Skin Cancer Survival

Skin cancer is considered by the American Cancer Society to be the most common of all types of cancer. One estimate says that about 5.4 million basal and squamous cell skin cancers are diagnosed each year, occurring in about 3.3 million Americans (some people have more than one type of skin cancer). However, death from skin cancer is uncommon; according to the American Cancer Society, it is thought that about 2,000 people in the United States die each year from these cancers.

“Most people who die from these cancers are elderly and may not have seen a doctor until the cancer had already grown quite large,” the ACS said on their website. “Other people more likely to die of these cancers are those whose immune system is suppressed, such as those who have had organ transplants.”

According to the Mayo Clinic, the risk of skin cancer can be reduced by limiting or avoiding exposure to ultraviolet (UV) radiation. Through this, Ann Welch, FNP-C, with Trinity Health’s Dermatology department maintains that sunscreen and surveillance are two important ways to avoid skin cancer.

Sunscreen

The majority of malignant melanoma is caused by sun exposure, she said. “Some are hereditary, but the vast majority are from some exposure.”

When it comes to preventing exposure to the sun, wearing sunscreen can help. Sunscreen, which absorbs or reflects some of the sun’s ultraviolet (UV) radiation, protects against sunburn.“The more sun you get, that increases your risk of getting skin cancer,” Welch said.

Sunscreens have an SPF, a sun protection factor, that measures the fraction of sunburn producing UV rays that reach the skin. “The numbers will tell you how long you can be out in the sun, how many minutes you can be out in the sun before you develop a reaction to the sun,” Welch said.

For example, sunscreen with an SPF 15 means that you can be out in the sun 15 times longer before you burn. The levels can vary from person to person, depending on skin tone, Welch noted.

Clothing, such as hats and shirts with long sleeves, can also protect against the sun.

Surveillance

Welch said that keeping an eye out for “the A-B-C-Ds of malignant melanoma” are important. Those include:

• Asymmetry – Is the lesion uniform in shape. “If you cut it along its long axis, is it a mirror image?” Welch said. “If it’s square or round, it’s still a mirror image of itself.”

• Border – Can you see where the lesion begins and ends on your skin. “There should be a clear border,” Welch said. “Does it look like someone penciled it in? You should see the edge of that lesion. If not, those are cause for concern.”

• Color– Is the color uniform throughout? The color can range from light tan to dark brown. “Do they have other moles that are similar in that color, or is it an odd man out?” Welch said. “Is it darker than any other lesions on your skin?”

• Diameter – Is it smaller than a pencil eraser, which is six millimeters? Welch said that malignant melanoma can include any one of these symptoms.

If any of these symptoms presents, contact your primary care provider or a dermatologist.

At Trinity Health’s Dermatology department, “We look at lesions through a dermatoscope, a special light we use to light up lesions to look for specific patterns that determine if it’s a benign mole versus malignant melanoma,” Welch said. If it appears to be a malignant melanoma, a biopsy would be completed, which would then confirm whether it was or not.

Trinity Health’s Dermatology department includes Ann Welch, FNP-C, and Jennifer Hunter, MD. For more information, call 857-7382 (Welch) or 857-5760 (Hunter), or visit www.trinityhealth.org/dermatology.

 

All About Asthma

Asthma is an inflammatory condition of the lungs that is defined by reversible airway obstruction.

The small airways have chronic inflammation that will periodically flare up or get more severe, which results in bronchoconstriction, explained Michael Reder, MD, an allergist and immunologist with Trinity Health. “The small airways get squeezed,” he said. “When this happens, symptoms such as coughing, wheezing, and shortness of breath appear.”

Inflammation will also cause the cells lining the airways to produce a lot more mucus, which contributes to the coughing and other symptoms, Reder added. Triggers that cause the inflammation to worsen include allergies, viral infections, exercise, irritants or pollutants, and cold dry air, Reder added.

Who Can Get It?

