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. 

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.

Less Time Traveling, More Time Enjoying the Outdoors | Matthew’s Altru Moment

Altru Moments - Published on April 24, 2017

Growing up in northwestern Minnesota was like a giant playground for Matthew Sisler, an avid fisherman, hunter and overall outdoorsman.

On a Saturday in June of 2010, Matthew was at work, and his mother expected him home shortly after his shift ended. They had plans to go clothing shopping for an upcoming school trip. When Matthew did not return home as expected, worry overcame his mother, Beth.

Like many rural communities, word traveled quickly that Matthew was missing, and a small search was soon underway. Matthew was found within hours, a few miles from his home, his vehicle lodged in the ditch. He was disoriented in a country setting that should have been more than familiar to him.

Because he was alone and unable to recall what had actually happened, this frightening event was left unsolved and somewhat unexplainable. Matthew was 17 at the time, received routine care and went on with his youthful adventures.

Puzzling Seizures
In January 2011 while ice fishing, Matthew experienced a seizure that raised more concern and initiated more medical care, with no clear diagnosis of a problem. Within a few short weeks, Matthew experienced yet another seizure while at school and was quickly transported to the emergency room in Thief River Falls. It was after the third incident that appointments were arranged with Dr. Matthew Roller, a neurologist at Altru Health System. Soon, EEG and MRI’s became common acronyms in the Sislers’ vocabulary.

Dr. Roller was determined to treat and diagnose whatever was causing the seizures. Matthew’s mother, Beth, smiles, “We have always had a lot of confidence in Dr. Roller.”

Rhonda, Dr. Roller’s nurse, worked closely with Matthew and his family to find the best fit with seizure medication. This type of medication can alter personality, and the Sislers appreciated Rhonda’s extreme patience, understanding and informative style during a scary and trying time.

Consulting with Mayo Experts
Dr. Roller recognized the benefit the Mayo Clinic Care Network could provide in properly treating Matthew. He reached out to his colleagues at Mayo with an eConsult, discussing the conditions Matthew was experiencing. Tests led to the diagnosis and finding of Arteriovenous Malformation (AVM), or a tangle of blood vessels in the brain that occurs in less than one percent of the population. Matthew was sent to Mayo Clinic in Rochester to further discuss options, which included invasive surgery or the Gamma Knife Radiosurgery. The therapy took place at Mayo in June of 2011.

“Everything at Mayo is like clockwork and very organized,” Matthew said. “There are no guessing games.”

All of Matthew’s follow-up care, from his initial Gamma Knife radiosurgery to his second surgery in June of 2015, has been at Altru’s Neurology department with the utilization of the Mayo Clinic Care Network through Dr. Roller. The exchange of information and quick responses to questions or concerns have been comforting for Matthew and his family. The availability of eConsults at Altru has saved the Sislers many miles and hours of travel, time away from work and responsibilities at home, and has reduced the financial burden.

Matthew’s condition, while difficult to detect, could have resulted in a stroke if left unidentified. Dr. Roller’s knowledge, coupled with the Mayo Clinic Care Network, has allowed Matthew to continue doing all the things he loves. He is a true outdoor enthusiast, hunting and fishing as often as possible, a wonderful brother, a fiancé ready to start a life with his bride-to-be, a first responder, a board member and a volunteer with the Red Lake Falls Ambulance service. Matthew says, “Life goes on.  I haven’t stopped living.”

As the first member of the Mayo Clinic Care Network, Altru Health System is helping to bring Mayo Clinic’s knowledge and expertise to the Red River Valley. Learn more about how we’re helping patients save travel time, money and miles through this collaboration.

Nursing Careers: Limitless Possibilities, Growing Demand

It's Altru - Published on April 18, 2017

Anyone who has visited a doctor’s office or spent a day in the hospital might feel like they know what it means to be a nurse. But the truth is, nursing is more than meets the eye and much more in demand than Americans probably realize.

Nursing has become the fastest-growing occupation in the United States. According to the Bureau of Labor Statistics, in 2008, there were approximately 2.6 million nursing jobs in the country. By 2018, estimates show that figure will grow to 3.2 million – a 22 percent increase of a half-million jobs.

Why the Demand?
Many factors contribute to the increasing need for nurses in the workforce. One of the biggest reasons is simple demographics. As the baby boom generation ages, more people need healthcare services. Studies show as many as 1/3 of people over the age of 65 have more than one chronic health condition.

