Winter 2014

PULSATIONS

A Healthy Dose of News from Sanford Health of Northern Minnesota 2014 Sanford Bemidji Cancer Committee Annual Report

Lizbeth Johnson learned firsthand the value of seamless care.

PAGES 3-5

Cancer annual report

Training for Hope

Not done fighting

Personalized care

By John Bollinger, MD Radiation Oncology Sanford Bemidji Cancer Center Cancer Committee Chair

Greetings from Sanford Bemidji Cancer Center.

Thank you for reading this special edition of Pulsations, dedicated to our oncology program. When you or someone you love is diagnosed with cancer, the only concern should be healing, not worrying about traveling great distances for lifesaving care. It is hard to believe that 20 years ago cancer care wasn’t even available in Bemidji. We have come a long way since then.

This last year has been very exciting as we received accreditation from the Commission on Cancer and the National Accreditation for Breast Centers. You will also read about the new support services, programs and opening of the Edith Sanford Breast Center. Today, Sanford Bemidji offers a multi-disciplinary approach to cancer care using state-of-the-art technology and innovative treatments, all close to home.

I want to personally thank you for placing your care and the care of those important to you in our hands, we take this responsibility very seriously and are honored by your trust.

The American College of Surgeons' Commission on Cancer granted Sanford Bemidji Cancer Center a three-year accreditation with commendation. The announcement was made at an event in 2014.

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Proven quality Sanford Bemidji Cancer Center’s accreditations continue to increase.

Accreditation is a voluntary process in which outside reviewers closely examine our program and our results. If we meet or exceed specific standards, we receive the stamp of approval. For patients and families, accreditation is an important measure of quality.

Working together within the Sanford system

L

izbeth Johnson is no stranger to cancer.

She was only 39 when she learned she had breast cancer. Her mother and sister are also breast cancer survivors. Now, two decades later, Lizbeth is battling cancer again. She and her husband, Gary, are grateful for the medical expertise and phenomenal support provided by Sanford Bemidji as well as the seamless care made possible by the coordinated network throughout the Sanford Health system.

"From the get-go until now, we have had a huge number of professionals here in Bemidji and at Sanford in Sioux Falls and Fargo who all played such key roles in my care to make everything come together," Lizbeth said.

"I'm especially grateful to Bemidji for what they did to make it possible for me to be home during my chemotherapy treatments."

The Johnson family pulled together to care for Lizbeth while she underwent treatment for ovarian cancer. (l-r): Lyndsay and Olivia Grand, Gary and Lizbeth Johnson, Owen and Rick Grand.

The Sanford system coordination made their experience basically seamless, Gary added. "We could go to Sioux Falls, Fargo and Bemidji and be at the clinic or hospital and everyone knew what was happening with Lizbeth. They all worked together to make sure she got what she needed."

Their story began last May one evening when they were quietly relaxing at home. Lizbeth offhandedly mentioned her clothes didn't fit right. Gary, who affectionately says his wife still looks like she did in high school, noticed firmness in her abdomen. The next afternoon, Gary called Sanford Bemidji Obstetrician/Gynecologist Jane Killgore, MD, and related his concerns. Dr. Killgore worked Lizbeth into her schedule the following day and ordered an ultrasound.

"I saw concern on Dr. Killgore’s face when she looked at the ultrasound and I knew our life was changing," Gary said.

"She told us it was highly suspicious for ovarian cancer. It was right before Memorial Day weekend. But they got the ball rolling immediately. Dr. Killgore told us we would need to go somewhere else if Lizbeth needed surgery because there were only a few surgeons in the region who specialized in ovarian cancer."

The following day, Gary and Lizbeth were called back to the hospital. Dr. Killgore had consulted Dr. Maria Bell, a gynecologic oncologist at Sanford Gynecologic Oncology Clinic in Sioux Falls, S.D. Dr. Bell requested that Lizbeth have a CT scan and electrocardiogram immediately. The next week, the Johnsons were planning a weekend drive to Sioux Falls. Dr. Bell worked Lizbeth into her schedule for Monday, June 2. Their daughter, Lyndsay, flew to Sioux Falls from Bemidji to join them. On Tuesday, Dr. Bell removed a twenty-centimeter mass from Lizbeth's abdomen.

"Dr. Bell even worked Lizbeth into her surgery schedule on Tuesday rather than Wednesday so Lyndsay could be there," Gary said. "Not knowing that surgery would be scheduled so fast, Lyndsay had a ticket to fly home Wednesday.

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Lizbeth Johnson enjoys the small things in life and is happy that chemotherapy is finished.

The time line is incredible for what the Sanford team accomplished for Lizbeth in such a short time."

The Johnsons had considered seeing a different ovarian cancer specialist. But Lizbeth couldn't even get an appointment until June 20. By staying within Sanford's coordinated care network, Lizbeth had surgery Tuesday afternoon, June 3, and was back home in Bemidji June 5. Dr. Bell scheduled a follow-up appointment in Fargo for Thursday, June 19, and Lizbeth began her chemo regimen in Fargo on June 20.

