the office or work near a gym, exercise over your lunch break when possible.
• Organize a lunchtime walking group, and pick up the pace.
• Drink plenty of water to stay hydrated throughout the day, and avoid those tasty temptations in the vending machines. 

Finding the time to exercise can be challenging, but with a little planning and creativity it can be done. Fitting exercise in at work can help to reduce stress, boost your mood and energy level and make you more productive. Plus, you will look and feel great!

Sandy TschosikSandy Tschosik is a registered nurse and has her Bachelors of Nursing from the University of Manitoba, Canada.  She currently is the St. Alexius community health services coordinator.





Coronary Calcium Scoring

Posted on February 26, 2014

As a cardiologist, the most common question I am asked by those who do not have a heart problem is, “What is my risk for a heart attack?” Often the question comes from a person who knows someone who has either survived a heart attack or who has died suddenly of heart disease.

Coronary Calcium ScoringDetermining one’s risk for a heart attack begins with identifying common risk factors for heart disease and then calculating an individual’s ten-year risk of heart attacks using “risk calculators.” One problem with this approach is that many heart attacks happen in people who are considered “low risk.” Because of this paradox, many blood and imaging tests are available to further define heart attack risk.

The most accurate of these tests is a coronary calcium score. The purpose of the test is to help a medical provider determine how aggressively to treat someone to prevent heart problems. A calcium score “sees” calcium within the blood vessels around the heart. Calcium in blood vessels is a sign of atherosclerosis, or hardening of the arteries. An abnormal calcium score is associated with an increased risk of heart attack and death.

The calcium score, however, is far from perfect.  Individuals with normal scores can have heart attacks, and those with abnormal scores can be free of heart attacks for life. Current recommendations from national cardiology groups recognize these limitations and recommend that the test preferably be performed on individuals with an intermediate heart attack risk (10-20 percent chance of a heart attack over ten years). 

As with most medical testing advertised to the general public, the purpose of the test is often misunderstood, even among medical professionals. Calcium scores do not identify blockages. This misunderstanding may lead to inappropriate testing and/or high risk procedures such as coronary angiograms (heart caths) for questionable benefit. Our current understanding of stents or heart bypass surgery is that, in most instances, they are no better than medications in people with normal hearts who have no symptoms with exercise.  Most people who undergo this test fit the above description, thus…buyer beware.

Calcium scoring has other drawbacks. In someone who is unlikely to have a heart attack, an abnormal score will bring about needless mental anxiety. Conversely, in an individual who is a ticking time bomb for a heart attack, a normal score may give a false sense of reassurance. Also, calcium scoring uses radiation, putting a small number of people at future risk of developing cancer from the test itself.

Abnormal scores in the right patient will appropriately lead to the initiation of healthy lifestyle changes and medications that lower cholesterol (statins) and thin the blood (aspirin). These therapies do work and will give a high-risk individual the best chance to delay or avoid a heart attack. Only with certain high scores should further testing (i.e. stress testing) be considered, albeit selectively. 

In my practice, I will generally obtain a calcium score for two types of patients. The first group is those at intermediate risk of heart disease who are unsure about cholesterol lowering therapy; second, patients with a low risk of heart disease but with an extreme risk factor (i.e. significant, early heart disease in the family). In the end, the best way to prevent a first heart attack is not with a calcium score, a cardiac stent or bypass surgery. The good news is that there are nine modifiable risk factors for heart disease that if corrected will absolutely prevent or delay a heart attack. A worldwide study identified these risk factors as:  high cholesterol, high blood pressure, smoking, diabetes, belly fat, high stress, lack of fruits and vegetables and sedentary lifestyle.

Dr. Matthew NelsonDr. Matthew Nelson is an invasive cardiologist at St. Alexius Heart & Lung Clinic. He is board-certified in cardiology and echocardiography. He has a special interest in preventative cardiology.





Are Electronic Cigarettes Safe to Use?

Posted on August 20, 2014

Is Electronic Cigarettes Safe to Use?From a novelty-like item to grossing nearly $2 billion dollars in 2013, electronic cigarettes (e-cigarettes) have found their way into almost every corner of the consumer marketplace. With third and fourth generation devices being introduced almost daily, this current trend doesn’t look to be slowing down anytime soon.  Despite manufacturer claims that e-cigarettes are effective in aiding smoking cessation and safer than traditional cigarettes, many experts remain skeptical and have significant concerns regarding their potential health risks.

