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

Whole, Unprocessed, Organic... Oh My! | Understanding Food Label Terms

Enrich - Published on April 4, 2017

Reading Food LabelsWhen walking down the aisle of the grocery store, you’re likely to see an abundance of healthy words jumping out at you from the boxes and cans. A box of crackers may boast being “whole-grain, low calorie and a good source of protein.” The carrots that are a bit more expensive are “organic” and eggs have a whole slew of identifiers meant to help you chose the right fit for your taste, health and animal friendliness. The challenge is deciphering these messages and learning what might be more of a ploy then a true benefit and vice versa. We’ve provided some of the most common food label terms and what they mean (or don’t mean) to help you navigate the aisles armed with what you need to know to buy the best grub for your family.

The Basics
The FDA has set guidelines around certain terms, and when companies can use them to promote their product. Here are a few you are likely familiar with, and when they can be used:

  • Low calorie: 40 calories or less per serving

  • Low cholesterol: 20 milligrams or less and 2 grams or less of saturated fat per serving

  • Reduced: At least 25 percent less of the specified nutrient or calories than the usual product

  • Good source of: Provides at least 10 to 19 percent of the Daily Value of a vitamin or nutrient per serving

  • Calorie free: Less than five calories per serving

  • Fat free/sugar free: Less than ½ gram of fat or sugar per serving

  • Low sodium: 140 milligrams or less of sodium per serving

  • High in: Provides 20 percent or more of the Daily Value of a specified nutrient per serving

In recent years, other identifiers have popped up that aren’t so cut and dry. Some of these are not regulated by the FDA or USDA, and some have meanings that can feel pretty misleading. Here’s what you need to know about some of the most commonly used terms.

No formal definition for the use of natural on food labels has been issues by the FDA or USDA; however the FDA does follow a policy that notes that natural foods fit the following:

  • The product does not contain added color, artificial flavors or synthetic substances

When it comes to meat and poultry, the USDA allows the use of the term natural in these situations:

  • Contains no artificial ingredients or added color

  • The product is minimally processed

  • The label must explain the use of the term natural – i.e. contains no added coloring, is minimally processed.

Processed and Unprocessed
Many people think of "processed" foods as unhealthy, packaged foods. While this can be true, the technical meaning of processed is more simplistic.

Officially, “processed” refers to food that has undergone a "change of character." While this can encompass packaged snacks and some less nutrient dense options, it also speaks to some foods you might not consider - for example:

  • Raw nuts are unprocessed, yet roasted nuts are processed

  • Edamame is unprocessed, yet tofu is processed

  • A head of spinach is unprocessed, yet cut, pre-washed spinach is processed

While you may not see as much food being touted as processed or unprocessed, it is good to understand the difference. Learn more about processed food.

Though not a regulated term, "whole foods" generally refer to foods that are not processed or refined and do not have any added ingredients.

When it comes to grains, “whole” is an important distinction. Other terms are often used and can be thought of as healthier options, but can be misleading. For example, wheat bread could still use grains that are not in their most whole forms.


As defined by the USDA, organic meat, poultry, eggs and dairy products come from animals that are given no antibiotics or growth hormones. Organic plant foods are produced without using most conventional pesticides, fertilizers made with synthetic ingredients or sewage sludge, bioengineering or ionizing radiation. A government-approved certifier must inspect the farm to ensure these standards are met. In addition to organic farming, there are USDA standards for organic handling and processing.

There are three levels of organic claims for food:

  1. 100-percent Organic - Products that are completely organic or made of only organic ingredients qualify for this claim and a USDA Organic seal.

  2. Organic - Products in which at least 95 percent of its ingredients are organic qualify for this claim and a USDA Organic seal.

  3. Made with Organic Ingredients - Food products containing at least 70 percent certified organic ingredients. For this level, the USDA organic seal cannot be used but “made with organic ingredients” may appear on the packaging.