Like most patients and families, the Johnsons wanted to stay close to home for treatment. But Lizbeth's recommended chemotherapy regimen was unlike anything that had been done in Bemidji previously. So she began treatment at Sanford Health in Fargo. Meanwhile, Fargo staff worked with Bemidji staff to support the Johnsons' desire to have Lizbeth close to home while having chemo treatments.

"The staff support and engagement at both locations was over the top," Gary said. "It took a tremendous amount of work to make it possible for Lizbeth to be in Bemidji for chemo."

From the get-go until now, we have had a huge number of professionals here in Bemidji and at Sanford in Sioux Falls and Fargo who all played such key roles in my care to make everything come together.

Sanford Bemidji Lead Chemotherapy Infusion Nurse Jennifer Gourneau, RN, and other staff members traveled to Fargo for training. They returned and trained other hospital staff. Sanford Bemidji Medical Oncologist Jayan Nair, MD, headed the planning and care coordination for Lizbeth.

"We literally had every hospital department involved in setting this up," Gourneau said. "Because of the complexity involved, Lizbeth needed to have the treatment in the hospital."

Prior to a treatment, Lizbeth received infused medications that made it more likely her body would be able to accept the intensive chemotherapy. During chemotherapy, Lizbeth simultaneously received multiple modes of several medications delivered from two separate entry points: a port inserted in her chest and a second port in her abdomen.

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During Lizbeth's first day of chemo in Bemidji, Gary was amazed at the number of professional staff caring for her, including a pharmacist and four nurses dedicated solely to her. He and Lizbeth appreciated being able to return to the comfort of their home at night. Their proximity to Lyndsay made it possible for her to join them regularly. Gary and Lizbeth treasure a photo of grandson Owen, born July 2, sleeping contentedly near his grandma in her hospital bed. Being able to remain in Bemidji reduced other stressors too, such as travel expenses, time away from work and separation from other family members and friends.

Lizbeth calls herself "one of the lucky ones" because only 40 percent of patients are able to complete this rigorous chemotherapy regimen.

"Lizbeth was very sick from her chemo therapy treatments for breast cancer and I was very afraid when I read the side effects possible with this," Gary said. "But they have learned so much in the years since then. The time they spent premedicating her to help avoid the side effects really helped her tolerate the chemotherapy."

Lizbeth completed chemotherapy in October and remains under the care of Drs. Bell and Nair. Meanwhile, Sanford Bemidji is developing an inpatient chemotherapy program, Gourneau said.

"We're grateful for Dr. Killgore because our story started there," Gary said. "She listened when I called and took it seriously. She followed up right away. Dr. Killgore knew who to contact within the Sanford Health system and made the referral to Dr. Bell. Following Lizbeth's surgery, Dr. Bell presented Lizbeth's case to the tumor board, where specialists at Sanford Sioux Falls met to specifically examine Lizbeth's care and ongoing treatment plan of care. We also appreciate how everyone worked Lizbeth in for appointments regardless of how full their schedules were."

After the stress of the last several months, Gary and Lizbeth are beginning to enjoy normalcy again. Grandchildren Olivia, 3, and Owen, 5 months, bring them joy. They look forward to again being able to hike, bike and golf. Currently, Lizbeth is on medical leave from her job as a middle school teacher. Gary is happy to be back to regularly working at Sanford Health HealthCare Accessories.

"Chemotherapy has been completed," Gary says. "That's the best part!"

Lizbeth Johnson enjoys spending time with her grandchildren.

When days old, her grandson Owen was by her side in the hospital while she received cancer treatments.

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Geographical distribution of primary cases 2013*

Kittson 0.27%

Top 5 cancers

Lake of the Woods 3.49% Koochiching 2.96%

Pennington 0.54%

Polk 2.96%

Beltrami 51.34% Clearwater 13.17%

2013 at a glance Becker 0.54%

Clay 0.27%

• 372 new patients came to Sanford Bemidji Cancer Center for diagnosis and/or treatment.

Itasca 1.34%

Hubbard 9.95%

Cass 10.48%

Wadena 0.81%

Primary service area

• 51.34% of those patients came from Beltrami County.

Secondary service area Outlying area

• The most common cancer diagnosis was breast cancer, followed by lung and bronchus cancer, prostate cancer, melanoma (skin) and colon cancer.

Wright 0.27%

Ramsey 0.27%

Sanford Bemidji Cancer Center 2013Sanford Distribution County Bemidjiby Cancer Center Sanford Bemidji Cancer Center 2013 Distribution by County 2013 distribution by county 10.48%

MN-Beltrami = 191 MN-Clearwater = 49 MN-Beltrami = 191

MN-Cass = 39 = 49 MN-Clearwater

9.95% 10.48%

MN-Hubbard =37 MN-Cass = 39

9.95%

3.49%

13.17%

0.27%

2.96% 3.49%

13.17%

2.96%

1.89%

0.27%

2.96% 1.34%

0.81% 1.34% 0.81% 0.54%

2.96%

0.54% 1.89%

0.54%

0.54%

0.54%

0.54%

0.27% 0.27%

0.27%

0.27%

0.27%

0.27%

0.27% 0.27% 0.27% 0.27% 0.27% 0.27%

51.34%

Other locations: Arizona 0.27% Iowa 0.27% North Dakota 0.81%

51.34%

MN-Hubbard MN-Lake of the=37 Woods = 13 MN-Lake of the Woods MN-Koochiching = 11 = 13 MN-Koochiching = 11 MN-Polk = 11 MN-Polk = 11