Electronic cigarettes are battery-powered devices designed to mimic the look and feel of a traditional cigarette without the harmful chemicals released from burning tobacco.  Although not highly-publicized, these devices contain nicotine, the same addictive property in cigarettes, in varying amounts, depending on company and brand line. Electronic cigarettes work as a heating element that vaporizes a liquid solution of nicotine and other chemicals to create a cloud of vapor. This vapor is then inhaled the same way tobacco smoke is inhaled with conventional cigarettes.

Despite extensive marketing campaigns and an ever-growing consumer population, little is known about the health risks associated with e-cigarettes. These devices currently are not regulated by the Food and Drug Administration (FDA) and have not been evaluated for their safety or effectiveness. Additionally, studies on the long-term effects of inhalation of the vapors from e-cigarettes are not available.  However, preliminary tests on samples of first-generation electronic cigarettes performed by the FDA have indicated that they contain carcinogens (cancer-causing agents) as well as toxins. Based on these limited studies, the FDA has concluded that control processes used in the manufacturing of these devices are “substandard or non-existent.”

Many experts have raised concerns about the marketing of these products and the attraction to young people. The tech-friendly designs, attractive flavors, (e.g. cherry, bubble gum, chocolate) and ease of availability (online, convenience stores, vending machines) make devices like electronic cigarettes appealing to younger demographics. A recent press release from the U.S. Department of Health and Human Services Centers for Disease Control and Prevention indicates the number of calls they have received about e-cigarettes skyrocketed from one call per month in September 2010 to 215 calls in the month of February 2014 alone. More than half of those calls made involved concerns about children under the age of five. According to the Centers for Disease Control (CDC), poisoning related to the electronic cigarettes liquid occurs in one of three ways: ingestion, inhalation or absorption through the skin and eyes. Ingestion of small amounts of nicotine by an adult can induce nausea and vomiting and could be potentially fatal for a small child.

Without official FDA regulations and stringent quality control processes, the safety of electronic cigarettes remains in question. The discovery of carcinogens in e-cigarette samples, many of which are found in tobacco cigarettes, contradicts the claims that these devices are a healthy and safe alternative to smoking.  Many major U.S. cities have added e-cigarettes into their clean air laws banning their use in public venues. Currently there are no universally-recognized studies to show that e-cigarettes are any more effective in helping people quit smoking than any tobacco cessation therapies. For individuals who are looking for assistance with trying to quit smoking, the FDA continues to recommend approved nicotine replacement therapies and medications. It is important to discuss any tobacco cessation products with a health care professional to ensure proper dosing and use.

Jordan Buchholz

Jordan Buchholz, RRT, CTTS, is a respiratory therapist at St. Alexius Medical Center






Lung Cancer Facts

Posted on June 25, 2014

Lung Cancer FactsThe lungs are a pair of sponge-like organs within the chest that are vital for survival. Their main function is to take in oxygen and get rid of carbon dioxide (a waste product). Air enters through the nose or mouth and passes into the lungs through the trachea (windpipe). The trachea divides into the right and left bronchi, enters the lungs and further divides into bronchioles. The alveoli are the small air sacs at the end of the bronchioles which are surrounded by several, tiny capillaries (blood vessels). When you inhale, oxygen moves from the alveoli into the capillaries and into the blood stream while carbon dioxide moves from the blood stream into the capillaries and into the alveoli.  When you exhale the carbon dioxide is removed from the lungs.

All tissues and organs in the body are made up of cells. When cells get old or damaged they die and new cells form to take their place. Sometimes cells don’t die but continue to grow out of control and form new abnormal cells, which can create a cancerous tumor. Lung cancer is cancer that starts in the lungs.

According to the American Lung Association (ALA), lung cancer is the second most common cancer and is the leading cause of cancer related deaths among men and women in the United States. Lung cancer claims more than 150,000 lives each year which is more than colon, breast and prostate cancers combined.

