Hear from a Doctor without Leaving Home

It's Altru - Published on June 14, 2017

Sharing concerns with your doctor, scheduling appointments and getting access to your medical information has never been this easy. With eVisits and MyHealth, Altru Health System is becoming more present online.

Altru eVisits
Have you ever had a little cough that you just weren’t sure about or a rash that didn’t seem quite worth a trip to the hospital?

Now by using Altru eVisits, you can tell Altru professionals your symptoms right on your smartphone or your computer. You even have the ability to add a picture to your eVisit if your concern is something visible. By doing so, an Altru provider can diagnose you online, give you a plan of action and/or send in your prescription. Or, they can let you know that it is worth coming in to have a physician look at it in person.

Altru eVisits are great in many different instances and will have a positive impact on:


  • Patients with busy schedules

  • Out-out-town patients

  • Patients with limited mobility

  • Visits that don’t require physical interaction


If you have a specific issue that isn’t an emergency, there is a good chance it can be resolved by an Altru eVisit. Remember, if your medical issue is urgent, do not wait for an eVisit consult.

Although it is a very exciting opportunity, before you jump right into your first eVisit, you must have already been a patient with Altru Health System and have an established MyHealth account. Log on to your MyHealth account to initiate an eVisit.



MyHealth
Along with our new online visits, Altru offers MyHealth online medical site. By being a former patient of Altru and by signing up for a MyHealth account you can:

  • Communicate with your provider’s office

  • Schedule/Cancel medical appointments. View upcoming and past appointments.

  • Pay bills securely.

  • View most test results, Radiology and Pathology reports and provider outpatient progress notes.

  • Request portions of your Medical Record with Altru (some fees may apply).

  • Request prescription renewals.

  • View your child’s record and print growth charts.

  • Manage care of elderly parents.


To sign up or for more information, check out the MyHealth login page.

See also:

I've Been Diagnosed With Heart Disease - How Will My Life Change?

Enrich - Published on June 8, 2017

Being diagnosed with heart disease brings a lot of new adjustments that can be overwhelming to deal with. The process of doing everyday things such as exercising and eating may change, but that doesn’t mean your entire life has to. You can still lead a normal, happy life after being diagnosed with heart disease.

Daily Habits
To ensure you take good care of your heart, focus on healthy behaviors and remove unhealthy habits.


  • Eat heart healthy foods. Make sure you understand what foods are recommended or should be avoided given your diagnosis and medications.

  • Make sure you’re aware of the potential symptoms relative to the type of heart disease you have been diagnosed with, and keep in touch with your doctor if anything changes.

  • Avoid tobacco use and secondhand smoke.

  • Avoid or minimize alcohol consumption.

  • Take your medications as prescribed.




Exercise
The key to staying positive during your lifestyle change is to focus on wellness versus illness. It is important to stay active in the safest way possible.

Many fitness centers offer physical assessments to help determine alternative fitness activities that you can benefit from and are safe. At Altru, the Sanny and Jerry Ryan Center for Prevention & Genetics and Altru’s Medical Fitness Center offer medically supervised exercise that can help you get started with an exercise program and help you progress toward a healthy lifestyle. Individuals that exercise typically experience greater quality of life in their advanced years. The key is finding a safe, effective way to exercise that you enjoy.

The American Heart Association recommends:

  • 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week

  • 30 minutes of activity per day, 5 days a week.

  • 40 minutes of moderate exercise per week for those with high cholesterol and/or high blood pressure


Pay attention to how you feel during and after your exercise sessions and adjust your activities as needed. Be patient with yourself and build on your exercise tolerance and endurance slowly.



Eat Smart
It is important to be mindful about what you are consuming. Focus on portion sizes and healthy choices.

  • Read food labels.

  • Avoid high fat, high cholesterol and foods high in carbohydrates.

  • Consume low sodium choices.

  • Drink plenty of water.


Learn more about some of your heart’s favorite foods.

Medications
The type of medications you are given will depend upon the type of heart disease you have been diagnosed with. For some, a daily Aspirin will be the extent of it, but others may need blood pressure medications, cholesterol medications, medications for fluid retention or medications that strengthen the heart for those with heart failure. The number and type of medications prescribed depend on the complexity of the heart disease. Your care team will provide you with information on how and when to take your medication. It is important to be consistent and diligent. Here are some tips to stay on track:

  • Set an alarm for your medication time.