MN-Itasca = 5

MN-Itasca = 5

MN-Wadena = 3

MN-Wadena = 3

MN-Becker = 2

MN-Becker = 2

MN-Pennington = 2

MN-Pennington = 2

ND-Cavalier ND-Cavalier= =22 AZAZ = 1= 1 IA-Story = =1 1 IA-Story MN-Clay MN-Clay = =1 1 MN-Kittson= =11 MN-Kittson

MN-Ramsey = 1 MN-Ramsey =1 MN-Wright = 1

* The 2014 Sanford Bemidji Cancer Committee annual report is based on data from Jan. 1, 2013 to Dec. 31, 2013.

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MN-Wright = 1

ND-Grand Forks = 1

ND-Grand Forks = 1

Primary site distribution for Sanford Bemidji Cancer Center Site Breast Lung & Bronchus Prostate Melanoma, skin Colon Lymphoma Non-Hodgkin Nodal Extranodal Hodgkin Bladder Leukemia Lymphocytic ALL CLL Other Myeloid AML CML Other Other leukemias Brain Other CNS Kidney Pancreas Rectum/rectosigmoid Uterus Cervix Ovary Stomach Esophagus Oral Cavity/Pharynx Multiple Myeloma Thyroid Testis Soft Tissue Larynx Liver/IBD Mesothelioma Small Intestine Anus Vulva Other Sites Total

2013 69 59 40 24 22 14 14 9 5 0 13 9 5 0 4 1 4 3 1 0 0 6 3 5 13 9 11 0 5 2 0 13 7 5 2 3 4 2 2 3 2 0 25 372

Male 0 31 40 15 10 4 4 3 1 0 10 6 3 0 3 0 3 2 1 0 0 3 0 3 9 7 0 0 0 2 0 8 3 2 2 2 2 0 2 1 1 0 14 177

Female 69 28 0 9 12 10 10 6 4 0 3 3 2 0 1 1 1 1 0 0 0 3 3 2 4 2 11 0 5 0 0 5 4 3 0 1 2 2 0 2 1 0 11 195

2012 75 48 33 31 21 20 19 12 7 1 24 8 5 0 5 0 2 1 1 0 1 6 9 17 8 14 11 1 4 8 5 11 5 2 1 7 1 6 1 0 3 2 17 399

Male 1 29 33 22 9 9 8 5 3 1 17 6 4 0 4 0 1 1 0 0 1 4 3 7 4 8 0 0 0 6 3 8 3 1 1 5 1 4 1 0 1 0 8 194

Female 74 19 0 9 12 11 11 7 4 0 7 2 1 0 1 0 1 0 1 0 0 2 6 10 4 6 11 1 4 2 2 3 2 1 0 2 0 2 0 0 2 2 9 205

2014 Sanford Bemidji Cancer Center Cancer Committee membership Cancer Committee Chair Radiation Oncologist Dr. John Bollinger Medical Oncologist Dr. Jayan Nair Surgical Oncologist Dr. Wesley Papenfuss Diagnostic Radiologist Dr. Michael Thurgood Cancer Liaison Physician Surgical Oncologist Dr. Allan Campbell Pathologist Dr. Arif Azam Patient Navigator Theresa Bentler, RN, BSN, OCN Certified Tumor Registrar Jessi Christ, BS, CTR Administration Representative Dr. Dan DeKrey Joy Johnson Oncology Nurse Jen Gourneau, RN, BSN

Cancer Program Director Shari Hahn, RN, MSN Clinical Research Representatives Susan Hudson, BS, BA, CCRP Kim Wold, MSPH, CCRC Dietitian Heather Knutson, MS, RD, LD American Cancer Society Representative Warren Larson Genetic Professional/Counselor Jennifer Leonhard, MS Rehabilitation Representative Brad Neis Tumor Registrar LaRayne Olson Community Outreach Janel Olson, RTT Palliative Care Team Member Denise Staehnke, RN, BAH Marketing Representative Lindsey Wangberg

Quality Management Representative Joann Greendahl, RN, BSN

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Our expertise Comprehensive care Cancer registry Clinical trials Diagnostic imaging embrace cancer survivorship Financial services Genetic counseling Hematology Infusion center Medical oncology Nutrition therapy Pain management Palliative care Pathology Patient navigators Pharmacy Psychological services Radiation onlcology Rehabilitation Research Social services Spiritual care Surgical oncology Tumor conferences

Team of experts Board-certified diagnostic radiologists Board-certified interventional radiologists Board-certified medical oncologist/hematologist Board-certified pathologist Board-certified radiation oncologist Board-certified surgeons Cancer survivorship experts Certified clinical breast examiner Clinical psychologist Clinical researchers Fellowship-trained surgical oncologists Fellowship-trained women's imaging radiologist Financial counselors Genetic counselor Nurses (trained in chemotherapy, infusion, oncology and palliative care) Outreach specialists Patient navigators Pharmacists Physician assistant Radiation therapists Registered dietitian Rehabilition therapists Social workers Spiritual advisor Support staff Tumor registrars

Here for you every step of the way At Sanford Bemidji Cancer Center, we are here for you through each stage of your personal cancer journey.