Asthma can hit any demographic, regardless of gender or age. According to the National Heart, Lung, and Blood Institute, asthma most often starts during childhood. In the United States, more than 25 million people are known to have asthma, about 7 million of them are children.

“Technically, you can’t officially make a diagnosis of asthma until you are five years old,” Reder said. “It doesn’t mean you can’t have it, but we stay away from officially calling it.” An acquired breathing test can confirm whether it is asthma or  reactive airway disease, which mimics asthma and sometimes can be treated the same way, but it is related to viral infections, the types of things children typically outgrow, Reder added. “A lot of the time, it gets referred to as childhood asthma. But sometimes we treat it the same way.”

According to the Centers for Disease Control and Prevention, children with asthma in the United States are having fewer asthma attacks. This is chiefly due to asthma management actions, such as avoiding or reducing exposure to asthma triggers, such as allergens and irritants, and by following recommendations for appropriate medical care.

Symptoms and Treatment

Anyone who has symptoms suggestive of asthma need two things, Reder said.

“First, they need a breathing test. This would tell us if they have asthma,” he noted. “Next, they should get allergy tested. Asthma is essentially allergies affecting the lungs, so they go hand in hand.”

Both of these tests can be performed at Trinity Health in the Allergy department.

Asthma is typically treated using two different types of medications, as there are two main driving forces of asthma symptoms – inflammation and bronchoconstriction, Reder explained. “The medicines we use target those two contributors. We use inhaled steroids to treat the inflammation and we use bronchodilators, like Albuterol, to temporarily relieve the squeezing.”

For patients with hard-to-control asthma, a variety of injectable biologics are available to help reduce their need for Prednisone, a steroid typically taken for an asthma exacerbation. “Prednisone works, but it’s bad for the body if you have to take it frequently,” Reder said.

The specialized anti-bodies in the biologics are used for helping people with moderate or severe asthma. “Xolar has been out for a while; that one blocks the allergy antibody (IgE). Nucala helps for people with eosinophilic asthma. The newest one is Fasenra, which affects eosiniophiles, the white blood cells typically involved in allergic conditions, including asthma,” Reder explained.

Allergy shots, or immunotherapy, is another form of treatment. “Immunotherapy is the only one that is considered disease modifying,” Reder said. “It has the potential to improve asthma outcomes and reduce the needs for medications.”

Trinity’s Allergy department, which includes Dr. Reder and Sean Stanga, MD, specialize in allergy and asthma treatment. If you show signs of asthma and would like to consult with an allergist, call Trinity’s Allergy department at 857- 7387. Their office is located on the third floor at Health Center – Medical Arts, 400 Burdick Expy E, Minot.

 

May is Better Hearing and Speech Month

Many children receive the help of a Speech/Language Pathologist (SLP), privately or in schools, to address all needs of communication.

Some children can’t produce speech sounds, while others have difficulty expressing themselves vocally and in writing, and organizing thoughts, explained Nadine Hagen, MS, CCC-SLP, manager of Trinity Health’s Speech Therapy Department. “To overcome learning challenges, the SLP helps children develop and demonstrate communication skills to better participate in class, follow instructions, and improve reading and writing skills.”

SLPs help children reach the goal of full communication skills in all environments. Areas of communication difficulties are:

• Articulation (way each sound is produced)

• Expressing wants, needs, and ideas

• Receptive Language

• Stuttering/Fluency

• Voice

• Pragmatics (rules of appropriateness for social language and communication)

• Swallowing

• Social language skills

• Nonverbal expression and gestures

• Formulating questions and responses

• Syntax (arrangement of words in a sentence)

• Semantics (interpretation of the meaning of a word or phrase)

• Comprehending presented information

• Using vocabulary appropriately

• Intonation

“Parents play a vital role in the success of speech therapy,” Hagen said. “The SLP works with a team of parents and other professionals to determine individual goals for a child. Progress is reported after each session. Goals are updated and/or modified to meet the needs of your child.”

