SH
M A G A Z I N E Spring 2013
Major surgery,
MINOR RECOVERY
Woman mends quickly following innovative procedure
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M A G A Z I N E Spring 2013
SANFORD
spotlight
Your comments, concerns and questions are always welcome. PLEASE CONTACT
Tim Flagstad, editor Sanford Health PO Box 5525 Bismarck, ND 58506-5525 tim.flagstad@sanfordhealth.org (701) 323-6512 SH Magazine is published as a community service of Sanford Health.
CONTRIBUTING WRITERS Tim Flagstad Patrick Kellar Kim Singer Mandy Thomas
PHOTOGRAPHY
The Creative Treatment Photography by Daniel Park
COVER PHOTO
Sarah Bunnell didn’t have to miss her daughter Hayley’s dance recital thanks to an innovative procedure at Sanford Health.
SANFORD HEALTH RECEIVES MAGNET DESIGNATION The Bismarck region of Sanford Health has again achieved Magnet® recognition as part of the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®, positioning the institution in the top 1 percent of facilities nationwide for nursing excellence. The Bismarck region, which includes the medical center in Bismarck and clinics in Bismarck, Mandan, Minot and Dickinson, is the only Magnet-designated health care system in North Dakota. Bestowed every four years, the Magnet Recognition Program’s distinction is the highest honor an organization can receive for professional-nursing practice. Just 395 of the United States’ nearly 6,000 facilities attained Magnet® status for this designation period.
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HEALTH IN FOCUS UNDERSTANDING COLORECTAL CANCER Colorectal cancer is the No. 2 cause of cancer-related deaths in the United States and kills more nonsmokers than any other cancer. In North Dakota, more than 400 men and women are diagnosed with colorectal cancer annually.
Douglas Berglund, MD Colorectal Surgeon Sanford Clinic Bismarck
Who is at risk? • Both men and women are at risk of developing colorectal cancer. • More than 90 percent of cases occur in people 50 or older, but the testing rate for adults age 50–59 is particularly low. • Those who have a history of polyps or cancer have a higher risk of developing additional polyps or colorectal cancer. • Those who have a family history of polyps or colorectal cancer are at greater risk. One in five people has a family history of colon cancer and should speak with a doctor about getting tested earlier and more often than others. • Risk is higher for people with certain conditions such as Crohn’s colitis and ulcerative colitis. People with these conditions should talk with their health care providers about getting tested at younger ages or more frequently. • People who smoke cigarettes may have an increased chance of developing colorectal cancer. Prevention Colorectal cancer often has no symptoms until it’s at an advanced stage, so regular screenings are important. Generally, people should have regular screenings starting at the age of 50, but those with a family history or other risk factors may want to begin screenings earlier. At least six of every 10 deaths from colorectal cancer could be prevented with regular testing. Screening tests can find precancerous polyps in the colon or rectum, and these growths can be removed before they turn into cancer. Physicians may suggest one or more tests for colorectal cancer screening, including a colonoscopy. A colonoscopy allows physicians to examine the entire large intestine, from the rectum all the way up to the lower end of the small intestine. The procedure allows physicians to look for early signs of cancer and remove any polyps. Douglas Berglund, MD, is a colorectal surgeon at Sanford Clinic in Bismarck. He is board certified by the American Board of Surgery and the American Board of Colon and Rectal Surgery. He has special medical interests in disease of the colon and rectum and is skilled in endoscopy and laparoscopy.
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Samantha Stroh, certified/licensed athletic trainer, and her Sanford Orthopedics & Sports Medicine colleagues take care of athletes before and during competitions and on site in schools’ athletic training rooms.
A VALUABLE PART OF THE TEAM Sanford athletic trainers help keep Bismarck athletes safe Late in the second half of a girls’ basketball game between Century High and Bismarck High, a Century player limps off the court after taking a knee to her quadriceps muscle. Samantha Stroh, a certified/licensed athletic trainer with Sanford Orthopedics & Sports Medicine, immediately takes charge. She escorts the hobbled player to the locker room, conducts an evaluation that reveals no serious injury, helps the player stretch and provides tips on how to manage the injury. The player quickly returns to the bench, as Stroh gives an assistant coach an update, clearing the athlete to return to the game.
