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Varicose veins may be more than surface-level problems

Dr. Nayan Desai:

I want to, through this podcast, tell people that it is a medical problem. People historically have equated varicose veins that it’s more a cosmetic problem. Thought about it as you know, more cosmetic problem, but that’s not true.

Alan Helgeson (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about varicose veins, signs, symptoms, and treatment options. Our guest is Dr. Nayan Desai, interventional cardiologist with Sanford Heart, Bismarck, North Dakota. Our host is Amanda Potter with Sanford Health.

Amanda Potter (host):

Thank you for joining me, Dr. Desai. I am genuinely excited to talk with you about varicose veins. I feel like there are a lot of old wives’ tales and misinformation about the topic, so, really happy to have your expertise here. Just for everyone listening, can you just tell us briefly about yourself and your background?

Dr. Nayan Desai (guest):

Sure. So my name is Nayan Desai. I’m one of the interventional cardiologists at Sanford Hospital in Bismarck. I’ve been at Sanford Hospital in Bismarck since 2018. I came here from New Jersey, and I live in Bismarck with my family. My wife is also a physician, and we have two young kids, Ohm and Mira, who are 8 and 5 years old.

Amanda Potter:

Bismarck is a great community to raise a family in, isn’t it?

Dr. Nayan Desai:

Yeah, that is so true.

Amanda Potter:

So, let’s just start at the very beginning. What exactly are varicose veins?

Dr. Nayan Desai:

That’s a great question. You know, when people think about varicose veins, they come to my clinic, and they talk about is it a circulation issue? And the answer is kind of a little more complex. Yes, it is a circulation issue. When you think about the blood flow to the legs, you think about the arteries which give us the oxygenated blood to our legs that keeps the blood moving, helps the tissue to stay alive, and then the veins are returning the bad blood flow from the legs to the heart, right? So that’s where the veins come in. These are the same veins we see underneath our skin or when we get IV access. So yes, it is a circulation issue, but it is different than arterial issue. Like when you think about diabetics or diabetics with gangrene or, you know, having people amputate their foot because the blood flow was not good, that is an arterial issue. That is a blood flow issue because of good blood not reaching to their feet.

With varicose veins, I call it more a nuisance problem. So there are two different vein circulation systems in our leg. One are those superficial veins, which just run underneath the skin, and the others are deep veins, which are located right near the bone, which are carrying most of the bulk of that bad blood flow up to the heart.

So, with varicose veins, these are those superficial veins which are underneath the skin, and these are nuisance vein. It is a disease, I would say, of healthy people. So, when they come to my clinic, I say that you are healthy, you are active, you are on your feet a lot, you’ve been standing in prolonged occupations, and that’s why you have the problems with varicose veins.

Amanda Potter:

Wow, I’ve learned so much, and I love that it’s a condition of healthy people. That’s really interesting. Is there any relation to something like deep vein thrombosis or any other conditions?

Dr. Nayan Desai:

Yeah, so as we just kind of said, right, the deep veins are the veins which are running deep inside the legs. The varicose veins are typically the superficial veins. There could be a connection. So, imagine, like, if you have a clot in your deep veins, now the blood is not going up to the heart, right? So, the blood has to magically figure out a way to reach the heart; otherwise, your leg is acutely swollen, painful. And then those superficial varicose veins come into play in some people where they have deep vein thrombosis. But, typically, the deep veins — we like to separate this condition out from DVT, or deep vein thrombosis from varicose veins. But, as a sequela, if somebody has had scarring or deep vein thrombosis, they could later in their life get varicose veins.

Amanda Potter:

Interesting. So, you touched on it a little bit, some of the potential symptoms, but can you talk more about how someone might know if what they’re experiencing is varicose veins?

Dr. Nayan Desai:

So, with varicose veins, it is a slow disease process, right? It’s very seldom an emergency. It’s a nuisance problem. As I said, it’s a problem of healthy individuals, people who are older, genetics, pregnant women, people who are standing a lot on hard surfaces, right? Of people working in restaurant industry. We have our farmers and ranchers here in North and South Dakota. So, those kinds of people who are on their feet a lot, especially even smoking, and women who have been pregnant multiple times.

I say, you can blame it on your kid because the uterus, when you’re carrying the baby, is pressing on the veins. The veins are very light there. Amanda, like, even if you hold a little bit of pressure, they can collapse, right? So, the baby’s head can press on the mother’s veins, and that’s where they can get the problems with varicose veins.

Amanda Potter:

Are there any hereditary factors at all? Like, if my mother or grandmother struggled with it, is that a sign that I might struggle with it as well?

Dr. Nayan Desai:

Yeah, I think genetics are a big player, because there are some genetic conditions. But, yes, you would want to ask that history. When I see that patient, those patients in my clinic, I’m typically asking them, yes, is there any familial component, like, your mom had it, or your dad had it, grandparents had it? You are likely more predisposed to have it.

Amanda Potter:

Okay, so let’s say someone feels like they are struggling with this issue. What are their first steps? Do they go to their primary? Can they see someone like you right away?

Dr. Nayan Desai:

I feel like with every disease process, right, it comes in different flavors, I would say. So you have patients early on with mild disease – they’re like, huh, my legs just get a little bit achy. It’s more a nuisance, but I can carry out my daily activities.

And then you have those patients – every time I walk, I feel my legs are hurting, they’re heavy. And I want to, through this podcast, tell people that it is a medical problem. People historically have equated varicose veins that it’s more a cosmetic problem. Thought about it as, you know, more cosmetic problem, but that’s not true.

With varicose veins, you would see those veins are big enlarged. The blood is not reaching the heart. So, the blood is pooling in their lower extremities, and they would feel heaviness, pain, swelling worse at the end of the day and get slightly better when they’re elevating their legs.

So, yes, they can directly see a specialist, but through this podcast, what we want to convey to our patients is, what are the steps which I can take if I start seeing this problems on my own? And that would be elevate your legs, do leg exercises, strengthen your calf muscles, right? Those are simple stuff which we can do if you’re prolonged standing in one position.

Even health care, like I see patients, a lot of them are nurses standing in the operating room, doctors. And compression socks are a great tool. Those compression socks, as I said, those varicose veins don’t need a lot of pressure. You can just kind of press lightly, even with your hand. So, 20-30-millimeter compression socks, which is available through any local pharmacy or through any big stores, you can start wearing them, and that’s a great habit. It strengthens your musculature, it protects you from worsening symptoms of varicose veins, and it gives you good relief.

Yes, like anything in life, it’s an adjustment. So when you start wearing those compression socks, initially you would start noticing pain, swelling and it’s like, oh, it’s uncomfortable. But trust me, over a period of time you will like those compression socks. That’ll become kind of your second habit. And, for us, in our kind of guidelines and where all the society guidelines come in, we don’t want to do any invasive procedures till somebody has at least tried it for three months.

Amanda Potter:

So, what I’m hearing is that maybe a lower-risk intervention like compression socks or doing these exercises, that’s something anyone can start at any time. Would you say that’s correct?

Dr. Nayan Desai:

Yeah, and as I said, you have to be careful. If you have arterial disease — as we talked about at the beginning of this recording, if somebody has arterial disease, they don’t have good blood flow going down to their legs, they’re having gangrenous diabetic foot. It’s best to talk to your local doctor or your primary care physician before you kind of take that on your own. But if you’re otherwise healthy, you’re young, you don’t have any diabetes, your circulation overall is good except for some superficial varicose veins, then I think it’s generally safe to go ahead and start using those compression socks.

Amanda Potter:

You kind of touched on this again, that it’s a disease of a healthy person. But are there ever any times when it’s a sign of a more serious problem or something that people should be really worried about?

Dr. Nayan Desai:

Sometimes, you know, if you have had longstanding DVT or those clots in the deep veins, then you would start seeing a lot of superficial veins, right? And deep vein clots can be a big issue, because those clots can go to the lungs, and you can have pulmonary embolism from those, and that can make you really sick. Sometimes, with varicose veins, you could have obstruction much higher up, which means blood is not able to return way higher up into your pelvis. So, it’s kind of those two can become a more kind of from a nuisance disease to more a little more serious medical problem.

Amanda Potter:

So, let’s talk about the treatments that are available. What can people expect if they do need a more intensive treatment?

Dr. Nayan Desai:

When I see those patients in the clinic, I usually go through a checklist in terms of, tell me about your symptoms, right? And we spent a little bit of time talking about those symptoms. My legs are heavy; my legs are swollen. Some patients would just have spider veins, and they are not really same as varicose veins, but they would be more like superficial veins or nuisance veins, as I call. There are two main superficial veins in our leg. One is the great vein, another is the small saphenous vein. So, you could have leakage in either of those.

So normally when you think about those veins, Amanda, you have good valves in those circulation, right? Those valves open and close and allow the blood to go up against gravity. And with varicose veins, the definition is the veins are enlarged and they’re leaky. Now, the valves are not functioning; the valves are not able to close to allow that blood to go up to the heart against gravity.

And that’s where you would see pooling in the legs. You would see swelling at the end of the day, you would start seeing those ropey earthworms patients complain about in their calf or in the upper part of their thigh. Weight is a big risk factor. So, somebody who is overweight is obese, as you can imagine, that also puts a lot of extra pressure not allowing that blood to return to the heart. Itching can be a symptom sometimes because you can imagine those veins are stretching the skin, the skin is getting dried out, restless leg, pigmentation. If you allow these veins to sit with these varicose veins for a long period of time, you would start seeing the skin becoming dark in that area. You would have rupture of those varicose veins are bleeding inside, internally, underneath the skin, and the skin slowly becomes dark.

And if you really let the problem progress, you would start seeing ulceration, ulceration typically around the ankle. As you can imagine, somebody who is upright erect, the maximum pressure is right around their ankle. The blood is pooling there; it’s not able to reach up to the heart, and you would see skin breakdown and ulceration in those areas around the ankle. So, these are the different spectrums. Of course, people come sometimes very early on with just superficial spider veins to way down to skin pigmentation, swelling, and then the worst would be the ulceration.

Amanda Potter:

And by ulceration you mean open wound?

Dr. Nayan Desai:

Exactly. So, ulceration is like open wounds. These ulcers or open wounds right around the ankle, right around the bony areas of the ankle, on the inside of the ankle, would be more considered a venous, or from varicose veins. They usually don’t heal, as you can imagine, because the circulation is not good. The veins are not returning the bad blood flow, so the blood is sitting there.

So, sometimes, it’s not uncommon for these patients to have ulceration for, you know, six months, one year, two years. These are chronic, non-healing, open wounds, and that can be risk for sepsis infection. It’s an open channel and, you know, usually with our feet, they’re not usually the cleanest areas of our body, right? There are a lot of germs around, especially if it’s a hot, sweaty day. You can imagine what all goes inside from that wound. It’s a direct entry for those microorganisms to get into your system. So, these are the various flavors it would come in.

Amanda Potter:

Yeah, that’s so interesting and scary, like you said. I was sitting here thinking that’s not a good place to have open wounds down by your feet, by the floor, by the street, not a good place. So, if someone’s at that point, what are their treatment options?

Dr. Nayan Desai:

So, when they come into our clinic, as I said, if you have symptoms which are lifestyle limiting, which are affecting your daily activities of life, you have tried the basic conservative measures: leg elevation, leg exercises, compression socks for three months, then we would go ahead with a dedicated ultrasound. So, it is more an involved ultrasound; it takes about 90 minutes. Try and make sure that you have that time. The sonographer gives me a roadmap. It shows me how big those varicose veins are and how leaky those veins are, right?

So, I get that two information, the size and the leakage. And then we put that into a map, and we kind of see which veins are leaky, which veins are enlarged. And that helps us to then plan their treatment and then going straight into the treatment options, that the treatment options over the last, you know, 10, 15, 20 years has just kind of exploded in this field.

Just because of the need, you start seeing so many patients. The original treatment, if you would hear, I have had my vein stripped—the most barbaric treatment. And what that means is they would just go in and yank that leaky vein out, right? So, sounds barbaric. We don’t usually recommend or do it now because we understand that when we are taking away, or yanking those veins out, you’re still exposing so some small veins to come around and have the problem recur again in a couple of years down the road. So, I would say stripping is usually not the first line of treatment we would recommend. Some of the office-based procedures—we talked about those spider veins where it’s just more underneath the skin. Some people do have pain, but most of the time I think it’s cosmetic for patients when they see those small spider veins around.

And that can be easily treated with just an alcohol treatment. You would kind of make some alcohol and form in the clinic; you would go inside those small spider veins and inject alcohol. And what that alcohol does is destroys those leaky varicose veins or spider veins. And then we move on to something which is more involved or something which we do more in as a procedure. There are different procedures available. As I said, I call it a destructive procedure. When your veins are unhealthy, they’re leaking blood, they are enlarged. You want to get rid of those veins. You want to allow the blood to flow into those deep, healthy veins. So that’s why we would actually destroy these varicose veins. And there are various options available: you can destroy them with heat energy, you can destroy them with laser, or you can destroy or seal them off with a glue.

And the procedure that I typically do on my patients is the VenaSeal procedure, or a glue-based procedure. So, we would go ahead around their ankle, put a small IV in. It’s not painful at all, but you can keep the patients comfortable when we are doing these procedures. Run the catheter all the way up from their calf up all the way into their thigh inside that leaky varicose veins, and we would start shooting small amount of glue and seal that leaky vein completely off. And then patients is like, where my blood goes, it goes into the healthy veins, right? If you can imagine that leaky varicose veins can keep getting stretched, enlarged and start pulling more blood when it is not working correctly. So, now we are redirecting the blood to the healthy veins.

Amanda Potter:

Rerouting it. That’s amazing. So, sometimes I see med spas advertising that they do treatments for this kind of thing, or you might have even seen maybe some storefronts in, like, a strip mall. Can you tell me what’s the advantage of going to an actual health care system like we have at Sanford Health?

Dr. Nayan Desai:

As I said, I don’t want to kind of, you know, give that impression, but there are different clinics; there are vein clinics available where you’re seen and evaluated by a health care professional versus these are these more cosmetic med spas. The problem with those happen is they can only do that alcohol injections, right? Those are those simplified procedures. But if you are not checking if your main vein is leaking or not, you are kind of just doing it more for cosmesis, but you’re not taking care of the pain, heaviness, swelling. If your main vein, the great saphenous vein, or the small vein is leaking blood underneath the skin, doing those med spa treatments are not going to be effective long-term.

You would have recurrence of those varicose veins as well as those problems will still persist. Yes, the skin at that area might look better because you have gotten rid of that spider vein. But I tell my patients, what is our aim? Is our aim cosmesis, or is our aim symptom relief? And that’s where I can help you more with symptom relief. The cosmesis component may or may not happen depending on how long you have had the problem for.

Amanda Potter:

It sounds like it’s truly more of like a band-aid-type approach, just put a band-aid on it. But, hey, great business model because they’ll come back and (laugh), they’ll have repeat customers, right?

Dr. Nayan Desai:

That’s correct.

Amanda Potter:

We’ve talked a little bit about some of the measures that people can take to prevent varicose veins, some of the risk factors. If someone has this concern, how can they start that conversation with their primary provider or their doctor?

Dr. Nayan Desai:

When you start seeing those superficial varicose vein come up, I would say actively bring that up. Most of the patients don’t even think about talking to their primary care doctor because the mindset is that it’s very cosmetic. People don’t think that this is going to, kind of, affect their quality of life. They would not think that, oh, my legs are hurting at the end of the day, it’s my varicose veins, or I have itching in my lower extremities. I have started to notice swelling at the end of the day. Think about these as real medical problems and discuss it with your family doctor or your primary care doctor.

As I said, we live in North and South Dakota right here in our Sanford Health System. Our patients, usually in the winter months, are wearing long clothes. Sometimes, it’s not even easy for your doctor to kind of, in that 15, 20, 30 minute visit, to get to that. And, if you’re wearing long clothes with stockings and stuff like that, they might not be able to see your legs. But I would say when you’re seeing that for the first time, bring that actively up. Tell them that these are concerning. What should we do next? Do you recommend anything? And I would say are any of our Sanford primary care doctors are very astute in terms of recognizing the varicose veins, understanding that these are real medical problems, and then referring to appropriate specialists like myself, if needed or indicated.

Amanda Potter:

What would you say is the most important takeaway that you would like to leave people with when we’re talking about this issue?

Dr. Nayan Desai:

Don’t be embarrassed; be proactive. And I’m going to just repeat those lines again. Get medical attention. There are great treatment options available where we can seal those veins. We can, you know, remove those veins as well with small incisions. We call them phlebectomies, or inject alcohol or foam-based sclerotherapy and make your leg truly better. When I talk to my patients after, it’s not just the cosmetic look of the leg, but it’s also when they say, oh, I feel right away my leg is less heavy. I can walk distances now. I’m not aware about my leg as much as I was aware about it before the procedure. You know, I can stand on my feet much longer. So, it is truly game-changing. If you do have moderate to severe venous insufficiency from varicose veins, which in common terms are leaky varicose veins.

Amanda Potter:

It’s quality of life, right? And people don’t have to suffer with it, is what I’m hearing.

Dr. Nayan Desai:

Yeah, and one of the other questions I get asked, Amanda, is as a heart doctor, is like, oh, if I get my varicose veins sealed, if I need bypass in future, the surgeons typically use these veins for open heart surgeries and bypass. And my answer to that question is, if these veins are leaky and not working well, they’re not going to work well in the heart. You don’t want those varicose veins to go inside your heart as well. And at that time, the surgeon can either use some of the arteries in your hand or other areas of the body which are more healthy. So, thinking about, oh, I don’t want to get this procedure done because I might need open heart surgery 15, 20 years down the road.

Amanda Potter:

Well, Dr. Desai, thank you so much for your time today and for explaining this topic, and we just really appreciate your expertise.

Dr. Nayan Desai:

Thank you for having me.

Alan Helgeson:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcasts series by Sanford Health, listen wherever you hear your favorite podcast. And on news.sanfordhealth.org.

Get more episodes in this series

Meet 3 women who are leading senior care into the future

“Reimagining Rural Health” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations.

Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Aimee Middleton, chief operating officer at Good Samaritan, talks with Stephanie Uhrmacher, administrator, senior living at Good Samaritan Society – Hastings Village, and Katie Davis, vice president of operations at Good Samaritan, on the topic of women leading senior care into the future.

Aimee Middleton (host):

Well, thank you Katie and Stephanie for joining me here today. I am so honored to just be here with you today. This is an exciting week for us as we kick off our annual operations conference. And who better to do it with me than a couple of Women of Distinction winners that we’ve had in the past. So, I would love for both of you to introduce yourselves as we kick this off here.

Katie Davis (guest):

Hi Aimee, thanks for having me today. So excited to be here. My name is Katie Davis and again, I serve as the vice president of operations for North Dakota and South Dakota.

Stephanie Uhrmacher (guest):

And I am Stephanie Uhrmacher, and I am the administrator for senior living at our Hastings Village campus. And that just means I am over the housing with services department, and we have about 350 residents on our campus.

Aimee Middleton:

I’m just going to kick right off and to start out. So, if you were to look back into your childhood, what do you think was the first job that you thought you wanted to do?

Katie Davis:

Well, I have a picture of myself holding a sign in kindergarten of wanting to be in the army. And I think if you know me very well, I would not probably be a good candidate to be in the army right now, but I wanted to be in the army.

Aimee Middleton:

Awesome.

Stephanie Uhrmacher:

I wanted to be a brain surgeon. So, I have a paper that I wrote that is about memory loss, and I thought that I was going to create a brain chip that you could download your memories and put them back in later. And now I’m like, well, we might actually be at that place. And I don’t know how I feel about it.

Aimee Middleton:

Right (laugh). Why does that not surprise me that you wanted to be a brain surgeon?

Stephanie Uhrmacher:

Now I’m like, no way. The actual doing the job would not work well for me.

Aimee Middleton:

I love it (laugh). Let’s fast-forward a bit. What was your first job that you ever had then?

Katie Davis:

So, my first job was working in an ice cream shop. I was in high school, but I think I ate more ice cream every day than I actually sold the ice cream. So, I don’t think I was a very good employee at that ice cream shop.

Aimee Middleton:

Again, I don’t think that that surprises me, Katie. I think you’re, you know, a social butterfly. I can see you doing that, eating ice cream.

Katie Davis:

Right? Yes, it was so good. All day, just eating ice cream all day.

Stephanie Uhrmacher:

Yeah. My dad managed a campground at Lake McConaughy, and so I worked the boat dock, and cleaned cabins, and worked in the store, and I think that’s where I learned you better love what you do every day. And it was the best. It was the best job.

