Helping Quitters Win

Enrich - Published on July 13, 2017

Altru’s Tobacco Cessation Services offer the keys to helping you stay a quitter and become the winner.

Quitting tobacco at any time in your life is the best thing you can do for your health and the health of those around you. In addition to saving money, you’ll also have more time with your loved ones.

As good as it is to do, quitting is hard. Even more, your surroundings may make it easy to fall back into old routine. Fortunately, Altru’s Tobacco Cessation Services provide one-on-one counseling by giving the most up-to-date information on tobacco.

The Program


Altru’s therapists are experts at helping you quit. With training through Mayo Clinic’s Certified Tobacco Treatment Program, we use motivational interviewing skills to help you devise a plan and get to the root of tobacco addition. Our goal is to provide education and support for any journey to a smoke-free life.

Depending on the patient, each can receive four sessions to meet with the certified tobacco treatment specialists. These sessions can be arranged based on the patient’s schedule – weekly, bi-weekly and even monthly. Best of all, if a patient reverts to using again, we can provide another four-week session in the year. The most successful platform is where one-on-one counseling is combined with a nicotine replacement therapy program (NRT). In addition to our program, we also recommend using your state’s quit line – ND Quits or MN QUITPLAN – for additional support.

The Vaping Alternative

Vaping isn’t a good alternative to using tobacco. “Unfortunately, there aren’t a lot of research studies on the lasting effects of vaping on the body,” Brien notes. Available research does show that many of the same harmful cancer-causing chemicals in cigarettes are also in e-cigarettes. “I personally don’t encourage e-cigarette use, especially when trying to quit smoking.”

Baby and Me Tobacco Free


Altru participates in Baby and Me Tobacco Free, offered by the North Dakota Department of Health. This program helps pregnant moms and mothers of newborns quit using tobacco and create a healthier environment for herself and her baby.

Eligible participants include pregnant women who currently smoke or who were a daily smoker at least three months prior to becoming pregnant. The program offers tobacco treatment and counseling including screenings for tobacco use, practical incentives and monitoring for success.

Simple Goal


Our goal is simple. No matter where anyone is in their quitting process, we want to help you become tobacco-free. We understand the science behind addiction can help you with nicotine withdrawal symptoms.

Most insurance policies cover the cost of the sessions. You’ll want to check with your individual plan for benefit details. Cessation medications may also be available at reduced and/or no cost for those who qualify from Altru Health Foundation.

If you are ready to quit, Altru is here to help. Call our certified tobacco treatment specialists at 701.780.5347.

Nicole Brien, Disease Management Educator with Altru Health System, has long had a passion for healthcare. She began at Altru as a respiratory therapist in the neonatal intensive care unit (NICU) in 2007. Soon thereafter, she followed her passion to provide education related to chronic obstructive pulmonary disease (COPD) and tobacco cessation for Altru’s inpatient population. Most recently, she’s been dedicated to helping pregnant moms quit smoking and she helped to establish a tobacco cessation program for the broader population. Nicole enjoys spending time with her family including two beautiful daughters, a dog and two cats. In her spare time, she enjoys crocheting, going to the movies, fishing and spending as much time at the lake as possible.

Stay Up-to-Date on Your Child’s Health | C & TC Visits in Minnesota

Enrich - Published on July 7, 2017

What if there was a way to inexpensively make sure your child was healthy and you had the opportunity to ask a physician all of the health and medical questions you’ve been asking Google? In Minnesota, there is an easy way, and it’s called Child and Teen Checkup visits.



Child and Teen Checkups or C & TC visits are offered throughout the state of Minnesota. Many children and teens are already receiving annual sports physicals, but it is important parents and children aren’t solely relying on a sports physical as their primary doctor visit. A C & TC visit will cover much more ground and be a better source of information.

What will they do at a C & TC visit?
You can expect a C & TC visit to include a head-to-toe physical exam, immunizations, a hearing and a vision exam, lab tests to check for diseases and exposures, a development and growth check, and referral to a dentist who will do an oral checkup.