  • Keep medication in a container marked with the day/time, and pre-fill it with the dosage needed.

  • Refill your prescriptions through MyHealth so you can ensure you don’t run out.


Follow-up care and visits
Follow-up appointments will be determined by the diagnosis and how stable the individual is. Usually, you’ll see your provider every six months or annually for routine appointments. Typically those patients that are hospitalized will be scheduled for a post-hospital appointment to assure the individual is doing well.

Once you have been diagnosed with heart disease you should have lifelong appointments with your cardiologist or primary care physician at least annually, or more as recommended. It is also important to stay on top of your overall care, so if you see your cardiologist for heart care, you’ll want to visit with your primary care provider for routine screenings and check-ups annually.

Potential treatment options
Altru’s Heart & Vascular team offers advanced, convenient care to ensure patients who are living with heart disease can be confident they are in good hands. Specific treatment options will depend upon the type of heart disease you have and your overall health condition. Treatment options may include:

  • Coronary disease: medical therapy, angioplasty, stents or coronary artery bypass as recommended by your provider

  • Rhythm issues: medical therapy, cardioversions, ablations, pacemakers or defibrillators may be recommended

  • Heart failure: medical therapy, cardiomems, an automated implantable cardioverter defibrillator, and heart transplant could be treatment options your provider will discuss with you


Regardless of the heart disease you have been diagnosed with, our team will help you through balancing your new lifestyle. If you have any questions about your heart care, or would like to schedule an appointment, call 701.780.6236 or contact your provider through MyHealth.

What Foods & Exercises Are Safe During Pregnancy?

Enrich - Published on June 6, 2017

There’s a lot to consider when you learn you’re expecting. Plans for baby names, nurseries, safety, feeding and other exciting changes likely fill the minds of expectant mothers. With all the excitement on the horizon, it can be a challenge to remember the changes you should make to your habits to ensure that you and your growing baby remain healthy throughout your pregnancy. To help simplify what you need to know, provided is a list of foods and exercises to add, remove or modify from your routine while pregnant.

Food & Drink

You may be familiar with some of the main foods to avoid in pregnancy, but due to risks of complications, more foods that could contain Listeria, Salmonella or e-coli have been added to the “avoid list” in recent years. However, some foods and beverages can be eaten safely as long as they are modified.

Avoid these:


  • Raw or under-cooked meat and fish

    • Such as: sushi, oysters, rare or under-cooked beef, pork or poultry



  • Unpasteurized soft cheeses

    • Such as: brie, feta, blue cheese or queso blanco



  • Pre-made deli salads or dips

    • Your best bet is to make your own to control shelf-life, ingredients and refrigeration



  • Unpasteurized milk and juices

  • Fish with high levels of mercury

    • Such as: tuna, swordfish, marlin and king mackerel



  • Raw dough or batter

    • Any pre-cooked mix that includes raw egg



  • Raw sprouts

  • Alcohol


Modify these:

  • Deli meats and hot dogs

    • Safe if heated to steaming (165 degrees) right before consumption



  • Eggs

    • Cook eggs until yolks are firm



  • Smoked seafood

    • Canned versions are safe, refrigerated versions are not unless heated to 165 degrees right before consumption



  • Homemade ice cream

    • Only safe if pasteurized eggs or egg products are used



  • Coffee

    • Drink no more than 200 mg/day,  which is one 10-12 oz cup of regular coffee




See a full list and safe cooking recommendations at foodsafety.gov.

Eat these:

In pregnancy, you’ll want to follow similar rules of healthy eating as is normally recommended, with a few modifiers to increase key vitamin intake, incorporate more protein and remove unsafe foods. Add these choices to your diet to help encourage a healthy pregnancy:

  • Greek yogurt

  • Dark leafy greens

  • Cooked eggs

  • Salmon

  • Lamb

  • Berries

  • Avocados

  • Beans and lentils

  • Nuts and seeds

  • Sweet potatoes




Exercise

While you should consult your doctors for individual recommendations, low-impact exercise is healthy and encouraged during pregnancy.

Include these:

As a general guide, a low-impact, pregnancy-safe exercise routine means about 30 minutes of exercise at a level where you could carry on a conversation. Some examples may include:

  • Walking

  • Prenatal Yoga

  • Swimming

  • Low-impact aerobics


Modify These:

  • Yoga & Pilates

    • If you can’t find prenatal classes, beginner to moderate level class can be safe. Let your teacher know you are expecting and they can recommend modifications.