Aimee Middleton:

That’s great experience, actually, especially for what you do today. You know, having that experience and serving others and that customer service, I see a lot of that in what you do today as well. Awesome.

Wanted to have both of you join me because you’ve also been honored as Women of Distinction. I’m so excited to have you talk a little bit about that experience. And maybe I would just open up what it meant to me. So, I had a distinct honor to win in 2023, the Women of Distinction. And it was a wonderful feeling. I’ll never forget it. I was driving in my car, and I’m driving along, and I get this weird phone number, and I ignore the phone call because I don’t answer sales calls, right?

And so then they leave a message, and he says he is the (McKnight’s Long-Term Care News) editor. And so I called back, and he told me that I had won this, and wow, that was so cool.

But instantly I was like, this is an amazing thing that they’re doing for women in our industry, and there are a lot of women in long-term care. And I started just ticking through the names of all the other people in our organization that would be great, especially the two of you. And so that’s what it meant to me. I was just so excited for what this meant for all women in our industry. How about both of you? What did this mean to you?

Katie Davis:

I think when I think of a woman of distinction, I think of somebody just making a difference in the lives of not only our professional community but also our personal community. I think of a woman of distinction of being a role model. And I certainly hope that I am role models to other employees within our organization. But yes, it was a great honor, and when I got the call, I was just speechless and didn’t even know how to necessarily react. But very, very honored, and it was a great trip.

Aimee Middleton:

Stephanie?

Stephanie Uhrmacher:

So, I have a little story that I think really truly shows what it means to me. And I did get permission to share this from my daughter whenever I needed to, but she was about 10 years old at the time and struggling with her mental health and was actually a little bit suicidal. And so we had just poured everything that I could into her. When your kid is going through that, that focus goes to her.

And I remember feeling like that doubt come in, like I’m letting everything else go. My work is going. Does my team think I’m failing? Am I failing my kids at home?

And I was at a counseling appointment with her, and Rex had told me, get on this call; it’s important, my supervisor. And so I rushed out because we were a little bit late, and we got in the car, and I got on my phone on our WebEx, and I hear him say, “Oh, the woman of the hour just got on,” and I’m on mute. So, Sophie’s saying, “Mom, it’s you; you’re the woman of the hour.” And I’m like, “It’s not me. Like it’s somebody else. Just be quiet,” you know? (Laugh)

And he made the announcement with Kara, and I was shocked. I just remember being shocked and then looking over at her, and she had tears in her eyes, and she was just like, “Mom, I’m so proud of you.” And I think that’s what it means, loving other people, just showing up and doing the best that you can at that time. And I just want to be that example for my girls and other girls in the industry. And I was very honored.

Aimee Middleton:

That’s an awesome story, Stephanie. And I love how real you are about what it also means to be a woman leader today. And while I don’t love what your daughter was going through, I also know how you dive in for everything. And I can just see you diving in for that. But to have this moment be a part of it, I can’t also help but feel God had a part in that, and how cool? But very, very cool for you and Sophie to remember forever.

Stephanie Uhrmacher:

Yes, it was. And she was so proud. She told all her teachers, all her friends (laugh).

Aimee Middleton:

(Laugh) I love it. I love it. Proud of her mama. She’s pretty awesome. So that’s pretty great.

All right, switching gears here maybe a little bit. Katie, what has your career path looked like leading up to your role that you’re in today?

Katie Davis:

Sure, so I would say my career path started in high school when I would just go visit nursing home residents. My mom would give me money to go to the county fair and go buy some carnations and roses, and I’d just go and visit.

And at the time I didn’t know I had such a love for seniors, but I think now fast-forwarding to college, I was a nursing assistant at a memory care, and then I started with Good Samaritan as an administrator in training at our Luverne campus. Was there for a little bit. And then my first role was in Austin, Minnesota, serving as an administrator. And I was there for a few years.

I then transitioned to our Albert Lea location, and I was there for about 11 years serving as the licensed nursing home administrator. I then had the opportunity to serve as a senior director for Minnesota. And I got to partner with all of our Minnesota leaders and directors of nursing. And then transitioned to the vice president of Minnesota, where I had the opportunity to focus on strategy and goal setting.

And now I’ve been in South Dakota, vice president for here the last couple months and have got to have the opportunity to work with our South Dakota/North Dakota leaders. So yeah, lots going on for the past many years, but it’s been really fun.

Aimee Middleton:

I love that. I love your career and how many places you’ve had different spots and maybe said differently. I love all those people that have gotten to experience Katie. Because to tour with Katie or to be with Katie is a unique experience. She is so present, always. Always knows people’s names, knows a little bit about them, and I can’t help but thinking all those people that have been impacted by you over those years, Katie, because you’re pretty awesome.

Katie Davis:

Oh, thanks, Aimee. Yeah, they certainly have had an impact on me, and I wouldn’t be where I am today without those leaders teaching me and leading me also.

Aimee Middleton:

Stephanie, how about you? What drew you into a career in senior care, and maybe add what’s kept you in it?

Stephanie Uhrmacher:

(Laugh) So I actually did not expect to go into senior care. I think I was a little different. I met my husband and had to move. He was a farmer; he wasn’t moving. And so I started looking, and I was in human resources at the time and took this job, and I was just so surprised at the diversity that senior care offers. I thought at the time, oh, it’s mostly medical, right? You think of nurses and med aides and CNAs, and really it’s so eye-opening. They have a role for everybody. There’s every job. And so I love that.

I think what keeps me in it is, again, going back, I just truly feel like Good Sam is a family, and they treat me like a family. And I don’t think you can say that there’s another company that has 50,000 employees and, you know the chief operating officer, and the chief financial officer, and the president. And they’ve come to your campus, and they know you, and they know your team. And that’s what keeps me there every day. My team, the family, I just truly love it. The residents, they become your family.

Aimee Middleton:

I really love that our family is one of our new values that we added to our overall mission statement. And I think that speaks exactly to it. We are a large family and serve each other and in so many different ways, and it’s refreshing to hear it from a leader as well. Katie, how does your job look different today than when you started? Is there a few differences that you’ve experienced?

Katie Davis:

Sure, yeah. I think, you know, looking back on 2009, the first thing that comes to mind is the just technological changes. From the 20th to 21st of the month, we get this big old packet in the mail of a thousand sheets of paper with your general ledger, your accounting statements, your staffing statements, your income statements. And we get this big old pack of documents, and that is how we would view our operational financial statements. And so that was always a big day to get the mail that day.

Same with the medical records. Everything was on paper back when I started. And now to think about having everything on paper would be a big old mess. But I think also, you know, in regards to service lines now, I would say there is such a big focus on home and community based services. And back in 2009, I would say there wasn’t a big emphasis. I think people want to stay in their homes; they want to do things in their homes as long as possible. And so we certainly see a bigger emphasis on HCBS than we did way back when I started.

Aimee Middleton:

Katie, I’ll stay with you here for a minute. Do you think that your role as a leader extends beyond the team that you directly serve? And maybe how does mentorship play into that as well?

Katie Davis:

You know, in my role I am always seeking out the employees who are wanting to grow their career. So maybe it’s a CNA to a nurse, maybe it’s a nurse wanting to be a DNS. Maybe it’s an administrator wanting to move to a senior director. So, always in the back of my mind of finding those employees who want to grow and who want to grow with our organization. So, I think inadvertently that’s always on the back of my mind is who is the next leader in our organization?

Aimee Middleton:

Stephanie, what qualities or strengths do you lean on that help you the most in your role today?

Stephanie Uhrmacher:

So, our Good Samaritan really dives into StrengthsFinder from Gallup, which I love, by the way. If you haven’t done it, you need to do it. And I’ve been doing it longer than even through Good Sam. So I definitely think my deliberative, which means you ask the “what if?” all the time. So, what is coming? What are these outcomes going to mean? You’re trying to perceive what will happen all the time, constantly.

However, that can hold me back. And so strategic is the strength that makes me finally make a decision. Like, yes, these are all the outcomes, but now we need to move forward, and what are we going to do here? So definitely those two.

Aimee Middleton:

So having both is probably kind of actually a unique combo I would say too, but also helpful. Do you ever feel yourself fighting with the two sides?

Stephanie Uhrmacher:

Yes, the deliberative I’ve really had to overcome. Like as I’ve gotten farther into my career, I’ve had to say, OK, yeah, you can think about all of these different outcomes, but that doesn’t mean they’re going to happen. And it’s still a good trait, but you have to just overcome that at a certain point. And so I’m glad that you can grow in your strengths as well.

Aimee Middleton:

Yeah. Absolutely. Well, WOO, it’s actually my top strength, and it’s “winning others over,” and that’s why this event to me is so energizing because in my role I don’t always get the opportunity to be with these leaders on a regular basis. And so I will woo this crowd like no other for the next week. And I love that too. So, it’s a great tool to use, and I’ve found a lot of benefits in it as well.

Tell me a little bit about what it’s like working in a rural area and maybe how that has shaped your leadership journey.

Stephanie Uhrmacher:

Absolutely. So I think working in a rural area really has shown me what it means to build relationships and why they’re so important. I honestly have to be honest, I grew up three hours west of Hastings. I didn’t even know Good Samaritan Village existed. And it’s funny because there’s 600 seniors there. How do you not know it existed?

But my mom, when I told her I was interviewing, she was like, “Oh yeah, your great-grandma lived in one of the garden apartments.” And I’m like, really? And then I get there, and my aunt calls and she’s like, “Hey, your great-aunt is moving into the assisted living.” And then my father-in-law says, “Oh, I used to mow my great-grandma’s lawn there and all her neighbors’.” Because at the time we didn’t mow, I guess.

And so it just is that realization that somebody is probably going to need your services or that care at some point. And we joke that everybody has a connection to Hastings Village. And remembering that and building those relationships so people feel comfortable coming to you. And I think that’s just so important in relationships.

Aimee Middleton:

Yeah. I can’t help but go back to your statement earlier about family, right? It’s all one big family. Katie, how about you? What do you think are some of the advantages of being a rural provider?

Katie Davis:

Yeah, you know, I would say in our North Dakota/South Dakota region, a majority of our locations are very rural. In towns of 800 to 2,000 people. And I think those locations really get to experience the support of the community. Usually the main organization in town, everybody knows the administrator, everybody knows the nurses, the community shows up for events. So it is fun to really be part, I think, of a community for that location.

Aimee Middleton:

Yeah, awesome. Again, back to that family, right? One big family. Stephanie, I’ll start with you on this one. What’s an example of an impactful moment with a resident or a patient, a family member, or a team member you will just never forget?

Stephanie Uhrmacher:

So I will never forget it but my maintenance director, he just retired this year, but he had worked for us for 42 years. And in those 42 years, we have a diner on campus that everybody in the community comes, like, that’s where you eat lunch and breakfast. And he would go every day and sit down with the residents and eat. And again, it’s building those relationships.

And he noticed one day one of the (independent living) residents that he usually always saw was missing. And so he stopped eating lunch, and he went over there like, “What’s going on? Why aren’t you here?” And he had fallen. And thank God Bob noticed, and he was able to get him the help he needed.

And that resident ended up using our continuum of care, and he moved into the assisted living, and he’s just thriving there. It just is really what he needed – somebody to notice him, to care. And now he still gets to go to the diner and be a part of all the activities and see all of his friends. But it just took Bob, again, building that relationship and noticing that he wasn’t there.

Aimee Middleton:

That’s a really awesome story. And I bet not only you will never forget that, but Bob probably won’t, the resident won’t. I would imagine that it impacted other team members too, on just that importance of paying attention, so that’s awesome.

Stephanie Uhrmacher:

Absolutely, yeah. The other team members, I mean, we still talk about it to this day, how much we want to be like Bob.

Aimee Middleton:

(Laugh) I like that. I had the pleasure of knowing Bob as well, and I love that. Be like Bob. (Laugh) That’s a great — something to achieve. (Laugh) Bob was pretty wonderful. Katie, how about you?

Katie Davis:

You know, I think it’s always amazing to see the final outcome of financial gifts being given to a location. And we recently had a family member donate a goat to one of our locations. At this location, there’s a courtyard that houses goats and chickens, and a particular resident loved, loved goats.

And so, this family member decided to purchase a goat and give it to the center along with all the food and the love and joy and laughter that resulted from the financial giving of this animal that residents could enjoy was just tremendous. And that lasted many years, or many summers, I should say. And it’s fun to see those generous donors being so generous and giving of their tithes.

Aimee Middleton:

Yeah, that’s a great example. I love the goats. I feel like you have these many farms in many locations, Katie, because I’ve heard you talk about goats and chickens.

Katie Davis:

Yeah, yeah, they’re just — they’re kind of all over the place, yeah.

Aimee Middleton:

(Laugh) I love it. But I bet that brought a lot of joy to those families and those residents. That’s awesome.

All right. For both of you, what does a Sunday night routine, what does that look like for you, and how does it help you prepare for a busy week? Maybe Katie, I’ll start with you.

Katie Davis:

Sure, I would say by the end of Sunday evening, I have a lot of Legos around my house. I have a lot of Nerf gun bullets, so definitely picking up and cleaning on Sunday. But my husband and I like to host. And so actually, Sunday evenings we oftentimes will have friends over for dinner together as a way to end the weekend and as kind of a fresh start to the week, get to converse, and have some good food. My husband loves to cook. He loves to smoke meat. So, that’s kind of what we’ll be doing on most Sunday nights.

Aimee Middleton:

Stephanie?

Stephanie Uhrmacher:

Mine’s a little more boring, but yes. Picking up, resetting the house, making sure meals are prepped. I have one daughter that’s in seven dance classes, so talking about the schedule, making sure we know where everyone is going. And then my husband and I take time to just have our time on Sunday after we get the girls to bed. So, that’s important to us. And then last thing, I always check my calendar, make sure I know what’s coming on Monday.

Aimee Middleton:

Oh, that’s good. That’s good. Yeah. I like to call my Sundays “selfish Sundays” because I like to be most selfish on that day. I want to do things for me. I try really, really hard not to check my email or to do any work if I can. And just really just take that time with my family.

And I too, like Katie, when I’m back in Nebraska, I take the opportunity to have the kids over, have a little bit of a meal, and just some relaxation. But that’s still me being selfish because I have a one-year-old granddaughter, and that’s a way that I get to see her for a little longer (laugh). And she’s mine (laugh).

Katie Davis:

So fun.

Aimee Middleton:

Alright, how about, what are your go-to books or podcasts here lately? Steph, you want to start there?

Stephanie Uhrmacher:

Sure. So right now I’m reading “Raising Worry-Free Girls,” which I think is an awesome one. My go-to podcasts or books, anything by Tony Robbins. I had the opportunity to see him in person, and it was amazing. Life-changing. And so I’ll always listen to his stuff. And then one, you have to watch the language, but it’s a fitness podcast, Jordan Syatt, and he’s just an awesome wellness fitness podcast person that I listen to right now.

Aimee Middleton:

That’s a good, nice variety of things (laugh). Katie, how about you?

Katie Davis:

Yeah, so I’m not a reader, but I do listen to podcasts as I’m traveling, and a few of them, parenting — any parenting podcast, I’ve been listening to some on tantrums and how to deal with 3-year-olds doing tantrums. I’m also into making artisan bread right now. So there’s some couple podcasts that are teaching me some various recipes. And so that’s been fun. I like to make different mocktails and cocktails, more recipes, I guess podcasts. So, between bread and wine and kid tantrums, those would be my top three.

Aimee Middleton:

(Laugh) I feel like those are semi-related somehow as well.

Katie Davis:

Yeah, it could be. Yes.

Aimee Middleton:

I love it. I love it. All right. How about a piece of advice that has shaped you, and how would you pass that forward to women entering our industry?

Stephanie Uhrmacher:

I had a wonderful leader named Marge Beatty, and she told me to make sure you’re always doing what you love. And the way that you can tell is mark every day on your calendar, an E, a G, or a Q, so excellent, good, or quit. And if you’re having a bad day, you go back and you look: did I have mostly E’s and G’s? Then, it’s not really that bad. Like, you’re just making this moment bad, but it is not a bad place, or it’s not a bad day or whatever.

If they’re mostly Qs, then it’s probably time for you to move on. And you need to make sure you’re where you love, and doing what you love and that’s OK. Change is okay. And so I’ve always just carried that through to people that are working with me as well. Because one person can just bring down that team, and you want them to thrive. Everybody has a place. And so making sure they have the right place and telling them that, that’s OK.

Aimee Middleton:

I love that. I love the reflection of it. And, because you’re right, we sometimes just have hard moments. But it doesn’t make for a really bad day. And if most of them are excellent, then that’s a good sign. I love it. Love it. That’s a great piece of advice. Katie, how about you?

Katie Davis:

Yeah, so you know, Aimee, there was a point in my career where I made a job change. And during that period of the job change, I was just working some crazy, probably unhealthy hours just to try to wrap my arms around a new job. And about two weeks into that, I got a call from a leader, and she said, Katie, you got to get some rest. And when she said rest, she didn’t necessarily mean sleeping or napping, but she meant more my personal well-being.

And as a result of that, I now include those three words into every weekly update that I send to my administrators and directors of nursing, telling them to get rest. Every Friday they get a note from me saying, “Get some rest,” with the intent being to take care of their personal well-being.

Aimee Middleton:

I love that. And I love the intentionality of passing that on to others as well, because I do think most of us in this industry, it’s a 24/7 business, so it is real easy to work 24/7. There’s no short list of things to do, right? But I love that intentionality that you pass on to your leaders as well.

My piece of advice for me was given to me by my grandmother, and she did own this phrase before Nike, but her phrase was, “just do it.” In fact, she saves her license plate from that year because she had a personalized license plate that said, “just do it.” And she saves that just to prove that she had it before Nike did it.

But to me what it means is don’t take too much time to deliberate; just do it. If it’s something you believe in and it’s something that you really feel is the right move, just do it. And that has served me well in a lot of different areas as well. And I would pass that on to leaders. You know, as I’m talking through a decision, oftentimes I’ll know what the decision they want to make. Just do it. You know what’s right.

Katie Davis:

I think, Aimee, you’ve probably told me that before. I think I’ve heard those words from you.

Stephanie Uhrmacher:

Me too.

Katie Davis:

And it’s been helpful to say, “Yep, just do it.”

Aimee Middleton:

Yeah, yep, yep. So that sticks with me (laugh). All right. How about if we had a magic wand and you could solve one industry challenge today, what would it be? Steph, you want to go first?

Stephanie Uhrmacher:

I would say providing accessible and affordable care and housing to all seniors, everybody that needs it. And I think especially for our campus, we’re always trying to bring different services and new things and to make sure that they have everything they need on campus, make sure they have all the activity. So, we have a clinic, and a spa, and we want to do a pharmacy. So it’s all right there. And I just wish that we could get it to everyone that needs it.

Aimee Middleton:

Yeah. I love your just do it attitude from there, because you’ve done a lot of work to add those other things to campus to really help drive down the costs of the campus to make it more affordable. So I love that you’re already working. Maybe your wand isn’t magic, but you’re already working that magic in some ways on your campus. Katie, how about you? What’s your magic wand going to do?

Katie Davis:

You know, I think our profession is just filled with so much love and joy and laughter each and every day. Though in the media today, sometimes it is infiltrated with negative stories and negative experiences. Good Samaritan and Sanford I think does a tremendous job on sharing positive stories, sharing positive experiences.

But I think as stakeholders of senior care, we all have to share those positive stories, those positive things happening in our locations. And we just need to continue to be really, really good advocates of senior care.

Aimee Middleton:

I love that magic wand for all of us.

Stephanie Uhrmacher:

Me too.

Aimee Middleton:

That would be awesome. For people to really just see how awesome senior care really can be. All right, well, we’ll work on that (laugh). All right. Final and last question here. What excites you most about the future of senior care?

Stephanie Uhrmacher:

For me, it’s the seniors. So, they’re just so fun and fresh, and they want a ton of activities, and they want to do a bunch of physical things, and they want to play pickleball. And so I’m excited to give them all those opportunities and let them have that community that they’re so wanting and needing right now. I’m just excited for that.

Aimee Middleton:

Yeah, that’s awesome. Katie?

Katie Davis:

Well, senior care is not going anywhere. We’re going to be here for a really long time, but I think some of the technology changes, you know, virtual care is coming. There’s always going to be something new down the pipeline. And 15 years ago, when I started as a nursing home administrator, I would’ve never even thought about virtual care. And now we’re to the point where that’s going to be integrated into our system. So I think just the technology and just the nuances that are continuing to come here the next five, 10, 15 years.