Making healthy choices for you and your family starts at the grocery store. Though it can be complicated to detect the real deal from a fraud, keeping some of these key terms in mind should help you make the best picks for you and your family. Altru’s registered dietitians provide nutrition advice and education, as well as offer a variety of options for individuals looking to make healthy choices. Learn more >> 

Source: eatright.org

Staying On Course: Tips for Golfing with Joint Pain

It's Altru - Published on April 4, 2017

Professional golfer Phil Mickelson was preparing to compete in the 2010 U.S. Open when, unexpectedly, his joints started to ache.

When the tests came back, Mickelson learned he had psoriatic arthritis. Genetics, the environment, viruses and the body’s immune system are all factors that might cause psoriatic arthritis. Mickelson has been back on his professional golf game for several years, thanks to early diagnosis and treatment.

Altru Advanced Orthopedics providers, Christopher Howson, DC, Jordan McIntyre, DC, Jeremy Gardner, MD, and Wade Olson, NP, participating in the Special Olympics North Dakota Golf Classic.

Many golfers are playing with pain, such as tendinitis, sore muscles and arthritis. Swinging a golf club requires moving at a very high speed in a short amount of time, increasing the risk of injury. We called on Dr. Jeremy Gardner of Altru Advanced Orthopedics to teach us where golfers are feeling the pain and how you can prevent it.

Golfing affects the entire body. Improper form can affect multiple joints, with special consideration for the lead wrist, elbow, shoulder, lower back, hips and knees. Swing alterations, such as a shorter backswing or proper weight shift, may decrease wear and tear on the body.

Keep in mind: it's important to properly stretch and warm up before and after a round to reduce pain and injury. Stretching and strengthening can help keep you healthy and improve your game.

Here are some other injury prevention tips for different body parts.

(Click to view larger.)

Next Steps
If you've tried these techniques and are still experiencing pain, it might be time to visit Altru Advanced Orthopedics. Altru's experienced orthopedic providers can work with you to understand what's causing your pain, and how to fix it. This might include physical therapy, or it could be time to consider joint replacement.

Altru offers anterior approach hip replacement, which allows for a smaller incision and less damage to muscles, resulting in less pain and faster recovery. With proper recovery time and physical therapy, you can get back to the links sooner.

Golf is a great way to stay active. It’s beneficial for strength, balance, coordination and range of motion. If walking is a possibility, aerobic exercise improves the heart, lungs and muscles and helps with weight control, mood and sleep.

See also:

Dr. Jeremy GardnerDr. Jeremy Gardner is an orthopedic surgeon at Altru Health System. Board certified in orthopedic surgery, he specializes in joint replacement, including direct anterior approach to hip replacement, osteoarthritis, rotator cuff surgery and sports medicine. Outside the office, Dr. Gardner is an active golfer, runner and scuba diver. He also enjoys hunting, fishing and archery. 

No Polyp Left Behind | Randy’s Altru Moment

Altru Moments - Published on March 31, 2017

For the past six years, Randy Schroder of Minto, North Dakota, has been visiting Altru’s Urology Department for regular six-month check-ups. In 2011 he was diagnosed with bladder cancer and had tumors removed, and has been keeping a close eye on it ever since.

During a routine urology appointment in April of 2016, Randy had a different nurse than usual. Susan Bostad, RN, who is usually in procedural services, was filling in that day.

“She was so sincere,” explains Randy. “She asked me, ‘Randy, have you thought about having a colonoscopy done? I really care about the patients I work with.’ I had one years ago because of abdominal pain, but hadn’t considered it recently.”

Because of his history of bladder cancer, Randy’s risk was higher. He was over 50. Perhaps it was time for a routine screening?

Do I Really Need a Colonoscopy?
Randy casually mentioned it to his wife on the drive home, and she set up an appointment. Two weeks later, he was getting a colonoscopy.

“The whole process felt like 10 minutes,” shares Randy. “Mid-way through the procedure, though, I remember my doctor gave the nurse a head nod, and I don’t remember a thing after that.”

Randy’s “10 minutes” was really two hours.