Not even two minutes of time ran off the game clock before the player steps back on the court showing no symptoms of the earlier collision. “Safety is the most important thing,” said Jim Haussler, activities director for Bismarck Public Schools. “If safety is No. 1, you have to put athletic trainers on a pretty high pedestal.” For Bismarck Public Schools athletes, those athletic trainers are Stroh and her colleagues. Sanford Orthopedics & Sports Medicine serves as the official sports medicine provider of Bismarck Public Schools as well as Bismarck State College and United Tribes Technical College.
During home events, a Sanford athletic trainer stands ready to prepare athletes for competition and provides care during the game as needed, freeing coaches of an additional responsibility and providing peace of mind to parents and administrators. “It takes a lot of pressure off coaches,” said Steve Miller, veteran Bismarck High boys’ basketball coach. “We don’t have to do the athletic training. They’re obviously a lot more knowledgeable about that than we are.” Daily during the school year, those same experts provide care for athletes at the schools. Stroh’s main assignment is Bismarck High. In the athletic training room, she tapes ankles before practice, offers treatment and evaluations for various injuries and instructs athletes on strengthening exercises and stretches to keep them healthy and prevent further injury. “She’s always here for you, so you don’t have to go anywhere for treatment,” said Keisha Engelhardt, a junior on the Demons girls’ basketball team. The familiarity the athletic trainers develop with the athletes helps with that care. “It’s nice to have a continuous presence of an athletic trainer there at practices and games because you get to know the athletes, and they get to know you. You learn their pain tolerance, their attitudes,” Stroh said. “My relationship with the athletes and coaches is amazing.” The news Stroh and her fellow athletic trainers must deliver isn’t always pleasant, of course. They must inform athletes, parents and coaches of potentially serious injuries, such as ligament tears or joint separations, and they refer athletes to specialists or a local emergency and trauma center when the situation calls for it. When athletes do get injured, it’s up to the athletic trainers to provide clearance before the athletes
return. For example, after sustaining a concussion, athletes must clear a five-step progressive physical activity program, which takes a minimum of five days. “Having the person who works with them daily provide the treatment on the court or in the athletic training room lessens the stress of dealing with an injury,” said Century girls’ basketball coach Ron Metz. Through the triumphs and the sometimes heartbreaking news, athletic trainers become as big a part of the team as anyone else. “Athletic trainers are seen as part of the coaching staff,” Haussler said. “They become as emotionally involved as anyone.” For more information on sports medicine services at Sanford Health, visit bismarck.sanfordhealth.org/ sportsmedicine.
To view a video to go along with this story, visit bismarck.sanfordhealth.org/magazine
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MINOR RECOVERY FOLLOWS MAJOR SURGERY Robotic-assisted surgery helps mother of three quickly return to normal activities
For weeks, Sarah Bunnell’s 3-year-old daughter, Hayley, practiced the routine for her first big dance recital. Bunnell, a 33-year-old Mandan resident, certainly didn’t want to miss it. Thanks to innovative robotic-assisted surgery at Sanford Health in Bismarck, Bunnell didn’t have to. Three days after undergoing a total hysterectomy, Bunnell felt well enough to sit in the audience during her daughter’s stage debut. “It was huge,” Bunnell said of being able to attend. “It was the main dance recital of the year, and she had been working on it and talking about it for weeks.” Ever since having her daughter three years ago, Bunnell suffered through painful monthly periods with heavier-than-normal bleeding. Of all the available treatments, she knew a hysterectomy was the best option, but, in order to care for her children—now ages 8, 6 and 3—she put off having the procedure. “You think it’ll take you out for at least six weeks,” she said. “With three kids, that’s not something that’s possible.” Although there are multiple ways to perform a hysterectomy, removing the uterus vaginally is the method surgeons prefer if possible. Because she had caesarean sections with her children, Bunnell wasn’t a candidate to have her uterus removed vaginally, said Christopher Danielson, MD, Bunnell’s physician at Sanford Obstetrics & Gynecology. When Sanford Health introduced da Vinci robotic-assisted surgery, Dr. Danielson had another option that could get Bunnell back to her normal routine quicker. “Robotic-assisted surgery allows us to do more complex surgeries in a minimally invasive manner,” Dr. Danielson said.