Our team is dedicated to discovering new ways to predict, prevent, diagnose and treat cancer. Our goal is to transform the quality of life for people with cancer today and tomorrow.

Our cancer center offers the most advanced care available in northern Minnesota.

Sanford Bemidji Our patients have access to world-class clinicians and an expert team of professionals Cancer Center team ready to provide innovative treatments and compassionate care for you and your loved ones.

Dr. John Bollinger Radiation Oncology

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Dr. Allan Campbell Surgical Oncology

Beth Ann Korczak, PA-C Medical & Radiation Oncology Breast Health

Dr. Jayan Nair Medical Oncology

Dr. Wesley Papenfuss Surgical Oncology

Help patients face cancer with strength and style Support Bloom The Boutique at Sanford Bloom The Boutique at Sanford was inspired by Cathy Nash, a breast cancer survivor who traveled more than two hours from her home in Bemidji to get a wig to wear during her cancer journey. Cathy wanted others going through cancer treatment to also have the opportunity to feel better and more confident with less hassle. Her mission was to bring this essential service right here, closer to home. Soon her passion ignited a spark in others, leading to the creation of the boutique. Friends of Sanford Health, a supportive, caring group of volunteers at Sanford Bemidji Medical Center, provided the seed money to open the boutique and also the ability to begin providing a complimentary wig* to every patient experiencing hair loss due to cancer or other life-altering conditions. The boutique is staffed by volunteers and supported through ongoing charitable gifts. Sanford Health Foundation of Northern Minnesota established a Boutique Fund, providing the opportunity for ongoing gifts to help sustain the boutique. To make a gift, call the foundation at (218) 333-5515. *Sanford patients who are diagnosed with cancer or other life-altering condition that results in hair loss will receive a voucher from their physician for a free wig at the boutique.

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Grateful for care close to home

When

Rodger Rieger felt fatigued during the fall of 2010, he attributed it to overwork.

Construction projects had occupied a lot of his time, as well as helping neighbors bring in docks, boats and boat lifts around the lake near his cabin in Tenstrike, Minn.

Eventually, though, he couldn’t catch up on sleep and developed a suspicious lingering pain in his chest. After a visit with his family doctor and a series of tests, Rieger was shocked to learn he had colon cancer. Surgery two weeks later revealed it was stage 3.

Fortunately, the treatment he needed was available at Sanford Bemidji, just 30 minutes away from his home in Blackduck, Minn.

“I was glad I could get the treatment in Bemidji instead of traveling,” Rieger said. After 12 rounds of chemotherapy, he was relieved to be declared cancer free.

But six months later, a follow-up scan revealed two spots on his liver. This time, however, the cancer was too far advanced for physicians in Bemidji, requiring Rieger to travel more than five hours one way, on six separate occasions, for surgeries and specialized care.

"That was quite a drive," Rieger said. "There were a couple of times when my daughter, who lives two hours northwest of Bemidji, took us [Rieger and his wife, Ruth], but most of the time we drove ourselves."

According to Dr. Wesley Papenfuss, situations like Rieger’s weren’t uncommon. As a general surgeon at Sanford Bemidji since 2008, Papenfuss witnessed the referral of too many patients for care elsewhere. “Sometimes we had to send patients seven hours away from their homes for high-end care,” he said. “There was a serious need for advanced surgical care in our community.”

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Rodger Rieger enjoys working in the shop that he and his brother-in-law built.

Colon cancer prevention

You’re never too young to start For the average person with no family history, it is recommended to have the first colonoscopy at age 50, but you are never too young to begin preventing colorectal cancer. That is the message cancer education team members took into our communities in 2014: a healthy lifestyle involving good nutrition and regular activity can significantly reduce your risk of colorectal cancer.

When partnered with regular screenings, colorectal cancer is more often found early, when it is most treatable, or prevented completely.

Sanford Bemidji’s 2014 cancer prevention goal was to provide community education on colorectal cancer prevention through nutrition and physical activity. The education team was composed of a certified cancer exercise trainer, an oncology registered dietitian and an oncology nurse.

The team participated in many community events, including seminars and presentations, community health programs, and several health fairs and expos, reaching over 2,500 people who attended these events. In addition, members of the team provided education on colorectal cancer prevention through nutrition and physical activity by speaking during a community radio talk show, publishing an article in the Sanford Bemidji Wellness Newsletter and publishing monthly recipes aiding colorectal cancer prevention in the Buy Line weekly newspaper, reaching an estimated 66,800 additional community members.

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To help fill that need, in 2012, Papenfuss made the decision to pursue advanced training at Roswell Park Cancer Institute in Buffalo, N.Y. While there, he had the opportunity to train with experts in surgical oncology and earned a fellowship in the field in 2014.

Rodger and Ruth Rieger at the family cabin.

He returned to Bemidji with the expertise to provide surgical options for patients battling many different types of cancer, including breast, lung, skin and every component of the gastrointestinal system—which includes the liver; good news for patients with diagnoses like Rieger’s.