Some factors that can increase your risk for developing lung cancer are:

Tobacco smoke: Smoking is the leading risk factor for lung cancer. The risk increases with the number of cigarettes smoked per day and the number of years smoked. The Centers for Disease Control and Prevention (CDC) state that smoking is the cause of at least 90 percent of lung cancer deaths. Tobacco smoke has more than 7,000 toxic chemicals in it, 70 of which are known to cause cancer. Smoking also can cause cancers in the mouth, nose, throat, esophagus, stomach, kidneys, bladder and bone marrow.
Secondhand smoke: Even if you don’t smoke, exposure to smoke that is exhaled from others increases your risk of developing lung cancer. 3,000 non-smokers die from lung cancer every year due to secondhand smoke.
Family history: If you have a parent, sibling or child with lung cancer, your chances of developing lung cancer are higher.
Radon exposure: Radon is a naturally-occurring gas that results from the breakdown of uranium in rocks and soil. It can leak through cracks in a foundation and accumulate to levels that are unsafe.
Other environmental chemicals: Workplace exposure to asbestos, arsenic, chromium, diesel exhaust, nickel, tar and soot, for example, can cause lung cancer.

Although you may not be able to prevent lung cancer, you can take the following steps to reduce your risk:

STOP SMOKING: This may be difficult, but it is the most important thing you can do for yourself and for those around you. When smoking is combined with other risk factors, your risk of cancer is even higher. Seek out smoking cessation programs and other available resources for assistance. Remember, no one has ever died from quitting tobacco. If you don’t smoke, don’t start!
Avoid secondhand smoke.
Test your home for radon: Radon gas is odorless and colorless. There are inexpensive and easy-to-use testing kits that you can purchase. For more information, contact the State Health Department.
Personal protective equipment: To avoid exposure to occupational/environmental chemicals, always wear protective equipment such as masks your employer provides.
Diet and exercise: Some studies show that people who have a diet high in fruits and vegetables and are physically active are at lower risk of developing lung cancer.
Screening for early detection: If you are between ages 55 and 74, with a history of heavy smoking (a pack a day for 30 years or two packs a day for 15 years) and currently smoke or have quit within the last 15 years, talk to your health care provider about lung cancer screening with low dose CT scanning.

Typically, lung cancer does not cause any signs and symptoms until the disease is advanced. Signs and symptoms of lung cancer may include: worsening cough or a cough that doesn’t go away, coughing up blood, shortness of breath, wheezing, chest pain, weight loss and fatigue. These symptoms also can occur with other illnesses, so it is best to discuss any symptoms and concerns with your health care provider. Do what you can to reduce your risk of lung cancer, and breathe easy.

Sandy Tschosik is a registered nurse and has her Bachelors of Nursing from the University of Manitoba, Canada.  She currently is the St. Alexius community health services coordinator.





Fatigue-Related Shift Work

Posted on August 13, 2014

Work StressMore than 22 million Americans work schedules that involve some type of shift work, including evening and night shifts, rotating shifts and on-call time. These types of shifts pose an interesting dilemma in regards to sleep quality and sleep quantity, which cause serious sleep-related accidents, putting not only the employee at risk but also their co-workers.  Some examples of fatigue-related problems that may put a patient at risk can include: lapses in attention and inability to stay focused, reduced motivation, irritability, diminished reaction time and indifference and loss of empathy. You can imagine that any of these can put a person at serious risk for harm.

In order to understand what exactly is going on with shift workers, you must understand that everyone has a circadian rhythm. This means that we are all meant to be awake during daytime hours and sleep during night time hours. Shift workers are exactly the opposite, and this may be what causes inadequate sleep quality and quantity.

So, how can shift workers make their lives easier and still assure their safety? Here is a list of suggestions that may help:

Breaks:  Breaks during work hours also may increase your alertness. Get up and move around, perhaps walk some laps around the workplace. There is evidence that brief rest periods in certain types of jobs may reduce fatigue without reducing productivity and may increase job satisfaction.

Sleep Schedules:  Permanent night shift workers should keep a regular schedule seven days a week. Employees working rotating shifts may need to delay bedtimes and arise times by two hours during the last few days of the evening shift when moving to nights.

Naps:  While getting sleep during one stretch of time is highly recommended, naps can be helpful when sleep time is fragmented. Napping can be especially helpful when naps are taken off-shift in the appropriate point in your circadian rhythm. It is important to note that brief naps at work may only increase your job performance due to sleep inertia (the body's tendency to want to remain at rest 15 minutes or longer after awakening). This means, taking a nap during a break may decrease your ability to react quickly.