  • Aerobic Exercises

    • If you attended classes before conceiving, at your doctor’s discretion you should be able to keep them up. Pay attention to your exertion levels and modify when you feel uncomfortable or can’t easily talk.



  • Strength Training

    • Use lighter weights to maintain your strength training routine. Avoid motions that quickly jolt your core or put strain on it.




Avoid These:

  • Hot Yoga, Saunas or Steam Rooms

    • High temperatures are not safe during pregnancy



  • Abdominal exercises

    • Laying on your back for extended periods is not recommended after the first trimester



  • HIIT or high-intensity training

  • Contact sports

    • Hockey, basketball, soccer, etc.



  • Activities with high risk of falling or being struck in the abdomen

    • Kickboxing, water sports, skiing, volleyball, etc.



  • Scuba Diving


It is important to note that every person and every pregnancy is different. While these guidelines will fit for most, it is pertinent to establish a relationship with a family medicine or obstetrics and gynecology provider once you learn you are pregnant. They will become your partner in the journey to parenthood and make recommendations and adjustments to your lifestyle along the way based on your individual needs. Find a provider that’s right for you at altru.org/providers.

Roshan Ghimire, MD, is a family medicine physician with an interest in obstetrics and women’s health. Dr. Ghimire enjoys family medicine as it allows him to interact with a variety of medical problems and different patient groups. He finds caring for pregnant women, delivering babies and then caring for that baby to be a very rewarding process. Dr. Ghimire enjoys traveling, reading and spending time with his family, especially his young daughter.

Reduce Stress to Manage Diabetes

Enrich - Published on June 5, 2017

Life is stressful at times for everyone. And, if you are one of the millions of people living with diabetes, stress often equals more problems.

Diabetes is a chronic disease that interferes with the body’s ability to regulate blood glucose levels at normal levels. It’s been long thought that a person's weight or diet were the only factors in whether or not they developed Type 2 diabetes. Research has also cited other factors including genetics, activity and stress levels and/or insulin resistance. When the body is under stress, which can be emotional or physical, the natural response is for the cortisol levels to increase. Cortisol is a stress hormone that can increase insulin resistance. This affects the body’s ability to move glucose out of the blood vessel and into the cell to be used as fuel or energy. Stress often causes a person to have an elevated blood pressure, muscles and blood vessels constrict, and breathing becomes shallow. All these factors can make a person with diabetes have less control over the management of their diabetes, putting him or her at higher risk for complications associated with diabetes. This includes an increased risk for heart attack, stroke, blindness, kidney disease, erectile dysfunction and neuropathy.

Over time, stress also increases the rate of depression and anxiety. Depression is often a factor resulting from the day-to-day struggle of dealing with a chronic disease that can cause debilitating complications, cost several thousands of dollars and shorten a person's life.



Fortunately, there are many options to help someone with diabetes manage stress. Some may choose to use an app to manage stress. The following are a few more possibilities.


  • Exercise is a great way to relieve stress, burn calories and decrease insulin resistance. It’s a win-win! There are so many forms of exercise, such as cardio, strength-training and even yoga. Treat yourself to a class to learn something different.

  • Find a hobby, go to the movies, read a good book, get a massage, spend time with a friend, get a pet.

  • Focus on deep breathing. This promotes increased blood flow and relaxation.

  • Practice meditation or biofeedback techniques.

  • Set reasonable goals with rewards

  • Journal, join a support group, or see a therapist. Psychological therapy can help a person deal with anxiety and depression that often result from diabetes. People with diabetes have voiced that they feel judged about their weight or diet, and even their lab values and are usually compared to others with diabetes. It’s best to remember that no two cases of diabetes are exactly the same. Something that works for one person may not work for another. People should never feel ashamed by their situation.

  • See a certified diabetic educator (CDE) and a licensed dietitian to help gain knowledge and receive support from specially trained healthcare professionals at diagnosis and routinely thereafter for best results.


Diabetes is difficult, and the professionals at Altru's Diabetes Center can help you gain control over, stay up to date on treatment options and to go from being a diabetic person to a person living with diabetes.

Jana Sherry, RN, Diabetes Nurse Educator has been working with Altru Health System for 24 years and has been at the Altru Diabetes Center since 2011. She is a Certified Diabetic Educator (CDE) in both North Dakota and Minnesota. She is excited to witness how diabetes care changes due to technological advances within the next few years. Jana lives out in the country with her husband and has three children and two grandsons with another one on the way. In her free time, she enjoys gardening, reading, baking and jewelry making.