“Before, we didn’t have a surgical option for Rodger, or patients like him,” Dr. Papenfuss said. “But today we do. We can manage that metastatic disease right here at Sanford Bemidji so it gives patients treatment options and it’s so much more convenient.”

Take control of your health and help prevent colon cancer.

Eat right • Eat more fiber from fruits, vegetables, whole grains and beans.

• Limit your alcohol intake to one drink per day or less. As alcohol intake increases, so does the risk for cancers and diseases.

That convenience may play a positive role in patient outcomes. “The most important factor to a patient’s prognosis is the ability to complete all therapy,” Dr. Papenfuss said. “When a patient has to travel, there are many reasons not to receive, or finish, treatment.

Travel is expensive and inconvenient, and many patients just don’t have the necessary resources.”

• Maintain a healthy body weight by balancing calorie intake with physical activity.

Adding new training and techniques to the depth of experience already available at Sanford Bemidji is an important step in advancing cancer care in the region.

• Get at least 2 ½ hours of moderate activity, or 1 hour 15 minutes of vigorous activity each week.

For Rieger, who has been receiving treatments since his cancer diagnosis in 2010, having high-end cancer treatments conveniently located close to home is very important. With treatment options available in Bemidji, Rieger and his wife are able to travel 30 minutes from their home and receive the necessary care from professionals they have come to trust and then return home to sleep in their own bed. Without the expanded cancer services in Bemidji, there would be the expense and stress of lengthy travel added to Rieger’s treatment. Expense and stress he doesn’t need in an already challenging journey.

• Limit red meat intake by eating no more than 18 ounces of cooked beef, pork and lamb each week.

• Avoid processed meat such as cold cuts, bacon, sausage and hot dogs.

Be active • Do cardio activities daily and strength training three times a week.

• New to exercise? Start off slow. Work up to 30 minutes of activity each day by doing 10-minute sessions, three times a day.

• Keep it fun by doing activities you enjoy.

• Once you're comfortable, increase the intensity, duration or frequency of your activity. You'll reduce your colon cancer risk by 30 to 40 percent.

Get screened • Even if you show no signs or have no family history of colon cancer, you still should have a colonoscopy starting at age 50 or sooner if your doctor recommends.

• The Centers for Disease Control and Prevention reports that 6 out of 10 deaths from colon cancer could be prevented if all men and women age 50 years and older were screened routinely.

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Back to a normal life Training for Hope helps ovarian cancer survivor rebuild her life

P

atricia Larson feels blessed to be surrounded by such a loving, supportive family. Her husband, Dick, their five adult children, 10 grandchildren, her parents and sister have made sure that she has never been alone during medical appointments, hospitalizations and chemotherapy treatments as she battled ovarian cancer. That journey, difficult as it has been, has rewarded Larson with new people in her life who have also become her family. They are the staff from Sanford Bemidji’s Training for Hope program, exercise specialists Tanya Clemenson and Sarah Lehman and her physical therapist Lyndsay Grand. Training for Hope has helped Larson rebuild her strength and stamina.

"I've worked with several people there and they truly are just like family," Larson said. "They are so caring. It never seems like this is a job for them.

I've had therapy in other places, and it's hard to explain, but this is just such a positive place. It's become a home away from home for Dick and me."

Patricia Larson (right) with her Training for Hope family, physical therapist Lyndsay Grand (left) and exercise specialist Tanya Clemenson (center). Not in the picture: Sarah Lehman.

Training for Hope, a cancer survivor fitness program, is individualized to the patient's needs. Located at the Sanford Outpatient Therapy & Wellness Gym, the program provides exercise specialists who work one-on-one with cancer patients to help them regain overall wellness. Once patients complete the program, they may continue to exercise at the gym. Training for Hope staff monitor their ongoing progress.

When Larson learned she had ovarian cancer, she traveled to Mayo Clinic, where she had previously received medical treatments over the years. Her Mayo oncologist, S. John Weroha, MD, specializes in ovarian cancer, a less common but often fatal type of cancer that only 22,000 American women were diagnosed with in 2014. Rodney Will, MD, her primary care physician at Sanford Bemidji, conferred and worked closely with Dr. Weroha and Mayo staff to coordinate Larson's medical needs.

"Bemidji and Mayo were a wonderful team, they worked together for my wellness," Larson said. "Dr. Will is my hero.

One time I'd come home from Mayo after a surgery and thought I was OK. But I wasn't and ended up in the hospital at Bemidji. I was very sick and everyone took such good care of me. When you live far away from medical care, you can't rely only on one place. You need someone closer too and I have a great team caring for me at Sanford Bemidji."

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Having such tremendous support allowed Larson to do what she called her new job: focus on following the doctor's recommendations and taking care of her body. Multiple rounds of chemotherapy, surgeries, clinical treatment trials and other medical procedures related to her diagnosis have been a routine part of life since her diagnosis last January.

"The Training for Hope staff have had a big job," Larson said. "They work with my upper body and help me overall with strength. My balance had gotten so terrible you could tip me over easily. I've always been on my feet a lot and wore a pedometer for years to make sure I moved enough. When you have a year of chemotherapy and surgeries, you really need help to improve your strength and balance again. Plus, I have a torn rotator cuff that I already had before the cancer, so they've been helping me with that too. Training for Hope has gotten me back to a normal life."