Patients will require a physician’s referral. For further questions or for a free screening, please contact Trinity Health’s Speech Therapy Department at 857-5514.

Two Associates Receive Eagle Awards

Tyson Williams, DPM, a podiatrist with Trinity Health’s Foot and Ankle clinic, and Kevin Melby, an athletic trainer with Trinity Health’s Sports Medicine department, were recently awarded the Minot Area Chamber of Commerce’s Eagle Award.

Dr. Williams was nominated for the award because he is “a very caring and concerned doctor.” The nomination letter for Dr. Williams explained that the patient had two foot surgeries “and things turned out great.”

Described as being “a great asset” to Trinity, Dr. Williams “explains things so that you know what all he will be doing during surgery,” the letter said. “I would refer him to anyone if you’re looking for any foot surgery at all.”

Melby has “gone above and beyond” when it comes to working with student athletes; in particular, the nominator referenced the times when he has helped her two daughters, who are engaged in varsity gymnastics, when it came time to diagnose concussions. “His care and professionalism has helped me, as a parent, understand how scary concussions can be,” the parent wrote. “He has been available 24 hours a day and his care for the athletes is second to none.”

To receive the Minot Area Chamber of Commerce Eagle Award is validation of the pursuit of the mission of Trinity Health, which values exceeding professional quality standards. If you would like to nominate a Trinity Health associate for an Eagle Award, you can do so by going to: http://www.minotchamber.org/about/chamberawards.

Active: To Be or Not To Be?

By Dawn Mattern, MD

Inactive. Coaches fill out rosters, listing Active and Inactive participants. Which one are you? More than half of Americans are inactive–they do not meet the recommendations for sufficient physical activity. To be active, an adult needs only 150 total minutes a week of exercise and children need 60 minutes a day.

Being active:

• Reduces the risk of cardiovascular death, cancer caused death, and all-cause death

• Reduces the risk of developing Alzheimer’s disease

• Reduces stroke, type 2 diabetes, depression, hypertension, arthritis, and falls

• Improves mood, energy level, sleep, strength, and endurance

Active doesn’t mean gym memberships or expensive equipment. Some can choose running, aerobics, weightlifting, biking, yoga, swimming, walking–the list is almost endless. And that’s the greatest part about it all; just move. With my patients, I count housework, gardening, walking the dog, body weight strength exercises, anything that gets the heart pumping. Sitting doesn’t count.

Sedentary behavior is now recognized as a risk factor for many diseases– high blood pressure, diabetes, heart disease, and more. Even though you may fulfill your activity minute requirements, if you sit all day, you haven’t done yourself any favors. Our bodies are designed to move, not sit all day.

May is Exercise is Medicine Month. The American Medical Association and the American College of Sports Medicine have collaborated to draw attention to the importance of exercise and our health. Exercise is recommended for prevention and treatment for almost all of the diseases that we diagnose every day. Exercise should be part of every prescription we give!

As in previous years, the Doc Walk will kick off Exercise is Medicine Month. Please join me at Oak Park on Wednesday, May 2, at 6:30 p.m. Let’s be Active!

Dawn Mattern, MD, is a board certified physician with Trinity Health’s Family Medicine and Sports Medicine departments. She can be reached at 857-5500.

Tips to Protect Yourself from Spring Allergies

Springtime brings warmer temperatures and blooming trees.  But for many people it also brings annoying seasonal allergies. 

A report by Mayo Clinic notes that about one in three Americans experiences some form of allergy.  Dr. Michael Reder and Dr. Sean Stanga, Allergy and Immunology specialists with Trinity Health, say the biggest culprit this time of year is pollen.

“Pollen is an airborne allergen produced by trees, grasses, and weeds, which is easily picked up by the wind and scattered for miles,” Dr. Reder said.  “When it comes into contact with a person’s nose and eyes, it can cause a variety of symptoms, including itchy, watery eyes; sneezing, and nasal congestion.”

