Meet Tricia Nechodom, AuD

In May, Trinity Health audiologist Tricia Nechodom, AuD, was awarded the YWCA Minot Women of Distinction award for health.

Nechodom learned in March from Ann Olson, then the Magic City Lions club president (and a past recipient and a good friend), that she was receiving the award. She says she felt “very honored, very humbled and kind of shocked, to be honest.”

She was nominated for her work on the Magic City Lions club fundraiser she created and chaired, Purses for a Purpose. The event has raised more than $60,000 in the three annual events that have taken place since its inception in 2015. All funds were donated to a Service Dogs for America program, which places service dogs with North Dakota veterans with post-traumatic stress disorder.

Nechodom was also nominated for her work in starting a pediatric loaner hearing aid program in North Dakota.

“It’s basically like the loaner we have here at Trinity Health, but for kids who  need insurance approval and need hearing aids. Or if their families don’t have money to afford certain pieces of equipment, our program can purchase that for the family,” she says.

“It’s designed for any children under the age of 18 in North Dakota in need of hearing aids or cochlear implant replacement parts,” Nechodom says. “Claims can be pending with insurance for weeks, sometimes even months. Children need consistent access to speech and language during critical periods of development and cannot afford to wait for insurance or equipment repairs.”

The program was a collaboration of the Minot Sertoma Club  and the North Dakota chapter of Hands & Voices, a support group for parents of children with hearing loss. The ND Hands & Voices Loaner Bank was created in 2014, two years after Nechodom joined the Audiology staff at Trinity Health.

Q & A

What was your first job?

Nechodom worked in a day care center, Buddy Bear Group Care, in Freedom, Wisconsin. “My aunt owns the center. It instilled a love for pediatrics from very early in my life.”

What is the next big thing right now in audiology?

“Right now, technology is changing very rapidly. Hearing aids are more connected to smartphones and apps that ever. Rechargeable hearing aid technology has been improving. Hearing aids can send alerts to family members that something is wrong. Hearing aids can track basic health data and send it to providers. I’m very excited to see where the technology goes in the next two to three years.”

How did you get involved in audiology?

Nechodom says when she was an undergrad and picking a career, she knew she wanted to work in the medical field. She opted for communication sciences with emphasis in speech pathology and started taking those courses. However, she decided that hearing “was really my passion.”

“I was working with an audiologist in a research lab at the time,” she says. “He was a good mentor, introducing me to basic testing, the foundations of audiology and how the career differed from speech.” She soon began working at the University of Wisconsin audiology clinic. “I was able to observe many clinical experiences there that really solidified audiology was my passion. I wanted to connect and reconnect people with their loved ones. There’s nothing better than when people are hearing their loved ones’ voices for the first time or the first time in a long time. We have a wonderful team at Trinity, and it’s a very rewarding field.”

What do you do in your downtime? What is your favorite way to relax?

“I’m really involved in our Magic City Lions club. I’m the hearing chairperson for the South Dakota, North Dakota and Saskatchewan district and keep very busy,” she says. In addition, she enjoys spending time with friends and family, reading, traveling and yoga. And then there is her 11-year-old lab, Hunter. “He keeps me busy,” she says. “Many of my patients know Hunter and all the crazy things he does. He’s like my baby.”

Best health tip for patients?

First and foremost, Nechodom says, hearing loss prevention is key. Protect the hearing you have by wearing appropriate hearing protection. Equally important is early identification of hearing loss.

“Don’t wait to come see us,” she says. If you have concerns with hearing, “get it checked out. It’s better to establish a baseline and start that conversation earlier. The longer you wait, the more the hearing system declines and the harder it becomes to successfully manage hearing loss.”


Know Your Risks: Gynecological Cancer


It can strike the lives of any women and as a woman ages, her risk of developing it increases.

The ‘it’ is gynecological cancer, which includes cancer of the cervix, ovaries, uterus, vagina, or vulva – the female reproductive organs.

The Foundation for Women’s Cancer stated that, in 2015, there were an estimated 98,280 women diagnosed with a gynecological cancer, and 30,440 deaths from it. Of these, uterine cancer was the most commonly diagnosed form, with 54,870 cases. Ovarian cancer, however, led to the most deaths: 14,180 cases.

The important thing to know about these cancers is to know your risks, look for the signs, be seen by a provider if you see any signs, and get treated, said Margaret Nordell, MD, an OB/GYN with Trinity Health.

Uterine, ovarian, and cervical cancer are the three most common gynecological cancers. Vaginal cancer – cancer that develops in the lining of the vagina – is rare, with about one of every 1,100 women developing vaginal cancer in her lifetime. Vulvar cancer accounts for only 4 percent of cancers of the female reproductive organs and 0.6 percent of all cancers in women. Women have a one in 333 chance of developing vulvar cancer at some point during their life, the American Cancer Society states.

Uterine (endometrial) cancer

Uterine (endometrial) cancer, which affects the uterus, is the fourth most common cancer for women in the United States.

Endometrial cancer is the most common cancer of the uterine corpus and is the most common of all gynecologic cancers. In 2016, an estimated 61,380 women in the United States were diagnosed with uterine endometrial cancer, the American Cancer Society said. It was also estimated that there would be 10,920 deaths from endometrial cancer, making it the sixth most common cause of cancer death among women in the United States.