Dr. Howard Hack, a gastroenterologist at Altru Health System, had spotted ribbon-like tissue that was a different kind of polyp—a flat colon polyp.

“Flat colon polyps went unnoticed until 10 years ago,” explains Dr. Hack. “My former colleague at Stanford, Dr. Roy Soteikno, published a landmark article in March of 2008 about them. Flat polyps account for about 10 percent of all colon polyps. They are thought to have at least the same potential for developing into colon cancer as regular polyps, and in fact, some of them probably are more pre-cancerous.”

Dr. Hack continued, “Flat polyps are only visible by observing subtle changes in the lining of the colon. Sometimes, they are covered with a thin mucous-like layer which betrays their location. If you miss it, then you are at risk for colon cancer.”

Peace Out, Polyp
Thanks to Dr. Hack’s trained eye, Randy’s flat polyp was quickly and painlessly removed before it turned into cancer.

“I use the technique called Endoscopic Mucosal Resection,” explains Dr. Hack. “This involves injecting a bubble of saline mixed with a blue dye, which lifts the polyp tissue away from the lining of the colon, allowing me to identify the border. I remove the polyp and secure the site with temporary clips which fall off after a few weeks. This allows the site to heal with low risk of bleeding.”

Colon cancer awareness

Randy is relieved Dr. Hack was skilled in recognizing this type of polyp and promptly removed it. “He said it was about the size of a quarter,” shares Randy. “He sent it off to be tested, and the results were benign. But, I looked it up online and found that if left untreated, it almost always turns to cancer.”

Randy’s future care plan involves an annual colonoscopy, and he regularly visits urology for check-ups.

“I saw nurse Sue again at my bladder check six months after having the flat polyp removed,” says Randy. “She was so happy to hear I had my colonoscopy done. Her encouragement might have saved my life.”

The 6’4” diesel mechanic thanked her and gave her a heartfelt hug.

“I can’t believe the difference she made. If I hit the lottery tomorrow, I’d give Sue a million dollars,” beams Randy. “She definitely prolonged my life.”

Due to advancements in detection and treatment, colorectal cancer death rate has been dropping for more than 20 years. When detected early, it’s treatable. Colonoscopy is the best line of defense in reducing risk. Schedule yours today >>

Serving People, Building Strength and Upgrading Lives | Anthony’s Secrets to Success

Enrich - Published on March 27, 2017

Anthony MorandoAnthony Morando is all about serving others and upgrading lives. In his role as manager of Altru’s Sports Advantage, Anthony continually inspires positive change and everyday strength for his clients and staff. Let’s take a behind-the-scenes look into Anthony Morando’s secrets to success.

Give us a run-down of a day in your life. What does your typical Tuesday look like?

  • 4:30-5 a.m. – Wake up, have my coffee and breakfast.

  • 6 a.m. – Train a group or kick off my day with a chapter out of a book.

  • 7-8 a.m. – Get my workout in. (My workouts Monday through Friday have to stay consistent because if I don’t get my physical fitness in, I don’t feel well. I don’t feel energized for the day.)

  • 8 a.m. – 5 or 6 p.m. – I’m either training a group, or fulfilling my role as the manager of Sports Advantage, and in addition to that I am constantly learning how to make our facility better. It’s always pretty busy.

  • Evening – Enjoy downtime at home with my wife, maybe watch a funny movie before bed.

  • 9:30-10 p.m. – Bedtime. Sleep is probably the most important part of my day. I boil some hot water with apple cider vinegar and a little bit of honey. It just kind of relaxes my stomach at the end of the day. I’ll go through a little bit of foam rolling before I go to bed to relax my muscles.

How do you spend your downtime?
I’m a big football fan. I played it in college; it’s my favorite sport in the whole wide world.

On weekends, I really, really try to get some time with my wife. We are two busy people. We try to do things together, whether going for a walk or getting away for the weekend. We value our downtime. We spend our week taking care of everybody else, as our goal is to upgrade lives. We also have to keep in mind that if we’re taking care of everyone else, we also have to take care of ourselves.

