Inspiring Health FALL 2019
A Natural Birth Experience A patientâ€™s labor and delivery with a volunteer doula
Vaginal Birth After Cesarean Determining the safest option for delivery
Growing Specialty Care at the Medical Plaza The specialty clinic begins a new expansion project
RU RA L CO M M UN IT Y
Welcome ENT Dr. Jonathan Mellema! Brookings Health System is proud to welcome Ear, Nose and Throat (ENT) specialist Dr. Jonathan Mellema, M.D., of Avera Medical Group Specialty Care to the medical staff! Dr. Mellema comes to Brookings with almost 20 years of medical experience. He received his medical degree from the University of Minnesota in Minneapolis and performed his surgical internship in the Department of Surgery and his ENT residency at the Department of Otolaryngology Head and Neck Surgery at the University of Cincinnati College of Medicine. Dr. Mellema can diagnose and treat patients of any age with problems related to the head and neck. Surgical procedures he can perform at Brookings Health include tonsil removal, adenoid removal, pressure equalization (PE) tube insertions for children, sinus surgery and surgery to straighten the nasal septum between the two nasal cavities. To schedule an appointment with Dr. Mellema, please call Avera Medical Group Specialty Care at (605) 696-2700.
WELCOME Dr. Emily Abele! Brookings Health System is proud to welcome OB-GYN Dr. Emily Abele, M.D., of Avera Medical Group Specialty Care to the medical staff!
Dr. Abele earned her medical degree from the University of South Dakota Sanford School of Medicine and completed her residency in obstetrics and gynecology at the University of Nebraska Medical Center in Omaha. She is a native of Sioux Falls and earned her undergraduate degree from Augustana University. As a local physician, Dr. Abele enables expectant parents to deliver their baby close to home. She is also able to treat area women of any age with gynecologic issues, including abnormal uterine bleeding, polyps, fibroids and ovarian cysts. She is also certified to perform da Vinci robotic-assisted surgical procedures for gynecology. To schedule your appointment with Dr. Abele, please call Avera Medical Group Specialty Care at (605) 696-2700.
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Image-Guided Sinus Surgery 3 Each year about 35 million Americans develop chronic sinus infections, also known as sinusitis, making it one of the most common health conditions. To help local patients who live with chronic sinusitis, Brookings Health has once again grown services to now include image-guided sinus surgery.
through the patient’s nasal cavity, a very fragile area. The ENT surgical platform increases sinus procedure accuracy and safety which results in shorter recovery, less pain and better outcomes for patients.”
With the recent additions of Otolaryngologists Dr. Thomas Tamura of Midwest ENT and Dr. Jonathan Mellema of Avera Medical Group, Brookings Health has significantly expanded access to Ear, Nose & Throat (ENT) services. This means area patients can receive diagnosis, treatment, medical and surgical services for conditions affecting the head, neck, sinuses, ears, nose and throat close to home. To support the service expansion, Brookings Health has invested in new ENT surgical equipment and instrumentation designed for the delicate areas of the head and neck. Part of that purchase includes a surgical platform and navigation system to perform minimally invasive image-guided sinus surgery. “Image guidance is becoming the standard of care for ENT procedures,” said OR Director Candace Johnson. “To avoid scars, sinus procedures are typically performed
The surgical platform creates 3D images using pre-operative CT scans of the patient’s sinus cavities. At the beginning of surgery, the surgeon scans a patient’s head to match it up with the CT scan. An electromagnet field is then established around the patient’s head so the surgeon can guide and track instruments in real-time via the 3D images. Using a magnifying endoscope, an illuminated tubular instrument the size of a pencil, the ENT surgeon removes the affected tissue and bone. The goal of sinus surgery is to flush out infected material, open up blocked passages and keep enough healthy tissue so that a patient’s nose and sinuses can function normally. The surgery resolves most patients’ symptoms, such as nasal congestion, facial pressure and sinus headaches. In addition, most patients experience significantly fewer sinus infections. Want to learn more about ENT services available at Brookings Health System? Visit brookingshealth.org/ENT.
Vaginal Birth After
Healthy People 2020, a federal government program, has a goal to reduce caesarean births nationwide. C-sections account for 11% of births at Brookings Health System, significantly less than both the South Dakota (24.5%) and national (32.0%) rates. One way Brookings Health curtails caesarean deliveries: offering mothers with a previous C-section a trial of labor after caesarean. The need for a C-section often doesn’t become obvious until labor is underway. It may be a safer way to deliver a baby than a vaginal delivery in cases where labor stalls, the baby is in distress or in an abnormal position, or there’s a problem with the placenta. Many mothers feel mixed emotions after a caesarean: joy from having a healthy baby and disappointment from missing out on a unique experience. However, just because a mother has given birth once by C-section doesn’t mean she needs to give birth again by C-section. “The thinking used to be, ‘once a C-section, always a C-section,’” said Obstetrics Director Mary Schwaegerl. “However, evidence-based research shows there are significant health advantages to mothers who try to labor and deliver vaginally after a caesarean delivery.” Women who achieve a successful vaginal birth after caesarean delivery (VBAC) avoid major abdominal surgery, meaning they also avoid risks such as infection, heavy bleeding, anesthesia reactions, blood clots, and surgical injuries to the bowel or bladder. They also have a shorter recovery period after birth and their babies avoid breathing complications and possible surgical injury.