Symptoms of endometrial cancer include postmenopausal bleeding, spotting, or cramping or persistent irregular bleeding at any age. As these symptoms are investigated early, high survival rates occur. Other symptoms can include abnormal, non-bloody vaginal discharge, pelvic pain, painful intercourse (dyspareunia), or unintended weight loss.

“Surgery is the best option,” Nordell said. It is also the most common initial treatment. Surgery would include a hysterectomy, the removal of the uterus.

Ovarian cancer

Ovarian cancer is the second most common of gynecologic cancers. The American Cancer Society (ACS) estimates that in 2017, about 22,440 women will be diagnosed with ovarian cancer, and about 14,080 women would die from it. According to the ACS, ovarian cancer accounts for 5 percent of cancer deaths among women, causing more deaths than any other gynecologic cancer.

About 20 to 25 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease, with the breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2) responsible for about 10 to 15 percent of all ovarian cancers, the Ovarian Cancer Research Fund Alliance (OCRFA) states.

“Women with a grandmother, mother, daughter, or sister with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer,” OCRFA states on their website. “The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent. The average woman’s lifetime risk is 1.4 percent.”

Symptoms are nonspecific and often mimic those of other more common conditions. It can often be misdiagnosed as irritable bowel syndrome, gall bladder disease, stress, or symptoms attributed to menopausal changes. Signs of ovarian cancer can be identified by persistent and/or worsening signs and symptoms, such as abdominal pressure, fullness, swelling, bloating, urinary urgency, or pelvic discomfort or pain.

Treatment options for ovarian cancer include surgery, which could be the removal of both ovaries, fallopian tubes, and the uterus, as well as nearby lymph nodes. This is followed by chemotherapy or radiation.

Cervical cancer

Cervical cancer, a specific form of uterine cancer, is the third most common of the gynecologic cancer. Its commonality is chiefly due to the effective and improving cancer screenings and technology.

The American Cancer Society estimates that in 2017, about 12,820 new cases of invasive cervical cancer would be diagnosed. About 4,210 women would also die from it.

The Papanicolaou test, colloquially known as a Pap smear, is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix. The Foundation for Women’s Cancer states that since its conception in the 1940s, the Pap smear has reduced deaths from cervical cancer by more than 70 percent. “It is hoped with wide-spread vaccination and improved screening strategies, fewer and fewer women will be affected by cervical cancer and pre-cancers in the future,” the organization stated on its website. (The ACS adds on their website that cervical cancer “was once one of the most common causes of cancer death for American women.”)

According to the Foundation for Women’s Cancer, early vaccination along with regular Pap tests and HPV testing when recommended is now the best way to prevent cervical cancer. The vaccination referred to is an HPV vaccine called Gardasil. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices, and the North Dakota Department of Health recommend routine HPV vaccination for all 11- to 12-year-old girls. Catch-up vaccination is also recommended for females ages 13 to 18, and for adults 19 to 26 who were not previously vaccinated.

Since 2012, the American Cancer Society recommends that cervical cancer screenings, such as Pap smears, should first be performed at the age of 21 years old. The previous guideline was 18 years of age but, as Nordell noted, young women who were still going through the maturation process would be tested and given false positives, leading to unnecessary surgeries.

After the first Pap smear, women are encouraged to get one every three years from between the ages of 21 to 29, unless recommended otherwise. From the ages of 30 to 65, the testing would be done every three years or every five years if combined with HPV testing. From the age of 65, recommendations suggest against screening for those women who are not at a high risk for cervical cancer.

Regardless of the three-year guideline, Nordell said that a lot of women aren’t comfortable “waiting that long,” especially as women are generally conditioned, given the previous guidelines, to get one annually.

According to the Centers for Disease Control and Prevention, risk factors for cervical cancer include smoking, having HIV or another condition that makes it hard for your body to fight off health problems, using birth control pills for a long time (five or more years), having given birth to three or more children, or having several sexual partners.

“HPV virus causes the most of these cervical problems,” Nordell said. It wasn’t until the 1980s that HPV was identified in cervical cancer tissue, implicating it in virtually all cervical cancers. “We don’t know how the HPV virus is out there, but the way to take care of cervical cancer is to get a Pap smear and treat it accordingly.”

As cervical cancer progresses, symptoms can include vaginal bleeding after intercourse, between periods, or after menopause; watery, bloody vaginal discharge; and pelvic pain or painful intercourse (dyspareunia).

Depending on its stage, treatment for cervical cancer can vary.

Risk factors for gynecological cancer

According to the Betty Allen Gynecologic Cancer Foundation, cancer can be acquired or inherited. “If the changes are acquired, they are caused by environmental factors and things people do, such as smoking,” the Foundation says on their website.

“Smoking is the worst thing anyone can do,” Nordell added.

Knowing your family’s medical history, when cancer is concerned, is also important. A Risk Assessment for Lynch Syndrome and Hereditary Breast and Ovarian Cancer Syndrome, which asks if the patient and/or a family member has been diagnosed with colon, uterine, breast, and/or ovarian cancer, is completed by patients; this can help determine the familial risk.

