Gundersen Magazine - Spring 2015

GUNDERSEN Y O U R G U I D E T O H E A LT H A N D W E L L N E S S

ENERGY INDEPENDENCE

Gundersen first in nation to reach energy milestone – p. 3

KIDS IN THE KITCHEN

Involve your child to help develop healthy habits – p. 10

SPECIALTY CARE + CONVENIENCE

See specialists available in your area - p. 12

Tanner’s Team Because amazing kids deserve amazing care – p. 5

Gundersen Health System has the following locations in your area. For a complete listing visit gundersenhealth.org.

IOWA

Calmar • 106 East Main Medical Clinic (563) 562-3211 Decorah

• 1830 State Hwy. 9 Medical Clinic, Behavioral Health, General Surgery and Podiatry (563) 382-3140 or (800) 865-3140 Eye Clinic (563) 382-2639 • 202 West Main Street Orthodontics (563) 382-2525

Fayette

• 110 King Street Medical Clinic (563) 425-3381

Lansing

• 50 North Fourth Street Medical Clinic (563) 538-4874

Postville

• 111 South Reynolds Medical Clinic (563) 864-7512

STEPHANIE CENEK, DNP Gundersen Calmar Clinic staff recently welcomed Stephanie Cenek, DNP, who provides family care services in disease management, preventive health, pediatrics and women’s health. She joins Rene Kriener, FNP. A native of Decorah, Stephanie is happy to be part of the Calmar community and to be caring for patients in Calmar.

“I was drawn to Gundersen because of its great reputation and the personal experiences I had as a patient and as a patient’s family member,” she says. “I have always been impressed with the care I’ve received.

My husband, Jason, and I had really hoped to move back to Northeast Iowa and Gundersen’s regional clinics provided an exciting new opportunity for our family.”

Waukon

She and her husband enjoy the outdoors, traveling and playing with their dog, Micah.

West Union

To schedule an appointment with Stephanie, contact Gundersen Calmar Clinic at (563) 562-3211.

• 120 2nd Avenue SE Medical Clinic (563) 568-3000 Eye Clinic (563) 568-3378 • 110 Jefferson Street Medical Clinic (563) 422-3817 • 112 Jefferson Street Palmer Lutheran Health Center (563) 422-3811 or (800) 541-4692

MINNESOTA

GERALYN ZUERCHER, MD

Harmony

• 805 Main Avenue South Medical Clinic (507) 886-8888 • 815 Main Avenue South Gundersen Harmony Care Center (507) 886-6544

Spring Grove

• 123 Fifth Avenue SE Medical Clinic (507) 498-3302 • 125 Fifth Avenue SE Gundersen Tweeten Care Center (507) 498-3211 Gundersen is published four times a year by Gundersen Health System. The information contained in the magazine is to educate consumers about various health subjects and is not intended to replace professional medical advice or service.

Personal health concerns should be brought to the attention of your physician or health professional prior to any change in medical treatment, exercise routine or diet.

For permission to reprint any portion of this magazine, to change your address, to let us know if you are receiving more than one copy or if you’d like to be taken off our mailing list, write to Gundersen Business Development and Marketing.

1900 South Avenue, La Crosse, WI 54601, or call (608) 775-3089 or (800) 362-9567, ext. 53089 Volume 4, Number 1 ©2015 Gundersen Health System EOE/AA/TTD/LEP Gundersen Lutheran Medical Center, Inc. Gundersen Clinic, Ltd.

Gundersen Orthopaedics helps biker pedal past injury

Family Medicine physician Geralyn Zuercher, MD, is caring for patients at Gundersen West Union Clinic.

Dr. Zuercher provides a variety of primary care services to patients of all ages, including obstetric care, well visits for children and adults, assessment and treatment of injuries and illnesses, referrals and health promotion.

“I believe Gundersen’s commitment to promoting both healthy individuals and healthy communities is an essential aspect of providing healthcare in rural Iowa and I am excited to be part of it,” says Dr. Zuercher. “I really enjoy getting to know folks and assisting them in improving their health and lives. I look forward to actively promoting healthy communities where I practice.”

In her free time, Dr. Zuercher, a native of Garber, Iowa, enjoys hiking, gardening, energy medicine and reading.

To schedule an appointment with Dr. Zuercher, call the Gundersen West Union Clinic at (608) 422-3817.