Prescription Medication:  Certain medications can be used to override the circadian rhythm in order to sleep during the day. However, these should be used with caution due to some side effects as well as the problems associated with the medication's effectiveness wearing off.

Diet:  Foods eaten at work should be healthy. Meals high in protein and carbohydrates are recommended.

Workplace Conditions:  Lighting levels and temperature should be considered. The work environment should be bright and cool. Also, engaging in conversation will keep the employee alert.

Sleep Hygiene:  The best treatment of all may be to practice good sleep hygiene. Here are some guidelines to help MOST people sleep better:

  • Sleep in a dark, cool, quiet comfortable room.
  • Maintain a regular wake time, even on days off work.
  • Use the bedroom for sleep (not for watching TV or balancing the checkbook.)
  • Keep the room cool and comfortable.
  • RELAX before bedtime and maintain a regular bedtime routine. Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
  • Exercise regularly, however, try not to exercise vigorously 4-6 hours before bedtime.
  • Avoid caffeine if already alert and within six hours of bedtime.
  • Cover windows with room darkening curtains or wear eyeshades.
  • Use some type of "white noise" a fan or tune the radio to the far end of the dial.
  • Turn off the ringer on the telephone, disconnect the doorbell or put up a "Do Not Disturb" sign.
  • While a light snack before bed can help promote sleep, avoid large meals.
  • Don't drink alcohol when sleepy. Even a small dose of alcohol can have a potent effect when combined with tiredness.
  • Sleeping pills should be used only conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks.
  • Avoid the use of nicotine close to bedtime or during sleep time.

Karla Smith

Karla Smith, BS, RRT, RPSGT, is the coordinator of St. Alexius’ Sleep Center.






Palliative Care Improving Quality of life

Posted on March 25, 2014

Palliative CarePalliative care represents a different model of care, focusing not on cure at any cost but on relief and prevention of suffering. The priority is supporting the best possible quality of life for the patient and family, regardless of prognosis. Although palliative care is provided in tandem with curative treatments, most people associate it with end-of-life care.

Nothing could be farther from the truth. Palliative care is aggressive medicine that focuses on what is troubling the patient the most, whether it is nausea, pain, confusion, loss of appetite or depression. It only improves a patient’s ability to tolerate medical treatments and have the strength to carry on with daily life.

Palliative care treats people suffering from serious and chronic illnesses such as cancer, stroke, HIV/AIDS, cardiac disease such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure,  Alzheimer’s, Parkinson’s and Amyotrophic Lateral Sclerosis (ALS) to name a few.

A team of physicians, nurses, social workers and chaplains work with a patient’s other physicians to provide an extra layer of support. Other team members may include pharmacists and other complementary care professionals. 

Together with the patient, family, and primary physician, the palliative care team:

  • Manages complex pain and other debilitating symptoms
  • Takes time to talk with patients regarding their wishes and goals
  • Coordinates care with the patient’s physician and other specialists involved in the patient’s care and treatment
  • Treats the whole person by meeting medical, emotional, spiritual and social needs
  • Provides support to family members who are coping with changes in their loved one’s health status and eases stress caused by the patient’s serious condition
  • Helps patients and families understand the choices they may face and anticipate their future needs
  • Provides patients more control over their care. 

The main goal of palliative care is to improve a patient’s quality of life and is not dependent upon whether or not his or her condition can be cured. A patient does not have to be on hospice or at the end of life to receive palliative care. Palliative care is for anyone at any age and any stage of an illness. For more information on palliative care and the St. Alexius team, click here.

Dr. Laura Archuleta

Laura Archuleta, MD, is a primary care physician with St. Alexius Family Mandan Clinic - North. She serves as medical director for St. Alexius’ palliative care program. She is certified by the American Board of Family Medicine and holds a Certificate of Added Qualification in Hospice and Palliative Care.




Getting on with Life Through Cardiac Rehab

Posted on March 17, 2014

Getting on with Life Through Cardiac RehabExperiencing a cardiac episode can be life-altering, and in some cases can end in surgery. From valve repair or replacement to bypass and heart transplants, matters of the heart can take their toll on a patient’s mind and body. That’s where cardiac rehabilitation plays a big part in recovery.