What exactly causes allergies is still a subject of study, but the allergic mechanism is well known.  “When you have a pollen allergy, your immune system mistakes an otherwise harmless substance as an invader and overreacts to the allergen by producing antibodies,” Stanga explained.  “These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction.”

Prescription medicines and allergy shots are effective ways to control allergies, according to Dr. Reder.  “If you suspect you might be suffering from allergies this pollen season, you should consider being evaluated by our allergy department and possibly get skin tested,” he said. 

Short of that, the simplest thing one can do to avoid symptoms is to limit exposure:

  • Avoid being outdoors on windy days, especially mid-morning to mid-afternoon, when pollen counts are often highest.
  • Cover your mouth with a scarf or mask.
  • Keep car and home windows and doors closed.
  • Change clothes and even shower to remove pollen that might have stuck to your clothes and hair.

For more information or to make an appointment, call the Allergy and Immunology clinic at (701) 857-7387.

‘Weigh 2 Change’ Begins Soon for People Eager to Make Lifestyle Changes

The Trinity Health Center for Diabetes Education will offer its lifestyle intervention program, Weigh 2 Change, starting with a pair of informational sessions April 17.

Weigh 2 Change is a yearlong, evidenced-based program that helps people make positive lifestyle changes aimed at improving health and preventing type 2 diabetes.  Based on the National Diabetes Prevention Program established by the Centers for Disease Control and Prevention, the program incorporates key elements recommended by the CDC, including nutritional and exercise counseling, group support, and the use of trained lifestyle coaches.

“The way to delay or prevent diabetes is through weight loss and increased physical activity, which are two key components in this program,” explained clinical dietitian Michelle Fundingsland, RDN, LRD, who leads the program.  It’s a one-year commitment, which might seem extensive, but our goal is to promote lasting lifestyle changes, which don’t happen overnight.”

About 86 million people in the U.S. have prediabetes – defined by the CDC as a person with a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes.  Risk factors include being overweight, inactivity, and having a family history of diabetes.  Research shows that people can lower their risk for type 2 diabetes 58% by losing 7% of their body weight and exercising moderately 30 minutes a day, five days a week. 

Prior to committing to the program, participants are invited to attend one of two free informational sessions called “Session Zero” meetings, where people learn about the program.  Two Session Zero meetings will be held Tuesday, April 17, at 12 noon and 4 p.m. in the Trinity Health Community Conference Room at Town & Country Center. 

“People who attend this session will complete a readiness-to-change questionnaire to help them determine whether the program is right for them,” Fundingsland said. “The questionnaire will ask things like – are you ready, do you have time for this, are you ready to make a change in terms of eating and physical activity?”

To participate in Weigh 2 Change, participants must meet the following criteria:

  • At risk for, or have, prediabetes
  • At least 18 years of age
  • Overweight
  • Do not currently have diabetes
  • Not pregnant

People who decide to commit to the program and are not covered by Medicare will be charged a fee of $220, which covers educational sessions and materials for the entire year.  For more information, call the Trinity Health Center for Diabetes Education at 857-5268.

Balloon Device Gives Severely Injured Patients a Fighting Chance

 Just in time for trauma season, doctors at Trinity Health have adopted a new technique that can stop fatal bleeding with a simple balloon device.

Dr. Gary Wease, a general surgeon and director of Trinity’s Trauma Program, says the ER-REBOA™ Catheter is now available to surgeons and emergency physicians as a lifesaving tool in cases where patients are at risk of bleeding to death due to massive blood loss that can’t be stopped with compression.

“Acute internal hemorrhage is the leading cause of death in trauma patients,” Dr. Wease noted.  “The sooner we can intervene, the better.  With the REBOA, we have a less invasive way to achieve immediate hemorrhage control so the patient can be stabilized and sent to the OR for definitive treatment.”

Traditionally, the only option doctors had to stop uncontrolled bleeding was to perform a thoracotomy, a major surgery that involves making a large chest incision, opening the rib cage, and putting a clamp on the aorta – the body’s main artery.  What the ER-REBOA™ Catheter offers is a minimally invasive alternative to this method, using a technology similar to the technique cardiologists use to open arteries of the heart.