But it isn’t just the aging baby boomers causing the need for more nurses. Jennifer Nuelle-Dimoulas, director of regional clinic operations for Altru Health System, says part of the issue is the high number of veteran nurses nearing retirement. She says of the estimated three million nurses in the United States, about 1/3 of them are over the age of 50.

“By 2025 we expect this will be the largest shortage of nurses since Medicare and Medicaid started in the 1960s,” she says.

Nuelle-Dimoulas says there is also more competition from other occupational fields. Women today aspire to many different kinds of careers, whereas—prior to 1970—they might have felt limited to teaching or nursing.

Healthy Salaries
But healthcare professionals are working hard to encourage people to give nursing another look, and it starts with salaries. Recent nursing school graduates can receive some of the highest starting salaries in the nation and have potential for raises as they gain career experiences.

According to the Bureau of Labor Statistics, the annual median salary for a nurse in 2015 was approximately $67,000. Nurses in personal care services, which include work in doctors’ offices, hospital and outpatient facilities, are the leading earners.

Nurses who opt to continue their training and education can expect even higher salaries. Advanced practice nurse practitioners (APRN’s) which include nurse anesthetists, nurse midwives and nurse practitioners have a median salary of about $105,000 a year.

Room for Growth and Change
Many people who choose nursing for a career will tell you they enjoy the flexibility it affords. With more than 100 nursing specialties—as well as advanced nursing degrees—nurses don’t need to stay in the same career track for years unless they choose. Movement can be lateral—from one specialized area to the next—or progressive, where nurses climb the ranks to supervisory or administrative positions.

With the great number of nursing jobs available at healthcare facilities, many nurses looking for employment can write their own ticket, choosing what kind of nursing work they’d like to do and the hours and days they want to work.

But Nuelle-Dimoulas says nursing goes beyond direct patient care. She says nurses with advanced degrees are policy makers, researchers and decision makers.

“Nursing is as creative as one sets their mind to be,” Nuelle-Dimoulas says. “The opportunities in nursing are expansive. Whatever piques your interest, there is a field of nursing for it. I’ve lived that creativity myself.”

Before accepting her position at Altru in 2016, Nuelle-Dimoulas—who is a native of Langdon, North Dakota—used her nurse and nurse practitioner degrees in a variety of ways from editing a medical journal to developing healthcare applications in IT and working in international medicine in Dubai, United Arab Emirates.

“I would challenge everyone to expand their view of nursing with a dose of creativity and imagination. The possibilities are limitless,” she says. “I have the benefit of looking at my career in a rear view mirror and I can see just how incredible it is.”

Do what you love. Make a difference. Join our team of over 4,000 health professionals and support staff committed to caring for the region for more than 100 years. Learn about nursing career opportunities at Altru Health System.

The Location of Your Headache Can Help Treat It

Enrich - Published on April 17, 2017

HeadacheAny headache is a bad headache, but a slight adjustment may fix it. With Over 150 different kinds of headaches known, these annoyances have numerous ways to interrupt your day and make it difficult or nearly impossible to concentrate.

“Tension headaches are the most common we see, as people sit for longer periods and carry stress in their upper shoulders and neck,” says Jordan McIntyre, DC, chiropractor with Altru Health System. “We also see headaches from the jaw, because people will clench their teeth from stress or sitting, and those muscles connect to the top of the head and make you feel like your head is throbbing.”

Sit Up Straight
Posture, too, is important, Dr. McIntyre notes. It’s far easier to get stiff and tight in the upper neck if core muscles are inactivated and the head and spine are unsupported.

“With tension and cervicogenic headaches, we typically look to see if anything needs to be adjusted. A lot of times, an adjustment or muscle release will get rid of the headache,” says Christopher Howson, DC, chiropractor with Altru. “Decreasing irritants in the spinal and musculoskeletal system helps a surprising amount when treating headaches.”

A Different Beast
“A lot of people think, ‘Oh, it’s a migraine,’ when they have a particularly bad headache, but migraines aren’t your typical headache,” Dr. Howson says. “Migraines will have a throbbing or pulsing quality, and tend to interfere with everything you do. They get worse with exercise or exertion, and many people will be nauseated or have trouble with light and sound.”

Some people who experience migraines will know beforehand due to a neurological sensation called an aura. A kind of warning, auras can be anything from seeing flashing lights to briefly losing the ability to speak correctly to smelling something that isn’t there, such as campfire smoke.

headache graphic

Where’s Your Pain?
The location of your headache pain gives a better idea of how to treat it.