What do you keep in your car in case you have extra time?
I have two books: a Bible and a pocket book (about Kaizen). It’s a good reminder that you don’t have to go from 0 to 60. If you can live your life like that, you can see how you improve with little steps. I also have a bottle of water handy and an air freshener, because I don’t want it to stink.

What personal development goals are you working toward right now?
I am fortunate to have a great base of information and knowledge. My personal goals are always refining those patterns. What can I do better? How can I constantly improve within my craft? That is going to entail reading more, learning more, going to different seminars, etc. Just being a better person and learning new things.

Fill in the blank:
I’m going to (  worry  ) less.
I’m going to (  explore the Midwest  ) more.
To get motivated, I (  try to create a different perspective for myself  ).

What’s the best choice you made last year?
Marrying my wife (Monique). 

What’s your mantra?
Always excel. It’s nothing fancy. It just means always try to do what you can do to get better. It can mean anything in your life. I have it written down in English and in Greek in my office and in a notebook. It’s a quick reminder and keeps me going. 

What’s your worst habit?
Biting my nails. 

Best habit for a healthy life?
Nutrition. You can work out as hard as you want, and you can read all the motivational books in the world. But if your nutrition isn’t on point, your tank is not fueled correctly. You have control of what you’re eating. That doesn’t mean don’t reward yourself. It means eating right 80-90 percent of the time. 

Favorite thing about our community?
Everybody is nice. I’ve never experienced this small-town feel before in my life. I had three kids come up to my door the other day, and they had baked us cookies. Also, there’s no traffic—that might be my other favorite thing. 

What foods do you buy most often at the grocery store?
Chicken, ground turkey, string beans, lettuce, tomato, avocado, broccoli, eggs, yogurt, apples, bananas and recently cranberries. We drink a lot of water, tea and almond milk. 

Favorite go-to recipe?
My wife bakes banana bread that’s really good and really healthy. (Get the recipe for Crazy Bread.) 

How do you find balance in your daily life?
Reading provides balance because it provides perspective. My next project is to re-read “Where the Red Fern Grows” because it’s going to relate to my life a lot differently now than when I first read it at eight years old. 

What message do you have for those who are struggling with their health and body image?
Try to create a new habit. Try to do something. Don’t be negative, because if you are, it’s going to make things 10 times worse.

We’re all about helping people. You can’t help anyone else unless you help yourself. It’s not being selfish; it’s being smart. Start somewhere. We upgrade lives; we don’t just train athletes. If you want your life to upgrade, we’re a great resource for you. There is zero intimidation here. We’re here to help this community. 

What is your favorite indulgence?
Pizza. I can’t say enough about pizza. Cheese, well done, no toppings. 

See also:

Colonoscopy: Real Questions, Real Answers from Altru’s Gastroenterology Providers

It's Altru - Published on March 21, 2017

Colonscopy QuestionsFriend: What’d you get for your 50th birthday?

You: I got a colonoscopy!

Probably not the answer your friend was looking for.

While a colonoscopy isn’t as exciting as a new gadget or as fancy as a new piece of jewelry, it’s one of the best presents you can give yourself (and those who love you).

Altru’s Gastroenterology Providers tackle some of the frequently asked questions about colonoscopy.

Do I really need to have a colonoscopy? What are the chances you’ll find something?

» Yes. While screenings for other cancers detect the presence of cancer, colonoscopy screenings can prevent colon cancer. During a colonoscopy, the physician is looking for polyps, small growths that over time can become cancer.

» If a polyp is found, the physician will remove it. In those over 50, polyps are found in approximately 25 percent of males and 15 percent of females, but are usually not cancerous. One in 20 adults will develop colon cancer in their lifetime. If caught early, colon cancer has a 90 percent cure rate.

» Colonoscopy is recommended beginning at age 50 and continuing until 75 years of age. People with an increased risk of developing colorectal cancer should begin screening at a younger age, and may need to be tested more frequently.