“Basically, the REBOA is a catheter with a collapsed balloon at its tip,” Dr. Wease explains.  “The catheter is inserted into the femoral artery of the leg and threaded up into the aorta.  Once the balloon has reached the optimal spot, it’s inflated, causing a temporary blockage of the aorta.”

REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta.  It’s the flagship product of Prytime Medical Devices, Inc., headquartered in San Antonio, TX.  The company designs, develops and commercializes minimally invasive solutions for vascular trauma.  Kari Mogen, a clinical specialist with the company, says, not surprisingly, the ER-REBOA™ device has its origins in military medicine.

“The underlying intellectual property for the ER-REBOA™ Catheter came from two military surgeons, Colonel Todd Rasmussen, MD, and Dr. Jonathan Eliason, and is based on their wartime experiences,” Mogen said.  “But the concept of occluding large arteries to stop hemorrhage dates back even further to the Korean War, when war surgeons looked for ways to save more lives on the battlefield.”

Mogen says the ER-REBOA™ Catheter is designed and indicated for temporary occlusion of large vessels and blood pressure monitoring, including patients requiring emergency control of hemorrhage.  For patients with truncal hemorrhage (affecting the trunk of the body), REBOA helps maintain blood flow to critical organs like the heart and brain until the hemorrhage can be definitively controlled via surgery.

In February, Trinity’s emergency, critical care, and anesthesia staff received training in the REBOA technique.  Trinity Health is now the first North Dakota hospital and one of nearly 250 worldwide to enhance its trauma arsenal with the device.  Dr. Wease says it should come in handy during the upcoming trauma months that fall between Memorial Day and Labor Day.

“We get some nasty accidents and motorcycle crashes during a busy trauma season,” Dr. Wease said.  “I can see us using it two or three times, maybe more.  The key thing is – you have to use it proactively.  So there may be times when we’ll put the balloon in place and not inflate it, which is fine.  It’s better than opening the chest and clamping an aorta.” 

Going Further With Food

By Brittany Rosin, Student Dietitian, Trinity Health

This year’s theme for national nutrition month is “Going Further with Food.” The Academy of Nutrition and Dietetics is teaming up with “Further with Food: Center for Food Loss and Waste Solutions,” an online hub for the exchange of information and solutions to cut food waste in half by 2030. It’s estimated that 90 billion pounds, or $107 billion worth, of food goes uneaten each year, costing an average of $1,700 for a family of four. At a consumer level, many fresh fruits and vegetables are never actually eaten, such as tangerines (52 percent), cherries (51 percent), cantaloupe (43 percent), peaches (42 percent), sweet potatoes (44 percent), bell peppers (39 percent), kale (38 percent), and carrots (34 percent). Wasted food means wasted nutrients. Whether you’re having a mid-day snack or fueling yourself to run a marathon, the foods you choose can make a real difference!

Here are five tips to go further with food:

1. Consider the foods you have on hand before buying more at the store.

2. Buy only the amount that can be eaten or frozen within a few days and plan ways to use leftovers later in the week.

3. Order smaller sizes of foods and drinks when eating away from home.

4. Be mindful of portion sizes. Eat and drink the amount that’s right for you, as MyPlate encourages us to do.

5. Get creative with leftovers, and transform meals into soups, salads, or sandwiches!

Night 1
Lemon-and-Sage Roasted Chicken

Ingredients:
2 lemons, thinly sliced
6 fresh sage leaves
1 (6-pound) chicken
3 teaspoons olive oil, divided
¾ pound parsnips, peeled and trimmed
¾ pound carrots, peeled and trimmed
½ pound turnips, peeled and trimmed
1-pound fingerling potatoes, halved
2 tablespoons chopped fresh thyme

How to make it:

Step 1: Preheat oven to 425°. Place six lemon slices and sage leaves under skin of chicken. Put remaining lemon into cavity. Tie legs together with twine, and tuck wings under. Brush one teaspoon oil over chicken. Place chicken in roasting pan; roast in lower third of oven for 1 hour 15 minutes or until an instant-read thermometer registers 165°. Transfer chicken to a cutting board; let rest for 15 minutes.