Cardiac rehabilitation addresses both the physical and emotional healing of cardiac patients. Workouts typically range from 40 to 60 minutes and are supervised by professional staff. Patients wear a monitor that records their heart rhythm. In addition, their blood pressure and heart rate are closely monitored while they work out. The goal is to increase both endurance and intensity, which gives a patient a good idea of what activities they can safely do at home. 

In addition, depression is sometimes experienced after a cardiac event. Cardiac rehab not only encourages patients to get out and make a commitment to getting on with their lives, it also allows them the opportunity to talk with others who are going through the same experience.

Education is another big component to cardiac rehab. Patients are offered several education courses that range in topics including reducing risk factors, making healthy food choices, reading food labels and visiting with a pharmacist. The goal of combined education and exercise is to help patients realize they need to make “lifestyle” changes, not temporary “event changes.”

Judy Myers, RNJudy Myers, RN, is coordinator of the cardiac rehabilitation program at St. Alexius Medical Center.






Teen Topics


Talk to Your Teens about Drowsy Driving

Posted on May 12, 2014

Drowsy DriverWhen our children are studying for their driver’s permit, we help them by explaining the rules of the road as well as discussing the dangers of driving under the influence of drugs and alcohol and texting and driving. But, how many of us discuss the danger of driving while drowsy or sleepy? I am willing to bet that this subject rarely comes up in conversation between teen drivers and their parents. However, new data released by the American Automobile Association shows younger drivers are more likely to drive while drowsy.

Here are a few sobering facts:

  • At least one in seven drivers between the ages of 16 and 24 admitted to dozing while driving at least once in the past year. This compares with one in ten among drivers of all age groups in one year.
  • Most fatal drowsy driving crashes happen when the driver is less than one hour from home.
  • Eyewitnesses to drowsy driving fatalities state that there is no attempt by the driver to slow down or avoid an imminent crash.

These facts should be enough reason to begin the drowsy driving dialogue with our teens. However, there are a few things one should know regarding sleep in general and how teens differ from the majority.

The average amount of sleep adults should get each night is seven to nine hours. Teenagers should be getting nine to ten hours of sleep per night; but, on average many teens are getting only seven to nine hours of sleep per night. They are usually so busy with life: school, homework, participating in school sports, working and socializing. Their attempts to fit all of this into one day causes our kids to get to bed later then we would like.

Ongoing sleep deprivation can reduce one’s ability to process information, sustain attention, have accurate motor control or react normally. These are exactly the skills needed to operate a vehicle.

To give you an idea of how serious sustained sleep deprivation is, let’s compare sleep deprivation in hours to blood alcohol levels:

  • 17-18 hours awake is similar to the performance of someone with a blood alcohol content of 0.05 percent. (0.08 percent is considered legally drunk.)
  • 20-25 hours awake is similar to the performance of someone with a blood alcohol level of 0.1 percent.

We can teach our teens how to improve their sleep quality by teaching them good sleep hygiene, discuss signs of becoming too sleepy when driving, give them tips on how to arrive alive and come up with a plan if they are too tired to drive.

Sleep Hygiene:

  • Establish a bedtime routine, even on weekends.
  • Avoid caffeine.
  • Exercise 20-30 minutes each day.
  • Eliminate or reduce the number of electronic devices in the bedroom.
  • Keep the bedroom at a comfortable temperature.
  • Restrict sleep on the weekends.

Signs a Driver Needs to Pull Over and Rest:

  • Yawning repeatedly.
  • Difficulty focusing, blinking often and heavy eyelids.
  • Trouble keeping head up.
  • Missing exits or traffic signs.
  • Feeling restless, irritable or aggressive.
  • Drifting from lanes, tailgating or hitting rumble strips.
  • Inability to clearly remember the last few miles driven.

Arrive Alive:

  • Get a good night’s rest before hitting the road.
  • Don’t be in a hurry to get to your destination.
  • Avoid driving during hours when you would normally be asleep.
  • Use the buddy system.
  • Take a break every 100 miles or two hours.
  • Take a nap.
  • Avoid alcohol and medications that cause drowsiness.
  • Consume caffeine. (The equivalent of two cups of coffee can increase alertness for several hours.)

Making a Plan:

  • Get a ride from someone else.
  • Take public transit or a taxi.
  • Pull over to a safe place, and take a nap in your car.
  • Draw up a contract.
  • Enroll in an “Alive at 25” course.