Sarah Bunnell’s quick recovery from her hysterectomy allowed her to continue to care for her children Brayden, 8, Treyton, 6, and Hayley, 3, with her husband, Aaron. “This
surgery is just going to change my life,” Bunnell said.
With robotic-assisted surgery, surgeons use small incisions to perform procedures, which can lead to less pain, less blood loss, less scarring and a shorter recovery time. Though it is called a robot, the da Vinci Surgical System cannot act on its own. Specially trained surgeons control every movement, and the system provides surgeons with enhanced capabilities, including high-definition 3-D vision and a magnified view thanks to a small camera inserted into the body through a minor incision. The surgeon has control over the robotic system, which translates his or her hand movements into smaller, more precise movements of tiny instruments that enter the body through other minor incisions. The instruments mimic—and, at times, exceed—the complex movements of the human hand and wrist. Sanford Health is the first and only health system in Bismarck-Mandan to offer this innovative technology, which is the most-advanced available for minimally invasive surgery. “I was a little bit leery about the surgery because I wasn’t sure about what it all entailed until I heard about it from a friend,” Bunnell said. “Dr. Danielson explained how there is less pain and less time out. All of those things got my attention.” She’s happy she chose robotic-assisted surgery. After the surgery, which Dr. Danielson performed using four small incisions, she experienced limited
pain and quit taking prescription pain medication within four days of the procedure. Three weeks after the procedure, she was back to her normal routine other than the standard limitations on how much she could lift, and the marks from the incisions on her abdomen were hardly noticeable. “I’ve been able to take my kids to their activities and take care of them,” she said. “I thought I would be out completely, and my husband would have to do everything.” Bunnell is excited for what’s to come.
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SIMPLE SCREENING; LIFE-SAVING RESULT
Dave Schmidt regularly walked his Maltese poodle mix more than a mile, and, when the weather allowed, he spent as much time on the golf course as possible. He felt no obvious ill effects of heart disease, such as chest pain or shortness of breath, and figured he was as healthy as any man his age could be. Had he blown off a simple screening, though, he now knows there’s a good chance he’d no longer be around. “The good Lord was looking over my shoulder. That’s how I feel,” said the 70-year-old Alexander, N.D., man. “I just got another chance at life. At 70 years old, you usually don’t get that.” A noninvasive cardiac calcium scoring screening at Sanford Health in Bismarck provided Schmidt that rare opportunity. In early fall, Schmidt underwent the screening, which involves a quick CT scan of the heart using the region’s most advanced CT scanner. The image of the heart the scan produces shows how much calcified plaque is built up in the patient’s coronary arteries. Radiologists use the image to assign a calcium score. The higher the score, the greater the chance the patient has coronary artery disease (CAD) and, thus, a greater chance of having a heart attack.
Dave Schmidt feels he has a second chance at life, and he’s spending it on the golf course with Darlene, his wife of 50 years, in the gym and with his family.
Any score over 400 is extensive proof of CAD. Schmidt’s screen revealed a shockingly high score of 3,053. “Coronary artery disease is much more prevalent than we used to think, and even those without symptoms are at risk for significant narrowing of their arteries,” said Matthew Iwamoto, MD, a Sanford Health radiologist. “These CT cardiac calcium scoring screenings show whether a patient has heart disease or is at risk for it.” After reading Schmidt’s scan, Dr. Iwamoto immediately referred the patient to a Sanford Health cardiologist. Soon after, Schmidt was on the operating table at Sanford Health having quadruple bypass surgery. Following surgery, Sean Russell, MD, the heart surgeon who performed the procedure, told Schmidt and his family that the blockage in his arteries was so pronounced that, without the bypass, a massive heart attack would’ve been likely. After completing cardiac rehabilitation, Schmidt has taken advantage of his second chance. For the second straight winter, he and his wife of 50 years, Darlene, escaped the cold of North Dakota for a rented winter home in Continued on page 10
Matthew Iwamoto, MD Radiologist Sanford Clinic Bismarck
Sean Russell, MD Heart surgeon Sanford Clinic Bismarck
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MINOR RECOVERY FOLLOWS MAJOR SURGERY continued from page 7 “I can’t wait. It’s going to be fabulous. I’m looking forward to living life normally without having to worry about that monthly pain,” she said. “This surgery is just going to change my life.”