Kent McDaniel lives and breathes biking.

From criteriums to road races, the Altoona, Wis., resident enjoys competing in them all.

Little slows down this 52-year-old athlete, who says, “I’ve been active my Edward Riley II, MD whole life.”

Gundersen orthopaedic surgeon

Not even a major injury would deter him from riding again. “I experienced my first bad crash and broken bone on May 5, 2013. I was competing in the La Crosse Fitness Festival road race,” states Kent who recalls little of what caused the accident.

Kent was knocked unconscious and when he “came to,” he was sitting alongside the road unable to move his leg. He was transferred by ambulance to Gundersen Lutheran Medical Center in La Crosse. “Kent suffered a severely broken hip and a dislocation of the base of his thumb from his wrist,” explains Gundersen orthopaedic surgeon Edward Riley II, MD.

He also repaired Kent’s dislocated thumb.

For the next 12 weeks, Kent was advised to put no weight on his leg. He found alternatives to stay active, such as water running at the YMCA, and later, riding a recumbent bike and “crutching” around the block. “I remained very compliant. I didn’t want to set my recovery time back any further.”

Four months following the injury, Kent was back to biking leisurely and couldn’t be more pleased with the outcome. He competed in the same La Crosse Fitness Festival event in 2014 that sent to him to the emergency room in 2013. “I’m lucky I don’t remember the exact spot where I was injured.”

With more than 10 races under his belt in 2014, he says, “Thanks to Gundersen, I’m riding as hard as I want to again.”

Though it was a rider’s worst nightmare, Kent felt fortunate to be under the care of Gundersen’s Orthopaedic Surgery team—annually recognized as one of America’s 100 Best Hospitals for Orthopaedic Surgery™ by Healthgrades® since 2012.

Dr. Riley explained Kent’s two options for surgery: either a hip repair (known as closed reduction internal fixation) or total hip replacement. “Kent was young and active, so we always prefer to fix the hip rather than replace it, with the goal of restoring him to the level of function he enjoyed before the accident,” states Dr. Riley.

Dr. Riley used a special table and live X-ray during Kent’s hip repair to precisely line up the pieces of broken bone. He then secured the bones in place with hardware until they healed.

Gundersen orthopaedic specialists provide care in the following communities: Boscobel | Cresco | Decorah | Hillsboro | La Crosse | Onalaska Prairie du Chien | Sparta | Tomah | Viroqua | Waukon West Union | Whitehall | Winona

Kent McDaniel has competed in the Chequamegon Fat Tire Festival for years. Not even a major hip injury in May 2013 would stop him from competing in the 16-mile Short and Fat Race in September 2013.

They can help you get back to an active lifestyle—whether you’ve been injured or have chronic joint pain. Visit gundersenhealth.org/ orthopedics/locations to schedule an appointment close to home.

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Gundersen first in the nation to reach energy independence milestone Gundersen Health System recently became the first healthcare organization in the nation to reach the milestone of energy independence. The organization achieved its first days of energy independence in the fall of 2014, marking the first time a health system produced more energy than it consumed.

consideration in the design, construction and remodel of the organization’s many buildings, with several receiving LEED certification, the national benchmark for efficient design and performance.

On-site renewable energy projects including solar panels, a geothermal heat pump and biomass boiler were also completed during this time. When combined with In 2008, Gundersen CEO Jeff Thompson, MD, set a goal for the organization to control rising energy costs and improve conservation efforts, the result is over $2 million in annual energy savings. Hundreds of thousands of dollars are also the health of the communities it serves. They focused reinvested back into the on two main initiatives— “ We set out to make the air better for our local economy each year reducing consumption by patients to breathe, control our rising by purchasing waste improving efficiency and energy costs and help our local economy. woodchips from local creating cleaner energy.

We believe we have made more progress on suppliers as fuel for the biomass boiler.

“We did not set out to be all three than anyone else in the country.” the greenest health system,” –Jeff Thompson, MD, Gundersen CEO says Dr. Thompson. “We Regional energy partnerships set out to make the air better for our patients to breathe, control our rising energy costs and help our local economy. The sustainability effort has also given Gundersen opportunities to collaborate with regional governmental We believe we have made more progress on all three than and business partners in several innovative projects. anyone else in the country.”