If you show any of the symptoms related to a gynecological cancer, or are concerned about the possibility of gynecological cancer, the OB/GYN team at Trinity Health would be happy to see you to address these issues.

OB/GYNs Margaret Nordell, MD; Jessie Fauntleroy, MD; Carol Schaffner, MD; and midwife Gloria Berg, CNM, are based at Health Center – Town & Country, Suite 102, 831 South Broadway, Minot. For an appointment, call 857-5703. David Billings, MD, is also located at that location; for an appointment, call 857-7394.

OB/GYNs Heather Bedell, MD; Tim Bedell, MD; Lori Dockter, PA-C; and Jennifer Johnson, MD, are based at Health Center – Medical Arts, 400 Burdick Expressway East, Minot. For an appointment, call 857-7397. OB/GYN J. David Amsbury, DO; and midwives Erica Riordan, CNM, and Kerena Saltzgiver, CNM, are also located at that location; for an appointment, call 857-7385.

North Plains CrossFit to Host ‘Lift Up Autism’ Sept. 23

North Plains CrossFit will join gyms and athletes around the world in supporting a fund raising event for autism.  The event, called “Lift Up Autism,” is scheduled Saturday, September 23rd, at the North Plains CrossFit center at the Minot Family YMCA. 

Lift Up Autism was started in 2013 by Josh Everett, a CrossFit enthusiast, who sought to raise awareness of autism spectrum disorder after his son Luke was diagnosed with the condition.  He called the event Lift Up Luke.  Since then it has been renamed and has grown into a worldwide campaign supporting early diagnosis and treatment of autism.

The way it works is that gyms sign up as a hosting site, and individual athletes are invited to register to participate in the specially prescribed workouts.  The event raises money thru donations and t-shirt sales, but there is no cost requirement other than participating in the workout. 

Last year over 7,000 athletes participated in Lift Up Autism, with more than $80,000 raised. 

Heading off a Heart Attack

Man Having Chest Pains

Palpitations. Shortness of breath. Feelings of discomfort in the chest can make one wonder: Is this a heart attack?

Heart attacks are common-1 in 6 people will die from a heart attack, and someone has a heart event every 34 seconds in the United States. So, a heart attack isn’t out of the question for many people.

Recognize and React

Jerilyn Alexander, RN, BSN, Stroke and STEMI coordinator for Trinity Health, says the best way to prevent damage from heart attacks is to recognize the signs of an attack and react accordingly. Heart attacks do the most damage during the first two hours after symptoms begin, so identifying a heart attack in its earliest stages is vital.

According to Mayo Clinic, a “textbook” case of a heart attack involves sudden, crushing chest pain and difficulty breathing, often brought on by exertion.

“Many heart attacks don’t happen that way, though,” the Mayo Clinic says. “The signs and symptoms of a heart attack vary greatly from person to person.”

Do you know the sings of a heart attack? Symptoms include:

  • Chest discomfort- Any pain between your navel to the nose.
  • Discomfort in the center of the chest- A feeling of pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body- This can include one or both arms, back, neck, jaw or stomach and can occur with or without chest pain.
  • Shortness of breath- This can happen with or without chest pain.
  • Chest pain- This can be more concerning if there is chest pain without activity.
  • Other symptoms- These can include cold sweats, nausea or vomiting, or light-headedness. People with diabetes may experience atypical-or sometimes a lack of- symptoms before a heart attack

If you think you or someone you know could be having a heart attack, what should you do? Call 911 or emergency medical services and get to the nearest hospital, Alexander says.

In 2016, 71 percent of patients came to the hospital by private vehicle. By driving themselves rather calling 911, they may have allowed greater damage to their heart. Studies show that patients who present via EMS receiver quicker treatment that those who come by private vehicle.

In addition, many people wait too long before presenting to the hospital. Most people usually wait until the second hour of signs to seek treatment, Alexander says.

Not only can taking the ambulance be a quick way to be transported to the hospital, but the technology contained in the vehicle can also help determine whether you are having a heart attack. EMS agencies in North Dakota can perform electrocardiograms en route to the hospital and transmit those readings to the nearest Emergency Department.

“We know if you’re having a heart attack before you get to the hospital,” Alexander says. “This allows the hospital to activate the Cath Lab and cardiologist earlier to allow for early intervention and treatment of your heart condition.”

“If you are experience signs, act on it,” she says. “The longer you wait, the more damage done to your heart.”

Who is at Risk?

According to the National Heart, Lung and Blood Institute, most heart attacks are the result of coronary heart disease, a type of cardiovascular disease. Cardiovascular disease is any abnormal condition of the heart or blood vessels. This includes not just coronary heart disease, but also stroke, congestive heart failure, peripheral vascular disease, congenital heart disease, endocarditis and many other conditions.

According to Chronic Disease in North Dakota: A Status Report for 2014, 7.7 percent of adults age 18 and older in North Dakota had cardiovascular disease in 2013.

With cardiovascular disease, hereditary risk factors (factors you were born with and have no control over) include things like age, gender, heredity and race. Those at greater risk are people age 65 and older, men, people with family history of heart disease and people who are Mexican-American, Native American or native Hawaiian, and some Asian-Americans.