Now that she is in remission and rebuilding her strength, Larson enjoys being more active again.

Twice a week, Dick and Pat leave their home in the woods by Itasca State Park to drive the 45 miles to Bemidji. Both work out together at Sanford where Pat continues the work she began in Training for Hope.

"That trip is worth every mile," Pat said. "We think the Training for Hope team is right up there with Paul and Babe!"

She continues to receive help from Training for Hope specialists. They have supplied her with home exercises and are always available to stop and offer help.

Her life has moved beyond cancer. She has returned to volunteering at Itasca State Park, where she does face painting at special events and other projects such as painting a large "face board" at the recent National Christmas Tree event. During her years teaching at the University

Cancer survivorship training and rehabilitation Sanford Bemidji Cancer Center and the Rebabilitation Department provide cancer patients a chance to get their life back. The Training for Hope and STAR Program® are available to anyone with a cancer diagnosis who has problems that didn’t exist prior to cancer. To learn more about either program, call (218) 333-5899 or ask your primary care clinician for a referral.

Training for Hope Your overall wellness during your cancer journey is our top priority.

Whether you are currently undergoing treatment or are a cancer survivor, Training for Hope can help you achieve a more fit and active lifestyle.

Our cancer survivor fitness program is: • Personalized: We provide one-on-one sessions catered to your individual needs.

• Convenient: Our trainers provide flexible scheduling options.

• Referral based: Your physician or therapist can provide a referral.

• Affordable: Your cost per session is minimal.

With the Training for Hope cancer survivor fitness program, individuals work with a cancer exercise specialist to regain overall wellness. The program works in conjunction with the STAR Program®, or on its own.

STAR Program® Survivorship Training and Rehab Individualized STAR treatment plans focus on: • Increasing strength and energy • Managing pain • Improving function • Enjoying a better quality of life Most health insurance providers cover STAR.

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Exercise specialist Tanya Clemenson helps ovarian cancer survivor Patricia Larson rebuild her strength following treatments.

of Minnesota, she became interested in seed mosaics and her artistic endeavors now include seed painting. She uses only seeds grown in Minnesota and, using a toothpick, applies them to her canvas one at a time. She finds renewed pleasure in regular pastimes such as filling the bird feeders on their property and visiting with her family who all live within driving distance. Her parents, ages 93 and 96, still live independently in Wadena and their example has been a source of inspiration for her.

I've worked with several people there and they truly are just like family. They are so caring. It never seems like this is a job for them.

With its lake view and towering pines, the home she and Dick built on Long Lake is a beautiful respite. The Larsons moved there following retirement in 2003.

"We've owned the land here for more than 30 years and would come here during the summers," Pat said. "Living in the woods has been a big but wonderful change. Bemidji is our closest medical facility and it's a ways. We love Bemidji. And every day I realize how blessed I am!"

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Not finished yet Bemidji man continues fighting until there’s a cure

P

atrick Dooley has always lived life fully, focusing on the positive and maintaining a healthy, active lifestyle that included competing in long-distance runs such as the Boston Marathon. Dooley continues to live with optimism and a competitive spirit that belies the seriousness of the lung cancer that has been his constant companion the last five years.

Knowing there was no cure didn't put Dooley down for long before it fueled his fighting spirit.

He finds ongoing strength in his faith, his family and the power of charting his own health course.

He is also very grateful for a supportive community and health care providers that cooperatively Starting in January 2010, Patrick Dooley began a daily diary documenting his focus for success. work together on his behalf.

Sanford Bemidji Internist Rodney Will, MD, is Dooley's primary care provider. Sanford Health Medical Oncologists Dr. Homayoon Shahidi, Fargo, and Dr. Jayan Nair, Bemidji, collaborate on his cancer care.

"Rod Will has been my doctor since he got out of medical school and he still looks like a young kid," Dooley says with a laugh. "He was the one who found a heart defect I'd had since birth right before I was going on a big game hunt in Alaska. He caught it and saved my life, and he's been my guide all these years. My cancer doctors have been great too."

He credits Dr. Shahidi with "giving me the shot I needed" after a Mayo Clinic physician told him stage 4 lung cancer was the worst it could be and there was little hope for any future. Instead, Dooley sought another opinion at the Roger Maris Cancer Center. "Dr. Shahidi agreed it wasn't good but the fact that I was in such good shape made him feel confident we could fight this together," Dooley said. "That was what I needed to hear."

In January 2010, Dooley began a daily diary that he has continued. Despite chemotherapy treatments that he says, "knocked the hell out of me and gave me side effects I don't ever want to go through again," he got on the treadmill every day and worked out until he couldn't go another step. He compulsively read up on what he needed to do to maintain his current health and regain good health. His focus for success: exercise, proper nutrition and rest. His key support: family and faith.

"I kept thinking about how I wanted to stick around for my family and Judy," he reflected. "Judy is always here for me. We have been together 54 years, starting when we dated in high school. She's prodded me to stay active and keep fighting."