Ease Your Mind about Heart Surgery with These Tips for Prep and Recovery

Enrich - Published on June 5, 2017

It is understandable to be nervous, anxious or confused about a surgery. That is why the heart and vascular team at Altru takes time to meet with patients on multiple occasions prior to surgery, along with sending you home with information on how the heart works, what your disease does to the heart, information on your procedure, and the recovery process.

Preparation
A nurse will send you a letter the day before surgery explaining everything you need to know in detail. Kristyn Lafferty, LPN with Altru’s Heart & Vascular Services, said the letter and other pamphlets will include a detailed list of things to expect and instructions, such as:


  • eating and drinking restrictions before surgery

  • medications to take and when to take them

  • how to do breathing exercises

  • the amount of time you can expect to be in each prep area before your surgery


You will also meet with your surgeon the day before and the day of your surgery. This way you will have a chance to have any questions answered directly.

Recovery
Each person is unique, therefore each surgery is unique. The recovery process and time may be different for everyone, but as a general guideline, plan to be in the hospital for about five to six days following your surgery. After your surgery, you will be given a list of daily goals containing what you can hopefully accomplish each day.

These post-operation daily goals include progress in these six categories:

  • diet

  • medications

  • breathing

  • IVs/tubes

  • activity

  • wound care


After your few days in the hospital, you will spend about four to six weeks doing very light activity and a lot of resting. In order for the breastbone (sternum) to heal, there is a ten pound weight restriction for six weeks. Because of medication you may be prescribed, you will not be allowed to drive until directed by your physician or nurse. You and your care team will decide when the best time to go back to work is, and that may also depend on your employer’s flexibility and job functions.

After you go home, you won’t have to worry about recovering on your own. A nurse will check in on you by phone to document your progress. You will receive regular phone calls to follow your recovery process at home. The nurse will ask the same questions each time to examine how you are improving. You will also be given the opportunity to bring up any questions or concerns you have with the recovery process.



At Altru
Altru offers pre and post-surgical care and coordination to assist patients in getting back to their everyday lives. Altru also offers cardiac rehabilitation which includes treatment, monitoring, and lifestyle change. These steps combine exercise with education and risk factor modification. If your recovery is going well, rehab may not be needed after surgery. If you do not need cardiac rehabilitation, but still need some assistance at home, a home care option may be available for you.

If you have a concern about your heart, schedule an appointment by calling 701.780.6236. Our team will help you understand your care, and ensure you are comfortable through everything from screening to surgery. Learn more about what we offer at altru.org/heart.

Beat the Summer Heat by Adding Some Wow to Your Water

Enrich - Published on May 31, 2017

Water is essential for our well-being. In fact, our bodies are made up of 50 to 60 percent water. It is continually used as our body functions, which makes it important to ensure it’s replenished. The correct balance of water and electrolytes determines how well our body runs; this includes our nerves and muscles. Staying hydrated removes waste through urine, controls body temperature, heart rate, and blood pressure, and helps maintain a healthy metabolism.



For years, we’ve been told to drink eight, eight ounce glasses of water each day. Turns out there isn’t much science behind that recommendation. But, before you put down your water bottle, there’s plenty to back up why it’s needed. In fact, we all need about one milliliter of fluid per calorie we eat. For example, if you follow a 1,600 calorie diet, you need almost seven cups of fluid per day. And, if you follow a 2,000 calorie diet, you need a little over eight cups of fluid per day. That age-old rule of eight glasses a day isn’t too far off the mark. Even more, our fluids can come from a variety of beverages, including those that contain caffeine. The diuretic effect of the caffeine is mild compared to the fluid provided. Want more good news? Your fluid intake doesn’t stop at what fills your cup. We can also get our fluids from foods such as soups, yogurt, fruits and vegetables.

Even though fluids can be found in a wide variety of sources, the liquid source is your best option. You should drink enough so that you go to the bathroom every two to four hours and your urine should be light in color. Dark urine is an indicator that you most likely need to drink more. Everyone is unique and certainly your size, calorie intake, activity level and type of environment you live and work in will determine how much fluid you need.

Add Wow to your Water
When it comes to beverages, water is a great calorie-free thirst quencher. Check out these ideas to add some “WOW” to your water without adding a lot of sugar and calories.