Step 2: Meanwhile, cut root vegetables into matchsticks. Toss with potatoes in a baking pan with remaining oil and thyme. Roast, stirring occasionally, for 45 minutes or until tender.

Step 3: Remove skin from chicken. Discard lemons from cavity. Slice enough chicken to serve 4 (such as breasts), and serve with half of vegetables.

Night 2
Mini Chicken Pot Pies

Ingredients:
1 sheet frozen puff pastry dough, thawed
2 teaspoons unsalted butter
2 teaspoons olive oil
3 tablespoons all-purpose flour
2 cups 2% reduced-fat milk
2 tablespoons lemon juice
2 cups shredded leftover chicken
2 cups leftover roasted root vegetables, coarsely chopped
¼ cup coarsely chopped fresh basil
½ teaspoon salt
¼ teaspoon pepper
4 fresh sage leaves
1 large egg white, beaten

How to make it:

Step 1: Preheat oven to 425 degrees. Roll out puff pastry to 1/4 inch thick, and cut into 4 (6-inch) rounds to fit over 1-cup ovenproof bowls. Keep pastry covered and chilled.

Step 2: Heat butter and oil in a medium saucepan over moderate heat; add flour, and cook, whisking constantly, for 1 minute. Add the milk in a slow stream while whisking constantly; bring the mixture to a simmer. Simmer for about 5 minutes or until thickened. Stir in next six ingredients (through pepper). Spoon mixture into ovenproof bowls. Top bowls with pastry, pressing against the outside edge of the bowls to seal. Place a sage leaf on top of pastry, and brush with egg white.

Step 3: Bake pot pies on a baking sheet in middle of oven for 17 minutes or until pastry is golden brown. Serve hot.

Guest House Celebrates 10th Anniversary

The Trinity Health Guest House is not just a place to stay, it is a home. And it has been a home-away-from-home for more than 19,000 individuals since it opened 10 years ago. The Guest House is a place to find refuge after a long day of tending to hospitalized family members, a place where people know what you are going through and can help you cope, a place…like home.

Most of the guests are from rural areas of North Dakota but the House has hosted family members from 46 states, four Canadian provinces, Puerto Rico, Guatemala, and Mexico. Guests often share a special camaraderie since they are coping with similar circumstances. The biggest comforts for our guests who reside at the House are the friendships they make.

The Trinity Guest House originated from a generous donation from a family. Now, through the Trinity Health Foundation, as well as funds collected at the time of stay and other donations made to the Guest House, repairs and replacement costs are paid for to keep the Guest House in operation; additionally, funds can offset the costs for families who can’t afford to pay for their stay.

Judy Gullickson, Foundation Facilities Manager, has managed the House since opening day; prior to managing the House she worked as a housekeeper at Trinity Hospital for more than 30 years.

Guests can stay at the Trinity Health Guest House while a loved one is receiving treatment at any of the Trinity Health facilities. “This place was our safe haven as we waited for our newborn to get better,” an entry in the Guest House’s guest book read. “Thank you for checking on us every day, giving us a smile that calmed us.”

“This is such a wonderful place to have available for families of patients,” a guest book entry said. “It takes a lot of stress out of the situation when you can be close to your hospitalized loved ones.”

Prior to the establishment of the Guest House, family members of patients would need to find hotel rooms. In years past, this could be an arduous task. The fact that the Guest House is located directly across the street from the hospital makes it a comfortable and convenient form of accommodation for patients’ family members.

The Trinity Health Guest House will hold an open house on Monday, April 16, from 4 to 6 p.m. Refreshments and tours of the Guest House will be provided.