For more on robotic-assisted surgery, visit bismarck.sanfordhealth.org/surgery. To request an appointment at Sanford Obstetrics & Gynecology, call (701) 323-8200.
Innovative robotic-assisted surgery for women Sanford Health is the first and only health system in Bismarck-Mandan to offer robotic-assisted surgeries using the da Vinci Surgical System.
Christopher Danielson, MD
Christie Iverson, MD
Peter Klemin, MD
Kathleen Perkerewicz, MD
Four obstetricians/gynecologists at Sanford Obstetrics & Gynecology in the Seventh & Rosser Clinic have received advanced training to perform robotic-assisted surgery. Some of the gynecologic surgeries for which they use da Vinci are: • Hysterectomies • Endometriosis procedures • Removal of ovarian cysts • Removal of pelvic adhesions • Vaginal vault suspensions Call Sanford Obstetrics & Gynecology at (701) 323-8200 to request an appointment.
SIMPLE SCREENING; LIFE-SAVING RESULT continued from page 9 Arizona. There, he exercises for at least an hour five days a week. He also continues his routine of walking his dog and golfs as much as possible. “I did 18 holes yesterday,” he said in February. All of it made possible by a simple screening. “That was a piece of cake. You walk in there, they gave you a gown, you go in the room and
about five minutes later, you’re done,” Schmidt said. “No pins. No needle. No nothing. There’s no pain. It takes more time to get in that little gown and get in there than the test itself.” A doctor, whether it is a primary care physician or a cardiologist, must order a cardiac calcium screening. Most insurance companies do not cover the cost of the screen at this time. The cost is $100, which is due at the time of the screening. For more information, visit bismarck.sanfordhealth.org/calciumscore.
17th annual
Saturday, April 13 8:45 a.m.–3:15 p.m. Century High School 1000 E. Century Ave., Bismarck
Great American Bike Race Sanford Health’s Great American Bike Race helps families of children with cerebral palsy and related disabilities.
2013 GABR stars
Each year two children are chosen to serve as ambassadors for the race. Cole Fleck’s family has benefited from the Sanford Health Great American Bike Race (GABR) by receiving orthotics, a wheelchair, a hydrotherapy pool, physical therapy services and an adaptive bike. Cole has collagen VI gene deficit, a rare muscle disorder that restricts the proper function of his muscles. He is one of only two people in the world to be diagnosed with this.
Cole Fleck
Seventh grade Shiloh Christian School, Bismarck
GABR has assisted Kenley Schneider’s family with medical bills and travel expenses from the numerous orthopedic surgeries she has had because of her cerebral palsy. GABR funds have also helped with the cost of her weekly physical therapy sessions. Most recently, GABR helped purchase an adaptive bike so Kenley can cruise around her neighborhood.
To find out more or give to the cause: • Contact Race Headquarters at 323-6376 • Visit bismarck.sanfordhealth.org/gabr • Head to Facebook and search “Sanford Health Great American Bike Race”
Kenley Schneider Third grade Lincoln Elementary School, Dickinson
Sanford 300 N. Seventh St. Bismarck, ND 58501
Non-Profit Organization U.S. Postage PAID Permit No. 187 Bismarck, ND
ADDRESS LABEL GOES HERE
100-11395-5258 3/13
Sanford Health welcomes
Eric Hart, DPM, podiatry
As a podiatrist, Dr. Hart provides medical and surgical care of the foot and ankle for patients of all ages. He has special training and interest in arthroscopic ankle surgery as well as diabetic foot care. Dr. Hart has practiced in Bismarck since 2009. Residency: Podiatric medicine and surgery: Intermountain Medical Center/ DVA, Salt Lake City Medical education: California School of Podiatric Medicine at Samuel Merritt College, Oakland, Calif. Request an appointment with Dr. Hart at Sanford Seventh & Thayer Clinic by calling
(701) 323-5226
or by visiting bismarck.sanfordhealth.org.