  • Add the traditional lemon or lime for a little fresh zing.



  • Drink fruit infused water. Add fruit to your glass of water or use special water bottles and pitchers that hold fruit and water. These can be purchased at a variety of stores.



  • Freeze fruit juice in ice cube trays. Add the frozen fruit cubes to water in place of ice cubes.



  • Add a packet of True Lemon and a spoonful of instant unsweetened tea to 16 ounces of water.



  • Add a small amount of cherry juice and an optional lime.



  • Make green iced tea: Boil four cups of water in a kettle and leave for a few minutes so the temperature naturally drops to no less than 195°F. Add three to five green teabags to a heat-proof pitcher and pour in the water. Leave to brew for one to five minutes. Remove teabags and add a little sugar if desired. Stir in six cups of ice cubes until melted, or use four cups of cold water. Add freshly sliced lemon to taste. Keep refrigerated and drink within 24 hours.


Becky WesterengWestereng, Becky 4C is a registered dietitian at Altru Health System. She is a diabetes educator and certified in sports nutrition. Becky is especially interested in helping people improve their eating and exercise habits by encouraging small steps and a positive attitude. She enjoys spending time with her husband and watching her three children perform music and play sports, while finding time to stay active herself.

The Scoop on Poop: What’s Normal, What’s Not

Enrich - Published on May 30, 2017

Poop. There, I said it. It’s not a fun thing to talk about, but if we are healthy, our poop should be, too. Let’s move beyond the awkwardness and into the important stuff. Here’s what you need to know to make sure your digestive health is in tip-top shape.



What is poop?
Bowel movements consist of dead cells, fiber and bacteria. Nutrients from the food we consume are absorbed into the blood stream. The rest is discarded.

So, how often should you poop?
Most people should have bowel movements between once a week and up to three times per day. The frequency and consistency of bowel movements combined with other symptoms such as abdominal pain, urgency or even bloating can be a sign of illness.

What does a healthy bowel movement look like?
The texture should be similar to toothpaste consistency—not too hard, not too soft. Stool which is too watery may mean you are not absorbing water or nutrients, which should be discussed with your doctor.



Seeing the Rainbow?
It’s important to pay attention to the color of your bowel movements. Like the famous emoji, healthy poop should be a medium shade of brown. Here are some colors to watch for:


  • White or gray: you could be having a problem with your pancreas or gallbladder.

  • Bright green: leafy greens (or artificial food coloring) can make your stool appear green.

  • Black: could indicate dried blood higher up in the digestive tract. Consult your doctor.

  • Red: blood in the stool is abnormal and should be brought your doctor’s attention.

  • Food in your stool: it is normal to see undigested food, such as corn, in the stool from time to time.


Happy Bowels
For happy bowels, remember the four Fs: fiber, fluids, flora and fitness. Eat plenty of fiber, stay hydrated by drinking water, consume foods such as white potatoes, vegetables and dry beans that support the growth of good bacteria, and move your body daily.

New areas of research are showing how what we eat and how we exercise can determine if we have healthy bacteria in our colons. Unhealthy bacteria can lead to obesity, diabetes, depression, and even Crohn’s and Ulcerative Colitis.

If unusual colors, patterns or pains persist beyond a day or two, call your doctor. The experts at Altru’s Gastroenterology Clinic specialize in prevention, diagnosis and treatment of disorders of the liver and digestive tract, including the esophagus, stomach, pancreas, gallbladder, small intestine and colon. We work with you to develop the best care plan to maintain good health.

Dr. Howard Hack, gastroenterologist, found the pursuit of medicine to be a perfect match for his lifelong passion for learning and helping others. He has worked in a variety of settings, including urban, suburban and rural areas. He has taught medical students, internal medicine residents and GI fellows at Stanford University, and has his work published in The Lancet (London, UK). In his spare time, Dr. Hack enjoys swimming, bike riding and ice skating with his family. 

 

See also:

Tips for a Bright Future Free of Skin Cancer

Enrich - Published on May 16, 2017

I treat my patients with the same respect and care that I would provide my family. I want my family to be free of skin cancer, so that means I want that for my patients, too. Skin cancer has quickly become the most common cancer in the United States, and melanoma skin cancer is one of the leading causes of cancer-related deaths, with the rate rising over the last few decades.