Aimee Middleton:

Yeah, I would agree with both of you. I feel a renewed sense of making senior care a little bit different here lately, and I’m excited about what that future looks like. I think these residents of tomorrow are going to demand more. They want to be that active resident, they want to live their life to the fullest, and they’re not going to accept anything less.

But I also see it on the team member side, in that team members are wanting to be creative in this generation of wanting better work-life balance and better life for all.

We’ve had the opportunity to have an Administrator in Training program for some time, and the ideas that these administrators in training are coming up with to just do things differently, to communicate to team members differently, to communicate to residents differently – I’m inspired by what they’re going to bring to our industry as well. So, I think that’s what I’m most excited for.

Well, ladies, thank you so much for joining me on this podcast today. It has been so much fun to get to know both of you a little bit better.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series wherever you get your podcasts and at news.sanfordhealth.org.

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Eat this, not that, to avoid inflammation

Natasha Hansen:

You’re more prone to inflammation as you age. So probably the older population is going to suffer from inflammation. Again, that pain, joint stiffness, things like that. But again, the younger population, especially those who are more active, are just going to constantly be having inflammation going on as well.­

Courtney Collen (host):

Welcome to the “Health and Wellness” podcast by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. Our conversation today will dive into why we experience inflammation, what it is, and some of the best anti-inflammatory foods to help us avoid it. Natasha Hansen is the senior sports dietitian here at the Sanford Fieldhouse in Sioux Falls, South Dakota. Natasha, welcome.

Natasha Hansen (guest):

Hi. Thanks for having me.

Courtney Collen:

We’re so glad to have you and your expertise here. One thing I’m learning about inflammation, whether you can feel it or not, it can affect everyone. Is that right?

Natasha Hansen:

Oh, absolutely. Some — and honestly, sometimes inflammation’s a good thing. If there’s, like, acute inflammation, there’s chronic inflammation. So, acute inflammation, like, if you’re starting to feel a cold coming on —

Courtney Collen:

Yeah.

Natasha Hansen:

Your immune response will kind of flare up, and that’s what that inflammation is, and that’s a good thing, right? We want our immune system to kind of respond to that.

Courtney Collen:

Sure.

Natasha Hansen:

Once it becomes chronic, that’s when, you know, certain infections, it can maybe not be such a good thing, but inflammation to some degree can be a positive thing.

Courtney Collen:

OK, I’m so glad we led off with that. I want to dive into this. What does it actually mean in the body? Like, specifically that chronic inflammation, what causes that?

Natasha Hansen:

Certain diseases are going to cause chronic inflammation. A lot of GI diseases. If there’s inflammation in the gut for a prolonged period of time. Like I said, infections, you know, once it becomes from sickness to infection and those antibodies kind of start attacking your immune system, that’s when it’s maybe not such a good thing.

Courtney Collen:

So, how do I know if I have inflammation? Like, what are some of the signs or symptoms that I might be experiencing?

Natasha Hansen:

Yeah, you might start to feel a little sore and stiff. You might have some skin issues, maybe even some, like, brain fog. Honestly, even just like working out, that’s naturally going to cause some inflammation. So, like, if you’ve ever felt super sore after a workout, that’s just because your muscles are inflamed. So, again, that’s more of like a positive thing. So, we always have some sort of inflammation in our body going on.

Courtney Collen:

Fascinating. Who suffers from inflammation the most, and is it more males, females that you see? Like, what can you tell us about maybe any specific age group or things like that?

Natasha Hansen:

Yeah, not necessarily, just because there’s so many different types of inflammation. I will say you’re more prone to inflammation as you age. So, probably the older population is going to suffer from inflammation. Again, that pain, joint stiffness, things like that. But again, the younger population, especially those who are more active, are just going to constantly be having inflammation going on as well.

Courtney Collen:

OK, so aside from age, are there lifestyle factors that can contribute to inflammation? And let’s talk through some of those.

Natasha Hansen:

Yeah, one thing actually what I thought of was just stress. So, like your daily stress. So, we all have some stress in our life, right? And so it kind of depends how well you’re able to manage that stress for that inflammation. So, chronic stress, if it’s not managed well, can cause that inflammation. Also, just like obesity, smoking, excessive alcohol intake, your diet — there’s certain foods that can cause inflammation. And so there, yes, there’s certainly a lot of different lifestyles that can cause that inflammation to happen more often.

Courtney Collen:

Sure, well, it sounds — chronic inflammation sounds super uncomfortable, and I’m sure that the people who suffer from it the most probably are thinking about ways they can combat it or ways that they can alleviate it.

So, let’s shift to food. Because I want to dive deeper into the kind of nutrition that can ultimately help prevent inflammation. But first, Natasha, I want to start with what foods cause inflammation. Like, what are some of the things that we’re eating every single day that we may not know, or maybe we do know, that would be contributing to inflammation in our bodies?

Natasha Hansen:

So, excess sugar, specifically added sugar. So, if you’re looking at a nutrition label, there’s sugar, and then there’s added sugar. So, you want to specifically look at that added sugar, and you want that to be low. It really depends what kind of food you’re looking at. But, like, any, anywhere between five to eight grams or less would be ideal.

Processed foods — so, there’s a lot of meats that are highly processed. So, you have hot dogs and bacon and sausage, even some deli — like prepackaged deli meats are going to be a little bit more processed than if you were to go up to the counter and get some deli meat from the deli station.

Certain fats, so, like, your saturated fats are going to be — your trans and saturated fats are more of your unhealthy fats, which are going to be like butter. A lot of foods that taste good, unfortunately (laugh). But, you know, anything that has butter in it. So, like your sweets and treats. Again, certain cuts of meat where you can see the fat that’s going to be like your saturated fat. That’s the difference between, like, skim milk and whole milk. Certain condiments like ranch, mayo, alfredo, cheese have a little bit of saturated fats, so —

Courtney Collen:

Oh, not the cheese.

Natasha Hansen:

I know, right? So, pizza, my weakness. And it’s not like you must completely eliminate sugars and processed foods and those saturated fats, but it’s about making sure you have a good balance and you’re watching that, and we’re not going in excess in those types of foods. Also, like refined grains, so, like, white grains versus your whole grains. So, white pasta, white bread, white rice versus, like, your whole wheat pasta, bread, and brown rice. Those are going to be — the white grains are a little bit more refined and processed.

Courtney Collen:

So, what I’m hearing, some added sugars, processed foods, trans-saturated fats, refined grains, and more can contribute to inflammation. So, let’s shift now and talk about some of the foods that we should be focusing on to help alleviate, relieve some of maybe the pain associated with inflammation or just help us kind of live healthier. Talk about some of those foods that you point to most.

Natasha Hansen:

I kind of mentioned that choosing more of those whole grains but then also, like, fruits and vegetables that are a little bit higher in fiber are going to be important just for that gut inflammation. You have, like, your healthy fats.

So, I kind of mentioned some examples of those unhealthy fats, but healthy fats are found in fish. So, especially salmon’s going to have some good healthy fats, nuts and seeds and avocados and olive oil are going to be some good healthy fats that help reduce inflammation. Antioxidants, so you have like vitamin A, vitamin C, vitamin E that are antioxidants. And so trying to have foods that are a little bit higher in those antioxidants just kind of help protect our cells from that inflammation.

Courtney Collen:

And there are so many good, healthy, rich-in-nutrition foods out there, like avocados, salmon, like some of those you mentioned. I love those too, like with pizza as well. You know, everything in moderation, right?

Natasha Hansen:

Yes, absolutely.

Courtney Collen:

So, are there any specific anti-inflammatory diets that you recommend for patients, or diets that would be helpful for people to focus on?

Natasha Hansen:

So, the Mediterranean diet’s high in those healthy fats. And it also, what I really like about the Mediterranean diet is that you’re not eliminating any specific food group. Like, there’s a lot of fad diets out there where it’s like don’t eat carbs or don’t eat, you know, animal proteins or whatever it might be.

So, you’re not completely eliminating any food groups with the Mediterranean diet, but you are eating foods that are higher in those healthy fats and then higher in fruits and vegetables, and then also just, like, you know, limiting alcohol is part of that Mediterranean diet as well.

Courtney Collen:

Yeah, absolutely. With nutrition, I hear a lot about fermented foods, probiotics. How do some of those help with that gut inflammation?

Natasha Hansen:

You know, probiotics is kind of a buzzword. There are supplements that are probiotics, but then we can also find probiotics in our foods. So, like you mentioned, any sort of fermented foods, but like yogurt, kefir, sauerkraut, miso, those are all going to be naturally occurring fermented foods, right? So, you’re going to be getting those probiotics naturally.

You could also take some sort of probiotic supplement too. I personally take one. I don’t like to give blanket recommendations for people to take one, but I have found that I really, I have noticed a difference from taking a probiotic. But I also try to increase my foods that have naturally occurring probiotics in them too and not just rely on my supplement.

And then there’s also, like, certain spices that can naturally kind of help with that inflammation too. So, you have like turmeric, cinnamon, ginger, so just kind of — there’s supplements out there like turmeric supplements. I don’t always recommend that because you can kind of overdo it too. But just season, you know, or adding some spice of turmeric to your food. Or ginger or adding actual ginger to your food too. Garlic is another one that can just kind of help naturally with anti-inflammation, and so just kind of seasoning your food with those spices can help too.

Courtney Collen:

Yeah. You can really get creative with some of those ingredients, you know, maybe skip the supplements, the pills, the things like that. But maybe just adding a little bit, find a fun recipe, add some chicken, you know, it’s really simple to do some of those things and —

Natasha Hansen:

Exactly. And if you’re just adding a little bit, sometimes you can’t even really taste it too, like maybe you’re not a big turmeric fan, but if we’re just kind of adding a little bit here and there, probably not going to be able to taste it a whole lot. Plus, our nutrients from our food are better absorbed from nutrients in a supplement, and so that’s why I’m always kind of pushing food first.

Now, if we get any blood work or lab values back that are deficient in certain nutrients, that’s when I might recommend a supplement. Or if we are having specific gut health issues, right? But I’m always going to push food first just because those nutrients are going to be better absorbed.

Courtney Collen:

Are there other treatment options outside of nutrition that could help someone suffering from inflammation?

Natasha Hansen:

Yeah, so even just exercise. So, I mentioned exercise causing inflammation but remember that’s the acute inflammation. That’s actually a positive thing, right? So, regular exercise, plus that can help manage that stress that I mentioned too. So, the recommended amount of exercise is 150 minutes of, like, moderate intensity. So, that’d just be like brisk walking. Or 75 minutes per week of more intense activities. So, like running and weightlifting. So, that can help that inflammation.

Also, just like adequate sleep. So, sleep, I mean, sleep affects everything, right? Sleep affects the food — types of foods we crave, our appetite, it affects our mental health, stress. So, make sure that we’re, you know, getting consistent sleep.

One thing I always say is it’s all about consistency. So, I’d rather have somebody consistently getting six to seven hours of sleep versus on the weekends getting like four and then during the week getting like 10, you know? So, it’s about consistency as well. And that’s with everything that I mentioned.

Consistency in exercise, consistency in sleep, consistency in nutrition. So, kind of maintaining that consistency. And then mentioned earlier, you know, avoiding smoking, limiting alcohol, those types of things too are going to be important.

Courtney Collen:

You know, when you’re working with patients, athletes here at the Sanford Fieldhouse, how do you find that inflammation affects athletic performance?

Natasha Hansen:

Yeah, so if we have a lot of inflammation that we’re not able to kind of control, the athletes that I work with are going to be really sore day to day. So, that inflammation to some degree again is good, but if we’re not able to recover from our workouts from day to day because our muscles are so sore, aka, they’re super inflamed, right? We’re at a higher risk of injury; we’re probably not making the muscle gains that we want. We might be losing muscle strength because we’re not having that energy for the next day to be able to have another good workout, right? We’re just kind of falling behind if we’re continuously super inflamed and then we’re not able to control that inflammation.

Courtney Collen:

So, with that acute inflammation that comes a lot of times with just being active and exercise, are there things that can help in recovery for those, like adequate stretching? You know, think like all ages, you know, not just specifically athletes here at the Fieldhouse that you work with, but, you know, somebody in their 40s, 50s, 60s that might run a couple of miles a week, or walk daily at an incline, or whatever it may be. You know, how can they relieve some of the inflammation that comes with maybe soreness, things like that, and kind of help aid in that recovery so that they’re even stronger the next day to go at it again?

Natasha Hansen:

Yeah. So, regardless of age or athletic level, making sure that we’re stretching and sleeping is going to be super important. But kind of circling back to nutrition, having a good recovery nutrition plan is going to be super important. So, it kind of depends, like, how intense, you know, if you were just walking or if you were jogging, right? And the duration of that too.

But always having some sort of meal or at least a snack within an hour after any sort of activity is going to be super important. Number one to just get the nutrients that we need and refuel that energy that we kind of used. But then also we want to recover that muscle as quickly as possible. So, carbs are going to be the number one energy source for our muscles, and then protein’s going to help recover the muscles.

So, I always say after any sort of training session, making sure we’re getting carbs because we just use up all our carbs for energy, but then also getting some protein in so that we can start that recovery process of the muscle as quickly as possible.

Courtney Collen:

Sure, so really not all inflammation is bad. I mean we talk about again, acute, chronic, but to some degree we want a little bit of the acute inflammation from exercise primarily. Is that right? So, not all inflammation is bad, Natasha?

Natasha Hansen:

Correct. Yeah.

Courtney Collen:

OK, good to know. If somebody has a question about inflammation in their body, wants to maybe find those personal solutions that could help them achieve their goals, where would you suggest that they start?

Natasha Hansen:

Yeah, I think if we’re starting to see symptoms that are past, you know, comfortability, right? That might be more of those chronic inflammation signs. So again, like that joint body — continuous joint body pain, fatigue, skin issues, digestive issues, bloating, gas, constipation, diarrhea, right?

If we’re starting to kind of cross the line, I would definitely go to your primary care physician first just to kind of — maybe you need to get some lab values kind of checked out, just make sure everything’s kind of working properly. And then you could look into your nutrition too and just kind of see if there’s any areas that maybe you could improve upon.

Courtney Collen:

Thank you. OK. I learned so much (laugh).

Natasha Hansen:

Good. I love that.

Courtney Collen:

And yeah, you are just a wealth of information here when it comes to inflammation and how to prevent it. And we are so grateful for your insight and your expertise. Natasha Hansen, thank you so much for your time and for being a part of this conversation.

Natasha Hansen:

Yes. Thanks again for having me.

Courtney Collen:

This episode is part of the “Health and Wellness” series by Sanford Health. You can find any of our Sanford Health series wherever you get your podcasts or by visiting news.sanfordhealth.org.

I’m Courtney Collen. Thanks so much for being here.

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Addiction recovery digs into causes, healthier responses

A note for our listeners: This episode includes descriptions of drug use and gun violence and may at times be too intense for some listeners. If you or someone you love is facing addiction, call the SAMHSA National Helpline at (800) 662-HELP (4357) or visit Sanford Health addiction treatment.

Cat Sonneman:

The hardest part of addiction is believing in yourself. And you shame yourself. You shame yourself every single time. Every single time you fall, you shame yourself, or society shames you. And that’s complete wrong way to go about it, to approach it, to look at it. And lots people don’t realize the certain things they might say are actually making that person feel shame.

Courtney Collen (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is a discussion about addiction and alcohol recovery. Our guests are Cat Sonneman and Sam O’Hern, a licensed addiction counselor at Sanford Health Park Rapids Behavioral Health in Park Rapids, Minnesota. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Thank you for joining us on the “Health and Wellness” podcast. Our topic today is addiction and overcoming addiction, and as we talk about this topic today, first of all, let me tell you, in this story, this is a story where there is joy and hope on the other side of addiction. There is possibility. And to get to that though, we need to start where it all began. For a wonderful person named Cat. Cat, introduce yourself please, and let’s tell us your story, and where does it begin?

Cat Sonneman (guest):

Caitlynn Sonneman, Cat. Well, for me, it was inherited. Like, I grew up in a very toxic, addicted family.

Alan Helgeson:

Give us a behind-the-scenes look at what that was for Cat and your family.

Cat Sonneman:

For me, it was — it was crazy growing up. All I knew was crime, drugs, every single night. Ever since a toddler, I’d always had one like nip of blackberry brandy before bed because I didn’t go to doctors or anything, so I was undiagnosed autistic and stuff. And from very early on you use, you learn to use a crutch just to go to sleep, or calm down, or have your family be able to stand you.

When I finally went out in the world, it was like culture shock. It was nothing. The world, the real world, of what I thought existed and the real world were completely different. Which also drove me into using more drugs, different kinds of drugs, because I was trying to find my way, if you will, in a world that I didn’t know existed.

Alan Helgeson:

In your life, Cat, you talk about being in a family where this was present all the time. Talk about your social group friends. Was that the lifestyle that was around you as well?

Cat Sonneman:

I didn’t have anybody that I would consider friends until I was probably 14 or so. We were really secluded from the outside world because we were always told cops, social workers, they’ll take you away. You’ll never see anybody ever again. So, we were coached and talked to about how to talk to people in the outside world so that they wouldn’t know what stuff really looked like.

Alan Helgeson:

So, beyond the addiction, what sort of feelings did that give you?

Cat Sonneman:

Just alone. I was always alone. Even when I was a kid, I was alone. I’d wake up alone. I still remember the panic of waking up alone and nobody being in the house. Not being able to have friends. Like, my sister was my best friend because she was in the same house. So, just alone.

Alan Helgeson:

Can you share what, maybe, a normal day was like for you? What an average day was like for you as a teenager?

Cat Sonneman:

As a teenager (laugh), I had left the house when I was 14. So, as a teenager, I went down to Florida. I had people who took me in right away, but those ended up being very crooked people, and that’s where my whole criminal lifestyle really took off. So, as a teenager, I was constantly dealing with violence. I was constantly dealing with just everything hectic. The world was constantly spinning. I got shot for the first time. My teenagehood, my first look on the world was very dark, grim place. And I learned right away that nobody could be trusted.

Alan Helgeson:

When did you first realize that what you were living in was an addiction?

Cat Sonneman:

That’s kind of hard to answer because there’s a point in your life where you kind of realize that you’re not in control anymore, that you have an addiction. But it fools you after that, just basically telling you that everybody else is trying to control you, that you know what you’re doing, that you need it.

And so it wasn’t until probably a decade after losing my older kids that I finally realized that I was addicted. And I would say that day would’ve been my older kids’ dad. He used to always leave his back door open for me, and I would come stumbling in there. He was a complete gentleman; he was an older man and I would flop down in his bed, completely out it. And he would get up out his bed and go and sit — lay on the floor to go to sleep in front of his TV.

Well, usually I would come in and out of consciousness, and there’d either be food in front of me or whatever, and he would nurse me back to health, basically, and then I would go out on my own. Well, before I had gone to his house that night, I had put an old, clogged needle in a pop can, threw it in his garbage can. Well, when I was recovering, I had ended up begging him to go out and get that pop can so I could fish out — or cut out — the dang needle, and then I took it apart (laugh) and unclogged it so that I could use it. And, I think that at that point in time I realized, wow, this is bad.

Alan Helgeson:

For somebody that hasn’t gone through this or on the other side, this sounds strange to say this: a person needs to hit rock bottom. Is that really a thing? Is that a truth?

Cat Sonneman:

All somebody needs isn’t to just hit rock bottom. There has to be a whole bunch of stuff that goes into it, because you can hit rock bottom a hundred million times. That’s the definition of being an addict is, or, well, being insane, which is also parallel to being an addict is you’re trying the same thing over and over and over again, always expecting different results. So, you’re going to hit rock bottom multiple times.

For me it was lots of the interventions. People don’t realize the small things they say or the small things they do. Even lots of the cops that I’ve dealt with do not realize probably the lots of the little things that were said that had made a difference over years. These little things matter.

Alan Helgeson:

So, you talk about these little things that kind of add up. My next question was going to be, how did you see it at the time? So, that really isn’t a thing, because for you, it was a number of things over time, but what does it feel like to want to bust out of it?

Cat Sonneman:

Out of addiction? I remember the last several, several times getting high. I would hate every single thing about it. I hated the taste. I hated the smell. I hated the people. I hated the way I acted. I hated — there was not a damn thing that I liked about it. I despised everything about it, yet I still had to use it. It’s almost indescribable, but it’s like being at the bottom of the pit and pulling on a rope, trying to climb yourself out. But every single time you pull on the rope, dirt falls in on you. You bury yourself more and more.

Alan Helgeson:

Was that the hardest part of addiction for you? Knowing and realizing you had this and were trying to climb out?