Gundersen has since implemented numerous initiatives, big and small, to reduce energy use across the organization. Energy efficiency has also become a key

For instance, Gundersen has partnered with Dane County—along with Blue Star Dairy Farms, Hensen Brothers Dairy and Ziegler Dairy Farms—on a dairy

CLEANER AIR

Over 50% reduction in harmful emissions related to energy production, helping to improve air quality and preserve our local environment

DOLLARS SAVED

Over $2 million saved annually through conservation and on-site energy projects alone, helping to control cost of care

DOLLARS REINVESTED

Over $1 million redirected back into the community each year through alternative local energy sourcing

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About Gundersen Envision

biogas digester facility near Middleton, Wis. Gundersen also partners with Maunesha River Dairy on another digester facility near Sun Prairie, Wis.

Gundersen has developed an environmental program, called Envision, which has set the national standard for sustainability—from an advanced recycling and waste management program to a robust energy conservation program to innovative partnerships for energy projects.

Dairy biogas digesters create energy by processing cow manure in air-tight tanks to produce methane gas. The gas is then captured and burned in a generator to create electricity—approximately 20 million kilowatt-hours (kwh) annually between these two facilities. A side benefit of the project is that it reduces phosphorous runoff, protecting area waterways.

Gundersen also collaborated with Organic Valley on a two-turbine wind farm, near Cashton, Wis., that generates approximately 12 million kwh of energy—enough electricity to power 1,200 homes each year. Gundersen also built a two-turbine wind farm just north of Lewiston, Minn., that also generates another 12 million kwh annually. The power generated from the turbines is sent to the grid and used by homes and businesses. Gundersen is paid for the energy which helps offset their energy costs.

“Our practices are proving that sustainable approaches to energy conservation can go hand-in-hand with solid financial business decisions. We are now sharing what we’ve learned with enterprises across the country,” says Jeff Rich, executive director of Envision.

Another partnership is with La Crosse County, who teamed with Gundersen on a project that turns biogas created from waste at the County landfill into electricity and heat. With production of approximately 8 million kwh a year, the project completely heats Gundersen’s Onalaska Campus while also generating over $200,000 in annual revenue for the County.

“We set our sights on a goal that had never been achieved. And while we are a national leader, we still have work to do,” says Jeff Rich, executive director of Envision®, Gundersen’s energy subsidiary. “We have crossed the threshold to energy independence. It’s like breaking the sound barrier. We were the first to do it and it’s pretty astounding. Our next chapter will be to turn days into months and years.”

Producing more clean energy than they use has been a challenge and a moving target. Hospitals typically use two and a half times more energy than commercial buildings. Wisconsin has one of the most energy-intensive climates in the nation. Also, since the goal was set, expansion has occurred within Gundersen, including construction of two new hospitals (a 25 percent increase in space). “We have shown that you can be financially disciplined, improve the local economy and positively impact the environment,” adds Dr. Thompson.

Businesses can contract with Gundersen and identify a number of quick-payback opportunities in an energy check-up which will likely reduce their energy use by 10 percent in one year. Consultations can also assist with building design, engaging leadership in green initiatives and renewable energy development.

“We’ve learned along the way,” says Rich, “and we’re willing to share that knowledge with others who are also committed to a healthier environment and bottom line.”

To learn more about Gundersen’s sustainability efforts, visit gundersenenvision.org, or call (608) 775-0880 or toll free (855) 669-1653.

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Amazing kids deserve amazing care For parents of children who need specialty care, coordinating that care and lengthy travel can often add stress to the situation.

At Gundersen Health System, we’re proud to offer parents and children world-class specialty care and coordination near the comfort of home.

Perhaps no one knows this better than the Winjum family of Caledonia, Minn.

In 2006, their son, Tanner, was born prematurely.

Tanner also has Down syndrome and many related medical problems.

Since Tanner’s birth, his parents, Jennifer and Troy, have relied on many pediatric specialists at Gundersen.

Kerry Jedele, MD, pediatrician and geneticist, is the primary care provider for Tanner and other children with complex medical needs. “I’ve known Tanner since birth. His Down syndrome affects

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multiple body systems,” she reports. “He has a heart malformation, hypothyroidism, pulmonary hypertension (high blood pressure affecting the lungs), cleft palate, feeding problems, hearing loss and developmental challenges. He’s also had many fevers, pneumonia, infections, gallstones and other health problems.”