Real answers by Anthony Chu, MD.

Will my insurance cover the procedure?

» Most insurance plans and Medicare cover colorectal cancer screening for people who are age 50 or older. Colorectal cancer screening tests may be covered by your health insurance policy without a deductible or co-pay. Consult your insurance provider for your specific coverage.

» Altru’s No-Cost Colonoscopy program offers financial assistance for eligible patients who are uninsured or underinsured. Funding is available from Altru Health Foundation, thanks to Altru’s Gala and grants from the North Dakota Department of Health. For more information, call 701.780.6533.

Real answers by James R. Wood, MD, FACP.

What does the colon prep liquid taste like? Why is it necessary to drink it prior to my colonoscopy?

» Patients have a choice when it comes to colon prep. GoLYTELY® is typically recommended as it has the best coverage from insurance. GoLYTELY® is mildly salty, but patients can mix lemonade or limeade flavor packets in to the liquid to make the flavor more enjoyable. The other two options – Prepopik and Miralax – aren’t covered as well by insurance, resulting in additional out-of-pocket cost to the patient. Prepopik tastes similar to sour orange cream candy. With Miralax, the taste is determined by the Gatorade flavor with which you mix the powder.

» It’s important to drink all of the colon prep to properly clean your colon. This helps to provide your physician with a clear view of your colon.

Real answers by Kamrin Macki, NP.

Who will perform my colonoscopy?

» Our doctors are experienced, board-certified and University-trained gastroenterologists. We follow the national guidelines for performance of the procedures, which assures the highest quality exams. We utilize a state-of-the-art facility with experienced nursing staff. Colonoscopies are performed differently for different issues in different patients, and thus need to be individualized.

» Endoscopic procedures performed by physicians with different training may not be able to provide the same ability to provide the quality of care. For example, identifying and removing large or "flat" polyps requires special training and experience which is available at Altru. Flat polyps were first identified at Stanford University in 2007. These flat polyps are more difficult to identify and appear to pose a higher risk for developing into colon cancers.

Real answers by Howard Hack, MD.

Why is good colonoscopy preparation so important?

» Bowel preparation for colonoscopy refers to the laxatives taken before the procedure to clean the colon of fecal debris. A colonoscope is a long, flexible tube with a television camera on the tip. The camera cannot see through fecal debris. So any fecal debris left in the colon could obscure identification of a polyp or even a small cancer.

» Several studies have shown that fewer small and large polyps are detected in patients with less-than-optimal bowel preparation. And, poor preparation has several potential consequences during the procedure itself. First, your colonoscopy may last longer because the doctor will need to take time to clear out debris. Second, your doctor may lack confidence that the colon lining was seen adequately and may ask you to return for a subsequent screening earlier than would be otherwise recommended (say one year, rather than five or 10 years). This will subject you to increased costs and risk. Finally, if the preparation is very poor, the doctor may have to stop the procedure entirely, and you will need to reschedule.

Real answers by Israr Sheikh, MD

Altru's Gastroenterology Team

To schedule a screening colonoscopy, call 701.780.6533. Learn more at altru.org/colon.

From Admission to Discharge, Your Safety Is Our Priority

It's Altru - Published on March 16, 2017

As we celebrate Patient Safety Awareness Week (March 12-18, 2017), here are some of the many ways we ensure safe care for our patients at Altru Health System.

Patient Safety Week

Addressing concerns. We diligently address every concern brought forth by patients, families and staff. We encourage patients to provide feedback and/or report any and all safety concerns by privately calling a patient representative.

Assessing fall risk daily. We perform a thorough standardized assessment immediately upon hospital admission, followed by daily assessments to determine individual fall risk. Each patient gets a score—low, moderate or high—and actions are taken to ensure patient safety depending on risk level. Actions may include: bed alarm, chair alarm, patient sitter and/or rounder.

Altru’s inpatient fall rate is 3.45 per 1,000 patient days. This is on the low end of the national, publicly reported inpatient range of 3.3-11.5 falls per 1,000 patient days, according to the NDNQI (National Database of Nursing Quality Indicators) database.