Cat Sonneman:

The hardest part of addiction is believing in yourself. And you shame yourself. You shame yourself every single time. Every single time you fall, you shame yourself, or society shames you. And that’s complete wrong way to go about it, to approach it, to look at it. And lots people don’t realize the certain things they might say are actually making that person feel shame.

And that shame is going to keep you wrapped up in it. It’s going to prevent you from being able to try and get help because you just get to the point where you’re worthless, you don’t deserve it, you’re always going to be a criminal, once a criminal, always a criminal. Because shame does play a really important part in it. I don’t know. I’ll take a break (laugh).

Sam O’Hern (guest):

You’re doing a great job, Cat. You’re expressing all of this in such a way that feels authentic to your story. And also, I’m sure there’s going to be a lot of people that can relate.

Cat Sonneman:

It’s like people always talk about tough love, and that doesn’t necessarily work. In fact, it can hinder when somebody’s first starting to use because tough love makes you, like, you’re already in a place of some type of mental situation, or emotional situation that you’re not dealing with.

And then somebody comes along and tries the tough love approach, and there’s good ways and bad ways to use it. Just kicking your teenager out or something like that because they’re using drugs is a horrible idea because there’s always going to be a gang or some drug that’s going to take them in.

But at the same time, if somebody I knew was severely addicted to drugs and they were in jail, I would leave them there. As much as I need to say it, I’d leave them there. Because literally the first thing in your mind when you get out of jail is, I need to use. I need to use. I need to use. And the longer you’re in there, the more that fate.

Alan Helgeson:

For somebody that doesn’t understand addiction, I’m going to ask in a different way to help. Can you explain what addiction feels like to someone who doesn’t know or can’t relate?

Cat Sonneman:

It’s like having an idol. It’s like having something that completely controls your life. You do not have your own life anymore. You are not in control of your life anymore. There’s something — it’s like a parasite. Something else is completely in control. And when you try to, like, let’s say compare it to cigarettes or caffeine, someone who drinks caffeine every single day and then they don’t drink caffeine one day and they’re completely out of it. They can’t function; they can’t find anything, they’ve got a headache all those things, and it’s multiply it by a lot.

Because even in addiction, it’s really weird that while you’re high, you might put something somewhere, but then when you’re sober, you can’t remember where you put it. It’s almost like there’s two different brains: the sober brain and the addicted brain.

Alan Helgeson:

Next question I want to move on to, Cat. And this isn’t only about addiction, but whenever somebody’s going through something, there’s always that somebody that says they understand what you’re going through, but they really don’t. Help us from that other side. Someone says to you, I understand what you’re going through.

Cat Sonneman:

When somebody says that, it absolutely pisses you off and upsets you. It is no way going to be looked at as consoling. Even if a counselor tried saying that there is so many people that will flip out on a counselor that I’ve known, that I’ve seen real life, because the counselor had said something along the lines of, I know what you’re going through. And they had no clue.

And then I’ve also met other counselors that didn’t want to tell us whether or not they were ex-addicts or not. And I don’t get the point of that, because for some reason, and I’ve talked to several people in treatments about this, when you know somebody has been an addict, there’s just this familiarity with them that you can’t explain.

Alan Helgeson:

Talking about generational cycles, and you grew up in a family and friend group that this is all you knew, but it came up as breaking generational cycles by wanting to be better. Not only for yourself busting out of this, everything that you knew and grew up into, not only for yourself, but also for your kids, your family. Can you go in and explain a little bit about that?

Cat Sonneman:

Simply, I started out my life doing the complete opposite of everything that my mom used to do, just wanting to be a completely different parent than anything that I had seen. And knowing that my whole entire life was not working for me, everything that I remember, everything that I know is not working for me, and just broke me in my soul to the point where I’m constantly reaching out for things that terrify me because I know all of this stuff. Like, I could get shot tomorrow. I’m like, oh, OK, I know what I’m doing. I’ve been shot a couple times.

But, like, when it comes to the fact that I might be going to college this fall, I’m terrified. I’m absolutely terrified. These are all positive things scare the crap out of me. So, breaking the cycle, I mean, being a cycle breaker, it takes a lot.

Alan Helgeson:

Well, everything you’ve talked about, Cat, pretty confident you’ve got this. Just know that, OK? We want to talk now with Sam. And Sam, why don’t you introduce yourself and how you know Cat?

Sam O’Hern:

Yeah, so my name is Sam O’Hern, and I am a licensed alcohol and drug counselor and a licensed social worker. And I practice out of the Park Rapids Sanford behavioral health location, doing outpatient programming, working with clients in a group setting and individual setting. And I also work within the Hubbard County Jail as well to do assessments and treatment coordination, working to get incarcerated populations the support and help that they want or need.

I’ve been a part of Cat’s journey for quite a while now, and I don’t know, Cat, if you want to chime in at any point, you certainly can, but I’ve been working with Cat for over a year. We originally started outpatient together last year. We were doing some virtual sessions together and in my online group that I had. And I’ve just really, I’ve had the absolute honor of watching Cat blossom through this whole process.

I feel like she has shown up authentically in every space that I’ve gotten to share with her. And I couldn’t truly be more proud of the progress that she has made. And like I said, it’s an absolute honor when you get to watch this for any of your clients. I hold a special place in my heart when I get to be a part of this kind of process.

Cat Sonneman:

It makes me feel amazing. But that goes back to, like, one of the last things that I said is that it’s still hard to take praise. Because even praise I’m not used to, and a lot of addicts aren’t used to. And it can almost be uncomfortable, but good. You have something you have to get used to.

Sam O’Hern:

Yeah, it’s a different kind of discomfort, I’m guessing, to sit with. I hope each time you hear it, it sinks in a little more.

Alan Helgeson:

Well, Sam, I want to ask you, are all addictions alike? Talk a little bit about the addiction that Cat has and what makes hers unique?

Sam O’Hern:

Just from my outside perspective, in the time I’ve gotten to share with you, Cat, I feel, like you’ve said, the roots run deep. This is multi-generational. This isn’t just something that you got into in your adult years. This is something that the foundation was really laid out in your childhood and probably even before you were earthside.

There’s a genetic component, and maybe some similarities is that behind every addiction is pain, whether that’s physical pain or emotional pain. And I can speak to almost every encounter that I’ve had. There’s always pain behind that. And I think that Gabor Maté was originally the one to speak to that and be able to safely say that there’s a common thread between all addictions and that pain.

People are unique, just like every client of mine is unique. I think that there’s different drivers behind that pain. There’s different masks that people wear. People are in different places in their journey. Not every addiction is created the same.

Alan Helgeson:

Is there something special about Cat? That her resilience and why she’s doing so well in her recovery?

Sam O’Hern:

Cat has a special kind of hunger. Cat, you have an absolute gift for wanting more information, for wanting to do a deeper dive on anything we speak about or anything that we talk about in group. And I think that curiosity is a superpower for you. I think that that helps to fuel you. And I think that that’s something that is going to carry you through many different seasons of life.

Like you said, you’re starting college possibly soon. And I think that curiosity, that hunger for knowledge, is going to assist you even in college. And I think it’s really helped to carry you through your recovery journey. You’ve always stayed curious with yourself.

Alan Helgeson:

So, Sam, let’s crack open the books here from your education to your clinical expertise. Let’s talk a little bit about addiction and recognizing when things become a concern. Let’s talk about some of those signs and symptoms that people might recognize or I might be able to recognize in myself.

Sam O’Hern:

I tell people this all the time is that we all have a vice. Whether that’s being on our phones too much, whether that’s eating when we get home from a stressful day – that addiction is a continuum. And I think that what I mean by that is it can start out very mild, very innocuous, where you’re maybe reaching for the TV remote more often or you’re reaching for your phone more often. We all have things that release the pressure valve in all of us.

On the other end of the continuum are things that are illegal, things that are dangerous to our own safety or to others’ safety. The thing that I try to keep in mind is — or to relate to my clients or family members is — that when it becomes your orbit, that your world spins around, or it becomes difficult to put that down. That’s when I think there’s just maybe a check engine light that comes on when you notice you’re spending a lot of your time, your finances, your resources. Time is a resource. And I think that when it becomes a main focus, that that’s kind of a, “Hey, what’s going on here?” Something to be curious about, not necessarily judgmental about, but more so curious with.

Alan Helgeson:

So, what can I do? What can somebody do — a brother, sister, a friend? What can we do to help a loved one that we might see struggling?

Sam O’Hern:

I really encourage people, and this is hard when it’s a family member or a loved one, someone close to you, but Cat already did a fabulous job outlining this.

Be curious. Replace that judgment with curiosity as much as you can. Sit and just hold space for somebody. Just listen. I think that our society doesn’t teach us enough how to be a good listener. I think a lot of people have opinions and maybe need to take some time to just listen to somebody that’s struggling.

I think that also respecting that that person that’s struggling is still a human being who needs autonomy, who needs to make their own decisions and their own choices. Forced sobriety isn’t long-term sobriety. Cat spoke to shame and how shame just creates layers of struggle and addiction. And I want to say it’s Brené Brown in one of her books that I read; she has a quote that shame doesn’t create sustained change. Shame just creates really good actors.

Long story short, be curious and not judgmental, and respect wherever that other person is at. Ask for help. You don’t have to be a professional in this. That’s why some of us go to school for this. Ask for help from resources around you, from whoever that person trusts.

Alan Helgeson:

Give us maybe some quick things or guide us. How can we better understand an addiction rather than jumping to that shame thing? And I know that’s not a quick fix, but help us. How can we do that for the long run rather than just the quick fix? Because, you know, you can’t just go, “Do this, and you’re going to be better at it.”

Cat Sonneman:

For me, it’s education in the roots. You got to go after the roots. Like, somebody might walk up to a loved one and say, “What, are you stoned?” Or, “Why are you using that stuff?” Or something along those lines. And accusatory never ever works; it just makes somebody defensive right off the bat. And so if you think somebody’s using, you should probably try and find out the reasons behind it, not focusing on it itself.

Sam O’Hern:

Yes, very well said, Cat. Finding the why. Finding the root ball of the situation is vital. And I think that someone’s not going to let down their guard and tell you why until they feel safe enough to do so. Everyone has a why. Nobody just wakes up one day and decides to use substances or decides to have a behavioral addiction. There’s always a why. It’s fulfilling some sort of need, some sort of unmet need, generally speaking.

Curiosity is just the key. I know I keep saying that like a broken record, but I really think that curiosity, if you can use that and just stay curious. You know, ask someone, “Hey, I noticed that you maybe are smoking more cigarettes, more marijuana, whatever it might be. Are you open to talking about that?” Or, “I care about you, and I just want to hear your perspective on how you feel about this.” Instead of, like Cat said, “Why are you doing this? What’s wrong with you? You were raised better.” None of that works. Better understanding yourself is important too. I think better recognizing your own biases, your own triggers, your own things that make you mad before you work on speaking to that other person is important.

Alan Helgeson:

Well, at the top of the episode today, I talked about what our episode was going to be about, but I also preface things that this is a story about joy and hope in the other side of addiction for Cat. And Cat, I’m wondering if you could tell us about your life now, how it’s different, and where you’re at in life, and how you’re making a difference to others?

Cat Sonneman:

I’m possibly going to school be a probation officer. I feel like I would be able to understand people and — that were in my situation for so long, better than most. It’s like golden sunrise days. I used to always have a dream about golden sunrise days and just the happiness in it. Like, it’s not all rainbows and sunshine. I mean, there’s a lot of crap that stresses me out. And it’s hard because you got to deal with it without a crutch, but it’s rewarding after a while.

You just — the fact that you have control over how you feel, you have control over yourself, is just amazing. And I never thought that I would ever meet my daughter that was adopted out. Now, I get to see her several times a year. Like, I’ve got all my kids back in my life. For the first time in my life, I actually understand that I’m a separate entity, that I’m my own self, and I’m starting to learn who I actually am, which is big key.

Parents, just let your kids be kids and find themselves, because when you try and put them in a box, that’s just a recipe for not good stuff (laugh). I don’t know, it’s like there’s — for the first time in my life, I’ve got a sight on purpose my whole life. I strive for a purpose even before I knew what a purpose was.

Alan Helgeson:

Cat, you talk about kids and how important they are in your life? And we do want to mention that we’ve had kind of a silent added guest in this episode too. It’s your 1-year-old daughter.

Cat Sonneman:

Yep. Which I actually have custody of, which was never supposed to happen again. I was not supposed to have custody of a baby again. Yeah, she’s doing amazing. They actually just closed my case because I willingly opened up a case when I was pregnant with her.

Sam O’Hern:

You way overcome the barriers that were up even a year ago, Cat. I mean, I just, I can’t speak to that enough. You put in the work for this.

Alan Helgeson:

We’d like to ask you, Cat, what is your encouragement to somebody listening that they themselves or a family member or a friend that may have someone that is struggling? What is some encouragement that you would offer? Because I don’t think that I know anybody that might be more suited to offer some great words of encouragement to share.

Cat Sonneman:

If your loved one relapses, the last thing you want to do is act like it’s the end of the world. Just constantly remind them that it’s getting back up that matters. Your loved one’s been sober for three days, and they come home and they’re high, and they’re upset about it, and they’re crying with you, or whatever. Just reassure them that it’s going to be OK. You’re going to get back up.

It’s the stigma towards mental health and addiction. That is the biggest issue. Not being able to talk about it is the biggest issue. Like, I’ll yell trigger in a store, and it helps me release that. But when people expect you not to do that or look at you funny, holding that in, the fact that you’re having a trigger or something, it just festers.

It’s the stigma between mental health and addiction that is the biggest barrier to people getting better.

Alan Helgeson:

Sam, what would you like to say is encouragement?

Sam O’Hern:

I think I would want to remind someone who is actively in addiction that you are worthy no matter what your past has looked like, no matter the things you’ve done to survive. You are absolutely worthy of better days ahead. If a relapse happens, you can get back up again. If you wind up in jail, you can get back out again. The possibilities are endless, even if it feels impossible.

And for someone who has a loved one struggling, just be kind. And if you are at your wit’s end and you can’t be kind, find someone who can. That person needs support and love more than anything. More than judgment.

Alan Helgeson:

Well said both of you. Any last-minute thoughts that either of you have?

Sam O’Hern:

I just want to add as a counselor that we always say we can’t accept responsibility for our clients’ struggles, and we can’t accept responsibility for our clients’ success. And I just want to outline that any client who does really well in residential or in outpatient or with a support group with AA, NA, nobody else can take the credit for that except them.

Maybe they’ve had a more supportive environment that they’ve had in the past, and that is huge. That can make or break recovery. But really, at the end of the day, it’s the work that they’ve put in day to day throughout their week, throughout their hours of each day, that really counts towards that.

Cat Sonneman:

I’ve got a parting message. One really good thing about the Sanford treatment centers is that they’re more so of like a harm reduction. And I think that that is definitely the approach that all treatment centers should take. When you are having people come in for outpatient and let’s say they’ve been using or something along those lines, they’re looking to be punished. So, they’re either going to skip, pretend like they’re sick, or, while they’re in class, they’re constantly going to be thinking, “Don’t pick me to have a UA (urinalysis) today. Don’t pick me to have a UA today. Don’t pick me to have a UA today.” They’re not going to be concentrating or thinking about what you’re trying to teach them or get down to the bottom of a certain feeling that they’re having. I really do think harm reduction is the best way to go about any treatment center. Let people focus on the information (laugh).

Sam O’Hern:

Yeah. I’m so glad you brought that up, Cat. Because harm reduction, just provide a little education piece on this interview. Harm reduction is a continuum. So harm reduction starts at, you know, someone might be considering cutting down on you, someone might be using in a safer way, using with others instead of by themselves.

And then harm reduction can go all the way. It’s the same continuum. It can go all the way to complete abstinence from substances. So, it’s really cool about the program, like Cat said, is that we support both models of recovery. Both complete abstinence as well as harm reduction for our clients.

And I think that does take away a lot of the stigma and a lot of the shame that people feel is they can show up as they are and we can, we can meet them where they’re at. We don’t have to force them into this mold that they’re maybe not ready for. We can truly meet clients where they’re at and work towards healthier options.

Alan Helgeson:

If you’ve been listening to this episode today on addiction and addiction recovery, there is hope. Remember, at Sanford Health, the best place to start is through your primary care provider. They’re really the quarterback of all things for physical and mental health needs. They can connect you to the right resources no matter where you are, and they will make things happen for you and get you the resources you need.

Courtney Collen:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen wherever you hear your favorite podcasts, and on news.sanfordhealth.org.

Get more episodes in this series

Sustainable home care needs caregivers, lawmaker support

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations.

Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with Lindsay Doak, director of health care research and education at BerryDunn, on the topics of leadership and culture, quality, and rural health access.

Courtney Collen (host):

Lindsay Doak, happy to have you here. Thanks so much for your time.

Lindsay Doak:

Thank you for inviting me.

Courtney Collen:

I’d love to start by having you share a little bit about your background and your work with BerryDunn.

Lindsay Doak:

Yeah, absolutely. So I have been working in home health and hospice for, I want to say 20 years. It’s hard to believe, but 20 years. Prior to this, I worked for an organization that also did home health and hospice consulting called Faci Associates.

And then I started at BerryDunn because I really, really thought that the industry needed the research that we were doing and the data and the insights and the education. And I was fortunate enough to have BerryDunn want to participate in that. And ever since then, we’ve done so many different things to help the home health and hospice industry grow.

Courtney Collen:

Amazing. I look forward to learning more here. You use data and research to improve quality outcomes and experience in home health. What does the data tell you are the biggest indicators of quality?

Lindsay Doak:

Yeah, it’s a loaded question because there’s a lot. I could probably talk about that. And I know we don’t have four hours, but we did a national health care home best practices study, and that was completely full of data of indicators that would impact quality outcomes, like quality of care or the patient experience or the caregiver experience, or your financial metrics.

So there’s a lot of different things that agencies can do to improve their quality outcomes. We can take a look at caseloads. So there’s different caseload metrics. For home health, it’s about 20. And then for hospice we’re kind of ranging between the 18 and 20. Productivity of course impacts your quality, but I think the thing that always, you know, when I looked at the data and analyzed everything, one of the things that always came up was your employee engagement, your turnover rate, and the percent of positions on the field.

So organizations can’t achieve success, I can definitively say that because every single data point, and this was from 781 home health organizations and 249 hospice organizations, they cannot achieve success if they don’t have an engaged workforce, people filled in the positions and reduction of that turnover. So you’re looking at less than 10% unfilled position and a less than 15% turnover rate, then you can start seeing that impact on your organization outcomes.

Courtney Collen:

Sure. Thank you. Tell us about your role in the education committee of the National Association for Home Care and Hospice and what you’ve learned through your involvement.

Lindsay Doak:

Yeah, so I always recommend if you can, and you work in the home health and hospice industry, get involved. So get involved in the Alliance. There’s Leading Age, there’s all kinds of committees that you can participate in if you’re a finance person or you’re a clinical person.

As a part of my role for these organizations, what we’ve done is we’ve taken a look at what is happening in the future of the industry. So what’s happening in the future of home health is drastically different than what’s happening in hospice. And what are the resources and education and tools, organizations, people working in the field need as they attend these conferences, as they participate to help them prepare for all these things that are changing. So I’ve just learned so much being a part of this from others on the panel, and really it’s a great place to just come together and talk about how we can help the industry.

Courtney Collen:

Yeah, absolutely. Lindsay, how do you define success in home health and hospice?

Lindsay Doak:

Yeah. Well, again, a loaded question, right? Because success can mean so many different things. You know, if you’re looking at any health care organization, success is going to be defined by meeting the quadruple aim. So you’re looking at engaged employees, engaged patients and caregivers, improved outcomes and reduced cost of care. So that’s the quadruple aim.

What we need to focus on though, is the priority of how you approach the quadruple care. Because you know, right now we are heavily focused on reducing the cost of care. Why is that? Because it’s predicted in 12 years, we won’t even have enough taxpayer dollars to cover the Medicare benefit. But we got to start with the patient experience and the outcomes because I strongly believe that if we start and start there and focus on the experience, the finances will come. And so making sure that you’re really taking a look at that quadruple aim.

Courtney Collen:

Thanks for the insight. What is one action home health and hospice providers can take to reach their full potential?

Lindsay Doak:

We’ve got to start aligning ourselves with different areas of health care. So what we’re seeing now is that organizations need to really start aligning with hospital systems, making sure that when hospitals are discharging patients to the home, particularly for home health, but also for hospice, that that is a seamless process. So with team, coming up with hospitals, that’s going to be important, that re-hospitalization rate. And what we’re seeing is that hospitals that are discharging hospice patients home without hospice are seeing significant increases in rehospitalization. So being a part of that continuum and really partnering with those hospital or organizations.