The journey to healthy and cancer free skin can be complicated and even time consuming. Here are some tips to remember on your journey to cancer-free skin.

Sunscreen should be broad-spectrum protection (protects against UVA and UVB rays), sun protection factor (SPF) 50 or greater, and water-resistant.


  • Apply sunscreen to dry skin 15-30 minutes BEFORE going outdoors. Be sure to apply it generously to achieve the UV protection indicated on the product label.

  • Re-apply sunscreen approximately every two hours or after swimming or sweating heavily, according to the directions on the bottle. If the bottle specifies a lower water resistance time, then reapply according to those guidelines (i.e. water resistance of 60 minutes needs to be applied every 60 minutes).

  • Skin cancer also can form on the lips. To protect your lips, apply a lip balm or lipstick that contains sunscreen with a SPF of 50 or higher.


Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible. Not all clothing is equal and certain fibers provide more protection. Seek out clothing lines that have special sun-protective qualities.

Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, find shade.

Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.

Get vitamin D safely through a healthy diet that may include vitamin supplements rather than from sun exposure.

Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look tan, consider using a self-tanning product, but continue to use sunscreen with it.

Be aware of sun sensitive medications. Certain medications can cause a phototoxic reaction where the medication absorbs UV light and then release it into the skin, causing cell damage. Consult your provider about sun sensitive medications. If you have been prescribed any of the common medications that can cause problems, use plenty of sunscreen and avoid outdoor activity during the hottest parts of the day when UV rays are the strongest.



Examine your skin regularly – at least once per month. Know what’s normal for your body and take inventory of all moles and spots. From that inventory, develop a routine and form a habit of checking your skin from head-to-toe once a month. During the check, make note of any changes or additions. Spotting things that are different and potentially worrisome are the purpose of skin exams.

Sunshine is not the only cause of skin cancer. The sun plays a big role, but is not the only environmental cause of skin cancer. Chemical exposure, radiation, smoking, genetics, family history, and tanning beds can contribute to increased risk of skin cancer. Be aware and mindful of the environmental causes you can avoid.

Establish a dermatologist. Are you worried about that mole? Losing sleep over that strange freckle? Were you a fake-baker? It is important to have a dermatologist you see regularly that you feel comfortable with. A great ice-breaker is to start with a basic skin cancer screening. Annual check-ups are often recommended, but if an area of concern appears, more frequent check-ups are acceptable.

Be proactive about your skin’s health. Schedule a skin cancer screen at Truyu Aesthetic Center. This quick and easy process involves a skilled dermatologist carefully examining your skin.

Here are eight sneaky places skin cancer can hide.

Sneaky Places Skin Cancers Hides(Click to view full infograpic.)


Dr. Saba Zabetian is a dermatologist at Truyu Aesthetic Center. She provides dermatology and dermatologic surgery services, with special interests in psoriasis and connective tissue diseases. Outside of work, she enjoys playing cello, drawing, painting, biking, skiing and swimming.

Back to Baking & Time With Grandkids | Rita's Altru Advanced Orthopedics Story

Altru Moments - Published on May 1, 2017

Rita Brodina spent over 25 years working as a nurse at the Good Samaritan Society in Park River. She retired in June of 2016, looking forward to spending time with her grandkids and working in her garden. Unfortunately, hip and back pain were getting in the way of her plans.



“I wasn’t able to live my normal life,” explained Rita. “Simply walking to the garden was difficult. Bending over to get cookies out of the oven became a challenge. The pain was keeping me from my normal activities.”

Rita sought care for her pain for several months without finding the right solution. She saw a chiropractor, tried physical therapy and nothing seemed to help.

Finally, after an X-ray indicated her hip might be the culprit of most of her pain, she was referred to Dr. Jeremy Gardner at Altru Advanced Orthopedics. Wanting to avoid surgery if possible, Dr. Gardner first treated Rita with a cortisone injection to see if that would ease her pain. For a while it was successful, but after a few weeks her pain was back.

“At that point, my pain was so distracting and had been for so long that I knew a more long-term solution was necessary.”

When Rita and Dr. Gardner made the decision that a hip replacement was the right treatment, he recommended total replacement with the Mako Robotic Arm. A new addition to the treatment options at Altru Advanced Orthopedics, the Mako allowed for a more precise replacement, which in turn meant less pain and a more natural-feeling joint for Rita.