Who can get a checkup?
Every child, teen and young adult should be receiving regular checkups, but how often is regular?


  • Babies: birth and one month and then at two, four, six, nine, twelve, fifteen and eighteen months.

  • Toddlers: yearly checkup at ages two, three, four, five and six

  • Children and Teens: every other year from ages six to 20


Why get a checkup?
These visits are accepted as the required physical examinations and checkups for programs such as:

  • Head Start

  • WIC

  • School

  • Childcare

  • Sports


The checkups are important for so many reasons, including having the peace of mind that your child is healthy and developing and growing well. By having regular checkups in children and teens, healthcare providers can detect and treat any health or oral issues early on. The lab tests that are done in C & TC visits will also determine if the child has anemia or has been exposed to things like lead or Tuberculosis.

You will receive important information about your child’s health from the provider at the checkups. These regular visits are also the perfect time for you or your child to ask questions or bring up any concerns that you may be having.



A common topic that might be brought up is vaccinations, especially vaccinations that are highly recommended but not yet required, like the HPV vaccine. It is recommended that all boys and girls ages 11 and 12 should receive an HPV shot to prevent the spread of HPV, as well as certain cancers in the future. Learn more about the HPV vaccine available at Altru Health System.

Carrie Clauson, PA, has been practicing at Altru Clinic in Crookston since 2006 as a Family Medicine provider. She sees patients of all ages and treats both acute and chronic conditions. She lives in Crookston with her husband, Rich, and two kids, Kaylie and Ryan. In her free time, Carrie enjoys golfing, traveling and watching the kids partake in many activities.

7 Nutrition Trends: Mythbusting with Altru Dietitians

It's Altru - Published on June 27, 2017

New nutrition trends pop up online and in health magazines all the time. With so much advice floating around, it’s easy to get confused about the right foods to eat. We went straight to the experts—Altru’s dietitians—and asked them to bust three popular nutrition trends. Here’s what they had to say.

1. Myth: Gluten free diets result in weight loss. 

Truth: A gluten free diet is followed when someone has been diagnosed with Celiac Disease. A gluten free diet consists of eliminating barley, rye, oats and wheat. Weight loss may occur if you eliminate most chips, cookies and desserts. If the chips, cookies and desserts are replaced with gluten free items, the calories are usually the same, due to using a different form of flour. So, if you haven’t been diagnosed with Celiac and want to lose weight, reducing calories and increasing exercise is the way to go.



2. Myth: Juicing (the process of removing juice from fresh fruits and vegetables) results in weight loss. 

Truth: Juicing is no healthier than eating whole fruits and vegetables. Juice is often lower in nutrients, and the fiber content is near zero. Whole foods usually contain more vitamins and minerals, as many of these nutrients are in or near the skin, which gets discarded as pulp when juiced. Your body does not absorb nutrients better in juice form.

Yet, juicing isn’t all bad. Additional truths:


  • Some juicers do reserve the extracted pulp. This fiber-rich pulp can be added to soups, stew and quick breads for added benefit.

  • Juicing may improve nutritional intake by incorporating fruits and veggies that may not get eaten due to flavor or texture preferences.

  • Juicing can be used as part of a sensible weight loss program, which would also include a variety of nutritious whole foods.


The bottom line: when enjoyed in moderation, fresh-squeezed juice can be a nice way to get in more vitamins and minerals from a variety of fruits and vegetables. However, the best way to lose weight and promote optimal health is to eat a well-balanced diet made up of foods from all food groups.

3. Myth: Since dietary supplements are easily available – and don’t require a prescription – they are safer than drug products and can be used to self-treat illness without a health professional’s advice or supervision. 

Truth: Taking supplements will not necessarily improve your performance and can be dangerous. More is not better. Studies have shown that some herbal products interact with drugs and can have a wide range of effects, including:

  • John’s Wort may interfere with drugs used by organ transplant patients, and drugs used to treat depression, seizures and certain cancers

  • Some alter effectiveness of oral contraceptives

  • Garlic, ginko, danshen and dong quai can cause the blood to thin


Always consult with your health care professional prior to taking dietary supplements.