In addition, they avoid risks association with multiple C-sections, including potential placental problems, heavy bleeding and possible need for hysterectomy. While the American College of Obstetricians and Gynecologists says a trial of labor after caesarean leading to VBAC is a safe option for most women, not every woman is a candidate. Mothers who are less likely to attain a successful VBAC will have a combination of factors. These may include increased maternal age, gestation over 40 weeks, maternal obesity, preeclampsia, short interval between pregnancies, a physically large baby and a recurrent reason for the initial caesarean. “While the best predictor of a successful VBAC is a prior vaginal birth and labor that starts spontaneously, a single one of the contraindications doesn’t exclude a woman from trying VBAC delivery,” said Schwaegerl. “It’s a decision an expectant mother should make with her OB-GYN.” For those women who try labor after a caesarean, Brookings Health’s OR team is on call to perform an emergency C-section if complications arise. “First and foremost, we want a safe delivery for both the mother and baby,” said Schwaegerl. For women who have a successful VBAC, they often feel fulfillment from experiencing a vaginal delivery plus the bliss of a new baby. Learn more about Brookings Health’s labor and delivery services at brookingshealth.org/OB.
A Natural Birth Experience Brookings Health System’s volunteer doula program provides a pool of doulas to assist parents who have their baby at New Beginnings Birth Center at no cost to the parents. For first-time mom Tiffany Niemann of Clear Lake, her volunteer doula helped her and her husband, Collin, have the unmedicated, natural birth they wanted. “Doula” is Greek term that means, “to mother the mother.” A labor doula is a woman who provides continuous labor support during childbirth, assisting parents with emotional and physical needs such as pressure point relief, positioning, relaxation and visualization. Tiffany first learned about doulas from a fellow SDSU co-worker who hired a doula to help her give birth without pain medication. When Tiffany learned she was pregnant with her first child, Savannah, she investigated doulas. She was pleased to discover Brookings Health offered a free, volunteer doula program and talked the option over with Collin. “Both him and I weren’t really sure what to expect,” said Tiffany regarding labor and delivery for their first child. “We both talked and agreed that we would like to have somebody there to just kind of coach us and be there for us. I also wanted somebody there to help with some massage techniques and breathing techniques so I could keep this as an unmedicated delivery.” When it was time for Savannah’s birth, Tiffany was induced in the evening by her OB-GYN, Dr. Larissa Bennis.
The next morning Tiffany and Collin met Alissa, the volunteer doula on shift for the day. Alissa asked the couple what their goals were and what they expected from their birth experience. “That was really helpful because I didn’t have to worry about her overstepping her boundaries at all,” said Tiffany. “We expressed to her we wanted my husband to be involved as well. That was really important for myself. I didn’t want him to sit on the sidelines and just watch everything going on.” Alissa showed Tiffany and her husband massage and breathing techniques. She coached Collin when to hold Tiffany’s hand and how to talk her through pain. She also educated them on how contractions work and helped Tiffany recognize when she was in a contraction and how to breathe through it. The doula services Alissa offered the Niemann’s complemented the care the couple received from Dr. Bennis and the obstetrics nurses. Thanks to the care from the entire labor and delivery team, Tiffany and Collin welcomed their baby girl only eight hours after induction. Choosing a volunteer doula as part of their care team helped Tiffany and Collin have the smooth, natural birth without pain medication they wanted. Visit brookingshealth.org/TiffanyN to learn more about the volunteer doula program and hear the rest of Tiffany’s story.
PROVIDERS at the Medical Plaza
First Floor: GENERAL SURGERY Theresa Oey
UROLOGY Dileep Bhat
ORTHOPEDICS Mark Mayer
After three years of consistent specialty services growth, patient care will soon expand to the second floor of Brookings Health System’s Medical Plaza.