Courtney Collen:

What is the greatest challenge facing home health providers today? And how does this impact services provided in predominantly rural areas?

Lindsay Doak:

Yeah. Well, rural areas, particularly, the biggest challenge, and it’s been this way for five years or longer, is workforce. Finding people. We’ve got to start advocating to our colleges, to our universities. And when people, you know, get graduation degrees or nursing degrees, they’re not electing home health and hospice. And we need more advocacy around those graduates coming into home health and hospice. So really focusing on our workforce, improving that, and then training them to their best abilities.

Courtney Collen:

Are you optimistic about the future of home care? And if not, what would you say needs to be done?

Lindsay Doak:

You know, some days, I’m mostly optimistic. I will say that. I’m mostly optimistic. You know, there’s a lot of things that happen. We just got announced, in home health, we’re going to get another pay rate cut. Say, you know, MedPAC has proposed a 7%, normally what we see is we end up getting about half of that, and we’re already struggling with margins and covering our costs. The average nursing visit is 30% higher than it was two years ago.

And so, if we’re not getting the revenue to support what we do, we can’t do what we do. So, I stay optimistic in that I truly do believe health care at home is the best possible setting for our patients and their caregivers. But we need CMS to understand the value of what we provide so we can get reimbursed.

Courtney Collen:

We are so grateful for the work that you do and that your teams do. And we thank you for being here and for your time.

Lindsay Doak:

Absolutely. Thank you so much.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series wherever you get your podcasts and at news.sanfordhealth.org.

Get more episodes in this series

True or false? Storms make your joints hurt

Dr. Drew Glogoza:

A lot of people come in and say, I think the weather just changed last week. My knees are starting to hurt again. So I will say this is a very common thing that patients will come in and complain of.

It has been researched. It’s a little bit difficult to control. The weather doesn’t always cooperate the way that we’d like. It does seem to be true. It does seem to be that barometric pressure and humidity and then temperature do seem to affect arthritic symptoms.

Matt Holsen (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about arthritis and joint pain. Our guest is Dr. Drew Glogoza with Sanford Orthopedics and Sports Medicine in Fargo, North Dakota. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

We’re talking about myths of arthritis and joint pain. And our doctor today is an orthopedic physician. Doctor, can you introduce yourself and a little bit about what you do and what location you work with at Sanford?

Dr. Drew Glogoza (guest):

My name is Drew Glogoza. I’m a sports medicine physician working in the Fargo location, taking care of lots of different joint pains. So hopefully I can help provide some insight on this conversation today.

Alan Helgeson:

I’ve been told on multiple occasions, “Yeah, you’ve got that.” Very informative for me, too. So first of all, can you explain arthritis?

Dr. Drew Glogoza:

So simply, I would tell you that arthritis is inflammation of the joint. This can be an acute inflammation or it can be chronic, and there’s a couple different kinds of arthritis that we have.

I think most commonly, and what we’re really going to talk about today is that degenerative arthritis – we’d call it osteoarthritis would be the actual name for it – but this is your wear-and-tear arthritis. Some of the other arthritis that people have is more inflammatory. If you think like a gout or rheumatoid arthritis, a little bit different process behind it and not so much wear and tear like the usual stuff that we’re going to talk about today.

Alan Helgeson:

How should I look for these or be able to tell these differences in my body? Can you explain a little bit of that?

Dr. Drew Glogoza:

Yeah, sometimes it’s a little bit tricky because the symptoms do really overlap for some of it. The most common complaint that people are going to come in if they have an arthritis, is going to be joint pain. That’s going to be the main problem that they’re going to come in and complain with.

But people also have stiffness, swelling, loss of range of motion. Sometimes people will have starting to form a deformity to their joint. Those are going to be the kind of the main things that people will notice when they come in.

Alan Helgeson:

Just because I want to get it clear because you know, sometimes I need to hear things a few times in arthritis. Is it different than joint pain and can you have one without the other?

Dr. Drew Glogoza:

That is a good question. So you can have, they’re both independent of each other. I would tell you that joint pain, we would call that arthralgia. So you have arthritis and arthralgia. They can be together and they can be separate arthralgia or joint pain. I would probably think about in an athlete or someone who’s active and is just having some overuse, that doesn’t necessarily mean that they’re going to have arthritis in their joint causing their pain. They might just have some pain from activity.

Now on the opposite side, you can have arthritis and not have pain in your joint. I would say most commonly we see this in clinic when we get X-rays of both knees or something like that. Or we can see two joints in one X-ray and one joint will be very arthritic and the other will not have very much arthritis in it. And there’s times where the very arthritic joint is not the one that is bothering someone.

Alan Helgeson:

That’s why you’re an expert and you know all this stuff, right? We can’t just diagnose this stuff on our own, Doctor.

Dr. Drew Glogoza:

We try hard with Google, but it doesn’t always work.

Alan Helgeson:

Let’s talk a little bit about the statistics around arthritis. OK, so maybe, maybe not, but is someone more likely to get it – are men more likely to get arthritis over women, or we’re not?

Dr. Drew Glogoza:

When we’re talking about osteoarthritis, which is that wear and tear degenerative arthritis, which is the most common arthritis, women are more likely to get it. Typically, it’s probably a breakdown of, you know, you might look at it like 47-ish% of women versus like 40% of men. So there is some discrepancy there between the two. You know, if you’re looking at population here in the United States, there’s probably a third of people in the United States that have arthritis.

Alan Helgeson:

Is some of that with women maybe being slightly higher? Does any of that have to do with osteoporosis?

Dr. Drew Glogoza:

I think it’s a good question and I don’t know that we know the exact reason for the differences between the two sexes. Different hormones of course could be playing a role in that. I’m not sure if osteoporosis that piece necessarily has a part to it, but there certainly is something because there is a difference between the two.

Alan Helgeson:

How about a time in our life and an age when it might come around for us? Is that going to be more of an indicator that we can look to?

Dr. Drew Glogoza:

Typically we start to see arthritis really start showing its angry face, around the 50s (laugh) is probably when it really will start showing up and start giving people trouble. Probably once you get to 70s or 80s, if you’ve made it that far, we’re not really seeing a whole lot of new arthritis showing up. So you might be in the clear if you’ve made it that far and haven’t had too much trouble.

Alan Helgeson:

Now when we talk specific places in the body, I’m guessing everybody can say, oh, I’ve got it right here and I’m raising my hand here. I’ve got it. I call it my thumb fat. I’m showing you here, Doctor, right here below my thumb. But where are like the more common places we’re likely to get it in the body?

Dr. Drew Glogoza:

So most commonly the knee is actually the main joint that people get arthritis in is the knee. After that it kind of breaks down. Now hand like you were showing is actually one of the next most common. Hip is shortly there quickly coming along thereafter. So, but the base of the thumb is a very common place for people to have arthritis.

Alan Helgeson:

Well, it’s nice to know I’m semi-normal I guess. Thank you. I appreciate it. That’s right.

All right, well let’s talk about some of those signs and symptoms. So if people aren’t maybe getting it yet or maybe they’ve had some pain, maybe we can talk about what some of those signs and symptoms are.

Dr. Drew Glogoza:

Pain is really going to be that main thing that people will come in and complain about. Probably the first thing that anybody would tell you they noticed about their joint when they, either they found out they had arthritis or they were concerned that they were having arthritis.

And then after that it just depends. Probably the more arthritis that’s in the joint, if it’s progressed, you’re going to start losing some of your motion in that joint, whether it’s your thumb or your knee or your hip. That’s probably another thing that’s going to be very common.

Swelling sometimes happens and doesn’t always happen but you know, people will come in and complain of that.

And then certainly you might start to notice that you might have a little bit of a deformity, and when I say that you might notice that if it’s your thumb, that’s your problem, you might have a big bump that you’re starting to get that you just didn’t have there before. Or you might start to be a little bit more knock kneed or bow-legged than you were before, if the arthritis is kind of changing the function of your – the structure of your knee.

Alan Helgeson:

Dr. Glogoza, let’s talk about risk factors to be aware of when it comes to arthritis. What are some of those risk factors of developing arthritis versus joint pain?

Dr. Drew Glogoza:

I think probably our strongest risk factor is age. Now I would tell you that it’s not necessarily perfect. Not every 70-year-old who comes into clinic has the exact same amount of arthritis, so it’s not a perfect correlation. But the older you are, the higher the risk that you are going to have arthritis.

We’ve already kind of touched on the sex differences there with females being more common and again we don’t really have a great explanation for that.

There does appear to be part of a genetic component. You can thank your parents for some arthritis. We don’t know specific genes or different things like that that maybe suggest for this wear and tear kind of arthritis, but it does seem to maybe run in the family a little bit.

A couple things that we may be able to control a little bit. Joint injuries are going to set you up to have arthritis. If you tear your ACL, that’s a very common cause of knee arthritis. So if you have a different break or you break a bone or have a fracture that goes through a joint, that can set you up to get some arthritis. So trying to avoid injuries is going to be a good thing.

Sometimes our bones just don’t always grow the way that they were designed to do, and there’s not really a lot that you can control with that. But it might set you up for an injury or a different wear pattern on the cartilage in the joint that will set you up for some arthritis as well.

And then lastly, and this is probably one of the biggest things that people deal with, is obesity. The more weight that you have, the more weight is going on these joints and makes them have to work harder and hold up against more weight. So it certainly can increase your chances of having arthritis. I think we also think that if you weigh more, there’s a chance that the arthritis might become more severe faster than what we typically would see than somebody who’s not obese.

Alan Helgeson:

Dr. Glogoza, let’s switch now. Let’s talk about arthritis and joint pain because in athletes and sports, which I know you see a good number of athletes and treat them, do people who perform at a high level of activity find themselves at maybe a greater risk for arthritis earlier or later in life?

Dr. Drew Glogoza:

It’s a really interesting question and I don’t know that we necessarily have the perfect answer for it. There is some research that’s maybe not the best research that does suggest that if you’re an elite athlete that you might have some increased risk.

Now I think you can simply think about it, if you’re an elite athlete, you’re probably playing a sport a lot, a lot of years playing a sport. A lot of time in those years playing sports you might also be at higher risk for having injuries than somebody who maybe isn’t playing something as much. So I think that there’s just a lot of things that go into that that make it a little bit difficult to fully understand. And that’s true even just for sports participation just in general. But for sure with when you get to that elite level, we do think that there might be some increased chance.

Alan Helgeson:

That’s talking about arthritis. Let’s switch and let’s fill in the blank with joint pain. Can we say something about joint pain in that same question?

Dr. Drew Glogoza:

Absolutely. I think that that’s, that’s probably going to set you up for it just because you’re going to be active. There’s definitely going to be some pain that can happen with different things and I think sometimes that’s frustrating for different levels of athletes.

Sometimes people will go years with never having an issue and then are very worried about it if they start to have a joint pain, and it is pretty common. Like I mentioned earlier, it doesn’t mean that you necessarily have arthritis. You could just have joint pain.

We do know that there is good evidence that says that recreational runners or walkers are not necessarily at increased risk for having arthritis. So this doesn’t suggest that we want you to be inactive. We know that inactivity increases your chance of arthritis probably from a piece of that overweight-obesity kind of thing that happens when we aren’t active. So we want you to be active. I’d expect that every now and then you’re going to have some joint pain but not necessarily arthritis.

Alan Helgeson:

Well let’s move on now to some things that we may have heard from our parents or grandparents or like we referenced earlier, Dr. Google or TikTok or even circulating elsewhere. Help us set the record straight on whether there might be truth to some of these things about arthritis and or joint pain. First one: weather changes can make arthritis symptoms worse.

Dr. Drew Glogoza:

That’s right. These are the questions everybody’s really been waiting for anyway, (laugh) so.

I will say I hear this a lot in clinic. A lot of people come in and say, I think the weather just changed last week. My knees are starting to hurt again. So I will say this is a very common thing that patients will come in and complain of.

It has been researched. It’s a little bit difficult to control. The weather doesn’t always cooperate the way that we’d like. It does seem to be true. It does seem to be that barometric pressure and humidity and then temperature do seem to affect arthritic symptoms.

They have done some things where they have put people into some controlled environments and they do seem to notice changes when those things that are controlled for are changed and it causes changes to their symptoms.

Alan Helgeson:

How about cracking your knuckles? Because I’ve got a string of Norwegian uncles that have cracked their knuckles. They could be in the hall of fame for this. Cracking your knuckles will give you arthritis.

Dr. Drew Glogoza:

Another good question and really a common thing that I think people wonder. I don’t think that we really have any evidence to suggest that it’s causing any joint damage by cracking the knuckle like that. So I would tell you that I think that that’s more myth than anything.

Alan Helgeson:

Eating foods like tomatoes or nightshades worsens arthritis.

Dr. Drew Glogoza:

I’m not sure if I would say specific foods like that necessarily will change or impact arthritis. We’ve talked a little bit about obesity and maybe lifestyle things. I think that if you are not eating healthy it’s probably going to set you up to have some arthritis specific foods. I’m not sure if we know exactly.

Alan Helgeson:

Resting joints is best for arthritis.

Dr. Drew Glogoza:

I think I would disagree with this a little bit. I might change the verbiage of how I would say that. I would say modifying activity is probably best for arthritis. If you are active and you’re having joint pain and we figure out that it’s from arthritis, I don’t want you to stop moving that joint. We want to keep moving it, but we might need to find a different way to do that.

If you’re a big runner, and running is killing your knees, we might have to think about bicycle cycling, that kind of stuff. Maybe we get you in the pool a little bit to get you active, but we want you to be active and keep your joint moving, not necessarily just shutting it down and resting.

Alan Helgeson:

Now this next one sounds exactly like something grandpa would say: you can’t stop arthritis.

Dr. Drew Glogoza:

This one’s pretty true. We don’t really have any disease modifying treatments to slow the progression of arthritis and I think that that’s one thing that can be very frustrating.

The one thing that I will say is that we don’t necessarily have a good rhyme or reason for how fast it progresses either. Sometimes people will progress in a year and advance pretty quickly through the different stages of arthritis. Other people will go 10 years and there’ll be no change to it.

Alan Helgeson:

Now this next one, Dr. Glogoza, I have to admit I hadn’t heard this one but wearing damp clothes causes arthritis.

Dr. Drew Glogoza:

I had not heard this one either. It does not seem like there’s really any evidence for that either to suggest that this is true. I’m not sure what the reasoning or the thought process behind it is. The damp clothes is kind of just superficial and on the skin and doesn’t really have a ton of effect on the joint.

Alan Helgeson:

Now how about this one? Arthritis only develops in older people.

Dr. Drew Glogoza:

I would say partly true. I think that we talked about the ages a little bit, so certainly we, we know that as you get older you’re going to have a higher risk for it.

We do see arthritis in in younger people and typically these are people who had an injury maybe in their teenage years or their twenties where they were playing a different sport or something like that. We would probably call this like a post-traumatic arthritis. But we do see it in younger people.

There are some other secondary causes that are side effects of medications, other things that can cause breakdown of the joint that can give you arthritis sooner. So it’s not strictly just an old person thing, but definitely more common there.

Alan Helgeson:

Growing up on a farm, this kind of feels like something that my dad would say as a farm kid. If you can move your joint, your bone isn’t broken.

Dr. Drew Glogoza:

It would be nice if that’s always true. It’s not though. Things that we see walk into clinic, I tell you what, it’s impressive sometimes what people are able to come in on. I’ve seen people walk in on broken ankles and be very surprised and we tell them that they have a fracture. So I wouldn’t say that it’s a hundred percent true.

I think that there’s probably more times when it’s broken, you don’t want to move it and that’s part of your body trying to tell you that there’s something wrong and needs to get some support in that area. But it’s not perfect. It can still be broken.

Alan Helgeson:

Let’s pivot now Dr. Glogoza. Let’s talk about some things we can do to help with joint pain or arthritis. Are there some specific treatments or relief for athletes or those that are in sports?

Dr. Drew Glogoza:

I think when we think about treating joint pain, arthritis, that kind of stuff, I would tell you that the goal is probably going to be limit pain and then try to improve function is how I would think about treating it. It’s not always easy to get rid of all the pain, so that may be an unachievable goal. So we try to limit pain to a level that is more tolerable and then improving the function so that you can get back to doing whatever you need to do. Whether that’s run the marathon or if that’s cut the grass.

But that’s how I would try to think about what we generally do for approaching treatment for these problems. Exercise is actually really good for our joints. We have really good evidence for that. Whether it be a home program that you’re working on your own or if you’re doing some formal physical therapy with a physical therapist.

We do have good evidence that the stronger your muscles can be, the better that joint is going to function. So trying to stay active is great. We also know that just a healthy lifestyle will be good. We’ve talked about different risk factors for arthritis, eating healthy, staying active, maintaining a healthy weight, all of that is going to be very good at preventing arthritis and arthritic pain in your joints.

I think that we touched about the knee pain and how much extra weight it sees and that kind of stuff. We have some evidence that suggested if you can lose 10% of your body weight you can have almost a 50% reduction in your joint pain. So that’s pretty significant if you’re able to either one lose the weight that you maybe gained over the years or if you’re able to keep it off.

Alan Helgeson:

So it’s nice to hear, Dr. Glogoza, it doesn’t matter whether you’re a ‘me’ or you are a high performing athlete that runs 5K’s or ultra marathons, whatever it might be. I mean really some of those treatments for relief – they’re the same, right?

Dr. Drew Glogoza:

Yeah, absolutely and and a lot of these exercise programs don’t necessarily need a gym membership. They’re not things that need to have big weight rooms. It’s stuff that we can do simply at home to just kind of maintain some strength in our muscles and keep us active.

Alan Helgeson:

Moving on to the next question here. Let’s talk about maybe some over the counter treatments or maybe some medications to recommend and I don’t know if you feel comfortable with this, what’s in Dr. Glogoza’s medicine cabinet that, gosh, you know, I was out doing a quick run around the neighborhood last night and I’m feeling a little sore. What does Dr. Glogoza use?

Dr. Drew Glogoza:

I think that a lot of people would tell you that they’re reaching for the ibuprofen or Aleve and I think we have good evidence to say that those really do help with arthritis pain.

Now the big catch with that is as we get older, which is more common with arthritis, sometimes those medications are not available for us to be using. So we for sure need to be checking with our regular doctors to make sure that they’re still appropriate for us to be using because there are some risks for side effects that we want to make sure that we’re not setting ourself up for.

But I do think that they probably provide the best treatment of the over-the-counter stuff. There are some topical treatment options. Lots of people do Icy Hot and Biofreeze and things like that, but there is a, I call it ibuprofen in a cream, but really what it is is Voltaren gel. It’s just Voltaren is another form of ibuprofen and I think it works really well. It’s topical so there’s not as much systemic absorption. It’s probably a little bit safer for people to try and use initially if they haven’t seen a doctor recently or not sure if they should be taking it or not. You just rub it over the joint that’s been painful and see if it works.

Alan Helgeson:

Thank you doctor for giving us the answers on maybe some things to help us out with some of the pain we might be experiencing. So we’ve tried these things, we’re keeping moving. When is it time to see an orthopedic physician or a provider?

Dr. Drew Glogoza:

That question is probably different for every person and part of that is pain is really, like I told you, is the main thing that people come in and that’s just going to be really different for every person. When people really come in is when it starts affecting your life commonly. If it’s waking you up at night, a lot of times people are coming in complaining saying, my knee’s hurting me, I can’t sleep at night, or my shoulder’s hurting me, I can’t do the dishes, I can’t put stuff back in the cupboards, I can’t reach the cereal box out of the cupboard. Whatever it is.

When it starts to really affect your life, I think that’s when people really start coming in and I think that is appropriate. That could be two days after your shoulder’s been hurting or it could be 10 years after your knee’s been hurting and you’re just tired of it and you want to figure out what’s going on with it.

Alan Helgeson:

Doctor, could you speak a little bit about when it comes to orthopedics and sports medicine? You know there are people that might have been living in pain for a long time and they’re worried that if they go in because something’s been hurting for a long time, instantly, automatically the only option is to have surgery. You have so many options, right?

Dr. Drew Glogoza:

There are a lot of options. You know, certainly for myself, I’m not a surgeon. So while I know what the surgery options are, I usually try to explore all of the options to figure out what works best with someone to come up with an individualized treatment plan.

Sometimes medications are appropriate and manage your symptoms and that’s all you need. Some people want to get active again. We get them in for some physical therapy, we give them some exercises and we get them going and that’s enough to make their knee feel better.