These strategies have been proven to work, so discuss the topic with your young driver. It will help them to become better drivers, but most importantly they will arrive home safe. Lead by example. Adults also should practice good sleep hygiene, know when they are too fatigued to drive and arrive alive!

Karla Smith

Karla Smith, BS, RRT, RPSGT, is the coordinator of St. Alexius’ Sleep Center.






Cutting and Other Self Harm Behaviors

Posted on March 10, 2014

There have been an increasing number of reports from parents that their high school aged children are engaging in cutting or other self-harm behaviors. As a clinician in the Bismarck area, I have observed that this is, indeed, a relatively common issue affecting adolescents and young adults. Self-harm is the act of deliberately harming one’s own body. Usually it is not intended to be a suicide attempt but is an unhealthy way to cope with psychological pain and strong emotions. This can be a mixture of worthlessness, loneliness, anxiety, anger, self-hatred and other emotions. Cutting is often done in order to distract from, or diminish these negative emotions; but, also can be a way of gaining a sense of control over one’s self and life, or as a way of expressing or communicating one’s feelings. It can bring a temporary sense of calm that is often followed by guilt, shame and a return of the initial negative emotion. Often, the person who cuts is having difficulty expressing their emotions to others. Self-harm can be linked to several mental health disorders, including depression, eating disorders and trauma-related disorders, but there is no single cause that leads to self-harm. 

If you are concerned that your teenager may be engaging in self-harm behavior, look for risk factors or warning signs. They include teenagers who:

  • Have social problems
  • Have friends who self-harm
  • Have a history of being abused or neglected
  • Spend more time alone
  • Tend to bottle up their emotions or be emotionally explosive
  • Act impulsively and unpredictably
  • Make statements about feeling hopeless or worthless
  • Wear long sleeves or pants when the weather is hot
  • Have white or red scratches or cuts on their body (often on the arms and legs)

If you have a loved one or friend who you think is self-harming, it is important to get help for him or her, even if you are scared that you would be betraying their confidence or don’t know how seriously to take it.  If a person is injuring himself/herself, even in a minor way, it is a sign of bigger problems that need to be addressed. For parents, remember not to criticize or yell at your child if you learn that your child is self- harming. Instead, express concern for your child and get them professional help. You can start by consulting your physician who will evaluate and make referrals to a therapist. For people who are concerned about a friend, encourage the friend to seek out professional help, or talk to an adult they can trust. Tips for you if your loved one self-harms: get informed, find support, keep communication open between you and your loved one and take care of yourself. 

For people who are harming themselves, focus on how to express yourself in positive ways, avoid alcohol and drug use and don’t be afraid to seek out help. You can find professional help that is supportive, nonjudgmental and encouraging. Treatment can involve talk therapy, medications or a combination. For more information on cutting and self-harm, visit the Mayo Clinic’s website. If you are having thoughts of suicide, call the National Suicide Prevention Lifeline 24-hour crisis line at 800-273-8255 (800-273-TALK).

Sara Horner, PsyDSara Horner, PsyD, is a licensed psychologist with St. Alexius Medical Center’s Archway Mental Health Services.





Human Interest


Finding Hope Through the Holidays

Posted on November 24, 2014

Finding Hope Through the HolidaysChristmas, Thanksgiving, and other winter holidays bring pictures to mind of family gathered around a beautiful table full of food. The love and joy of family are visible in the picture almost radiating warmth from the picture. Not the picture many who have recently lost a loved one are ready to bear. Rather than see the abundance of family, you see the empty place left by one who has died. Rather than remember happy family traditions, many people feel sad over traditions that will never be the same without the special talents and contributions of the one you have loved. Many grieving people would like to skip from November to January to avoid the sadness of the holidays that are forever changed. Now is the time to plan what you want to do and what you do not want to do during the holidays.