Dr. Jedele sees Tanner regularly for well-care visits. Because of his complex health needs, she often sees him for urgent care, too, and facilitates visits with other specialists. “Dr. Jedele is very thorough. She not only provides Tanner’s general medical care, she’s also interested in how he’s doing at school, what he needs at home and his future needs. We discuss healthcare guidelines for people with Down syndrome, making sure all his needs are met.”

“I call her for everything,” says Jennifer of Tanner’s care coordinator Kristi Sunday, RN. She is a resource and advocate for children like Tanner and their families; helping them to navigate the healthcare system.

“They know they can come to me for questions or concerns. I also provide education and work with schools and the community to connect families with needed resources there, too,” she explains.

“Kristi attends many of Tanner’s appointments,” reports Jennifer. “She helps occupy him so I can talk with the doctor; writes down things to remember; and follows up when we’ve been in Urgent Care. She’s a really great resource for us.”

Because Tanner has a serious heart condition, the Winjums rely on the expertise of pediatric heart specialist (cardiologist) Susan MacLellan-Tobert. During regular visits, she follows Tanner’s progress including growth, stamina and how well his heart is working.

In addition, Dr. MacLellan-Tobert is often called when Tanner arrives in the ER or Urgent Care. “Many physicians aren’t familiar with children with such complex medical issues. I help determine if his heart condition is causing the

Uko, MD, a specialist in pediatric digestive disorders (gastroenterologist), is a relatively new addition to Gundersen’s team of pediatric specialists. “We no longer have to travel to see a specialist. Having Dr. Uko here is huge,” says Jennifer.

problem or how his illness will affect his heart,” she explains.

Tanner frequently sees pediatric ear, nose and throat specialist (otolaryngologist) Michael Case, MD. “We see a lot of children with special “ Tanner has never followed a nice needs,” says Dr. Case. “Tanner Tanner also sees several other has very narrow ear canals so and tidy medical textbook. Having specialists at Gundersen, such as speech therapist Jody he’s susceptible to chronic ear so many people that know your Walters and registered dietitian problems that need special Margie Ley. attention. Ear infections affect child so well is very reassuring.” not only Tanner’s comfort but his –Jennifer, Tanner’s mom long-term hearing and ability to Jennifer says, “Each of Tanner’s learn, so my challenge has been to keep his ears clear.” providers know him so well. They ‘get him.’ Tanner has never followed a nice and tidy medical textbook. Having so many people that know your child so well is very Jennifer adds, “It’s important that we have access to reassuring.”

Dr. Case because Tanner can get into trouble fast with his sinuses and ears. Dr. Case is very flexible about getting Tanner is now 8 years old and in 3rd grade. “He’s a great kid.

Tanner in quickly, which we really value.”

It’s been fun to watch him grow up, get stronger and more Todd Mahr, MD, Pediatric Allergy, Asthma and Immunology, confident,” states Dr. Case. This is a sentiment shared by all those who care for Tanner. monitors Tanner’s allergies and mild asthma. “We need to keep his nose and sinuses open—often an ongoing When Tanner grows into adulthood, Gundersen also has problem for children with Down syndrome,” says Dr. Mahr. specialty clinics such as its Adult Down Syndrome Clinic and Adult Congenital Heart Clinic to make sure specialty “I was impressed that Dr. Mahr asked me, ‘How do you care is addressed for life. “The continuity of care we offer think Tanner is doing,’” Jennifer recalls. Dr. Mahr explains, to Tanner and other children with complex needs is “After 25 years, I’ve learned to listen to parents, especially exceptional,” Dr. Jedele concludes. when it comes to kids with special needs. Tanner has a great mom who is very in tune with him.”

If your child needs specialty medical care, call (608) 782-7300. For a full list of our many pediatric specialists Tanner’s feeding problem, gallstones and elevated liver visit gundersenhealth.org/pediatrics to learn more. function need ongoing specialized care as well. Victor

TANNER’S TEAM: Michael Case, MD Pediatric Otolaryngology

Kerry Jedele, MD Pediatrics and Genetics

This is just a small sampling of the many pediatric specialists that care for Tanner.