Other times we do some injections. I do a lot of injections, and certainly there are a lot more tolerable than the immediate pain after a surgery for sure. Those are probably the main treatments that I think about that are short of surgery, but there are definitely options.

I haven’t really touched on it much, but there’s some bracing options that we try to do sometimes for people. Don’t think that just because you’ve had a lot of pain and you’ve been putting it off, that you’re going to come in here and we’re immediately going to tell you, you just have to have surgery for this.

Alan Helgeson:

What last-minute thoughts do you have as we put a bow on everything we’ve talked about here? Making us actually feeling better by sharing some great information about arthritis and joint pain.

Dr. Drew Glogoza:

I think arthritis is very common. I think joint pain is very common. We know that those things are going to happen and we’re happy to see you and try to help you through things.

I think it’s important for everyone to stay active and try and be healthy. Maintaining strong muscles is going to help you keep healthy bones, which is hopefully going to help prevent any kind of arthritic symptoms that you might develop over the years.

If you’re struggling with the joint pain, make sure to come in here and see us at Sanford. We’re happy to help you out. Come up with a treatment plan, individualize it with you and get you back to whatever your desired level of activity is.

Alan Helgeson:

Dr. Drew Glogoza, a specialist with Sanford Orthopedics and Sports Medicine. Thank you for joining us today.

Dr. Drew Glogoza:

Thanks for having me on. It’s always fun.

Matt Holsen:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen wherever you hear your favorite podcasts and on news.sanfordhealth.org.

Get more episodes in this series

Navigating senior care from the sandwich generation

Sarah Yoder:

There is joy along this journey. If you’re taking care of young children and caring for elderly aging parents there’s a tendency to feel like one is just a burden and one you want to tend toward doing, caring for your kids or just having to meet the needs of your elderly parent. And I would just say find the joy.

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about the sandwich generation and the various challenges of children caring for older parents. Our guests are Sarah Yoder, Alecia O’Neill, and Kelsey Nicola. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

This is the “Health and Wellness” podcast. I’m Alan Helgeson, and we’re talking about the sandwich generation and their challenges of caring for older parents and young children. And we have several guests joining us today, Alecia, Kelsey, and Sarah all around this round table here as we discuss this topic. Alecia, could you introduce yourself?

Alecia O’Neill (guest):

Yes. Hi. I am Alecia O’Neill. I’m the administrator for senior living within Good Samaritan here in Sioux Falls. So I oversee several of our independent living and assisted livings in the Sioux Falls area.

Kelsey Nicola (guest):

My name is Kelsey Nicola, and I am the manager for Prairie Creek memory care assisted living here in Sioux Falls.

Sarah Yoder (guest):

And my name is Sarah Yoder, and I have a parent who has lived in Good Samaritan for probably about seven or eight years and moved through the system and we’ve kind of lived out this sandwich generation theme here.

Alan Helgeson:

Well, I’m so grateful that you guys are taking time out of your day to talk about this very important topic. You hear this term sandwich generation and you know, it’s not about something with cold cuts and rye bread and mayonnaise. It’s a very important topic, and as we hear about the baby boomer generation getting bigger and bigger and the health needs that are coming, we’re trying to put some definition around this. So, Alecia, wondering if you can help us define what is the sandwich generation?

Alecia O’Neill:

The sandwich generation can be defined as a group of people that probably find themselves, they have young children at home, but they also have aging parents that are starting to need help, and they identify that now they need to become the caregiver for those parents as well as their children.

Researchers found that it’s usually people in their 30s, 40s, and 50s that tend to find themselves – I was astonished to hear even one out of 10 people, parents, find themselves caught in that generation of caring for children as well as their parents. That was a lot to me. I thought one in 10 and 66% of those caregivers are female as well and are still working outside the home. So balancing that work life and their children as well as then being the caregiver for their parents.

Alan Helgeson:

It can be so much. We know that a lot of folks as even single parents these days that it’s just so much that you spend a lot of time working, you care for your kids that there just isn’t any downtime. Right? So some of those characteristics you talked about with all of that going on here as we’re dealing with this, what we’d like to do is through the course of this episode is we hear about sandwich generation is putting a face on it and talking about that and explaining that. And Sarah’s here today as somebody that’s living and going through this. And Sarah, you talked about for the last several years you’ve been going through this with your family member. Tell us a little bit about your story.

Sarah Yoder:

Yeah, so thank you for having me, Alan. I really appreciate it. It’s kind of, as I was thinking about this, I was thinking about other people in my situation that may have young kids right now and what they may be facing. So my story really begins, my mom was a single parent and raised me as a single parent her entire life. And so there was always kind of a sense that I was parenting my parent all along the way.

However, in 2014 began the journey of really increased caregiving for me.

Mom was diagnosed with the first of five cancers over the next three-and-a-half years, between 2014 and 2017. And there were lots of surgeries, procedures, tests, doctor’s visits, chemo, radiation. At that time I had three children under the age of 10 at home, a 3-year-old, 6-year-old, and 10-year-old. And so it was a lot to try to find ourselves in a place where Mom needed care. There was really nobody else to do that. And then our children were growing and needing, of course, the nurturing and development that come with that stage for them. So yeah, it was a lot to juggle.

Alan Helgeson:

Do you have siblings around in the area too? Or are you an only child around here that it fell to? Or how did that dynamic work?

Sarah Yoder:

Yes, that’s a good question. I do want to say I probably cannot do this at all without the care of my husband. He has just been the absolute best partner and caregiver. I do have one sister, one sibling, and she moved away and has not been able to participate in caregiving. And so it really has fallen to me.

We do have both my husband and an aunt and uncle who have just been wonderful. There have been people absolutely that have journeyed with us through this process. But I think all along the way you can still begin to feel this overwhelm. You can feel the fatigue. You can start to feel how in the world do I balance all the demands with everybody needs something all the time? (laugh)

Alan Helgeson:

So Sarah, have you had to, during the course of this, maintain work as well too, in some role or capacity?

Sarah Yoder:

Yeah, I worked part-time here and there, but I also volunteered. Probably the bigger chunk was volunteering in my kids’ classroom. I was in their school half a day every week for nine years. And so because of my husband’s work, I was able to primarily stay home and really spend a lot of time volunteering in the community. I volunteered with our church.

And then I also was a caregiver to my aunt who had Alzheimer’s. She was in our home for several years. So there was, I’m a natural caregiver kind of a person who kind of enjoys that, and people describe me as very empathetic and it comes naturally to me, but it’s still very difficult.

There are friends that I have that would not describe themselves as natural caregivers or maybe not have the history of moving through health care systems or navigating that quite as easily. And, you know, people really need a lot of support.

Alan Helgeson:

Knowing just the medical piece alone takes so much time, and then dealing with some chronic conditions. You talked about several types of cancers. Talk about all these medical appointments and trying to juggle that in with an aging parent.

Sarah Yoder:

That’s really true. The medical appointments and even just navigating the health system can be really a daunting task in and of itself.

My mom was a nurse. She was a health care administrator growing up my whole life. So there was a little bit of familiarity there, but even with that, I found myself in a place where I would have to repeat myself often. I would have to make a case for what was going on. I would transport her.

Even just the scheduling of transporting, arriving, juggling kids’ activities or kids’ school pickups, all of those things kind of coincide together and really become kind of this perfect storm that really just kind of has the potential to really be burdensome and produce some anxiety or strain on the family.

I would say as far as health care, navigating health care, you know, sometimes you need an expert. Sometimes you need somebody who is an expert in their field to come along and figure out some health care things.

But I would say for the sandwich generation as an encouragement, more than that, you need a relationship. You need somebody – you need caregivers who know your parent well. They know the story. They know they history. I could give you tons of names of wonderful caregivers. And Sanford, Dr. (Stephen) Foley, Annie Bettcher (RN care manager), they’ve walked with us for years through some of these things. I can tell you countless nurses have walked into rooms with me, and they just know. They just get it in ways that other people don’t because they’re caregivers themselves.

Alan Helgeson:

Those relationships are so important, aren’t they, Sarah?

Sarah Yoder:

Yes, absolutely.

Alan Helgeson:

I mean, you had the benefit of your mother actually coming from that health care background. You had a little bit of a kind of that seed of knowledge. I mean, it helps a little bit, right? I mean, knowing some of that stuff, sure.

But let’s switch now. At some point you needed to make that decision or come to that decision where you needed to move into some care choices where your mother could be and to find a place where she could live and to be cared for, right? So a Good Samaritan was the place where you chose. Talk about how you got to that decision and what it looked like to get to that decision.

Sarah Yoder:

That’s a really good question actually, Alan. You know, in 2014 when Mom was diagnosed with the first of five cancers, we really began kind of this intense season of all these tests and doctor visits. And Mom moved into our home for a while because that was really the only way that I could care for her and our children who were very young. And so we had this blended home with Grandma who was losing her hair and having doctor’s appointments and juggling kids’ activities as well.

And you know, at the end about in 2017, after about three-and-a-half years of kind of walking that road, it just became really apparent to me that I needed help. I needed a support system. I needed some professionals to come alongside. And we began to look at several different places. The Good Samaritan really stood out.

Mom being in health care really wanted the continuity of care that Good Samaritan offered. And so she began looking. I began supporting her in that process and encouraging her. There was a lot of resistance and hesitation to do that because that’s a really big step in giving up independence. But she lived in Good Samaritan for years and really received wonderful care there.

Alan Helgeson:

One of the things that you have to look at too is as things move along as you may need additional levels of care, is that a consideration that was part of your decision making as well?

Sarah Yoder:

Absolutely. Absolutely. You know, Mom’s terminology was always the continuity of care, that she could move along through the system as care needs increased. And you know, for me, I guess part of that was knowing that that was available, but also just having relationships with folks that knew my parent, knew where she was at and really could help us discern what she needed at the time, what was going on, how she could be best supported, what services they would offer.

Alan Helgeson:

So during this time, a lot of folks maybe feel that they’re pushing a parent towards a decision like this. How was that relationship with you and your mom? Was she making that decision on her own or were you helping to nudge her in this role? What was that like?

Sarah Yoder:

Yeah, that’s a good question. I would say it was a dance. Yes, it was (laugh) not easy for sure. Sometimes there’s resistance because there’s a lot of loss of independence. Or that’s the feeling, that there’s loss of independence. There’s a desire to continue to keep trying things and just maybe situations will change and then they’ll be able to navigate things.

So again, that’s where kind of the outside perspective really became beneficial. These are people who work with this population all the time and know what people need. They know and can observe the needs of your parent as well as you discuss those things. So yes, there was absolutely some, “Hey, I think we’re at this point, I think you need this.”

But after several years of all those health care appointments, we’d been on quite the journey. And so there was also some awareness, some comfort of, OK, I’m going to be in a place where I can have the care that I need and the support that I need.

Alan Helgeson:

Did you feel like you were alone and on an island of your own going through this?

Sarah Yoder:

That’s a tough question. I think those feelings can come anytime. I think that can be when you’re just beginning this journey and kind of wondering. One of the things as I was reflecting on this and what it was like for me is there are so many responsibilities, especially when my kids were young, sandwich caregivers really struggle from fatigue.

There’s around-the-clock caregiving, someone always needing something. It can feel like you personally have no free time, no margin in your life. Your friends may have hobbies or do things that you absolutely just don’t have time for. It’s an attempt to balance all the demands, the good things like children’s activities, and then also kind of just desiring to invest in their own growth and development, their shaping, their guiding.

So it can feel really like a role reversal and it can feel lonely and overwhelming, emotionally draining to have to give support when you feel like you’re the one who needs the support yourself.

Alan Helgeson:

Up and down all over the place. And then you mentioned talking about the comfort of having that external support, like the health care, the caregivers, like the doctors, the nurses, all of them being supportive. Did they play an important role at this time as well?

Sarah Yoder:

Absolutely, yes. I think I said before there were just kind of relationships with people that would just kind of know. There are some times where you will find yourself explaining situations or trying to grasp situations or trying to explain things you don’t understand medically or from a health perspective. And you need people to come along and help you discern that.

But then there are other times where there are just people who are excellent caregivers who really can come alongside you in really beautiful ways. They can put their hand on your shoulder and just say, you know what? I see you. I get it. I know what you’re carrying. Sometimes not even fixing things, but just being known.

Alan Helgeson:

You started out with your mom several years ago at one place. Where are you at today with your mom and Good Samaritan?

Sarah Yoder:

Well, that’s actually kind of funny that you ask because I was thinking, you know, we’re through this season. My kids are now 20, 16 and 13. They’re off to college and driving. And then yesterday I found myself scrambling as I’ve been working on Mom’s taxes and trying to get all that paperwork done and there’s all these hiccups and roadblocks along the way trying to navigate those things and get exactly the paperwork that I need.

Yesterday I found myself at her apartment having her on speakerphone with another administrator, trying to get authorization to get the paperwork we needed. All the while she’s having a low blood sugar, so I’m fixing her a snack and trying to get to my son’s band concert in time. I was driving to Brookings for his band concert. So just continuing to juggle all of those things.

Alan Helgeson:

And you just become a master scheduler, and it just becomes what you do, right? What services or what level of care is your mom at today? Has she moved to different levels?

Sarah Yoder:

Yeah, she lived in independent living for quite a while. She’s currently living in assisted living and they’re wonderful to her.

Alan Helgeson:

Appreciate you sharing your story and we’ll come back with some more of those things.

Alecia and Kelsey, I want to talk to you – and let’s talk about some numbers here. Have you noticed any recent trends or changes in the demographics or experiences of the sandwich generation? As we’ve been talking about this, we had a really nice lead in here in getting that phase to what really the sandwich generation is, and what it really means of what somebody’s going through.

Kelsey Nicola:

Like you had mentioned, Alan, we have more people than the baby boomer generation with chronic illnesses, which means that they’re needing support a little bit earlier than what we’ve seen before. So we’re getting people younger coming into our facilities and into assisted living and into my memory care.

That means typically that their spouses are still working. And so it really puts a strain on those spouses and children, if they have them, because we might call them and say, “Hey, something’s going on. We need your help today.” But they’re working and they have to try to juggle getting out of that. Or like Sarah said, going to children’s activities. All the while we’re trying to still learn their loved ones and how best to support them, especially at younger ages.

Alan Helgeson:

Are you finding a good level of employer flexibility in this too, these days? Is that being helpful to these working spouses?

Kelsey Nicola:

I have seen people who back down to part-time hours to have that flexibility, and then I’ve also seen people who have had the ability to no longer work to help support their loved ones in the facilities. I wouldn’t say that employers are always as forgiving as they need to be or flexible with people’s loved ones, which really puts a strain and brings a lot of guilt into their spouses’ lives.

Alan Helgeson:

It’s really all over the place. You talked about specifically that Kelsey, you work in the memory care area. Can you explain a little bit more about what the memory care area covers and serves for Good Sam?

Kelsey Nicola:

Yeah. Our building specifically, it’s a memory care assisted living. We have 32 private suites, so all of our residents do get their own rooms with a bathroom, and we serve populations who have to have a diagnosis of dementia.

People come in maybe needing just queuing support, getting to activities or to the dining room. And then we also go up to people needing full assistance with all of their activities of daily living. We do support a little bit higher level of care than what Sarah’s mom, the facility Sarah’s mom is at, but at the end of the day it’s still assisted living. So we give as much support we as we can and a lot of cognitive support.

Alan Helgeson:

So can you give an idea of like the age range that you may support?

Kelsey Nicola:

My youngest resident currently is 60 and my oldest one is almost 97.

Alan Helgeson:

Well let’s talk about some of the common emotional and mental health challenges faced by the sandwich generation.

Kelsey Nicola:

We see a lot of grief, a lot of guilt that is associated with having to make that decision to move to a facility where they can receive care. We all know that people want to stay at home as long as they can, and we support that. And also spouses really take those vows to heart and they want to care for people in sickness and in health and be with them. It’s very hard for people to come to the decision that they need that support.

And it’s not just spouses. It’s children too. We often, in my building, will find we have family members, children, spouses who are in our offices asking us to give the answer what do they do? And we don’t always have that answer, but we can be there to support them and talk about other experiences that we’ve seen with people and as they go through guilt and grief.

Alan Helgeson:

Not having any answers here, but I’m guessing everybody wants you to tell them what to do, don’t they?

Kelsey Nicola:

Yes, they do. (Laugh)

Alan Helgeson:

They want you to give them the magic answer because they have no idea, right?

Kelsey Nicola:

They don’t. Nope. And it’s a hard journey for everybody, and every journey’s different.

Alan Helgeson:

What can they do? How do you maybe guide them with some of these mental health challenges and some of this grief? Where do you guide them and maybe direct them to help them go through some of these things?

Kelsey Nicola:

In Sioux Falls, we’re very lucky to have a number of different programs available. We have the Alzheimer’s Association and we’ll give them information on that.

And we also have Active Generations, which is a fantastic resource for people where they can go. If they’re not ready to move into our building, we often will lead them to Active Generations and let them know of the services that they have there.

We also have good partnerships with Home Health in Sioux Falls and we can refer them to Good Sam Home Health or Sanford for a little bit of extra assistance in the home.

We also let them know that what they’re feeling is not uncommon and it doesn’t mean that they’re doing anything wrong. We let them know that their journey is individual, and that’s OK. They’re going to come to that decision when they need to, but we’re going to be there for support and resources when they need us.

Alan Helgeson:

Are there any support things or guidance that you offer for those family members? Are there some things that you can help them with?

Kelsey Nicola:

Yeah, we have a library at Memory Care in our building that has a ton of books on resources, different types of dementia, people’s own individual stories and kind of how-to books. And we also partner with people to come in and do like education series, education talks. We have numbers for clinics that they need to get ahold of and pamphlets and business cards for different groups. Like associated with the Alzheimer’s Association.

Alan Helgeson:

Are there resources as well, Kelsey, for family members and the children as they’re looking for this stuff? And where could they find that?

Kelsey Nicola:

There is a really good resource online. It is www.good-sam.com.

One thing that is wonderful on that website is a connection to what is called our connection center. So somebody can call in, say I have my parent who’s needing extra support and I just don’t know where to start. If they give us the location that they’re from and where they’re kind of looking and just a little bit of background on what that parent is maybe needing, they have people who will take all that information down and then email it to those locations so that we can reach out to them, then get a little bit more of an idea of what they’re needing and set up tours, ask if they want more information and send that out.

Alan Helgeson:

Kelsey, what is the Good Sam Connection Center phone number?

Kelsey Nicola:

It is a toll free number. It is (855) 466-3726.

Alan Helgeson:

Can you repeat it one more time in case people are running, grabbing a pencil and we’ll hit it again here at the end of the program.

Kelsey Nicola:

Sounds good. The toll free number for the connection center is (855) 466-3726.

Alan Helgeson:

Alecia, can we talk about some of the financial things here? How does being a sandwich generation caregiver impact someone’s financial situation?

Alecia O’Neill:

You’re in a position of not only planning maybe for college expenses and your own retirement planning and then looking out for your loved ones, the funds that they’ve spent their years earning, and how do I best utilize those funds to get my mom or dad on the best care that they need?

And so really just balancing that out and as much as you maybe feel guilty about it, you need to look to protect yourself first. And so I think really working with a financial advisor too on making sure you know your own financial situation and what do you need to set yourself up for the next few years and then having that difficult conversation early, I think with family members is very important.

Maybe even before you get to the point where you’re a caregiver to understand your parents’ finances, where are their accounts, what do they have for insurance accounts? What do they have in savings so that when you are in a caregiving situation where they can’t make those decisions on their own anymore, you’re a little more prepared.

And then putting all of that in one spot. So making sure you have your loved one’s accounts and all of that information together so that it’s easy to grab when you are having to do taxes or things like that that you hadn’t really thought that you’d have to do someday.

And then just working with that financial advisor I think would be helpful too, to then what’s out there for grants or scholarships or programs then for my kids. So the important message is don’t forget yourself in that and maybe make sure you’re protected that way too.

Alan Helgeson:

At Good Sam, how do you help somebody navigate those discussions and plan for things like that as they’re looking for care options?

Alecia O’Neill:

So it’s really just sitting down and looking at what they have for finances and then looking at our different levels of care to see where maybe they could afford to receive the care.

Like Kelsey said, within Good Sam and Sanford, we have a lot of different ways that support and caregiving can be done. So maybe it is caregiving in the home and so maybe that’s where they need to start and to understand the financial implications of maybe they can afford to bring in a home health caregiver.

Or maybe it is moving into one of our locations within independent living or assisted living. So just trying to balance through that. We really refer people more to their financial planners and things as far as their investments and things like that, especially people that are starting this journey and just starting to look out. It’s things to think about as they’re planning for what does it cost for assisted living?