“Dr. Gardner was confident I was a good candidate for a replacement with the robotic arm,” remembers Rita. “They took a CT scan of my hip to ensure everything would match up precisely, and my new joint would be a perfect fit for me.”

Prior to her procedure, she and her husband attended an informational class held by Altru’s Joint Replacement Center so they’d know what to expect.

“The class was so important for my husband,” shared Rita. “It really showed him that he would have to be my coach and partner through this, and that he’d have a big role right after surgery. The information made him more comfortable with that and prepared us both.”

Rita had her replacement on November 21, 2016, at 7:30 a.m., and by 2:30 p.m. that same day, she was walking to the bathroom with the help of a therapist.

“It was really kind of amazing. I was up and moving so soon, already starting exercises with physical therapists in the hospital and preparing to leave the day after my surgery.”

Now, about four months later, Rita is looking forward to getting her garden ready for summer without assistance.

“Before my surgery, I was in too much pain to tend to my garden, so my kids had to help me,” shared Rita. “I’m so looking forward to doing my own flower beds.”



She’s also grateful to be more active with her grandkids since recovery.

“Before, I didn’t pick up my granddaughter,” reflected Rita. “I was unsteady, and it made me nervous. Now, she’s ten months old and I can carry her around. That feels great.”

With the advanced technology of the Mako Robotic Arm, a strong support system in her family and a dedication to her exercises to strengthen her leg and hip, Rita was able get back to an active and enjoyable retirement.

The Coconut Oil Controversy

Enrich - Published on April 28, 2017

“72 percent of Americans think that coconut oil is a healthy oil to be used for cooking , yet only 37 percent of nutrition experts agree.” -The New York Times 

Coconut Oil

There are three kinds of people in this world. People that use coconut oil religiously, people that believe coconut oil is “bad for you” and people that just have no idea what to think of it so they stick to butter and/or olive oil.

Nonetheless, the demand for coconut oil has skyrocketed in the past decade, likely due to the higher fat, lower carb diet trend, as well as coconut oil’s fatty acid profile. Claims have been made that coconut oil is a healthy substitute for a variety of other cooking oils; however, many still believe that it poses a health concern since 92 percent of its composition is saturated fat.

What most people don’t know is that not all saturated fat is created equal. There are a variety of fatty acids that make up saturated fats, with some being more beneficial or harmful than others.

Fat Basics
In order to better understand why coconut oil is all the rave, one must understand the fundamentals of fat. There are essentially three types of fat:  saturated, unsaturated, and trans fats. All fats are made of fatty acids (carbon-hydrogen chains), which are categorized by how long they are (based on the number of carbons) and whether or not these chains contain double bonds. Saturated fats have no double bonds, while unsaturated fats have one (mono-unsaturated) or more (poly-unsaturated) double bonds.

Coconut oil has become increasingly popular because its purported health benefits appear to be related to its high content of medium-chain fatty acids (MCFAs). Simply put, medium chain fatty acids are basically medium-sized fat molecules or structures. MCFAs are always saturated and contain 6-12 carbons, while long chain fatty acids (LCFAs) contain 13 carbons or more. Whether a fatty acid chain has more or less than 12 carbons matters significantly, because the body finds it easier to absorb short- and medium-chain fatty acids. Their smaller chain lengths allow them to bypass the fat storage pathway and, as a result, are sent directly to the liver to rapidly become energy for the brain and muscles. As a result, coconut oil is in high demand (especially with athletes) because it is the largest food source of MCFAs, a quick source of energy. 

MCT Oil
If you’ve never heard of the previously discussed MCFAs, chances are you may have heard of MCT (medium-chain triglyceride) oil. The fatty acids found in MCT oil are almost exclusively MCFAs. Almost 100% of the fatty acids found in MCT oil are MCFAs, which are quickly converted into fuel for the body to use. Besides MCT oil, other good sources of MCFAs include coconut oil, palm oil as well as grass-fed butter, cheese, whole milk and full fat yogurt. 

Coconut Oil Composition
Coconut oil is composed of both medium-chain fatty acids and long-chain fatty acids. Approximately 62 percent of coconut oil’s fatty acids are MCFAs (medium chains), with the remaining being LCFAs (long chains). For some reason, many confuse the composition of coconut oil with MCT oil, yet they are not identical. You could say they are like cousins—some of their “DNA” matches, but not all of it. Though coconut oil has MCFAs in it, MCT oil is more concentrated and is nearly 100 percent MCFAs.