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They have three adult children: Kathleen, Scott and Mark whom Dooley affectionately refers to as Missy, Scotter and Punk. They also have five grandchildren.

A series of events in rapid succession reminded Dooley there is a greater power sustaining him. Shortly after his Mayo diagnosis, Dooley got a call from a sister, who also has an incurable disease. She told him she was sending him one of her guardian angels. Father Tony Fernando, who was Mother Theresa's priest until her death, gave Dooley scapulas from Mother Theresa's coffin as a symbol of God's faithfulness. Dr. John Bollinger, Sanford Bemidji radiation oncologist, called Dooley to personally reiterate Dr. Shahidi's estimate that Dooley's good physical condition gave him an edge on his disease. Dr. Bollinger had treated Dooley for prostate cancer 10 years previously.

"I ask myself why does God still want me here," he reflected. "Evidently, He feels I am not finished."

Always active in the community, he believes helping others helps him too. Recently, Dooley organized and helped with a fund-raising team for multiple sclerosis to support a Sanford Bemidji employee with MS. He often finds himself providing business advice and assistance. Although he retired 20 years ago, his professional background as a utility services regional manager provided him with tools to help others in business.

He continues to be proactive, taking his medications according to protocol, researching his disease and treatments, and trying to stay positive in the face of disappointment. When he learned his cancer had moved to his liver, he researched and agreed to be the first Bemidji patient placed on a new treatment drug. While it required major dietetic changes that included giving up coffee, he stayed the course until he was in remission again. Then last June, he woke up one night unable to move. Following a harrowing ambulance ride to Sanford Bemidji and a diagnosis of Lyme disease, Dooley recovered only to learn his cancer had returned because of his depressed immune state. He agreed to take another new medication he hopes will bring him more time.

I ask myself why does God still want me here?

Evidently, He feels I am not finished.

"They are making a lot of progress with cancer and the longer you fight it, the better your chances to beat it," he asserted. "If your cancer ignores a medication, hang on because there is another one that will come out. And if you're having financial trouble paying your share, there are foundations that will help with expenses. I've helped other cancer patients find financial help too."

At 75, Dooley still describes himself as living the good life. He and Judy own a log home on a Bemidji lake where they enjoy quiet winter evenings cooking together and relaxing by the fireplace. Not that he relaxes too much.

When cancer took away his ability to run, Dooley replaced it with bike riding. Winters he's on his bike indoors 45 minutes to an hour almost every day; summers he rides 12 to 15 miles outside every day.

"I don't want this to sound like a brag story," he reflects. "When I go to the clinic and hear people tell their stories, it motivates me too. If my story motivates anyone, that would be awesome. I just keep thinking, 'As long as I'm alive another day, that's what's important to me now."

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C a r e without limits SANFORD CENTER SanfordBEMIDJI Bemidji CANCER Cancer Center

Ensuring a future of cancer care excellence Today, according to the American Cancer Society, half of all men and one-third of all women in the United States will develop cancer during their lifetime. On average, in the Bemidji region alone, approximately 400 people are diagnosed with cancer each year. These are staggering statistics.

C a r e without limits

There are no guarantees in life – especially when you’re diagnosed with cancer.

But with care that’s close to home, we will alleviate some of the stress for patients and families.

With care that’s coordinated, we will make the journey more comfortable and SANFORD BEMIDJI CANCER CENTER convenient.

With care that’s comprehensive, we will have the experts, technologies and treatments to provide people with the greatest advantages in their fight against a devastating disease.

Together, through Care Without Limits we will provide close, coordinated, comprehensive cancer care, creating the most advanced cancer center our region has ever known.

You can help us transform cancer care in the Bemidji region.

For more information about the Sanford Health Foundation of Northern Minnesota and the Care Without Limits campaign, call (218) 333-5515 or shfoundation.bemidji@sanfordhealth.org. sanfordhealth.org/About/Foundation/Bemidji

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Stage 3 cancer diagnosis doesn’t stop Sarah Anderson from living fully

The weeks leading up to the final day of school in 2013, Sarah Anderson kept reminding herself she needed to take a picture of her 7-year-old daughter, Margie, on the bus. On the last day of school, her camera didn’t work.

Sarah was devastated.

Not because she missed the picture, but because Sarah didn’t think she’d ever see her daughter on the bus again. Sarah had been diagnosed with stage 3 breast cancer that month.

“That’s when my reality really hit me,” she said.

“The scariness of my circumstances was so overwhelming. When I wasn’t able to get that picture I realized how much the little moments are taken for granted.”

Sarah Anderson made the most of her reality when diagnosed with stage 3 breast cancer in 2013.

The 36-year-old wife and mother’s life changed without warning on Mother’s Day when she found a lump in her left breast.

“Nothing can ever prepare you for that devastating news,” she said. “Your whole life changes right then.”

From the beginning to the end, every step of the way, I felt like I was the only patient there.

A mastectomy with removal of lymph nodes was scheduled the next week, followed by eight rounds of chemotherapy and 28 radiation treatments at the Sanford Bemidji Cancer Center.