You know, there’s long-term care insurance out there. Some people don’t even know that. And so just giving them the questions to ask maybe of their financial planner, how do I protect my estate? And things like that as I go through this journey from maybe independent living all the way up to skilled nursing care and giving them those resources.

But typically we would refer them back to their financial planner for the details to work out what works best for them. But like Kelsey said, we try to be that resource and having those business cards or flyers or things to refer them on for that, but at least we can give them those questions to start asking and thinking about.

Alan Helgeson:

So, really big takeaway: Start now and remember, you have lots of options. So the key thing here, just you have to start now.

Let’s go back to looking at some effective ways for individuals in the sandwich generation like Sarah. Give us some strategies that we can put to use and think about those things as we’re starting that.

Alecia O’Neill:

I think back to that financial question as well as, you know, when Sarah talked about all of those different emotions and burnout is what I think about sometimes is don’t be afraid to ask for help. And I think this is a great resource for people to even know what is out there for help.

A lot of facilities maybe offer respite care. So is there an opportunity where I can get a break? Kelsey mentioned the Active Generations. They’re a great place here in our location, and I’m sure others across the country maybe have like a daybreak kind of program or a respite care kind of program where you can have your loved one go for some time so that you can get a break.

And again, reaching out to, you know, our Good Sam Connection Center to connect you with different resources, just asking some of those questions of us, we can help navigate that circumstance or have that conversation with your loved one too, of what’s out there.

And so maybe if they aren’t quite ready to make that move, we can again pair them up with our home health or other services that we’ve just kind of been learning about too within our state, with the Department of Human Services, they’ve got Dakota at Home, and there are a lot of different caregiving grants out there, other caregiving programs that can help people finance some of these respite stays as well that we’ve just learned about in the last few months too.

So we can help make that call. We can help you kind of get some of those resources, whether you’re ready to move into one of our locations or if we can help pair you up with some of the other resources in this state as well as within our organization.

Alan Helgeson:

Alecia talked about, you know, some of these big things, the financial things, but are there some more basic things on that to-do list that we could do?

Kelsey Nicola:

One thing that sticks out into my head is that we are not a population anymore that stays in one spot. People might have kids who have moved across the country, just even across the state or out of the country.

One of the things I think is very important is having a conversation before you need assistance about do you want to stay where you are living now or do you want to get closer to where your family is? Just having a very honest conversation about that. It is uprooting the life of somebody, but it also in the end does provide more support for the person who is needing that support at the time.

Something else is, like Sarah had mentioned, her mom and her started looking for different locations, looking at different locations where her mom could get that support. It’s important to know what your options are in the area that you live or in the area that you want to live so that when the time comes that you need that support, it’s not a last minute thing and you end up someplace where maybe you didn’t want to at that time.

I think those are a couple of the biggest things, building your support system. Also, it doesn’t have to be family. It doesn’t have to be people who you are necessarily close with. Ask your friends, ask your loved one’s friends if they are somebody who can help support when that time comes.

We have a resident who gets support from friends and a friend of a friend. And she has just a wonderful support system here, which is so comforting to her kids who are not here. So building that support system is something that is crucial to caregiving for anybody out as well.

Alan Helgeson:

Can you again, run through those resources that are available at Good Sam and Sanford Health?

Kelsey Nicola:

We have on Good Sam’s website, it’s www.good-sam.com, resources that talk about the different level of cares that Good Samaritan offers. So we have independent living, assisted living, memory care assisted living’s in there, respite care, and then also our skilled nursing facilities. Those are wonderful websites and resources just to give a brief overview of what those levels of care are.

And we also have that connection center that people can call into. They talk to somebody and tell them just a little bit about the situation that’s going on, the location that they’re at, and then the connection center will email the location. Then the location can reach out and give resources as well.

Alan Helgeson:

Kelsey, what is that number for the connection center?

Kelsey Nicola:

The connection center number, it’s a toll free number. It is (855) 466-3726. And if you call and it’s after hours or on a weekend, you’re able to leave a voicemail and we get back to you.

Alan Helgeson:

Can you hit that number one more time please?

Kelsey Nicola:

(855) 466-3726

Alan Helgeson:

As we’re winding down the episode today, it’s been so much great information to share. What advice would you give someone who is just beginning to navigate the challenges of being in that sandwich generation from your perspective?

Alecia O’Neill:

Just know that we’re here to help, and there are many resources out there. You don’t have to do this alone. That’s what we’re here for. And that’s, I think, our favorite part of our positions and our jobs is being able to help guide families with these decisions and help give them the resources that they need and the support that they need to navigate this journey.

Get them the care wherever they desire, whether it’s home or in one of our locations. That’s my favorite part is being able to see how we can support and guide them, get them the help they need, and then ultimately, if they do decide to move in, see them flourish in our environment.

So don’t do it alone. There are many resources out there to help you.

Alan Helgeson:

Well, we’re so grateful that both of you are here and helping people feel comfortable because it is scary for somebody starting that journey and you’re making it better for people and for the people that are becoming residents and calling Sanford Health and Good Samaritan home.

So we want to turn to you as we wind down the episode today. Sarah, we are so grateful that you chose to come and share your story here and putting a face to what the sandwich generation is and can’t think of anybody better to give us advice as somebody that is going to be starting this journey. Tell us what would you offer as advice to somebody that’s starting.

Sarah Yoder:

I thought of those people who are just beginning this journey and really wanted to be a voice of encouragement and support for them. I think it’s important to just be aware that Good Samaritan and Sanford Health really are excellent at resourcing services. They can really help people who are beginning on this journey asking questions, where do I turn? How do I find resources? Even just filtering through that can feel overwhelming, and so they can do a wonderful job at providing those.

But I would just really encourage the person out there who’s listening that it goes so far beyond just services. You need to begin within those services to develop relationships with people that will come alongside you for a long time.

Yes, I have been in this caregiving sandwich generation role for over 10 years. I think it’s been about 13 years. So within the financial advisor, having the person that when you call, they know your name, the physician or the nurse advisor that really knows your situation and journeys with you, the person at Good Samaritan who knows your mom and her favorite preferences or activities, those kinds of things really help to develop those relationships and will sustain you in different ways.

I would also just say there is joy along this journey. If you’re taking care of young children and caring for elderly aging parents there’s a tendency to feel like one is just a burden and one you want to tend toward doing, caring for your kids or just having to meet the needs of your elderly parent. And I would just say find the joy.

Children can bring such joy with creativity and laughter and discovery as they’re growing. Children themselves can benefit from observing good caregiving. It can contribute in very healthy ways to their development. They themselves can feel like they’re contributors by bringing a glass of water. When Grandma needs her pills or taking out the garbage and having additional responsibilities, it can make them feel proud. It’s not necessarily something to shy away from, but involve them.

And then I would just say, look for support within the entire community. Find a church. The church is a place where we can bear one another’s burdens. We can be known. For me, finding rest and peace, hope and comfort in knowing and abiding in Christ, Good Samaritan was so important to Mom that there was a faith component in that. And I would agree wholeheartedly.

And then look to the community. There are excellent educators within the schools that will come alongside your children and provide some of that support to speak into their lives, notice their giftedness in there, and encourage them, guide and support them.

And then just the advice I would give: Don’t be afraid to establish healthy boundaries. Acknowledge your limits. You’re only human. There are limits to what you can do. So don’t put extra burdens on yourself. Be gentle with yourself along the way. You’re learning. You’ve never done this before, so give yourself some grace. Again, find a faith community. We need each other and we can share each other’s burdens along the way.

And then find that relational support, not just online chats, not just searching on your computer, but find people who will call and check in on you, who will send you a card or might just show up with a casserole. Sometimes you just need a casserole.

Alan Helgeson:

Sarah, Alecia and Kelsey, thank you for being here today because you’re sharing great information, really being a lighthouse to folks that are trying to find information, valuable information as they’re going through the challenges here and caring for older parents. And they also have young children at the same time learning about the sandwich generation. I’m Alan Helgeson. This is the “Health and Wellness” podcast.

Cassie Alvine:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.

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Mission mindset will help senior care meet growing needs

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with Dr. David Gifford, chief medical officer for AHCA/NCAL (American Health Care Association and National Center for Assisted Living), on the topic of how the association is advancing quality care for seniors.

Courtney Collen (host):

Dr. Gifford, it’s so nice to have you.

Dr. David Gifford (guest):

Nice to meet you, Courtney.

Courtney Collen:

I’d love to start by learning more about your role as chief medical officer at the American Health Care Association and National Center for Assisted Living, and then some of your background up to this point.

Dr. David Gifford:

Well, my son often says when asked what do I do, I spend most of my time in meetings and doing email and phone calls. But really I’d say a lot of time is spent really trying to focus on how to help members address quality. And that’s either through payment, regulatory measurement or quality improvement efforts.

Courtney Collen:

You recently co-authored a book about successful long-term care providers. What was your biggest takeaway or “aha” moment, if you will, that you experienced while writing this book?

Dr. David Gifford:

It was a lot of fun writing this book. And you don’t get to go up and talk to people who are really doing very well and say, “Why are you so good?” And so that was a lot of fun. And you know, Good Sam was one of those in there.

The take-home message was discipline to the mission, being very mission driven and letting the mission really drive all the things you do. I conceptually understood that before the book, but it really came through in talking to everyone.

Courtney Collen:

Yeah, certainly. Thank you. What are the American Health Care Association and National Center for Assisted Living’s priorities around quality care?

Dr. David Gifford:

We look at how quality of care is delivered and achieved through a wide lens. So how do we address payment policy? Because that affects quality. How do we address regulatory issues? Because that affects quality. How do we address the public reporting and five star (CMS Five-Star Quality Rating Program)? Because that affects quality. How do we do educational programs? Because that affects quality.

So we really focus on all those different areas to try to address it. Some are more directly impactful in the sense that they work closely one-on-one with a member and others. We’re working with federal agencies to try to make the changes.

Courtney Collen:

What innovation or action do you think will move the needle the most on expanding access to high-quality care?

Dr. David Gifford:

You know, what came out in the book and also in the keynote we just heard, right? The inspirational speaker Chad Foster, who’s blind. It was mindset, actually. It’s the mindset of how are we going to try to achieve quality and that it is achievable. And when you sort of set that aside, you’re able to sort of come up with new and innovative ways to address it and how do you really use the mission and the IDT team (interdisciplinary team), the team that we have working together to address that.

And when you do that, sort of everything else sort of suddenly figures out ways to overcome all these external challenges. That as Chad Foster said in his speech, often is used as crutches to explain why we can’t do what we want to do. And that really came through in the book.

Courtney Collen:

What in your eyes is the biggest threat, especially to rural communities?

Dr. David Gifford:

I think the biggest threat to rural communities, well, I’ll answer it in two ways.

One is I think staffing. You know, there has been an inward migration from rural areas into cities. And the pandemic helped slow that down a bit. So I think it staved off some of the challenges in rural areas.

But I would say the other threat in the rural areas with staffing, and it’s related to that, is that we’re all –the different health care providers in the rural community are competing with each other for staffing and competing with each other for resources. And there needs to be a way to really come together and collaborate, to work together to try to address that and overcome some of the regulatory payment silos that have been created. And there are ways to overcome that. And I think that the biggest challenge is overcoming the sort of the siloed nature of health care and that we have.

Courtney Collen:

I appreciate that insight. Do you see access to rural care, rural health care specifically as a public health issue?

Dr. David Gifford:

Absolutely. I mean, the public in rural areas need access to care and it is threatened with closures. It’s threatened with not having enough staff or qualified staff in the area. It’s threatened by not having access to, you know, high bandwidth Wi-Fi that you could use telemedicine to overcome. And so I think all of those things need to sort of be addressed.

And I see the health care not as an individualistic approach where I just sort of wait for someone to come to me for care, but more as how do we take care of the whole population and then how do we design the system to do that. When you do that, it changes the dynamic and it makes it more of a public health issue than just a health care clinical issue.

Courtney Collen:

Sure. Despite the challenges of the last few years, how have you seen organizations like Good Samaritan innovate and continue to raise the bar on quality care?

Dr. David Gifford:

I think that those that are being successful, A, are really looking back and relying on their mission. And I think Good Sam has got a great mission and we actually highlight in the book a lot of what Good Sam does with their mission and everything else. So you all have it right.

I think the others, the other way is to begin to think beyond what I would term a fee for service, a per diem sort of payment approach, and begin to think about it in a more of a population health approach. So, like with Good Sam, with I-SNP (Institutional Special Needs Plan) development we’ve been pushing the networks and bringing providers together so we could work collaboratively together, because that’s what’s going to take to address the problems beginning to sort of diversify.

And I think Good Sam even did that with a partnership with Sanford and a number of other issues. So I think Good Sam is really well-positioned and is not an organization I’m actually worried about going into the future because you all really sort of get it and are always thinking about innovative ways to approach the situation.

Courtney Collen:

Wonderful to hear, Dr. Gifford. Lastly here, are you optimistic about the future of senior care? What would you say are the biggest opportunities to improve?

Dr. David Gifford:

Well, the growth of older Americans, particularly over 80, who utilize a lot of our services, is going to double or triple in the next five to 10 years. So, the demand is going to be huge. So, in that sense, there’s going to be huge opportunities. And I think it’s going to cause us to think about different ways of providing the care. Which I think will, in the long run will be good for that.

So I’m very sort of bullish on the future for geriatric care in America. There will be challenges but there will be high demand. And with high demand, it usually brings innovative opportunities, which are always just exciting to see.

Courtney Collen:

Absolutely. Well, we really appreciate your insight here and your time, Dr. David Gifford and all that you do. We appreciate you.

Dr. David Gifford:

Well, thank you, Courtney. Thank you.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series wherever you get your podcasts and at news.sanfordhealth.org.

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Fight your body’s ‘decay code’ with daily movement

Anthony Morando:

I think with exercise, even with movement, you want to constantly try to reduce inflammation. Life is inflamed. Life is inflammation, mentally and physically. When we move, when we exercise, when we have that emotional commitment to something, well-being, we feel better.

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about movement and the basics of how to get moving for your health. Our guest is Anthony Morando with Sanford Sports Performance. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Anthony, thank you for joining us here today on the podcast. And I love this topic because it applies to me. I mean, I’m going to take stuff away from this and I do from every podcast we get, but I think there’s things that everybody’s going to get out of this one.

We’re talking about movement and knowing that you work with Sanford Sports and you deal with some of the biggest, brightest stars and people that have the potential to go on to do some of the greatest things and the athletes that you’re working with, but you also work with regular people, people that just need to get moving, want to move more, want to move better.

Let’s talk about folks that want to just start doing that. So our podcast today is about helping people with a basic nuts and bolts of getting movement. So how can movement look different within the different age groups? Now, we’ll break down the age groups, and you can go into some of these different areas as you want to, but we’re talking pre-teen for folks that have young kids, teens, those young adults, 20s, 30s, middle age, older adults, seniors. And I’m guessing it’s all a little bit different. So that’s a pretty wide open question to start. Where you need to jump in, just go ahead and do it.

Anthony Morando (guest):

Yeah, you got it. First off, thanks for having me. I think that the centric point today will be movement, which movement is essential for everyone’s health and well-being, no matter what age you are from cradle to grave.

And I think where we start with this is basically just given a range of the ages that we have in our facility at Sanford Health. And we have kids in the fourth grade who are learning how to be better movers through competency, through checklists, through specific exercises that are going to provide that competency through a checklist.

And then you have our high school athletes who are more consciously competent along with the collegiate and professional. But then you have our adults and our general population, and everybody’s trying to move. The differences, with the ages, are competency. The differences, with the ages, are sometimes full range of motion. As we get older, as our body gets older, we start fighting that decay process.

And decay might sound negative. I like to call the decay, the tide – the tide’s coming. So how do we fight the tide? And the way we fight the tide is through movement, resistance training and conditioning. I think in the general population setting, if somebody has some type of significant difference in movement, chances are they can’t go through a full range of motion. And then the pattern could possibly be dysfunctional if there’s weight attached to it.

So the first thing we try to do is groove the pattern, see if the pattern can become a little bit more functional. And if it looks pretty good, then maybe they start moving weight through a partial range of motion.

With athletes, it’s a little bit different. Chances are with an athlete, if there’s some type of limitation or lack of range of motion and a specific pattern, it could be due to an injury. It could be due to some other type of limitation on top of that limitation. So we have to be chief mechanics of movement. Our goal is to use movement, exercise, as our platform to create a better scenario for that individual person.

Alan Helgeson:

So when you and your team are working with somebody that might be in middle school training to be better at that football or baseball level, as opposed to somebody like me just trying to do a little bit better, trying to incorporate some more activity for heart health. Let’s talk about what qualifies as a movement and how might that be different with some examples from person to person.

Anthony Morando:

I think with movement, with a younger athlete, a kid, and take it again, take it from that fourth grade age, all the way through a senior in high school, their movement demands, when they’re training for specifically a sport or sports, their movement demands differ on a consistent basis. Some days they’ll move in a linear fashion. Some days they’ll move in a lateral fashion. And then there’s some days where they’re moving in a multi-directional fashion.

Now, if we’re going to link that to a scientific term, they move in a sagittal, a frontal, and a transverse plane. So our intent with all three planes is to create an environment, a climate that is specific to sport. Because sport is played in all three planes unless you’re a rower, right? And we don’t have many rowers around here in the Dakotas-slash-Minnesota, but you know, there are few sports that are only that one-dimensional plane.

So we train all three planes of biomechanical movement in order to create a stimulus that they can adapt to, whether it’s inside the weight room, on the field, on the ice, on the court.

Now those movements include all types of variations, meaning they’ll activate their glutes in that plane, they’ll dynamically move in that plane, they’ll perform plyometrics in that plane. They’ll lift weights in that plane, they’ll condition in that plane.

The difference with someone like yourself is as we get older, we have to fight that decay code differently because now it’s fitness for life. Once you surpass sports, right? Now, the great thing about sports is sports teach that fitness is an important part of life. But then when we’re done playing a sport, we still have to be fit. That should be the goal. And those planes change as you get older.

Some adults don’t necessarily move in the transverse plane as much as they used to due to a knee injury, you know, so what do you do? Some don’t move in a frontal plane because of a hip injury. So what do you do? So those are the differences that start happening when it comes to specific movement patterns.

Alan Helgeson:

Let’s talk about walking as good exercise. Tell us about why that’s a good thing to do. What can a person try to do to make an impact? And how many steps a day can make a difference?

Anthony Morando:

So right out of the gate, I’ll say that 10,000 steps a day is a cheat code for life (laugh), right? If you are getting 10,000 steps a day, it means that you’re moving significantly and you’re burning at least five (hundred) to 600 calories a day if you do have a wearable, right? And wearables, I’m sure we’ll get into that, but it’s easy to track.

But movement is life. And fitness – under the fitness umbrella, walking is included in fitness. And I would say that walking is like, you know, it’s, it’s funny. I have some Chapstick with me right now. Some would call this lip balm. I think walking is a great version of hip and back balm, right? Like, it’s soothing. It’s therapeutic.

You’re outside, you could be inside, but either way, you’re moving. And whether you’re listening to music or you’re moving in just silence, it’s a great way to generate at least three new ideas. Simultaneously, you’re performing aerobic exercise. Not everybody is capable to walk. There are people out there that have limitations that don’t allow them to walk. So what do we do? How do we find a way for them to move and get that same type of hormonal endorphin type of effect that’s going to still benefit their body? And there are machines, there are ways to still resist whatever type of mechanism they’re using, right? But we have to find a way to move.

Now, walking, again, it’s the bedrock of movement. If you can walk, it’s a great thing to do every single day. So we’ll start with that.

Alan Helgeson:

Great stuff about walking, but let’s take that even bigger. Let’s talk about the suggested minimum amount of exercise for benefits. And how much exercise a week does that look like?

Anthony Morando:

Yeah, Alan, you, you’re going to see the U.S. Department of Health is going to suggest 150 minutes a week. They’re going to suggest 30 minutes a day, five days a week. That’s what they’re going to suggest. I think that, say if I’m the one making the decisions for the country: one, right here we go, yep, I’m the guy for the job, right? I’m going to suggest at least 300 minutes a week. Now, that’s not to say that that answer is wrong, that they give, that recommendation is wrong. That’s taken into effect that I think we do need to exercise more.

