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.



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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 altru.org/hand or call Altru Advanced Orthopedics at 701.732.7700 to request an appointment.

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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.

Heart Attack Symptoms in Men vs. Women

Enrich - Published on April 16, 2017

Man Having Chest PainsHeart attack symptoms may not look as dramatic in women as they do in men, but they are just as threatening. A man experiencing a heart attack may suddenly grab his chest, double over in pain and collapse. Women do not typically experience these intense symptoms. Instead, the attack may be mistaken for a bad case of indigestion or they may feel a heaviness or pressure on the chest. Women may also notice other subtle symptoms, including:

  • Arm and shoulder pain

  • Discomfort in the jaw

  • Lightheadedness

  • Nausea

  • Shortness of breath

  • Sweating

woman who has chest pain

Risk factors
The chance of having a heart attack can increase due to certain risk factors, such as other medical conditions, genetics and lifestyle choices. Risk factors include:

  • High blood pressure

  • High cholesterol

  • Diabetes

  • Physical inactivity

  • Overweight

  • Smoking


People of certain races are also more at risk, including:

  • African-Americans

  • American Indians

  • Asian-Americans

  • Mexican-Americans

Additionally, while most heart attacks occur after age 65, men are more likely to have a heart attack before age 65. Women should pay close attention to subtle warning signs of a heart attack if they take birth control pills or are postmenopausal and not taking estrogen replacement therapy.

Cutting-Edge Cardiac Technology
Altru’s Heart & Vascular team is continually advancing care to ensure those at risk for heart disease can take action to prevent heart attacks. In April 2016, Altru installed a Toshiba Aquilion™ ONE ViSION 640-slice computed tomography (CT) scanner, a dynamic volume system capable of almost instantaneously scanning the heart of patients with resting heart rates up to 75 beats per minute. “The scanner provides images with a very low dose of radiation,” says Joe Gemmill, manager of CT, MRI and Nuclear Medicine. “This technology helps our cardiology team capture clear, intricate images of the heart and coronary arteries. The people in the Red River Valley now have access to a world-class CT scanner close to home.”

What You Can Do
Talk with your doctor about your personal risk factors for heart attack and follow preventive measures to keep your heart healthy. Prevention methods include:

  • Exercise regularly. Thirty minutes a day is the recommended minimum.

  • Eat a heart-healthy diet complete with whole-grains, lean protein, fruits and veggies.

  • Don’t smoke. If you need help quitting, look to Altru’s tobacco cessation program for guidance.

  • Manage your stress. Practice mindfulness or stress-reducing activities such as yoga or meditation. Even five minutes of meditation each day can greatly reduce stress and improve your health. (Learn how Dr. Aboufakher incorporates meditation into his daily life.)

Keep your heart in check. Learn how we can help at altru.org/heart.

The Most Common Running Injuries Our Sports Medicine Doctor Sees

Enrich - Published on April 13, 2017

As training heats up for the Grand Forks Wild Hog Marathon, it’s important for runners, both new and seasoned, to understand the potential injuries associated with this sport and how best to prevent and treat them. Unlike contact sports, running involves you, your shoes and the ground. Unfortunately, that lack of equipment and control can lead to injuries and pain from over-use, improper form or footwear and the surfaces you run on. Some of the most common injuries seen by Dr. Billy Haug at Altru Advanced Orthopedics include the following.

Knee Injury Running

Iliotibial Band Syndrome
Commonly caused by over-use of the legs in runners, iliotibial band syndrome affects the band of fibrous tissue along the side of the thigh that provides stability to the knee and hip. When the condition occurs, you may experience that the band rubs against the hip or knee bone each time either are used. This can cause pain on the outside of the knee or hip that is especially noticeable as you begin activity. Pain tends to decrease as your body warms up, or when you are at rest.

Prevention & Treatment
Follow a proper training program that includes rest days and cross training. Take part in cross-training activities that focus on upper body or movements that are side to side, like jumping jacks, to give the band a rest. If your pain becomes more severe, seek care at Altru Advanced Orthopedics. We may recommend physical therapy, medications or injections.

Knee Pain

Patellofemoral Pain Syndrome
Another condition often associated with over-use is patellofemoral pain syndrome. Most commonly seen in young adults, it is associated with pain around the kneecap. It’s often referred to as “runner’s knee” as it’s common in the sport, but, it can be associated with other activities, and even in those who are not active. Beyond overuse, kneecap alignment issues can also cause patellofemoral pain syndrome.

Prevention & Treatment
This condition is very common, even in non-athletes, and can be managed fairly conservatively. Self-care might include rest, reduction in activity level or strengthening exercises. For those training for a marathon or longer race, I recommend quadricep strengthening exercises, cross training such as cycling if it doesn’t bother the knee, or reduced mileage or a modified running routine with more cross training built in. prevent the pain associated with this condition, ensure you have the proper running shoes for your needs, try running on softer surfaces (i.e. a track or a road, where safe), and consider custom orthotics.

Ankle Injury Running

Stress Fractures
Stress fractures in the tibia, the largest of the two bones in the lower leg, are very common in distance runners. Stress fractures are caused when the muscle surrounding the bone contracts for a long period of time, causing stress on the bone as the body relies on it more. A change in training surface can make you more susceptible to a stress fracture, as your body gets fatigued more quickly as it adapts to the change. Symptoms of a stress fracture including pain in the lower leg, which might be accompanied by swelling or tenderness.