  • Base of skull—Cervicogenic headaches feel a lot like tension headaches but are often caused by muscle spasms in the area and can be treated with an adjustment of vertebrae.

  • Side of the head—Often, when pain is localized to the side of the head, a chiropractor will work on jaw muscles, even from inside the mouth.

  • Neck—For headaches caused by stiff muscles in the neck, chiropractors use dry needling to release tension at specific trigger points.

Altru’s chiropractors can treat your pain from head to toe. Schedule an appointment with Dr. Howson or Dr. McIntyre by calling 701.732.7620.

Heart Disease: What Is and Isn’t in Your Control

It's Altru - Published on April 17, 2017

heart-disease-in-control-tipsBeating an average of 115,200 beats per day, hearts provide the lifeblood of oxygen and nutrients to keep our bodies alive and well. A lot goes on in those four little chambers.

Dr. Rabeea Aboufakher, section chief of cardiology at Altru Health System, explains some of the most common heart diseases, as well as risk factors and lifestyle prevention tips to keep your ticker in top shape.

Coronary artery disease (CAD)

  • What it is: Coronary artery disease (CAD) is a chronic disease characterized by plaque buildup in the walls of the coronary arteries. These are the small arteries that run on the surface of the heart muscle and provide the heart with blood. Blockage can develop slowly to cause angina (chest discomfort on exertion) or suddenly to cause a heart attack.

  • What you can control: High blood pressure, diabetes and high cholesterol through lifestyle modifications or medication. Smoking cessation is particularly important. Patients with CAD will also benefit from a diet low in saturated fat and cholesterol, as well as regular exercise. Weight is important, but diet and exercise matter even more. Certain medications such as aspirin and a statin reduce the risk of future cardiac events.

  • What you can’t control: Family history plays a role. While you can manage high blood pressure and diabetes with lifestyle and/or medication, the onset of these conditions is not always in your control.

  • Treatment: When patients suffer from a heart attack caused by a blocked coronary artery, opening the artery with a stent is life-saving. At Altru, we have a team on call 24 hours a day to make sure this therapy is offered quickly and effectively. In certain situations, bypass surgery is needed and this too is offered at Altru.

Peripheral arterial disease (PAD)

  • What it is: Peripheral arterial disease (PAD) is a chronic disease characterized by plaque buildup in the large peripheral arteries, such as the arteries that supply the lower extremities. In severe cases, it can lead to non-healing wounds and possible amputation. A common symptom is pain and fatigue in the leg muscles with walking.

  • What you can control: Similar to that for CAD, high blood pressure, diabetes and high cholesterol through lifestyle modifications or medication. Smoking cessation is particularly important.

  • Treatment: When the arteries are blocked, procedures such as balloons, stents or bypass surgery are needed. Altru offers all these treatments.

Congestive heart failure (CHF)

  • What it is: Congestive heart failure (CHF) is a syndrome caused by inability of the heart muscle to pump blood adequately, failing to meet the demand of organs and tissues. Symptoms are related to fluid overload, such as shortness of breath and leg swelling. Any heart disease can result in CHF when advanced. Close follow-up is necessary to avoid fluid accumulation and hospital admissions.

  • What you can control: Follow a low sodium diet and occasional fluid restriction. Keep regular check-ups.

  • Treatment: Certain patients should have a defibrillator to protect them from dangerous arrhythmia. For others, a permanent monitor placed in the pulmonary artery can track fluid status and direct therapy. Altru offers all these services and will soon launch a special congestive heart failure clinic. 

Atrial fibrillation 

  • What it is: Atrial fibrillation is a very common arrhythmia. The atria, or the upper chambers of the heart, fibrillate (instead of squeeze), causing fast heart rates. Symptoms include palpitations, dizziness, shortness of breath and chest pain, among others.

  • What you can control: Unfortunately, the only thing you can do is be aware. Keep regular check-ups.

  • What you can’t control: Family history.

  • Treatment: Medications are often needed to slow the heart rate. Blood thinners protect from blood clot formation inside the heart. Different treatments are available, including ablation procedure now offered at Altru.

Patients who already have heart disease benefit from regular visits with their cardiologist to assess symptoms and evaluate risk. For all, checking blood pressure and cholesterol levels regularly is important to reduce risk. Stress testing can also be helpful if symptoms occur or are difficult to evaluate.