4. Myth: Avoid carbohydrates to lose weight. 

Truth: Cutting back on carbs may help you lose weight in the short term, but this is mainly because you are eating less food and calories. Significantly reducing carbohydrates means you will miss out on nutritional benefits provided by healthy choices, such as whole grains, fruits, starchy vegetables, dairy, and dried peas and beans. Low carb diets are restrictive and hard to follow. The weight you lose will likely be regained.  



5. Myth: Coconut oil is healthier than olive oil.

Truth: Coconut oil does not offer any more health benefits beyond olive oil. In fact, it may be unhealthy if consumed in large amounts due to its saturated fat content.

Coconut oil is rapidly increasing in popularity and health claims range from helping people lose weight to curing Alzheimer’s disease. There are two basic categories of fat: saturated and unsaturated. Coconut oil is about 90 percent saturated fat. Too much saturated fat in the diet can raise LDL “bad” cholesterol, which increases the risk for heart disease. It also raises HDL “good” cholesterol.

Olive oil is mainly an unsaturated fat, and unsaturated fats lower LDL “bad” cholesterol and raise HDL “good” cholesterol. Coconut oil can be used occasionally for its flavor or to replace other hard fat sources, such as vegetable shortening in baking.

6. Myth: A healthy diet is too expensive.

Truth: Consider not only the cost at the grocery store, but also the economic costs of diet-related chronic diseases. It’s possible to eat well on a budget.

Obesity, heart disease and diabetes could be dramatically reduced by a healthy diet. While groceries do add up quickly, it’s difficult to put a price on healthy eating. To help keep healthy foods a part of any budget, keep the following in mind:

  • Get into the habit of menu planning and shopping from a list. Avoid wandering aimlessly through the store, picking up items you might end up using.

  • Pay attention at the checkout. Make sure prices are tallied correctly.

  • Buy store brands. These are often 15-20 percent less expensive when compared to national brands, while the quality is very similar.

  • Shop the perimeter of the store to avoid tempting convenience items in the middle aisles. These are often less healthy and more expensive.

  • Use coupons and watch sales to take advantage of great deals. Remember: the deal isn’t so great if you don’t need the food or won’t use it.

  • Eggs, beans, canned tuna, frozen veggies, peanut butter and seasonal fruits and veggies are a few healthy foods that won’t break the bank.

  • Plan a meatless meal once or twice a week. (See Myth #3.)




7. Myth: A vegetarian diet does not provide enough protein.

Truth: Protein doesn’t just come from animal products. Beans, nuts and whole grains can provide ample protein for almost everyone as part of a well-planned diet.

Plant-based proteins are loaded with other nutrients as well: fiber, folate, potassium and antioxidants, to name a few. Substituting meat for beans and using animal protein as an accent rather than the main event of a dish are effective strategies to prepare filling and nutritious meals. Eating plant-based protein sources may also help you lose weight, lower cholesterol and blood pressure, and slash your risk of cancer and heart disease.

Lifestyle modification, rather than quick fixes, is the way to go for long-term weight loss and maintenance. If you are looking to manage your weight by changing your diet and exercise for the better, check out Altru’s Weight Management Program or visit with one of our dietitians.

Heart Conditions that Run in the Family | Know Your Risk

Enrich - Published on June 26, 2017

Most people are aware that heart disease runs in the family. But when should you have concerns regarding your own heart health?

“One of the most common heart conditions we see that carries a higher risk for family members is coronary artery disease,” states Mary Krogstad, a cardiology nurse practitioner at Altru Health System. “Coronary artery disease is usually caused by the buildup of plaque in your arteries, and this buildup restricts blood flow to your heart."

Two common heart conditions that can be inherited and often coincide with coronary heart disease include hypertension and hyperlipidemia.


  • Hypertension, or high blood pressure, is a condition where a restriction of the blood flow in your arteries causes an increase in pressure.