6 Tyler Harrell
EAR, NOSE & THROAT (ENT) Jonathan Mellema
OBSTETRICS & GYNECOLOGY Kirstin Sholes
Growing Specialty Care at the Medical Plaza
In 2016 Brookings Health System launched the Medical Plaza, a 30,000 square-foot medical office building connected to the hospital that houses physicians who regularly care for patients in the hospital setting. The building opened with a finished first floor, leased by Avera Medical Group Specialty Care, and shelled-in second floor, ready for expansion when needed. “Part of the reason we built the Medical Plaza and undertook the hospital expansion and renovation project was to attract specialty providers to Brookings. As such, we knew we would need to accommodate future growth,” said CEO Jason Merkley. “It’s fantastic that we’ve been so successful in attracting talented providers, including orthopedic, ENT and gynecology surgeons, in only three short years. The Medical Plaza’s first floor, however, is now overcrowded. It’s time to finish off the second floor with exam rooms and offices so our medical staff can continue to expand.” Construction on the second floor started in August and is anticipated to be ready for providers to move-in at the end of the year. Avera Medical Group Specialty Care plans to relocate the offices for the practicing OB/GYNs and dermatology to the second floor. The first floor will still house general surgery, urology, orthopedics and ENT. In addition, podiatry services will move from the Avera clinic located at 400 22nd Ave. to the first floor of the Medical Plaza. “Each floor should be able to accommodate about eight to ten providers,” said Merkley. “With 12 different specialty providers already on board, that gives some extra space for growth and to continue recruiting specialties to Brookings.”
SPORTS MEDICINE for Kids Playing sports offers children both physical and psychological benefits and has been linked to future success in life. But children who play sports are also growing and developing, putting them at risk for injuries that require sports medicine expertise.
The popularity of youth sports and recreational activities means kids are more likely to experience a sports-related injury. In fact, one in three children who play a team sport is seriously injured enough to miss practice or games.
Many times the first step a parent makes with an injured child is their primary care provider or the ER. For serious sports injuries, the next step often leads to seeing an orthopedist.
“Kids are becoming much more Michael Holmoe, D.O. competitive at a younger age,” said Dr. Michael Holmoe, orthopedic surgeon and sports medicine expert at Avera Medical Group Specialty Care. “Whether its gymnastics, tumbling, basketball leagues – you see kids who are as young as three and four who are being very active in competitive sports.” In fact, more than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities. Some of the most common sports-related injuries among children are sprains, muscle strains, bone or growth plate injuries and repetitive motion injuries. While boys account for 61% of all sports-related injuries, girls are more than eight times likely to have an ACL injury. “Sports injuries impact kids greatly because it affects their daily function. When you have a kid and he or she has an injury, you know it’s holding them back from what they want to be doing. They can’t really progress until they’re feeling better,” said Dr. Holmoe.
“Sports injuries are diagnosed first and foremost by the patient coming in, giving us a history of what’s going on, when did it start and how has it progressed,” said Dr. Holmoe. “Once we have an idea of what’s going on, we’re able to do a physical diagnosis and physical exam. We may order additional tests, such as an X-ray, ultrasound, CT or MRI, to get a better idea of what’s going on.” From there the doctor collaborates with the parent and child to develop a rehabilitative care plan. Depending on the injury, treatments may include casting, physical therapy, medication or surgery. “When an athlete comes to see me, my goal, personally, is to get them back on the playing field or back to the condition that they were in previously,” said Dr. Holmoe. “I want them without pain. I want them to be as active, or more active, than where they were before their injury.” Hear more from Dr. Michael Holmoe about treating sports medicine injuries online at brookingshealth.org/SportsMedicine or call (605) 696-2700 to make a sports medicine appointment.
300 22nd Avenue Brookings, SD 57006
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EXPANDING VISION SERVICES This summer Brookings Health System acquired M.D. Bartley Opticians, the optical store immediately next door to Yorkshire Eye Clinic. To signal the addition of optical services, the health system added “and Optical” to the Yorkshire Eye Clinic name. It also added new choices for customers.
With the addition of the optical store, Yorkshire Eye Clinic & Optical now offers ophthalmology, optometry and optical services under one roof, making it the most comprehensive vision center in Brookings. The optical store is maintaining its products and services, including UV coating, progressive lenses and transition lenses. However, it’s also added more variety to its selection of adult frames, adding luxury brands like Jones of New York, Vera Bradley and Carolina Herrera. “We have frames and lenses available at every price point to fit each patient’s budget,” said Optician Sheila Cavanaugh. “We can even cut lenses right here in the store for anyone who wants to try to keep the same frames.”
The optical store has also expanded its offering to include a more comprehensive line of kids’ eyeglass frames. To promote the new kids’ line, parents of children who have their routine eye exam with Optometrist Dr. Taylor Kneip can purchase one pair of glasses for their child and get the second pair of glasses at 50% off. In addition, selected kids’ frames have a limited one-year warranty. In addition to filling prescriptions written by the Yorkshire Eye Clinic & Optical doctors, the optical store also still accepts prescriptions from any other eye doctor or outside eye clinic. “Adjustments are always free with purchase,” said Cavanaugh, “and we’re happy to repair damaged glasses and provide replacement parts as needed.”
Time for new glasses? Call Yorkshire Eye Clinic & Optical at (605) 696-8870 or learn more online at brookingshealth.org/Optical.