In 2016, 235 patients at Trinity Health were diagnosed with having a heart attack. Of those patients 74 percent were male and 26 percent were female. Despite the lower number of women here who had heart attacks, cardiovascular disease is still the No. 1 killer of women; the American Heart Association says heart disease causes 1 in 3 deaths for women each year.

At Trinity, the average age of a patient with a heart attack is 65, Alexander says.

“That’s young,” Alexander says. “That’s very young.”

About 70 percent of North Dakotans with a history of heart attack are 65 and older, the Chronic Disease in North Dakota report said.


The No. 1 risk factor for developing cardiovascular disease is hypertension – or, simply put, high blood pressure.

Blood pressure is the force of blood against artery walls. High blood pressure can cause the heart to work overtime. In addition, the force of the blood flow can harm arteries.

According to the Centers for Disease Control and Prevention, about 1 U.S. adult in 3- that’s about 75 million people- has high blood pressure, and only 54 percent have it under control.

“I see 80-year-olds that say they have no medical history, but they haven’t been to the doctor in 50 years,” Alexander says. “People don’t usually seek out medical help unless there is something wrong or they are sick.”

In addition, she says, “some people do have a difficult time regulating their blood pressure, either because they don’t take their meds because they feel they don’t need them or they can’t afford them.”

Regularly scheduled checkups should be performed to keep heart disease at bay.

Here are a few steps you can take to prevent or control your blood pressure:

  • Maintain a healthy weight- According to the CDC< being overweight or obese increases your risk of heart disease.
  • Be physically active- The American Heart Association says staying active is oen fo the most important things a person can do to help curb obesity and lower the risk of heart disease.
  • Follow a healthy eating plan, which includes foods lower in salt- According to the American Heart Association, too much sodium in your system causes your body to retain water, which puts an extra burden on your heart and blood vessels. The association recommends no more than 2,300 milligrams a day, with an ideal limit of no more than 1,500 mg per day for most adults. In addition, the CDC suggests eating plenty of fresh fruits and vegetables and lower processed foods.
  • Don’s smoke- It’s no secret that smoking isn’t healthy for you. According to the CDC, smokers have a much higher risk of developing coronary heart diseases than nonsmokers.
  • Follow the advice of your provider- Take all medication as prescribed.

Trinity Health Introduces New Health Screenings

Radiology Screening-July 17, 2017 6

Trinity Health is pleased to provide the community greater access to additional health screenings. Available screenings include: Abdominal Aortic Aneurysm (AAA), Carotid Artery, Coronary Artery Calcium Scoring, Electrocardiogram (EKG), and Peripheral Artery Disease (PAD). Our imaging technology provides earlier disease detection and promotes timely care.

Abdominal Aortic Aneurysm (AAA): …… $35

Carotid Artery: …………………………………. $35

CT for Calcium Scoring: …………………… $60

Electrocardiogram (EKG): ………………….$20

Peripheral Artery Disease (PAD):…………$35

Abdominal Aortic Aneurysm Screening

The abdominal aorta is the largest blood vessel in the body and is responsible for blood flow to all vital organs in the body. An abdominal aortic aneurysm (AAA) is enlargement in the lining of the wall of the aortic blood vessel. As the vessel wall becomes thinner, primarily due to age and other risk factors, it can expand, leading to a possible rupture. A ruptured aortic aneurysm can cause life-threatening bleeding since it is the main supply of blood to the body.

This screening uses ultrasound imaging to scan and measure the abdominal aortic vessel – this is located right above your navel – for the existence of an aneurysm that can rupture and possibly be fatal.

Many patients choose this test if there is a history of AAA in their family. By being screened with this test each year, patients have more control over this potentially deadly condition – especially because it has almost no warning signs – and can take preventative action with their provider before it becomes life threatening.

Symptoms of an aneurysm include:

• Intensive back or abdominal pain

• Rapid pulse in the abdomen

• Nausea and vomiting

• Excessive sweating

• Shock

While noticeable symptoms of an abdominal aortic aneurysm are uncommon, there are risk factors that should be taken into consideration when questioning whether or not this screening would be beneficial.

These risk factors include:

• Family history

• Hypertension

• Smoking

• Hardening of the arteries or atherosclerosis

• Age

• Gender (men are more prone to this disease)

The best way to find out if you have an abdominal aortic aneurysm is to get screened. If diagnosed with an aneurysm, your provider may request regular screenings every six to 12 months.

Treatment from early detection can increase survival rate by 50 percent to 75 percent when compared to emergency treatment after a ruptured aneurysm.

Carotid Artery Screening

Blocked carotid arteries are the leading cause of stroke.

Carotid arteries are located on each side of the neck, right below the jawline. These arteries are responsible for supplying oxygenated blood to the front part of the brain; this part of the brain is responsible for thinking, speech, personality, and sensory and motor functions.

Over time, fatty substances and cholesterol build up on the insides of the arteries, thus causing the arteries to become narrow, decreasing the blood flow to the brain. Interruption in blood supply to the brain causes temporary or permanent loss of movement, thought, memory, speech, or sensation. Strokes can occur if the artery is too narrow to supply blood to the brain; if the artery ruptures and leaks blood into the surrounding area; if a piece of plaque breaks off and travels to the brain; or if a blood clot forms and blocks other blood vessels in the brain.