Susan MacLellanTobert, MD Pediatric Cardiology

Todd Mahr, MD Pediatric Allergy, Asthma & Immunology

Victor Uko, MD Pediatric Gastroenterology

Kristi Sunday, RN Care Coordination

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We have a new way to your heart

Sampoornima Setty, MD Gundersen cardiologist

Are you or someone you love living with aortic valve stenosis? This condition, affecting about 1.5 million people in the United States, is a narrowing of the valve in the main heart artery due to calcium deposits. It causes the valve to not work properly so the heart must work harder to pump blood through the valve.

The traditional treatment is to replace the valve using open heart surgery. But many patients are not candidates for this surgery. For them, Gundersen now offers another option called transcatheter aortic valve replacement, or TAVR. “TAVR is a minimally invasive surgical procedure that’s FDAapproved for patients with severe symptomatic aortic valve stenosis who are not candidates for open-heart surgery or patients who are risky to operate on,” reports Gundersen cardiologist Sampoornima Setty, MD, FACC. Candidates for TAVR are patients with: • scarring from previous bypass surgeries or radiation • severe hardening of the artery • older patients (mid 80s or older) who otherwise would not be considered for open-heart surgery “At Gundersen, TAVR can be done with different approaches,” Dr. Setty explains. “The primary approach uses a catheter, threaded through an artery in the groin traveling up to the heart. The catheter delivers a collapsed new valve

to the site of the faulty heart valve using guided imaging.

Once at the valve site, the new valve is expanded, pinning the old valve leaflets out of the way as it takes over the valve function.”

If a patient has small arteries or major blockages in the arteries used to deliver the new valve, the procedure can be done in one of two more direct routes using a slightly more invasive surgery. With any of the approaches, the procedure is done on a beating heart and there’s usually no need for a heart bypass pump.

“While TAVR is less invasive than open-heart surgery, it’s not without risks. That’s why TAVR is used only on select patients,” says heart surgeon Sajjad Rizvi, MD. “Despite the risks, TAVR can be an effective option to improve quality of life in patients with limited choices. And because it’s a minimally invasive procedure, patients usually have shorter hospital stays and faster recovery than with traditional open-heart surgery.”

At Gundersen, the procedure is a collaborative effort between a team of cardiologists and heart surgeons. In addition to Drs. Setty and Rizvi, the team includes heart surgeon Venki Paramesh, MD, FACS and cardiologists Raju Ailiani, MD; Hjalti Gudmundsson, MD; and Michael Witcik, MD, FACC. If you think you may be a candidate for TAVR, talk with your primary care provider about a referral to the Gundersen Valve Clinic, visit gundersenhealth.org/TAVR or call (608) 775-2335.

Gold standard treatment for brain aneurysms It was just days before Christmas 2013, and Polly Mihalovic and her husband, Scott, were carpooling home from work. Polly exited the car and was walking to their front door while Scott parked. She put her purse down and bent over to grab her keys.

Mouhammed Kabbani, MD “As soon as I lifted my head up, I knew Gundersen neuroendovascular something wasn’t right. I didn’t feel pain, but I felt a lot of pressure,” Polly surgeon

recalls. “I knew something was off.”

Something was “off,” but she wasn’t sure what. “Within a few minutes, I started to vomit,” Polly says. Thinking she could have a migraine headache, Polly declined Scott’s offer to go to the emergency room. After a nap, more vomiting and no change with the pressure she was feeling, Polly agreed to get medical attention.

A computerized tomography (CT) scan and CT angiogram of the head performed at Gundersen Health System’s emergency room showed a bleeding stroke due to a ruptured aneurysm in Polly’s brain. By that time, she also had numbness in one hand and other symptoms.

Neuroendovascular surgeon Mouhammed Kabbani, MD, was called immediately. Dr. Kabbani talked with Polly and Scott, explaining the aneurysm and how he planned to repair it. He stressed that surgery was needed immediately.

“I didn’t get to say goodbye to anyone because Dr. Kabbani said we had to go. He said his team was all ready for me,” Polly says. “I told him, ‘I’ll put my life in your hands.’ It was just Dr. Kabbani and me.”

Dr. Kabbani treated Polly with brain aneurysm coiling, a state-of-the-art procedure that uses platinum coils to block blood flow into an aneurysm. It’s safer than past procedures, involves no skull incision and requires almost no recovery time.