  • Hyperlipidemia is the technical term for high cholesterol. When your body is producing too much “bad” cholesterol in your blood, or LDL, it builds up in your arteries and restricts the flow of blood to your heart.


Hypertension, hyperlipidemia and coronary heart disease all develop over time and can cause more serious problems such as a heart attack or stroke.

I have heart disease in my family history. What should I do?
If someone in your immediate family developed a heart condition before the age of 55 for men or before the age of 65 for women, you are considered to have a family history of heart disease. Because common familial heart conditions develop slowly, the symptoms may be subtle. If you learn you have a family history, share that with your provider and monitor symptoms carefully. You should tell your doctor if you are experiencing chest pain, heart palpitations or shortness of breath and fatigue.

Depending on your overall health, family history and whether or not you are experiencing symptoms, your provider may recommend that you have regular screenings completed to check your heart health. These tests could include one of the following:

  • Stress test – The stress test usually involves exercise, like walking on a treadmill or riding a stationary bike, to measure how your heart performs during physical activity.

  • Echocardiogram – This test, also called an echo, is a type of ultrasound that uses sound waves to produce moving pictures of your heart. This helps your provider identify which parts of your heart may not be contributing normally to its activity.

  • Electrocardiogram (EKG or ECG) – An EKG checks the heart’s electrical activity to narrow down the possible causes of chest pain and other symptoms of heart disease.

  • Coronary angiogram – During this test, a special dye that’s visible in X-ray images is injected into the blood vessels of your heart through a catheter. The dye helps to identify blockages and narrow spots in your arteries.

  • Cardiac CT scan – A heart CT scan tests the coronary calcium in your arteries and can potentially identify heart disease before you have any signs or symptoms. However, some types of heart disease don’t show up on a CT scan, so your doctor may order other tests as well. This test is best for patients with moderate or unknown risk of heart disease.




“The test or treatment recommended by your provider will be determined by the way you present at the clinic or hospital,” explains Krogstad.  “For example, if you arrive at the emergency room because you’re having a heart attack, the emergency room staff might order an EKG. If you tell your primary care provider during an annual checkup that you’ve been having chest pains, he might recommend you start with a stress test or an echo.”

How can I prevent heart disease if it runs in my family?
If you have a family history of heart disease, prevent these conditions or slow their progression through lifestyle change and preventative care. Choose heart healthy foods, don’t smoke and exercise regularly to help decrease your risk or minimize the effects of heart disease. Krogstad recommends 20-30 minutes of movement every day. “Not everyone likes to run on a treadmill. Find something that you enjoy doing to get those minutes in each day.”

She also encourages patients to know their heart health numbers.

  • An LDL cholesterol level of less than 100 is optimal for a person without heart disease, whereas a patient with heart disease should aim for an LDL of less than 70.

  • Your “good” cholesterol level, or HDL level, if you are a healthy adult with no known heart conditions should be above 40. A patient with heart disease may have a 20-30 HDL number with the goal to increase it to 40 or higher.


Sometimes medications can be introduced to help with these numbers, but changes in your lifestyle are usually the best way to decrease your risk.  If you don’t know your numbers, schedule an appointment with your primary provider to be tested. You’ll want to meet with your doctor regularly to make sure you are properly managing your health.



Krogstad states, “I always tell patients recently diagnosed with any of these three heart conditions, it’s not the end of life. They are treatable conditions.” She encourages patients to be proactive with their heart health by maintaining a healthy lifestyle early in life, even if you don’t have a family history of heart disease.

If you have a family history of heart disease, or simply want to be proactive about taking care of your ticker, learn more about what Altru’s Heart and Vascular Services team can offer to keep you well at altru.org/heart.

Mary Krogstad, FNP-C, is a cardiology nurse practitioner with Altru Health System specializing in adult cardiac conditions. Mary earned her degree from the University of North Dakota in Grand Forks, North Dakota. Outside of work, Mary and her husband enjoy spending time with their two children. They like to attend sporting events including baseball, basketball and football, and spend time at the lake during the summer. Mary also participates in 5K and 10K running events, attends spin classes and enjoys golf.

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.

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