Risk factors for a stroke include:

• Diabetes

• Over the age of 40

• Family history of strokes

• TIA – minor stroke

• High blood pressure

• Tobacco, alcohol, and drug abuse

• High cholesterol

• Obesity/ overweight

• Inactive lifestyle

• Atrial fibrillation or irregular heartbeat

• Unhealthy diet

• Cardiac disease

• Gender

• Race

• Oral contraceptives, with co-existing conditions

Symptoms of a stroke include:

• Sudden weakness or numbness of the face, arms, or legs, particularly on one side of the body

• Loss of speech or trouble understanding

• Sudden unexplained memory loss

• Sudden loss of vision in one or both eyes

• Double vision

• Sudden severe headache or pain, with no known cause

• Dizziness

Coronary Artery Calcium Scoring

Calcified plaque results when there is a build-up of fat and other substances under the inner layer of the artery. This material can calcify which signals the presence of atherosclerosis, a disease of the vessel wall, also called coronary artery disease (CAD).

People with this disease have an increased risk for heart attacks. Over time, progression of plaque buildup can narrow the arteries or even close off blood flow to the heart. The result may be chest pain, sometimes called angina, or a heart attack.

A cardiac CT scan for coronary calcium is a noninvasive way of obtaining information about the presence, location, and extent of calcified plaque in the coronary arteries. CT images of internal organs, bones, soft tissue and blood vessels typically provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

As calcium is a marker of CAD, the amount of calcium detected on a cardiac CT scan is a helpful prognostic tool. The findings on cardiac CT are expressed as a calcium score.

Electrocardiogram (EKG)

An electrocardiogram (or an EKG) is a safe, painless screening test that records the heart’s electrical activity by placing several electrodes on the body. It can determine if the patient has a normal cardiac rhythm.

Baseline EKGs may be increasingly beneficial for those with other health conditions or diseases that increase their chances of having heart disease. Some providers strongly believe that people older than 35 years of age need a baseline EKG before health issues develop. The baseline EKG may be compared to later EKGs to see if changes have occurred, or if heart disease risk factors have developed.

Atrial fibrillation, or a-fib, is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During a-fib, the heart’s two upper chambers (the atria) beat chaotically and irregularly – out of coordination with the two lower chambers (the ventricles) of the heart. A-fib symptoms include heart palpitations, shortness of breath, and weakness.

Episodes of atrial fibrillation can come and go, or you may have chronic atrial fibrillation. Although a-fib itself isn’t usually life-threatening, it is a serious medical condition that sometimes requires emergency treatment. It can lead to complications. Treatments for a-fib may include medications and other interventions to try to alter the heart’s electrical system.

Risk factors for a-fib include:

• Age

• Heart disease

• High blood pressure

• Other chronic conditions

• Drinking alcohol

• Family history

• Obesity

• Smoking

Symptoms of a-fib include:

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat, or a flopping in your chest

• Decreased blood pressure

• Weakness

• Lightheadedness

• Confusion

• Shortness of breath

• Chest pain

Peripheral Artery Disease (PAD) Screening

Peripheral artery disease is the weakening of blood flow due to the hardening of the arteries. PAD increases the risk of heart disease by four to six times.

Screening for PAD measures the blood flow through the peripheral arteries in the arms and legs while checking for blockages from plaque.

PAD mainly affects the arteries located in the arms, legs, and feet, as well as the kidneys and stomach. These arteries are responsible for the blood flow to those areas and can cause painful symptoms when this blood flow is stopped or weakened.

Early detection and screening is the best way to avoid heart attack, stroke, and other long term arterial problems associated with PAD.

Peripheral artery disease is a lot like carotid artery disease in that fatty deposits build up in the inner linings of the artery walls, restricting blood flows. PAD often goes undiagnosed until painful symptoms start showing up – late detection could lead to increased risk of heart attack and stroke.

If you are at risk, the American Heart Association recommends you take steps to detect this disease early so you cans start a treatment plan with your provider.

Risk Factors for PAD:

• Diabetes

• High blood pressure

• Smoking and excessive alcohol use

• High cholesterol

• Poor diet

• Heart disease

• Lack of exercise

• Obesity

• Family history

• Age

Symptoms of PAD:

• Pain during exercise, which is relieved during rest

• Intense back or abdominal pain

• Cold legs

• Poor wound healing

• Constant leg pain, tingling, burning, or loss of sensation

Other screenings at Trinity Health include: mammography, which includes 3D mammography that can help catch the signs of breast cancer in women with fatty breast tissue; lung cancer screenings, that can help detect lung cancer in early stages at a time when it can be treatable; and vein screening clinics, that are used to help detect chronic venous insufficiency.

These screenings are followed up by a letter from the interpreting radiologist or cardiologist. All studies are reviewed by a licensed board-certified physician. Some of the screenings will require additional evaluation which might be offered and supervised by a Nurse Practitioner.

All screenings are performed at Trinity’s Advanced Imaging Center, located at Health Center – Town & Country.

If you think that you have one (or more) of these diseases, please consult with your primary care physician. Otherwise, to schedule a screening, call Trinity Health’s Imaging Scheduling Line at 857-3220.