The big debate on whether or not coconut oil is beneficial to our health arises from the ratio of medium-chain fatty acids to long-chain fatty acids. This is because MCFAs raise both HDL (“good”) and LDL (“bad”) cholesterol. Therefore, it is important to note that coconut oil is not a “win-win” situation when it comes to improving cholesterol levels.



Extra Virgin vs. Refined
Whether it is olive or coconut oil, extra virgin (unrefined) is the better choice. Virgin oils are extracted from one pure source, therefore are less processed.

Refined oils, like canola, are purified via acid and contain fewer nutrients due to chemical processing. These oils are extracted from many sources. For instance, canola oil is an industrial product extracted from several cultivars of rapeseed. Some of these oils are chemically transformed into trans fats during this combination process. In fact, researchers at Health Canada found that canola oil contained the most trans-fat at 2.4 percent when compared to other refined oils. The processed food industry considers refining these oils essential to preserve its sensory value, so they sacrifice health for things like texture, scent and visual appeal. 

Smoke Point: Choosing the Right Fat
When it comes to cooking, the type of fat you choose matters. Assessing the smoke point of fats is a critical part of healthy cooking. Smoke point is the temperature at which a fat starts to burn and smoke. When you cook foods with a fat that’s been heated beyond its smoke point, not only do you end up with a burnt flavor, but you destroy beneficial nutrients.



For very high temperatures (frying in a wok or searing meats), choose avocado oil; it won’t burn or smoke until it reaches 520F! For mid-temperature cooking, use virgin coconut oil, grass-fed butter or virgin olive oil. Choose extra virgin olive oil for salad dressings or already cooked foods, but do not use for high heat cooking.


  • High temperature cooking - Broiling - Avocado Oil

  • Medium temperature cooking - Sauté - Coconut Oil, Butter, Virgin Olive Oil

  • Low temperature cooking - Salad Dressings - Virgin Olive Oil


Coconut Oil vs. Butter
Both coconut oil and butter are significantly high in (saturated) fat, therefore very high in calories. The bottom line is that each has its place in cooking and neither one is superior to the other. When it comes to cooking, they both have the same smoke point so choosing one or the other depends on the flavor profile you’re looking for. If you’re making a curry or stir fry, coconut oil might be your best bet, while you might want to stick with butter to make a delicious chicken piccata.

Pros (+) and Cons (-)
Coconut Oil

  • Antibacterial properties

  • Anti-inflammatory properties

  • Hair and skin care

  • Source of antioxidants

  • Minimally processed (extra virgin)

  • Greater source of MCFA’s

  • Slightly more calories


Grass-Fed Butter

  • Less saturated fat

  • More unsaturated fat

  • Packed with vitamins A, E and K

  • Anti-inflammatory properties

  • Provides more long-lasting energy

  • Composed of palmitic acid, which is associated with plaque build up

  • Can be salted; look for unsalted, grass-fed butter


Dietitian Takeaway
Coconut oil can be used in a variety of ways. While many use coconut oil for cooking or baking, coconut oil can be found in a variety of lotion and soap products due to its antibacterial, antioxidant and anti-inflammatory properties. These properties are just a few reasons why coconut oil has become increasingly popular over the last few years. Another reason includes its fatty acid composition. Coconut oil is a good source of medium-chain fatty acids, which can be converted into quick energy to fuel the brain and muscles.



Nonetheless, coconut oil should not be considered a “superfood” as it has its downfalls. Like other fats, coconut oil is very high in fat and calories, therefore it should be used sparingly to cook and flavor foods. Some may confuse coconut oil and MCT oil, though they certainly have their differences. MCT oil is almost entirely composed of medium chain fatty acids, providing quicker, more efficient energy. On the other hand, MCT oil is typically unflavored and more expensive. It may also cause digestive issues if consumed in large quantities, so one should start with small doses if considering this product. Consuming 1 tbsp (20g) of pure MCT oil, or 5 tsp of virgin coconut oil, 1-3 times/day with food is the current research-supported supplementation protocol.



At the end of the day, our diets should be comprised of primarily unsaturated fats from natural sources like nuts, seeds, olives and avocados, while leaving a spot at the table for saturated fats like coconut oil, as they truly do come with some health benefits... and tons of flavor, of course.

Danielle RancourtDanielle-Rancourt is a performance dietitian with Sports Advantage. She enjoys cooking, baking, working out and spending time outdoors to keep busy.

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