“The cancer center became a new addition to my family,” Sarah said. “My nurse navigator was my extra set of ears. She gathered my information, scheduled my appointments and got me prepared for what was coming next. I could ask her anything and it would be taken care of.”

By turning chemo treatments into a party, Sarah Anderson was able to have a one of a kind experience.

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The staff made Sarah's comfort a priority and encouraged her to continue living fully during her treatment, and so she did.

“Each round of chemo, my family and friends and I turned it into a party,” Sarah said.

“Each round had a theme, decorations, food and fun! From themes celebrating my birthday to having the traditional Bemidji theme of black and red checked plaid, we made my experience one of a kind.”

It’s this personalized care that made Sarah feel special and helped her beat cancer.

“From the beginning to the end, every step of the way, I felt like I was the only patient there,” she said. “From starting in the radiology department to the surgery department, oncology department and radiation department, things flowed seamlessly along.”

Sarah knows how precious time with her daughter Margie is.

Together, they enjoy milk and cookies after school.

She finished radiation treatments in December 2013 and is now cancer free.

Five months later, she successfully took a picture of Margie on the school bus.

“I realized how far I had come, what I had been through and how I got my moment back,” she said. “I had tears of joy, happiness and gratefulness.”

The team at Sanford Bemidji Cancer Center helped make sure Sarah Anderson saw her daughter on the bus again following a stage 3 breast cancer diagnosis in 2013.

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Board of Directors

Expert breast health care at Edith Sanford Breast Center Sanford Bemidji is proud to serve women’s breast health needs at the newly opened Edith Sanford Breast Center. Located in the lower level of the Sanford Bemidji Main Clinic, our new center provides everything a woman needs for breast care in one convenient location, including:

Sanford Health VISION

Improving the human condition through exceptional care, innovation and discovery.

Sanford Health MISSION

• Mammogram scheduling without a physician referral • On-site screening and diagnostic mammograms Call (218) 333-5475 to • Breast biopsies and ultrasounds schedule a mammogram • Certified clinical breast examiner today and ask about • Certified breast nurse navigator our special after-hours • Fellowship-trained radiologist appointments.

• Fellowship-trained surgical oncologists • Nationally accredited technologists, nurses and staff

A healthy fragrant treat. It is low in added sugars and fat and high in fiber making it fit for cancer prevention.

¼ cup rolled oats 1 Tbsp. walnuts 3 Tbsp. all-purpose flour 3 Tbsp. whole wheat flour 2 ½ Tbsp. packed light brown sugar 1/8 tsp. cinnamon 1 Tbsp. plus 2 tsp. canola oil 6 firm, yet ripe pears, peeled (if desired), cored and cubed* ¼ cup raisins 1 Tbsp. lemon juice 2 Tbsp. sugar 2 Tbsp. flour 1/8 tsp. nutmeg Pinch of cloves Caramel pecan or vanilla nonfat frozen yogurt or low-fat ice cream (optional)

bemidji.sanfordhealth.org

* The Bosc is a winter pear with a yellow-brown matte skin and creamy white flesh that's ideal for cooking and baking.

Recipe courtesy of: American Institute for Cancer Research

Dedicated to the work of health and healing.

Sanford Health of Northern Minnesota VISION

Sanford Health of Northern Minnesota will be the region's premier, patientcentered health care delivery organization.

Pulsations is a publication of Sanford Health of Northern Minnesota. Advice offered in this publication is provided for informational/educational purposes only and is not intended for the purpose of diagnosing or prescribing. Consult your physician before undertaking any form of medical treatment and/or advice contained in this publication.

Providing the highest level of care is important to us and we welcome your comments. Please feel free to contact our Patient Relations Department at (218) 333-5996 or provide feedback through our web site at bemidji.sanfordhealth.org.

Recipe

Pear Crisp

Jason Caron, MD, Chair Carri Jones Glen Lindseth Kay Mack Bruce Meade Dan Olson Steve Rogness Judy Roy James Russ Margie Ryan Mark Shanfeld, MD Dean Thompson Andy Wells Nate White Rod Will, MD

Ins truc tions: 1. Pre hea t ove n to 375 2. Lightly spr ay 8- ° F. or 3. In food pro ces sor 9- inch round cake pan. , pul 15 sec onds. Add flou se oat s and walnut s r, brown sug ar and cinnam on. Ble nd 15 running, driz zle oil more sec onds. While and ble nd 30 sec ond Tra nsf er to bowl and s. set aside.

4. In another bowl, tos s pea rs wit h nex t ingredien ts. Spoon six pea cake pan. Cover wit rs into pre par ed h pre ssing dow n gen oat mix ture, tly. Bake 45- 50 minute s, until top pin pea rs are bubblin g is brown and g. Ser ve hot , topped wit h non fat froz en yogurt or low -fat ice cre am, if desired.

Ma kes : 9 ser vings Nu trition al info : Per ser ving: 164 calorie s, 4 g. total fat (<1 g. sat ura ted fat) , 34 g. car bohydr ate s, 2 g. protein, 4 g. die tary fiber, 3 mg. sodium

Pulsations A Sanford Health of Northern Minnesota publication.

Sanford Health of Northern Minnesota 1300 Anne St. NW, Bemidji, MN 56601 (218) 751-5430