Encouraging honest feedback. Altru has a robust reporting culture for any patient safety or quality care issues. Our reporting structure is non-punitive, encouraging open and honest communication about concerns relating to patient care and safety. In addition to reporting falls, we also document any and all near-falls. This is all tracked in real time to accurately reflect reality and consistently hold staff accountable.


Analyzing errors. If a fall does occur, action is taken immediately. This includes notifying the charge nurse and hospital supervisor, provider and other caregivers, including the patient’s family. We include the patient in a group huddle to assess and revise interventions. Then, a root cause analysis (RCA) is completed to analyze what went wrong and make sure the issue never happens again.

Using the best technology. Healthcare technology can assist staff by providing simple reminders and prompts to keep our patients safe. Electronic medical records can improve the ability to diagnose diseases and reduce—even prevent—medical errors, thus improving patient outcomes.

Washing hands—often and well. Hand hygiene is a great way to prevent infections. Providers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care. Healthcare providers can explain how and why they clean their hands before, after and sometimes during patient care, and let patients know it's okay to ask about hand hygiene.

Keeping it clean. Our Environmental Services team uses a number of quality checks to ensure patient rooms are as clean as possible. For example, an “encompass room check” marks 18 touchpoints before and after a room is cleaned to check and score overall cleanliness. This attention to detail doesn’t go unnoticed—we ranked at the 84th percentile (goal was 70th) overall for 2016 in HCAHPS scores for cleanliness. Beyond the basics, we take extra measures keep our environment squeaky clean, from using bleach for C-diff cases to adding new UV light machines to kill 99.9% of bacteria.

Although we are using this week to celebrate our patient safety achievements and increase awareness, safe care is Altru’s focus 24 hours a day, 7 days a week, 365 days a year.

See also:

Lynn Huot has been a nurse for 30 plus years with the past 12 years as a Registered Nurse. She obtained her BSN from Mayville State University in 2016 and is currently the Director of Quality and Patient Safety at Altru Health System. Lynn enjoys spending her free time with her family as well as spending time at the family cabin.

Central Sterile: Where Healthcare Really Starts

It's Altru - Published on March 13, 2017

Central Sterile is actually the first step in ensuring you recover from whatever ails you, because those technicians are responsible for properly tracking, cleaning and sterilizing all the instruments and medical supplies that may cross your path.

Because the work of Central Sterile is done behind-the-scenes, patients may never realize the crucial role they play in keeping you healthy and helping you recover. These individuals exist solely to protect the welfare and safety of every patient that comes through the hospital doors.

Central Sterile technicians are the people who organize and assemble the instruments needed for surgical cases, meticulously track every scissor, screw and drape in the facility and maintain adequate amounts of each, as well as disassemble and reassemble contaminated medical supplies and equipment.

It’s not a role to be taken lightly.

Central Sterile technicians are an integral part of the healthcare process, and it’s a great fit for someone interested in medicine who doesn’t want to shell out hundreds of thousands of dollars for medical school. In fact, many sterile processing technician programs can be completed in six months to a year, and for much less investment than other medical career paths.

That’s good news, especially considering the job market for Central Sterile processing technicians is expected to grow by 20 percent by 2020. Even though improved technology is making it easier for these technicians to track and order equipment, individuals still maintain a critical function for any hospital or healthcare facility. Thanks to high demand in the market, job security and professional development, opportunities abound as entry-level technicians move up toward supervisor and management levels.

Perhaps the most important aspect of the central sterile role is the ability to develop a rewarding career in the healthcare industry. Though patients are not doling out hugs or handshakes on a regular basis, central sterile technicians can find fulfillment knowing those patients have left healthier. That’s thanks to the vital job technicians have provided by supplying the tools necessary to set them on a path toward recovery.

If you’re interested in filling the important role of a Central Sterile processing technician at Altru Health System, apply at altru.org/careers.

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