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Polly Mihalovic and her husband, Scott, participate in La Crosse’s 2014 Oktoberfest Torchlight Parade less than a year after successful treatment for a brain aneurysm. Photo courtesy La Crosse Festivals.

“Brain coiling is the gold standard now,” Dr. Kabbani assures. “It’s a delicate, difficult operation, but it has been very successful.”

Polly’s story could have had a very different ending. “I consider myself very blessed,” Polly continued. “Today, I honestly don’t think I have any deficits from the aneurysm.”

Dr. Kabbani agrees. “Polly did quite well, despite not coming in to be seen quickly.”

To avoid an aneurysm, Dr. Kabbani says, “People can do themselves a big favor by controlling high blood pressure if they have it, and by quitting smoking.”

Risk factors also include a family history of aneurysms and having already experienced an aneurysm.

If you suspect you may have a bleeding brain aneurysm, seek medical attention immediately by calling 911. Warning signs include a sudden, severe headache that feels like it’s the worst of your life; nausea or vomiting; loss of consciousness; sudden blurred or double vision; and sudden dizziness or trouble walking.

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Apheresis helps retiree go from wheelchair to walking Wayne Wojciechowski, of Onalaska, Wis., closed a remarkable chapter of his life on July 1, 2011, when he retired as assistant academic vice president of Viterbo University. After 33 years, he looked with anticipation to beginning the next chapter of his life. But as the Michael Leone, MD pages began to unfold, it was far from Gundersen what he’d envisioned. neurologist

“I began having severe pain in my legs at night. Soon, the pain persisted throughout the day. I lost my strength and sense of balance, and couldn’t walk,” recalls Wayne. It was devastating for an otherwise healthy, active 69-year-old man who was just one month into retirement. He was eventually confined to a wheelchair.

Wayne turned to Gundersen Health System for an answer. Following various tests, neurologist Michael

Leone, MD, diagnosed Wayne with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). It is a rare neurological condition in which the body’s immune system attacks the nerve cells.

Wayne started corticosteroids, which is often a first-line treatment for CIDP. With little to no improvement, Dr. Leone recommended therapeutic apheresis, a general term for treatments that eliminate harmful proteins, chemicals or cells in the blood that contribute to disease.

Gundersen’s experienced IV Therapy team has more than 12 years of experience administering apheresis. “We use an automated and incredibly accurate apheresis machine.

Whatever is contributing to a patient’s medical problem gets systematically depleted from the body. In turn, the patient experiences fewer and fewer symptoms,” explains Brian Linse, RN, IV Therapy.

These therapies can be tricky, but often they produce significant improvement. “Because of the immunological basis of CIDP, neurologists work closely with hematologists and often rheumatologists to make sure the workup is complete, there are no underlying conditions and to coordinate the immunological therapies,” says Dr. Leone.

Thanks to Gundersen treatments, Wayne’s quality of life has improved substantially. He is not only walking again but enjoying his favorite hobbies—golfing, swimming, woodworking, gardening and more. “Once you lose something, you recognize how much you miss it. And then to realize I got it all back…it’s a miracle!”

Wayne credits part of his success to the “incredible collaboration at Gundersen.” Specialists in Neurology, Hematology, IV Therapy, Physical Medicine & Rehabilitation, Physical Therapy and Orthotics helped him along the way. “I feel blessed that the expertise was in one location. I never had to be transferred elsewhere for care. At Gundersen, you never stand alone. And that is comforting.”

Getting your kids interested in the kitchen From the time they are old enough to crawl, many children find the kitchen to be a fascinating place. According to Gundersen registered dietitian Valerie Pampuch, RD, kids can do more in the kitchen than just bang pots and pans together. “Getting your children Valerie interested in cooking and baking early Pampuch, RD in life can help them learn healthy Gundersen registered dietitian eating habits,” says Valerie. “While they are helping you is a great time to teach them healthy food habits.” Here are some ways kids of every age can assist in the kitchen.