Here are a few tips for coping with the holidays after the death of a loved one:

  • Be gentle with yourself. Acknowledge you have limits. You may need some extra help with holiday tasks this year.
  • Remember your anticipation may be worse than the actual days. You are not alone. This is a normal part of the holidays for many grieving people.
  • Be realistic. It is easy to become overwhelmed with the tasks and time pressures of the holidays. Plan ahead and prioritize. Say no when you need to.
  • Adapt. Adapt traditions. Adapt your plans. Some traditions may need to be changed or eliminated during your grief. Do what seems best for this holiday season. Next year you will be another point in your grief. Traditions that seem overwhelming this year may be comforting next year.
  • Allow yourself to grieve. Tears are ok even during the holidays. Do something symbolic in remembrance of your loved one whether a special ornament or a lit candle or some other item to celebrate the uniqueness of your beloved.
  • Celebrate the spirit of the holidays. The religious meaning of the holidays brings joy and peace beyond oneself. Hope in the midst of grief. Finding joy in the midst of the holidays does not mean you love your loved one less. It is an acknowledgment of our God who is bigger and stronger than our pain. God, who gives us hope.

Finally, allow yourself to be surprised. The holidays may turn out to be far more special and more meaningful than you anticipate as you remember the gift of your loved one.

Reverend Lori Lundblad


Reverend Lori Lundblad, MDiv.  Hospice and Palliative Care Chaplain at Home Care & Hospice.




Saying Thank You to Our Veterans

Posted on November 11, 2014

Thank you to our Veterans!Though many of us acknowledge Veteran’s Day on November 11, we seldom stop and say thank you to the veterans in our life. Many of us are fortunate to know a veteran we can thank in person, but we should realize that every day more and more of our nation’s veterans are dying. As these men and women who helped shape our nation’s history are lost, do we take the time we should to thank them for their service?

The We Honor Veterans program was formed in collaboration between the Department of Veteran Affairs (VA) and the National Hospice and Palliative Care Organization (NHPCO). Through the collaboration of these two organizations, and the partnership of local hospices, veterans at end-of-life are getting the thanks they deserve, sometimes for the first time. In order to be a part of the program, the veteran needs to meet hospice eligibility criteria under Medicare/Medicaid or other private insurance guidelines.

The We Honor Veterans program supports honoring veterans in many ways. One of the easiest ways to honor a veteran is simply giving the veteran the chance to tell their story. This can be done informally or as a part of The Veteran’s History Project. To learn more about the Veteran’s History Project visit

Another method used to help honor a veteran is a pinning ceremony. Ceremonies can be customized by each local hospice partner, but generally involve the hospice social worker and nurse taking a moment with the veteran and their family to recognize the sacrifice the veteran has made to our country. During the ceremony the veteran is presented with a flag pin. This presentation can be performed similarly to traditional military ceremonies when honors are given. The veteran may choose to wear their military hat, and a scripted reading is often used. The suggested reading is as follows: Ms. /Mr. Veteran, thank you for your service to our nation. Thank you for the sacrifices you made and your willingness to serve our country. You endured hardships and you were willing to risk your life to maintain our freedom. On behalf of (our staff, the VA, ___ Hospice) please accept our thanks and gratitude. When you see this pin, know that your service to the nation is deeply appreciated. We thank you.

Another piece to the We Honor Veterans program involves partnering veteran volunteers with veterans at end-of-life. Veteran volunteers are involved with listening to the veterans tell their story, assisting with the pinning ceremony, and giving the hospice patient the opportunity to build companionship with the veteran volunteer. The military is full of comradery and the shared experience between the veteran volunteer and the hospice veteran can bring healing to the veteran who is facing a terminal diagnosis. If you are a veteran who is interested in volunteering to work with other veterans on hospice, you should contact your local hospice for more information.

The We Honor Veterans program also supports training and education for hospice staff. Veterans may have symptoms during their dying process that can be related to their military experience. Hospice staff members that are a part of the We Honor Veterans program receive specialized training and education on how to deal with these symptoms. Additionally, hospice approaches symptom management from a team approach involving physicians, nurses, social workers, chaplains, pharmacists and therapists with knowledge of hospice care.

If you know a veteran who is approaching end-of-life please consider utilizing hospice services for their care. Hospice provides spiritual and emotional support as well as bereavement services in addition to skillful pain and symptom management. When selecting a hospice program, you can see who is a part of the We Honor Veterans program by going to and viewing the WHV partner directory.

Lindsey Lee

Lindsey Lee, CHI St. Alexius Health hospice coordinator, received her certification in Hospice and Palliative Care Nursing through the National Board for Certification of Hospice and Palliative Nurses. Lindsay began her career at St. Alexius in 2009.