For more information, visit and click on “Imaging Health Screenings.”

‘FirstCare’ Walk-In Clinic Opens Today


Calling it a new day in same-day medicine, Trinity Health opened a walk-in clinic today at Health Center – Medical Arts called FirstCare Walk-In Clinic.

FirstCare provides healthcare access on a walk-in basis with no appointments.  The walk-in clinic welcomes patients seven days a week with extended hours from 8 a.m. to 8 p.m. on week days and 9 a.m. to 5 p.m. on weekends and holidays. 

Thomas M. Warsocki, FACHE, vice president of Physician Network Services, calls the new clinic a significant step in non-emergent care.  “FirstCare gives patients the direct accessibility of walk-in care without compromising quality,” he said.  “Patients have ready access to lab, pharmacy and imaging services in addition to the full range of integrated services available through the Trinity Health system.  That’s important to someone who might have a condition that requires a higher level of care.”

Staffing the clinic is a new team of providers committed to providing first-class walk-in care.  Dr. Marisa Albertson is a Minot native, who’s practiced Family Medicine in the community for many years.  She is joined by nurse practitioners Jessica Fricke, NP, and Roxann Brown, NP.

Dr. Albertson says FirstCare Walk-In Clinic is dedicated to serving patients of all ages in need of immediate care for non-life-threatening conditions.  “We treat any injury or illness that requires immediate care but isn’t serious enough to warrant a visit to the Emergency Department.  For emergent conditions people should go to the Emergency/Trauma Center or call 911,” she said. 

Choosing FirstCare Walk-In Clinic offers significant advantages for patients, according to Warsocki.  Trinity’s fully integrated electronic health record means a patient’s health information can follow them if they visit other Trinity providers.  In addition, Trinity offers an online patient portal that gives patients secure internet access to their health information. 

“Another patient friendly feature, thanks to our achievements as a ‘most wired’ system, is that patients can gauge how long they might have to wait.  Our website,, provides average wait-times for FirstCare’s walk-in patients, with wait-time updates every 15 minutes,” Warsocki explained.

Dr. Albertson noted that patients who seek medical attention at FirstCare Walk-In Clinic may receive assistance in finding a primary care physician or specialty care physician if needed.  “Every patient should have a regular provider who knows their history and can provide comprehensive care.  But given the twists and turns of everyday life, we’re happy to offer FirstCare to get through those conditions that can’t wait,” she said, adding, “If you need care, we will see you.”

Patient has Newfound Respect for Trinity Health Following Heart Incident

Like a lot of folks his age, 70-year-old Steve Joraanstad of Crosby ignored the shortness of breath that had crept into his otherwise hale-and-hearty lifestyle. As owners of Travel World of Crosby, he and his wife Ardis weren’t exactly couch potatoes. They were always on the go.

“We escort close to five group cruises a year with walking tours,” Joraanstad said. “I had noticed a little shortness of breath, but I thought it was just a natural part of aging. Maybe I was a little out of shape.”

On the morning of May 30, he experienced a symptom he couldn’t ignore. “I had just returned home from chairing a meeting of the sales tax committee,” Joraanstad recalled. “All of a sudden, I had terrible chest pains. I knew something was wrong so I took two aspirin and drove the five blocks to St. Luke’s Hospital, a critical access hospital.”

One of his daughters, Jody, is Chief Financial Officer at St. Luke’s. He stopped by her office, but she could see he needed immediate attention. She summoned an emergency crew, which arrived quickly and got him into a wheelchair.

“I remember Gene, the nurse practitioner, saying that my hands felt clammy,” Joraanstad said. “They took my blood pressure, and it was 220 over 150 (sky high). They immediately took me to the ER and gave me nitro. Within a half-minute, I was feeling better.”

Fortunately, an EKG showed no heart attack. But as protocol requires, they put him on  nitroglycerine drip, and loaded him into an ambulance. “I think the aspirins and the nitro saved me from having a heart attack, and it saved my life,” he added.

North Dakotans are fortunate to live in a state with a well-established STEMI care system. STEMI systems provide a regional approach to cardiac emergencies. In spite of long distances between rural communities and heart centers like Trinity Hospital, ambulance services and community hospitals are equipped with 12-lead EKG to quickly recognize STEMI heart attacks (those caused by a blockage in a coronary artery) and activate the appropriate protocol.

Jody had already called Ardis, who rushed over from the travel office. With Steve in the ambulance and the two of them in tow, they all high-tailed it to Minot. “I was sitting up and talking,” Joraanstad said. “I felt pretty good.”

When he got to Trinity Hospital, a multi-disciplined team was waiting for him. Trinity Health has earned recognition for its cardiac program, which prides itself in having a “door-to-balloon” time of less than 60 minutes for STEMI patients. Door-to-balloon refers to the interval between the patient arriving at the hospital and the moment the artery is reopened through coronary intervention, often via balloon angioplasty.