Ages 2-5 years ❏ Wash fruits and vegetables ❏ Gather the ingredients ❏ Stir batter in a bowl ❏ Frost cookies or cupcakes ❏ Sprinkle flour or sprinkles ❏ Use cookie cutters ❏ Mash with a fork ❏ Tear lettuce leafs ❏ Taste test – arguably the most important job of them all

Ages 6-8 years ❏ Whisk eggs ❏ Assemble own pizza ❏ Make sandwiches ❏ Set and clear the table ❏ Cut with scissors ❏ Grate cheese (be careful of your fingers) ❏ Beat or fold ❏ Peel oranges or eggs ❏ Cut with a small knife

Ages 9-12 years ❏ Grate cheese ❏ Cook soup over stove ❏ Cut vegetables with butter knife or paring knife ❏ Prepare salads ❏ Plan out the family meal ❏ Follow a simple recipe ❏ Use a peeler ❏ Open cans ❏ Make a salad

Ages 13-16 ❏ Use kitchen appliances ❏ Prepare part of a meal ❏ Grill meat on the grill ❏ Bake a cake ❏ Use of all kitchen equipment ❏ Follow more complex recipes and prepare an entire meal ❏ Knowledge of food hygiene Even though having your children help in the kitchen can be an enjoyable experience, the kitchen can be a dangerous place.

“Keep hot items away from the edge of the stovetop or counters. Also prevent children from climbing onto counters or the stove and be careful of hot foods splashing onto them,” advises Steve Manson, MD, Gundersen pediatrician. “Kids should not be allowed to use sharp objects, nor use blenders, mixers or the microwave without supervision. Also be sure there are no poisonous products under the kitchen sink, and test the batteries in the kitchen smoke detector.”

For more information go to gundersenhealth.org/nutrition.

Talk with your healthcare provider to discuss whether apherisis is right for you.

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Are we really too clean?

While it is good to keep a clean house and avoid places where you are at greater risk of picking up germs, experts say it is actually good to get dirty once in a while. “Hiding our children from all of the dirt around us may actually do more harm than good. Small exposures over time ‘exercise’ our immune system and give us the ability to fend off larger attacks by the same bugs in the future,” explains Bridget Pfaff, Gundersen infection control specialist. “Being too clean can increase the risk of diseases like asthma, allergy and other autoimmune diseases.”

Is stretching necessary before exercise?

Some people were taught to stretch before a workout while others were taught to stretch after working out, all with hopes to prevent injury. So which way is correct? According to Gundersen exercise physiologist Eddie Stenger, “Research shows there is very little benefit to stretching before exercising.” If you can exercise comfortably, and without injury, there is no need to stretch before you exercise. Eddie suggests easing into your workout such as a light walk to warm up the muscles instead of stretching. After a workout, a little stretching while the muscles are still warm may be beneficial if you have a muscle that feels tight. You should feel some slight discomfort with the stretch but you should not feel sharp or intense pain. Although stretching may not always be necessary with exercise, it may be beneficial in maintaining flexibility.

Hospice is more than caring for the dying Rosalie (Roz) Schnick knew that she was about to lose her soul mate. Roz watched as Ron, her husband of nearly 43 years, went from a strong and intelligent man, loved by friends and respected by his peers, to a shell of himself in just a handful of months.

Need help changing your habits? Try a wellness coach

Cerebral amyloid angiopathy progressed rapidly in Ron. Like Alzheimer’s, the disease claimed Ron’s mind and body.

But, it happened so fast. One day Ron could walk … the next he couldn’t.

Eat healthy. Get more exercise. Stress less.

It’s easy to say, but not always easy to do.

Gundersen’s Wellness Coaching program helps people improve or increase healthy behaviors, like fitness and nutrition, and decrease stress levels.

On Nov. 11, 2011, Roz learned Ron’s prognosis—five months or less to live. As Ron was a veteran and West Point graduate, Roz takes special meaning in receiving this awful news on Veteran’s Day.

A Gundersen wellness coach sits down with the client to talk about where they are, where they want to be and how they’re going to get there. Together the coach and client design a personal wellness plan with personal goals. The client checks in with their coaches as often as needed, either in person, on the phone or by e-mail, to talk about how things are going, get motivation and set new goals for the next visit. At the end of their work, the client has developed the tools needed to sustain the healthy changes.

Group coaching is also available for companies and businesses.

To learn more, go to gundersehealth.org/wellness/wellnesscoaching, call (608) 775-6870 or (800) 362-9567, ext. 56870, or email wellness@gundersenhealth.org.

say they want at the end of life: • S upport for patients and family caregivers •P ain and symptom control •O wn home management of health •H ome visits, medication management, resources for caregivers and 24/7 telephone support are available “Being able to keep Ron at home meant a lot to me.

