7 Nutrition Trends: Mythbusting with Altru Dietitians

It's Altru - Published on June 27, 2017

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

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

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



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

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

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


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

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

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


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

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

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

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

  • Some alter effectiveness of oral contraceptives

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


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

4. Myth: Avoid carbohydrates to lose weight. 

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



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

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

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

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

6. Myth: A healthy diet is too expensive.

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

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

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

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

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

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

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

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

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




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

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

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

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

Heart Conditions that Run in the Family

Enrich - Published on June 26, 2017

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

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

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


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

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


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

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

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

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

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

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

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

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




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

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

She also encourages patients to know their heart health numbers.

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

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


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



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

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

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

Hear from a Doctor without Leaving Home

It's Altru - Published on June 14, 2017

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

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

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

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


  • Patients with busy schedules

  • Out-out-town patients

  • Patients with limited mobility

  • Visits that don’t require physical interaction


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

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



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

  • Communicate with your provider’s office

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

  • Pay bills securely.

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

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

  • Request prescription renewals.

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

  • Manage care of elderly parents.


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

See also:

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

Enrich - Published on June 8, 2017

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

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


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

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

  • Avoid tobacco use and secondhand smoke.

  • Avoid or minimize alcohol consumption.

  • Take your medications as prescribed.




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

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

The American Heart Association recommends:

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

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

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


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



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

  • Read food labels.

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

  • Consume low sodium choices.

  • Drink plenty of water.


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

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

  • Set an alarm for your medication time.

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

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


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

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

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

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

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

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


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

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.

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.

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:

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

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. 

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