Emergency physician Paul Olson, MD, and cardiologist Sarmir Turk, MD, took charge of Joraanstad’s care. An angiogram – the gold standard for diagnosing an emergency heart event – was recommended. But first they decided to do a high-speed CT scan, an excellent tool for quick coronary analysis. The scan confirmed the need for an angiogram, an advanced X-ray that examines blood flow through the heart’s vessels. The diagnosis was not good. Steve had 90 percent blockage in his left coronary artery, dubbed the “widow maker” because of its critical role in feeding blood to the majority of the heart’s muscle. Total blockage in that vessel is usually fatal. He also had 50 percent blockage in another vessel.

He was scheduled for bypass surgery on both arteries with C. Etta Tabe, MD, a cardiothoracic surgeon. He recalled that in their first encounter Dr. Tabe said with good humor, “You’re the one who shouldn’t be here.”

“Normally patients are taken up to 5th Floor prior to heart surgery,” Joraanstad noted. “They put me in ICU.”

On June 1, Dr. Tabe performed a successful double bypass procedure. His son Scott from Indiana and his other daughter, Liz, from California, joined the rest of the family. “I was up walking the next day,” Joraanstad recalled. “It was pretty gingerly, but I was walking. Teresa (from Cardiopulmonary Rehab) was a big help getting me started on recovery.”

Since leaving the hospital, he’s been walking and taking advantage of some cardiac rehab sessions in Williston. “I’ve lost 24 pounds,” he added.

Having a heart attack or even a near heart attack can be a life-changing experience. In Joraanstad’s case, it’s made him a believer in Trinity Health and all of its caregivers. “I am one of many that has said if I have heart problems, don’t bring me to Minot but bring me to Bismarck. Well, my heart story has changed my opinion on that statement,” Joraanstad wrote in a letter to the editor published July 9 in the Minot Daily News.

“My experience from ER to surgery has been just awesome,” he declared. “Everyone always made us feel completely comfortable.”

“You have incredible nurses,” Ardis added. “As I told Dr. Tabe, we never felt rushed by anyone. They always had time for us. No matter what kind of questions we asked they always took time to answer.”

Joraanstad has recounted the details of his heart incident and the care he received in letters to newspapers, all the while utilizing his signature talent – remembering people’s names. On cruises, he is known for introducing a room full of people complete with first and last names, hometowns, and occupations. “I was brought up to respect people and to call them by their name and to thank people when they did something for you. Everyone wants to be called by their name and thanked for doing a good job,” he said. “At the hospital, I called everyone by their name and thanked them every time they came into my room and helped me, and when they left my room.”

It was a rare omission then that in his letter singling out for recognition nearly every doctor, nurse, and clinician, he left one name out. “I forgot to mention Dr. Paul Olson (the emergency physician), and he did such a great job,” Joraanstad said.

Born and reared in Crosby, Steve graduated from the University of North Dakota and quickly began climbing the corporate ladder of Colgate Palmolive, working his way up to area manager and handling some of the company’s largest clients. But he and Ardis always had their sights set on returning to Crosby.

When his parents sold a decades-old clothing business, the Joraanstads decided to make their move. They bought the store, owned and ran the local movie house, Dakota Theatre, for 22 years, and later launched the travel business, which became hugely successful. Notably, Steve served 15 years as executive director of the St. Luke’s Community Foundation and is a former president of the hospital board.

Asked what other lessons he’s come away with, he replied: “An eye opener for me is that you need to pay attention to what your body is telling you. I had shortness of breath, probably for a year. I’m thinking that was the first indication that something was wrong.”

Trinity Health Adds Palliative Medicine Program

Trinity Health has expanded its continuum of care at Trinity Hospital, adding Palliative Medicine to its scope of services. Palliative Medicine is a program of specialized medical care for people with serious and life-limiting illnesses.

Leading the program are Ann M. Hoff, MD, and Kristy Leier, FNP-C. They work with a team of physicians, nurse practitioners, nurses, social workers and other specialists to focus on providing relief from the stress and symptoms associated with the serious or life-limiting illness and to improve quality of life for patients and their families.

A Bismarck native, Dr. Hoff received her medical degree from the University of North Dakota School of Medicine and Health Sciences and completed an Emergency Medicine residency at the Mayo School of Graduate Medical Education in Rochester. She was a member of Trinity’s Emergency/Trauma team for six years before leaving in 2015 to complete her palliative fellowship at the University of Minnesota. She’s a member of the American Academy of Hospice and Palliative Medicine and the American College of Emergency Physicians.

A North Dakota native, Kristy Leier, FNP-C, received both her Bachelor of Science in Nursing and Master of Science in Family Nurse Practice from the University of Mary, Bismarck. She practiced in Trinity’s Emergency Department for 12 years as an RN, and upon completing her nurse practitioner training served seven years as a provider in emergency, occupational and family medicine settings. She’s a member of the American Association of Nurse Practitioners, the North Dakota Nurse Practitioners Association, and American Academy of Hospice and Palliative Medicine.

Five Trinity Employees Receive Eagle Award

Congratulations to the following individuals for receiving the Minot Area Chamber of Commerce Eagle Award for excellent customer service:

Kathy Beeter, director of Business Services, “was fabulous. I contacted Trinity Health in order to arrange a payment plan for my medical bills. (…) Her demeanor was calm and professional, which put me at ease. She offered to look into options for me and then would call me back. She did so within 10 minutes and arranged for a plan that was manageable and better than what I would have hoped. Health and medical issues are stressful enough, not to mention mounting medical bills. Kathy was respectful and understanding of my situation. She is absolutely deserving of the Eagle Award for exceptional customer service.”