Somehow, I think Ron knew that,” Roz says.

For more information about Gundersen Hospice, call (608) 775-8435 or visit online at gundersenhealth.org/ hospice.

A few days after Christmas—following a visit for Ron to Gundersen Emergency Services—staff talked to Roz about the benefits of hospice care. With assistance and support from Gundersen Hospice, Roz was able to care for Ron in their home until his death on March 31, 2012. For that, she will be forever grateful.

But hospice isn’t only about caring for the dying—it’s equally as much about caring and providing support for the living. Gundersen Hospice stays in close contact with a patient’s family for 13 months after the patient dies.

“It doesn’t stop with the death,” Roz says. “That’s when it begins. You are grieving, going through that process— incredible grief that just overwhelms you. With Hospice, there are grief coordinators to help you through it.”

Roz gives the analogy of a mother eagle bearing up her offspring as they learn to fly.

“That is what this whole Hospice program felt like, that I just kept on being lifted up, so that I didn’t fall,” says Roz. “You know there is someone there for you, to answer your questions, to help you when you are in need and to let you know when things are changing, so that you are not alone.”

Gundersen Hospice provides the type of care most people

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SPECIALTY SERVICES IN YOUR AREA Gundersen Health System is dedicated to providing care as close to home as possible.

Gundersen has providers in the following specialties who see patients in your area.

Calmar

Cresco

West Union

Available via Telemedicine Genetic Counseling OB & Oncology Endocrinology Neurology

Cardiology General Surgery Orthopaedic Surgery Podiatry Urology

Audiology Cardiology Podiatry General Surgery Nephrology Obstetrics & Gynecology Oncology Orthopaedics Otolaryngology Podiatry Urology

Decorah Allergy/Immunology (Peds) Audiology Cardiology Dermatology Endocrinology General Surgery Nephrology Neurology/Sleep Studies Obstetrics & Gynecology Oncology Orthodontics Orthopaedics Ophthalmology Otolaryngology Pediatric Specialties Podiatry Rheumatology Urology Available via Telemedicine Endocrinology Genetic Counseling OB & Oncology Hematology Neonatology Neurology Oncology Pediatric Specialties Pediatric Surgery

Postville Available via Telemedicine Endocrinology Genetic Counseling OB & Oncology Nephrology Neurology Oncology

Waukon General Surgery Nephrology Ophthalmology Podiatry Available via Telemedicine Neurology Nephrology Oncology

Available via Telemedicine Behavioral Health Cardiology Cardiothoracic Surgery Endocrinology Genetics OB & Oncology Hematology Nephrology Neurology Oncology Orthopaedic Surgery Pediatric Surgery

Telemedicine expands local access to specialty care Through the use of interactive video, audio and a secure, high-speed Internetbased connection, patients in your area can link with medical specialists at Gundersen Health System in La Crosse—in real time. Clinical telemedicine complements the specialists who see patients in person, giving patients easier, timelier access to specialists. We are continually adding telemedicine specialties, so make sure to check if your service is available locally.

YOUR OPINION MATTERS. JOIN GUNDERSEN ENGAGE TODAY. Gundersen ENGAGE is a new online marketing panel made up of healthcare consumers (patients and non-patients) from all over the region. The role of the panel is to provide Gundersen valuable feedback on a variety of marketing topics. Listening to the voice of our community is important as healthcare plays such a vital role in people’s lives. The dialogue occurs online (never by phone) and you can choose the topics you wish to provide confidential feedback on (typically taking less than five minutes). You may be asked to join an online discussion board or focus group, take a quick survey or answer a poll question to: • Share experiences on social media or websites • Voice your opinion about marketing strategies • Evaluate advertising messages or designs • Review website design, content and navigation • And more . . .

Help guide our marketing decisions by joining Gundersen ENGAGE! Visit GundersenHealthENGAGE.com for more information!

Visit gundersenhealth.org to find the names of your local visiting specialists.

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Non-Profit Org. U.S. Postage PAID Permit # 395 La Crosse, WI

Gundersen Health System 1900 South Avenue La Crosse, WI 54601

Love + Medicine We won’t kiss your forehead to see if you have a fever, but like Mom we believe in dispensing love + medicine.

GUNDERSENHEALTH.ORG/LOVE+MEDICINE