Aboufakher, RabeeaDr. Rabeea Aboufakher is the section chief of cardiology at Altru Health system. He is board certified in cardiovascular disease, interventional cardiology, internal medicine and geriatric medicine. He is a fellow of the American College of Cardiology and the Society of Cardiovascular Angiography and Intervention. In his free time, Dr. Aboufakher enjoys reading, swimming and playing table tennis.



See also:

Do I Have Carpal Tunnel Syndrome? What Everyone with Wrist Pain Should Know

Enrich - Published on April 17, 2017

Carpal tunnel syndrome causes pain, tingling and numbness in the hands, wrists and arm that will wake up the soundest of sleepers in the middle of the night. They might find relief running hot water over their wrists or taking an anti-inflammatory medication, but most likely the pain will come back in the morning. So what exactly is carpal tunnel syndrome and is there anything you can do to tackle it for good?

The carpal tunnel is a narrow passageway comprised of bones, ligaments and tendons at the base of the hand beneath the palm. Carpal tunnel syndrome is caused when the median nerve – which runs from the forearm down through the hand – becomes compressed in the carpal tunnel area.

Dr. Brad Meland, a hand, wrist, and nerve surgeon at Altru Advanced Orthopedics says the culprit is a ligament at the base of the hand that becomes too tight.

“Basically, that cuts off the blood supply and will slowly kill the nerve fibers in the area,” he says. “That’s what causes the pain and numbness.”

Dr. Meland says a number of things cause the ligament to press down on the nerve. Some people are just born with a narrow carpal tunnel, others experience swelling in the area from pregnancy, arthritis, injury or other factors. Sometimes work is to blame.

“We see a lot of dental hygienists or people who work with computers. Anyone who holds their wrists in a flexed position for a long period of time is at risk of developing carpal tunnel syndrome,” he says.


But Dr. Meland says no occupation is immune. Carpal tunnel syndrome happens to both men and women, young and old, construction workers and hairdressers. According to the American College of Rheumatology, carpal tunnel syndrome is one of the most common nerve disorders affecting between four to 10 million Americans.

Dr. Meland encourages people to see their primary care doctor soon after symptoms start because mild to moderate carpal tunnel syndrome can be reversed if it’s caught soon enough.

Travis MacKenzie, a certified hand therapist for Altru Health System, says he always starts with a conservative approach, including education and ergonomic assessments.

“We talk a lot about posture. Sometimes exercise can improve posture at your desk and that could help relieve symptoms,” MacKenzie says.

For some, he might recommend wearing a splint to keep the wrist in a neutral position, while for others creating a plan of nerve and tendon gliding exercises will relieve tension on the nerve and help it better glide through the carpal tunnel. Other treatments include ultrasound, iontophoresis and deep tissue massage. But MacKenzie says time is of the essence.

“The longer the symptoms have gone on, the less successful these treatments are likely to be,” he says.

If that’s the case, Dr. Meland will step in to perform surgery.

“I do around 10 to 12 (surgeries) a week on average. Many people elect to have surgery because they simply can’t handle the pain anymore,” he says.

Dr. Meland performs the carpal tunnel surgery by making two small incisions and cutting the ligament to relieve the pressure. After the ligament is cut, the pressure on the nerves goes away and the nerves repair themselves. The patient is awake the whole time and the procedure takes about 30 minutes. He says his patients are using their hands again the next day and require little time away from work.

Both Dr. Meland and MacKenzie say there are plenty of weapons in the fight against carpal tunnel pain.

“It’s nothing you have to live with,” MacKenzie says “There are treatments that can and will eliminate the symptoms.”

If you think you might have carpal tunnel syndrome, visit to or call Altru Advanced Orthopedics at 701.732.7700 to request an appointment.

See also:

Tips for Preventing Blood Clots while Traveling

Enrich - Published on April 17, 2017

Are you traveling on a long trip or sitting for an extended period of time? Remember to take five, and give yourself a break at least once per hour. Your body will thank you for getting the blood flowing again. Here are some basics on deep vein thrombosis (DVT) and information about what you can do to prevent blood clots.

Risk Factors
Everybody is susceptible to DVT; however, factors such as surgery or injury increase risk. Other risk factors include:

  • Obesity

  • Dehydration

  • History of blood clots

  • Smoking

  • Taking estrogen (oral contraceptive tablets or hormone replacement therapy)

  • Having a chronic condition (congestive heart failure, COPD [chronic obstructive pulmonary disease], IBD [inflammatory bowel disease], nephrotic syndrome)

  • Lack of movement

    • Risk is three times higher when on a “long haul” – eight or more hours on a plane, car or train.