Sharon Hagelund, an environmental aide at Trinity Homes (5E), “does her job very well. She always helps everyone and is very kind and helpful with the residents.”

Martha Johnson, RN, Surgery, Trinity Hospital-St. Joseph’s, “was the nurse in my surgery room with my recent carpal tunnel surgery. She made me feel comfortable and reassured me that all would be fine and it was! She is an awesome nurse and her upbeat attitude really made me enjoy my time in Same Day Surgery. Thank you for being there for me!”

Jackie Schneider and JoAnn Mosser, office assistants at Trinity Homes, “are the friendliest, courteous, and most polite ladies. They are always waiting with a smile and friendly greeting when anyone comes to the front office at Trinity Homes. Jackie and JoAnn are always ready to help and/or answer any questions, whether it be from residents, staff, or visitors. Jackie and JoAnn are always very willing to help with any fundraisers, and always have creative ideas, as seen when you come to the front office. It is always decorated for the holidays and seasons, and is so cheerful and welcoming. Jackie and JoAnn have been instrumental in raising funds for Relay for Life and did an excellent job.”

Receiving the Eagle Award is validation of the pursuit of the mission of Trinity Health, which values exceeding professional quality standards.


Bringing Awareness to Suicide

Worried teenager woman on the beach in winterEach year, 44,193 Americans die by suicide. For every suicide, there are 25 attempts.

Suicide is the tenth leading cause of death in the United States, the American Foundation for Suicide Prevention states.

In North Dakota, specifically, it is the ninth leading cause of death. Recent data states that North Dakota ranks 15th in the nation for its rate of suicide deaths. While the rate of suicide increased slowly from 2006 to 2015, from about 11 to 13 per 100,000 individuals, North Dakota’s jumped from about 13 to 17 per 100,000 individuals, the American Foundation for Suicide Prevention states, citing 2015 data from the Centers for Disease Control and Prevention (CDC). According to these data, the demographic hit the most by suicide are those between the ages of 35 and 44 years, for whom suicide is the first leading cause of death.

“It’s pretty predominant, especially among depressed patients,” said Lea Johnson, LICSW, a therapist with Trinity Health’s Behavioral Health Services, noting that thoughts of suicide is one of the nine criteria for screening for depression.

Suicide ideation – the thoughts of suicide – is a symptom of depression. The cause can come from many sources:

“If people have chronic pain, they may think of suicide,” Johnson said. “If they are younger and they have some undiagnosed mental health condition or an adjustment – like a breakup – there could be a suicidal thought.” The frequency of suicide ideation “depends on the person,” Johnson added.

Of her depressed patients, Johnson would say half would have intermittent suicide ideation.

A study from the Center for Rural Health – University of North Dakota School of Medicine & Health Sciences, cites several factors related to suicide. They include:

• Mental illnesses such as depression and Post Traumatic Stress Disorder (PTSD)

• Barriers to get help

• Alcohol and other drug abuse

• Rural isolation and loneliness

• Mental health treatment stigma

• Bullying, harassment, and violence

• Historical trauma/cultural “numbing”


The North Dakota Suicide Prevention Program lists the following as suicide warning signs:

• Appearing depressed or sad more of the time

• Talking or writing about death or suicide

• Withdrawing from family and friends

• Feeling hopeless

• Feeling helpless

• Feeling strong anger or rage

• Experiencing dramatic mood changes

• Abusing drugs or alcohol

• Exhibiting a change in personality

• Acting impulsively

• Losing interest in most activities

• Experiencing a change in sleeping habits

• Experiencing a change in eating habits

• Losing interest in most activities

• Performing poorly at work or in school

• Giving away prized possessions

• Writing a will

• Feeling excessive guilt or shame

• Looking for a way to kill oneself, such as searching online or buying a gun

• Talking about having no reason to live

• Talking about feeling trapped or in unbearable pain

• Talking about being a burden to others

• Acting anxious or agitated; behaving recklessly

• Withdrawing or feeling isolated

“There is no single factor that could influence one to have suicidal thoughts,” explained Heather Sys, RN, BSN, MBA, director of Behavioral Health Services at Trinity Health. “All of the factors that are cited could influence one to feel this way.”

In addition, Johnson said, there are signs that can “be vague and people may not see it until the suicide is completed.”

At Trinity Health, inpatient and outpatient services are available for those suffering from depression or suicidal ideation. Services are provided by psychiatrists, psychologists, Licensed Independent Clinical Social Workers, Licensed Professional Clinical Counselors, nurse practitioners, and clinical nurse specialists. Outpatient services, such as crisis counseling and individual, family, and group counseling, are available at Health Center – Riverside, 1900 8th Avenue SE, Minot. At Trinity Hospital – St. Joseph’s, located at 407-3rd Street SE, Minot, inpatient services such as crisis stabilization are available.

The American Foundation for Suicide Prevention also provides opportunities for survivors of suicide loss to get involved through a wide variety of educational, outreach, awareness, advocacy, and fundraising programs.