Prevention & Treatment
The best way to prevent stress fractures is to utilize proper form & footwear. Take advantage of a gait analysis at the Sanny & Jerry Ryan Center for Prevention & Genetics, where a physical therapist will analyze your running mechanics and provide recommendations. They will also guide you to the best style of shoe for your unique needs. Strengthening your calf muscles can also help in prevention.

If you think you might have a stress fracture, schedule a visit with me. Though X-rays cannot always initially detect stress fractures, together we can assess your injury and develop a plan to get you back to training. Unfortunately, you’ll typically have to avoid running and similar activities for around eight weeks. This is a good time to build core muscles and focus on cross training activities, such as swimming, that don’t cause pain or further injury.

Overall, running injuries are best avoided by ensuring you are fully prepared for each run, that you are training properly and not over-exerting yourself. Take advantage of free training plans, include cross training in your routine, and mind your distance. Though it might be tempting to push through the extra mile on a long run, an injury that sidelines you from the race you are training for is not worth it.

When determining whether or not to seek medical care for your pain or injury, consider its severity. Soreness is normal when pushing yourself in sport, but if your pain is distracting or interfering with your activity, or if it’s accompanied by swelling, it’s time to pay us a visit.

Dr. William Haug Jr.William Haug Jr., MD, enjoys getting to know his patients and finding out what is important in their life. If a patient would like to get back to work, or get back to an activity like biking or gardening, Dr. Haug strives to make that happen. He is an active supporter of Special Olympics, ARC Upper Valley and the BUDS (better understanding of Down Syndrome) program. He enjoys spending time with his wife and two children, being in the outdoors and staying active with winter bike racing, endurance races and kayaking.

Music Therapy + Child Life | Calming Patients, Healing Patients

Altru Moments - Published on April 7, 2017

Everly is a sweet and smiley toddler who happens to have MMIHS (megacycstis microcolon intestinal hypoperistalsis syndrome), a rare genetic syndrome. She receives music therapy and child life services during her weekly visits to Altru for dressing changes and lab draws. These appointments had always caused a sense of fear.

Yet, music therapy and child life services at Altru have helped melt away Everly’s anxiety.

“We are able to sing favorite songs with Everly, her parents and the staff doing the procedure,” explains Leslie Saulsbury, Altru’s Board-Certified, Licensed Music Therapist. “This allows her to feel more comfortable, which results in the procedures going much smoother."

“Through the use of age appropriate distraction, toys, and comfort positioning, Everly is able to complete her weekly appointments with a smile on her face,” adds Melissa Swenson, Altru’s Certified Child Life Specialist.

Though music therapy and child life make a “dream team,” as Everly’s family calls it, music therapy and child life can co-treat, but frequently work with separate patients throughout Altru Health System.

Rocking & Rolling & Healing
Leslie provides music therapy for patients of all ages in the medical/surgical unit, orthopedics, cardiac care, pediatrics, inpatient psychiatry, NICU, intensive care, surgical critical care, palliative care and oncology.

She uses clinical and evidence-based music interventions to help patients accomplish individualized goals. Through music, she helps patients like Everly reach non-musical goals, such as managing pain, anxiety or stress, enhancing wellness, expressing feelings or improving communication.

“To do this, we can play music, listen to music, write songs, improvise or engage in music-assisted guided imagery and relaxation,” explains Leslie. “Anyone can participate, regardless of musical ability. I’m using music to help patients cope during their hospital stay.”

And if patients are coping well, their whole hospital experience can have a more positive outcome.

In 2015, Altru made history by being the first hospital in the state of North Dakota to fund a music therapy position, and thousands of patients and families have been able to benefit from these services.

Instruments, equipment, and recorded music used in the program are funded by grants and donations. All music therapy services are complimentary for our patients.

Playing & Exploring & Healing
The child life program, which has been in place at Altru for 23 years, is a complimentary service to pediatric patients and families.

“I help families cope with the challenges of hospitalization, illness and end of life by providing age-appropriate information, emotional support, developing coping strategies and guidance to parents, siblings and extended family members,” explains Melissa. “I help explain a child’s diagnosis in ways they can understand, reducing fear, anxiety and pain.”

Melissa provides support using coping strategies and distraction with patients for procedures such as catheters, lab draws, IV starts, scans and dressing changes. When kids are prepared for what they will experience and are distracted with age appropriate activities, they will cope better with their procedure and it will be more positive for the medical team and their family.

Child Life is run by donations and is a complimentary service to approximately 2,500 pediatric patients and families a year.

Everly’s mom, Erin, shares, “Music therapy and child life has helped us make a scary experience for our daughter each week an enjoyable one. We are beyond grateful for this. She truly loves seeing these wonderful therapists each week and taking part in the singing and dancing.”

For more information about the music therapy program, or questions about donations, contact Leslie Saulsbury, MT-BC/L at lsaulsbury@altru.org.

For more information about the child life program, or questions about donations, contact Melissa Swenson, CCLS at mswenson@altru.org.

See also: Providing Comfort to Children through Song

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