  • Age

    • After age 60, risk of blood clots increases considerably.

    • There is an 80-fold increase in risk of blood clots for an 80-year-old versus a 20-year-old.

Ways to Prevent Blood Clots
Getting blood flow back from the leg to the heart demands muscle movement. Preventing blood clots can be as simple as walking down the aisle while flying or wiggling your toes while cruising through the countryside.

When traveling, wear loose, comfortable clothing. Drink plenty of water to stay hydrated (and lay off the alcohol). Do not smoke right before flying. If you have had a pulmonary embolism in the last three months, you should not travel. Airlines are especially risky since they’re pressurized to lower oxygen levels.

Sitting at a desk all day? Every hour, take a quick walk down the hall for water or a bathroom break. All it takes is a few calf raises or foot taps to encourage blood flow. For those in a wheelchair, foot movements are still beneficial, as is active assistive range of motion.

If you are at higher risk of DVT, preventative measures may include wearing graduated compression garments (knee highs) or taking a mini dose of blood thinner before the trip.


(Click to view larger.)

Since 90 percent of all blood clots occur in the legs, the most common symptom is pain in one leg. The area might be swollen, reddened and warm to the touch.

If you are experiencing sudden shortness of breath and pain in your chest when you breathe deeply, it is possible that the clot isn’t allowing blood flow into your lungs’ arteries. If this happens, seek immediate medical attention.

To find out more about DVT and available treatment options, visit Altru’s Heart and Vascular Services or schedule an appointment by calling 701.780.6400.

Swanson, Keith 4C

Keith Swanson, MD, is a vascular medicine physician at Altru specializing in peripheral arterial disease management, chronic venous disease, limb swelling, venous and arterial thrombotic disorders, and chronic non-healing limb ulceration. In his free time, he enjoys physical fitness, watching his kids participate in sports and sitting around the campfire.



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7 Ways to Use Your Lunch Break to Improve Your Health

Enrich - Published on April 16, 2017

LunchAre you stuck in a rut at work? Do you have low energy during the day? Would you like to lose some weight? Breaking up your day with some exercise will boost your metabolism and leave you re-energized for the rest of the afternoon. Incorporate these simple tips into your work week to improve your health.

1. Squeeze in a workout. If you have the time, use your lunch break to fit in a gym session. Walking on a treadmill, riding a recumbent bike or an elliptical, or completing a strength training circuit is a great way to relax and revitalize.

2. Take an exercise class. Group exercise classes are fun ways to add variety to your workout. The instructor will likely challenge you more than you may choose to do on your own, and the camaraderie of a group provides great accountability to help you remain consistent and follow through with your intention to exercise regularly.

3. Step it up a notch. Activity trackers are a fantastic incentive to get more exercise. Aim for 10,000 steps a day. Choose a lunch destination that is a good 15 minute walk from your office and you are well on your way. Plus, the walk will break up your afternoon and give you a mental break from work.

Businesswoman climbing a stairway

4. Hit the stairs. Skip the elevator, and challenge yourself to walk a few flights of stairs. You'll get your heart pumping and your blood flowing, plus it's a quick way to burn calories when your time is limited or you cannot get outdoors.

5. Be a video star. Why let a rainy day get in the way of exercise? Bring an exercise or yoga video to play in a meeting or conference room. Ask a couple of work colleagues to join. There are almost an unlimited number of videos on YouTube that you can watch for free.

6. Pump it up. It is possible to exercise at the office without taking up a lot of space or calling a lot of attention to yourself. Body weight movements, exercise bands and exercise ball movements are space efficient ways to get a quick workout.


7. Stretch. Sitting in front of a computer all day means that certain parts of your body get extra tight over time. Your hip flexors, shoulders and neck are especially prone to injury and tightening. Take a few minutes to stretch out during lunch to ensure that your body stays in tip-top shape.

There are many ways to be active during your break. Not only is exercise good for your body, studies have shown that it helps you be more mentally aware, creative and productive throughout the day. If you don’t know where to start please talk to an exercise professional to help get you on the right track.

Adam SorumAdam Sorum is a Medical Fitness Specialist at Altru's Medical Fitness Center, an ACE Certified Medical Exercise Specialist, ACE Certified Personal Trainer and group exercise instructor. He is the North Dakota State Captain of the Medical Fitness Association. He has over a decade of experience helping people with various health conditions exercise in a safe and comfortable manner. In his free time, Adam enjoys spending time with family and friends playing foosball, fishing, hunting and cooking.

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