Now, simultaneously, life is busy. People are busy. They can’t fit in a half hour some days. My job is to encourage them to fight that human nature. If somebody’s able to watch a show for 45 minutes, then you can still watch the show. Watch it on a bike, or watch it on a treadmill. You know, it’s significant to understand that if we don’t move, we slow down and the tide comes closer. Exercise, moving is the single most important thing you can do. And if you do it for an hour a day, it’s 4% of your day.

Alan Helgeson:

Anthony, that should be on a billboard. I love it. But we’re going to take it here to the benefits of all this movement. Let’s talk about how exercise can work towards our blood pressure. Can you give us a little insight on that?

Anthony Morando:

I think the blood pressure question is pretty simple. I think you have to think of pump efficiency. If we have a pump, and a pump is a contributing factor to a lot of different entities in this world. Our pump allowance happens with exercise. We create a better pump. And if we have a better pump, then there’s less pressure on our blood vessels and opportunities for our cardiovascular health just continue to stay open.

We have an open opportunity to be healthier if our blood pressure is lower. And there are three quick ways to lower your blood pressure in the natural remedies:

• A, going back to walking, you can walk every single day. That’s going to give you a chance to lower your blood pressure.
• B, strength training. Strength training is another form of lowering your blood pressure.
• And C, putting it all together where I can do a strength training exercise, and then maybe I can walk for 60 seconds on an incline treadmill, go do another strength training exercise. And then maybe I can crawl on the floor for 10 yards. That’s another example of aerobic and anaerobic exercise that are combined to decrease blood pressure.

Alan Helgeson:

Making us feel good about the benefits of movement. But Anthony, we’re about 10 minutes and change into this podcast. Let’s talk to the folks that maybe haven’t incorporated movement into their day-to-day routine, or for whatever reason, just start doing things. Life has changed. They haven’t found the time or made the time, whatever the reason is. What are those small steps? We could just get started, get the jumper cables out and just get started.

Anthony Morando:

You know, Alan, I think the first step to all of this is we have to connect with people psychologically and emotionally before they take that journey. You know, before they actually say, OK, I’m going to try to become fit. Like everybody has some type of blockage on the reason why they can’t or won’t do something. And you have to connect and commit. It’s easy to get a customer. It’s hard to get a client.

And I’m going to emphasize, I’m going to hit on that point because I feel like it’s important. It’s easy to have a customer – knock, knock, hi, I would like a personal training session for 60 minutes (laugh), right? That’s great. And that’s a quick transaction. Got a couple bucks in the pocket and life is good, but life becomes better for you and for them through longevity. So connect and commit. That transaction needs to become a transformation.

So that customer, you want that customer to become a client. And the only way to do that is to care about them and is to create a relationship first. And then, they become a client and then they don’t leave. And that’s simple. That’s simple math right there, right? That’s the T plus T equals, I don’t know what the equals sign is yet, but transformation. How about a T equals a TA transformation equals a transaction. And vice versa. They go hand in hand.

I believe that it doesn’t matter where you start. It matters that you keep it up forever because that will work. You can start by walking. You can start by doing five pushups a day, right? You can start by pulling a band apart five times a day. It doesn’t matter. What matters is that you do it and then you do it again the next day and then you do it again the day after that, and so on and so on. And then on top of that, why are you doing it? Why are you doing it?

Alan Helgeson:

Well, Anthony, let’s get into it here. Let’s start naming names. Let’s talk about some good forms of movement for beginners, those exercises and certain ones for certain age groups. So let’s even break it down here by some of those age groups for fitness levels, and let’s even talk about maybe some modifications if we want to get into that a little bit after the fact. But let’s go.

Anthony Morando:

Yeah, you got it. What’s important to understand when you’re classifying exercises in movement patterns? It’s important to understand something called the LTAD model – the long-term athletic development model. That was established through the late ‘80s, ‘90s and early 2000s compiled over time.

I think it’s important to understand that if I have a fourth through sixth grader or even, you know, Alan, I have four kids, right? They all move constantly. When you have these little kids up until the fourth grade, you’re working for suppleness. You are working for coordination. So what are the exercises that you can give somebody at a young age? They can body weight squat. They can learn how to do a hang, right? A lat hang or a hanging pull up. They can learn how to do a pushup. They can learn how to do a TRX row.

We have a lot of our little kids doing TRX rows, which is just suspended handles from a higher surface, and they can pull their body weight up. Body weight, split squatting body weight exercise is done in a real efficient and functional pattern along with sprinting and along with jumping and landing. That’s really good for a little kid. And they also get that within their sports.

And then to put the cap on the bottle with the kids, games, small area games, obstacle courses, teaching kids how to play, hang, jump, roll. That’s all effective for their motor development and for their overall development as the years go on. As they grow, as they get into that sixth through eighth grade range, Alan, and some of them start hitting puberty, that’s when we start introducing load to these patterns, meaning we’re going to give them weights. That body weight squat now turns into a possible goblet squat, right?

That pushup turns into a bench press. That lat hang turns into a pull up. Now the exercise is the basic movement patterns that we gave those kids become more demanding. Through high school, they’ve become more demanding and along with college and professional.

General population adults change due to mileage on the body. Adults still squat. Adults still hinge. They still pull, they still push, they carry things. The only difference now is for an adult client, when they’re squatting their squat might not be on their back barbell. We don’t load our adults in that axial formation where their skeleton is loaded, where their spine is loaded. Instead, we load them maybe from the bottom and maybe their hips tap a box or their glutes tap a box when they squat. There’s all kinds of modifications for an adult to squat because we still need to squat.

For pushups, if somebody is unable to do a pushup from the floor, we’ll elevate their hands. If somebody is not doing a pull up due to a shoulder issue, then that pull up turns into a lap pull down. So there are modifications, there are ways, but there are cans versus can’ts for everybody that wants to train. And everybody can train. Every body can train. And I’ll almost put the “have to” in there because it’s important. Because guess what? It keeps you alive longer.

Alan Helgeson:

Well let’s move to some of those basic rules here, Anthony. Someone who’s maybe not been very active or getting going into this stuff. You want to be watching out for things, you know, that you want to be careful not to overdo things as you’re kind of moving into this stuff and you don’t want to go from zero to 10 right away. What are some of those things we should be looking out for?

Anthony Morando:

I think no matter what, strength training, learning how to strength train properly is extremely important. You’re going to need to learn how to squat in a functional pattern, performing a upper body push exercise, an upper body pull exercise. And I say hip hinge, RDL is common when I say when hip hinge or deadlift. And I don’t say deadlift right away though, because everybody thinks that that’s just picking up heavy weight from a floor. Deadlift, meaning you’ve got to pick up a heavy bag of groceries at some point off the ground. So we want to still teach that pattern along with aerobic exercise.

If somebody’s just starting out, you don’t want to throw them into interval training right away. We have a great group here right now who, it’s called the transformation group, where six, seven weeks ago we didn’t give them any interval-based training, but now we do because they’re six or seven weeks in. But their cardio or their conditioning started off with a brisk walk. There needs to be integrity in the weight room because if there’s not, somebody can get hurt. And our first rule, no matter what, is do no harm.

Alan Helgeson:

Next question, Anthony. We know a little internet can be dangerous for everybody involved. So we’ll do some looking at different things and then we see terms like intensity, endurance or both. So as we’re starting with things like this, people may think they should focus on these things. You tell us as an expert, how do we decide what we should focus on as beginners when we’re getting into something like that? How do you make that determination?

Anthony Morando:

Number one, if you’re starting anything, it needs to be, the word fragmentation needs to exist. Small fragments over a long period of time. So if you’re starting out with fitness, first thing I advise is some type of low level aerobic activity for 30 minutes, along with two to three strength training exercises. That’s a 45 minutes to one hour piece of your day. If you’re unable to fit that in or fit both in, then maybe that day one would be some type of low level aerobic exercise.

And day two, you focus on more than two to three strength training exercises instead. And then you alternate that. I’m always going to push for six to seven days a week. You can do something every day if you gauge the intensity properly.

Engaging the intensity properly comes down to fragmentation. Leave a little bit of gas in the tank every single day so you can wake up and go back to more the next day. Over time, again, if you keep it up and if you get into a groove, then it becomes good for you because it’s something that you’re doing on a consistent basis. Consistency is key when it comes to fitness, but it needs to be fragmented.

Now, intensity and endurance and all the training variations and attributions out there, they’re different for everybody. That’s why it’s important to have an assessment.

Alan Helgeson:

Anthony, the next question I want to jump to is that word, the big M word here, “modification.” So I may have taken a tumble down a mountain from skiing and I’ve had some snowboarding incidents where, you know, I’ve got some orthopedic issues and there are people out there that have bad knees. They might be overweight, or if you’re pregnant, let’s talk about modifications. How do we figure these things out?

Anthony Morando:

Modifications are just, they are magic bullets within exercise, right? Like exercise is the magic bullet, right? That’s the magic pill that that’ll keep your life better and it’ll keep you around longer. But the modifications in the magic bullets within the magic bullet. I mean, they really work too. I mean, imagine going to the gym and your shoulder’s killing you, but then all of a sudden a coach could say, oh, wait a minute, wait a minute.

You know what, maybe you shouldn’t be pressing this over your head, but I bet you if you do it at 45 degrees, it’ll lessen the intensity on the shoulder. And then boom, Alan, all of a sudden you’re pressing at 45 degrees and you look at me and you go, whoa. Mind blown. We do that every day.

Alan Helgeson:

What I’d like you to speak just a few seconds about here, the modifications. I think modifications keep a lot of people away because they can’t do what they maybe used to be able to do. Or if they feel they’re having to do something different than what everybody else does, they feel different about it. Nobody wants to look different from what other people do. That’s a big deal. Can you speak a little bit about that?

Anthony Morando:

I appreciate that too. Because that’s certainly the other side of the coin while we’re talking, right? If we just talked heads, now let’s talk tails. It goes back to psychologically connecting with your clients. It goes back to saying, OK, you know what Emily, you’re not going to do this because we know this is going to light your knee up. I’m going to, or one of our coaches are going to say to ourselves, due to our experience in education, we don’t want the modification to necessarily be easier.

We want it to still be challenging. So we might manipulate the sets and reps for that individual. We might make that individual load, that modification, a little bit more than they would with a normal exercise. We want them to feel probably more challenged. That way they have the sense and feel internally that, OK, this is modified, but this is still really challenging for me.

There’s two things that happen. They’re either going to be satisfied with that modification or they’re going to want to go back to the normal exercise because the modification is too challenged, right? And with the athletes, it’s a little bit different because the way I modify an athlete, it’s like, OK, here’s the deal. If that’s hurting, that’s fine. I’m not going to try to put you in more pain. But if you’re not going to run, then I’m going to give you a low impact exercise or a low impact protocol on this bike, and this bike might be worse than the run. And I bet you four out of seven of them start running again. (Laugh)

You know, that’s not that bad. I think I’ll take the run and I’m not walking around like a little demon, but simultaneously I’m going to be demanding. Yet I’m going to be fair.

I’m going to give you both sides of that coin. And if you can run, you better run because you’re going to take away from the specificity of your sport. But if you can’t run, it’s not going to be easier. You can see, I can, you know, we flick the switch, right? With an athlete, you’re still connecting with the athlete. You are not degrading them in any way. You’re giving them an option. It’s democratic.

With the adults, it’s different. You have to give them something where they’re going to want to feel more challenged. So it is just, it’s just knowing people, right? It’s people. Modifications have to do with people too. Not just you being the expert on the exercise.

Alan Helgeson:

Let’s talk about something that we know people hear when they go to their doctor’s office and they hear the term, if they haven’t been active, that they hear these words. Muscle atrophy. What is it? And can you reverse this?

Anthony Morando:

Muscle atrophy is just decrease in muscle mass. It’s decrease in strength. Can you reverse it? Yeah. It’s one of those scenarios where we get older. We all have a genetic pool. People lack activity. There’s some medications out there, there’s injuries out there, there’s limitations.

But either way, finding a way to strength train two to three times a week will fight against the atrophy. That atrophy is just another word for the decay code. Daily exercise, emotional commitment, reasonable nutrition, and a real engagement with living will fight against any type of atrophy. It’s just going to. I mean that. That’s it. And it starts with exercise. It starts with exercise.

So atrophy, defeating the atrophy or working against it to delay it, starts with exercise. Whoever out there is listening. If you feel like, “oh, it’s too late to start.” It’s never too late to start. It’s great if you committed to this before, when you look back, if you’re 42 right now and you don’t start till you’re 60, you don’t want to look back and say, you know what? I wish I started with 42. It’s a lot harder at 60. That’s not going against any 60-year-old out there. That gap, that 18-year gap is a big difference.

You can start today. All you have to do is move. If you don’t know what type of movement that is needed for your body, then just walk.

Alan Helgeson:

But let’s talk about tracker watches, apps, those kinds of things. What are some of those things that Anthony recommends to people he works with? Or your family comes over for Thanksgiving and they say, oh, Anthony, tell us what’s going to help me on the tech side.

Anthony Morando:

The trends of fitness, we always have to be aware of. I think wearables have become a really big deal. Everybody I see is, is chances are they’re wearing an Apple watch. I love my Apple watch. I get to track my workouts. I get to track my heart rate. I think wearing an Apple watch is important because you can track your intensity, right? You can track how often you’re training. It rewards you and almost gives you this little technological incentive. Like, “good job,” “keep moving,” right?

But some people need to see that or hear that. Some people have never worked out seven days in a row before. Some people have never worked out four out of seven days before. That wearable is going to give you some type of award. It gives you a little medal – it pops up, right? Some people think that’s cool.

The wearables are important, I think, for heart rate, especially because heart rate is going to dictate the intensity zone that you’re training in. A heart rate monitor in general, a heart rate monitor, keeping track of what your heart is doing, what the pump is doing during your least intense zones and your most intense zones. That’s important too.

As for a smartphone or an iPhone, there are several apps. Now, I’ll say from a technological standpoint, having some type of online training software app is significant for people because online fitness has become a popular entity throughout the world. It’s global. And I’ll take one more step above that, and this might not be too technological, but YouTube is still a go-to when it comes to education. Not Instagram, not Facebook, not Twitter. It’s YouTube. YouTube still holds strong and there’s bad content everywhere. There’s good content everywhere. But if you can find the right coaches on YouTube, there are so many videos with great coaches performing exercises.

That would be my answer when it comes to technology in the fitness realm. Now there’s probably 19 or 20 more Alan, but just to keep it simple, that would be a baseline.

Alan Helgeson:

Let’s get to hydration and water. How important does that play a role in any movement and activity and why?

Anthony Morando:

Water is 75% of our body. So hydration plays an important role for multiple factors. A couple that come right to my head would be vitality. In order to function, in order to live, to sleep well, to move well, to breathe well, you’re going to need to be hydrated. While you work out, you’re going to need to sweat. If you’re dehydrated, then you might not sweat as much as you should be.

The other piece of it too is you need to drink water to feel better. Like you feel good when you drink water. You feel alert when you drink water. The fact that you’re hydrated is another version of meaning “I am” right? Like, I am. Just like when you drink your coffee, that stimulant, it gives you a bigger version of “I am.” You feel great when you’re doing it, but water’s a constant. It’s like anything else. It’s like exercise that’s constant. It needs to happen on a consistent basis because if it doesn’t, there are significant health dysfunctions that come with dehydration.

Alan Helgeson:

I’ve got a friend here that I work with and says, when he’s not drinking enough water, you don’t feel it necessarily the same day. He can really tell the next day. That’s a big thing. You can tell the following day.

Anthony Morando:

Yeah, you’ll get a headache, feel fatigued, feel lethargic, you know, you might even have some type of delayed onset muscle soreness. I’ve heard that in a lot of people who are frequently dehydrated and believe it or not, people have trouble drinking water.

Alan Helgeson:

Anthony, we’ve had a great program here today, but as we wind things down here, let’s kind of tie a bow around everything here with final thoughts about why we should get moving. Is it that hard? I want you to really leave us with something inspirational that’s kind of like your big job and what you do. Send us out the door here with making us feel good that we can get this done.

Anthony Morando:

Well, I think with exercise, even with movement, you want to constantly try to reduce inflammation. Life is inflamed. Life is inflammation, mentally and physically. When we move, when we exercise, when we have that emotional commitment to something, well-being, we feel better.

And if we feel better and our physical self-perception is heightened, things go better. I don’t know if I’m too inspiring, but I will say that I try to be factual when it comes to exercise because I love and appreciate it and it’s done a lot for me in my life. Overall, if you’re going to leave you with something, it’s fitness is the celebration that we’re alive and we can move. That’s it. If we’re given this body, we might as well do the best we can with it. So don’t fill it with sugar. Move it more. Try to read more to make sure that that brain is feeling better, and engage in good activities that make you feel better. Lift a couple weights. Be reasonable with nutrition. Drink a lot of water and keep moving and things might just feel a little bit easier and you might look better and feel better.

Alan Helgeson:

Anthony Morando, thank you for joining us here today. Anthony, general manager of Sanford Sports Performance in Grand Forks. Great stuff. My big takeaway here among all of it, I wrote this down here too, that movement is life.

Cassie Alvine:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.

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Why breast density affects your mammograms

Dr. Andrea Kaster:

One of the things we want to drive home is that if you know you have denser breast tissue and that mammograms are still very valuable – they’re still the gold standard for screening – but we know that there are certain things that we cannot see on them and that it’s important to pay attention to your breast. Know what feels normal for you so that you’re more likely to notice a change. And if you do notice a change, we want you to come in and get it checked out.

Courtney Collen (host):

This is “One in Eight,” a podcast series by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. One in eight women will be diagnosed with breast cancer during her lifetime. So we want these conversations to shed light on awareness, featuring expertise from our Sanford Health providers that could save your life or the life of someone you love. We’re glad you’re here.

In this episode, we are talking about breast density, what it is and why it’s important in your care journey at Sanford Health. Joining me is Dr. Andrea Kaster, a breast health specialist who provides care to patients at the Edith Sanford Breast Center in Fargo, North Dakota. Welcome, Dr. Kaster. Thank you so much for being here.

Dr. Andrea Kaster (guest):

Thank you for having me. I’m glad to be here and talk about this timely issue.

Courtney Collen:

We’re so happy to have your insights and we’ll get started with this question: What is breast density and how is it determined?

Dr. Andrea Kaster:

Breast density is essentially a mammographic finding. And that’s a very important point to drive home, is really we know density based on how the breasts image on their mammogram. And so what it is, is the relative amount of glandular lobular structural tissue, or connective tissue, relative to fatty tissue in the breast.

And so the reason that matters is that the more fibrous tissue and glands and ducts show up white on a mammogram, whereas fatty tissue shows up more gray appearing. And so the whiter the background is, the more dense your breast tissue is essentially on the mammogram.

So cancer shows up white on a mammogram as well and so if you have a very white background, you’re looking for a white mass within a white background.

Courtney Collen:

Why is breast density an important factor in mammograms?

Dr. Andrea Kaster:

So, breast density has two major implications on mammography. One is that it can make it harder to see masses. So like talking about the masking effect of that glandular tissue relative to the fatty tissue. So harder for radiologists to see masses and sometimes then the masses actually have to get bigger before they can be seen.

And then the other thing is, which is not completely understood, is that women who have dense breast tissue do tend to get breast cancer more often. So whether it’s just the relative amount of more active cells in their breasts, there’s not really sure what that connection is, but it is an independent risk factor for breast cancer. So it’s a twofold risk.

Courtney Collen:

OK, good to know. How common is it for women to have dense breasts? Is it common?

Dr. Andrea Kaster:

It is common. And that’s a very good point to make is that actually 50% of women have what would be considered dense breast tissue.

So the American College of Radiology has four categories of density that are given with every mammogram that’s done. And that is a category A, B, C, or D, which means primarily fatty-replaced breasts, scattered fibroglandular changes, heterogeneously dense, or extremely dense breast tissue. And it’s the heterogeneously dense or extremely dense categories that count as dense breast tissue.

So 50% of women fall into one of those two categories on average, it depends somewhat on age, but we would say about 10% of women have fatty-replaced breasts, 40% have scattered fibroglandular changes, 40% have heterogeneously dense and about 10% have extremely dense. So it is not uncommon or abnormal to have dense tissue.

Courtney Collen:

Are there any lifestyle factors that contribute to having dense breasts? Why do some women have more of that dense breast tissue than others?

Dr. Andrea Kaster:

Density is primarily determined by your genetics, just how your breasts were kind of genetically predisposed. So we will see family where, yes, all the women have denser tissue. And so that is the primary reason that we will find dense breast tissue in some women compared to others.

There are definitely other things that go into it. So, you know, genetics is a big deal. As you get older, your breast density tends to go down. So we lose some of the more ductal and the lobular tissue and it’s more fatty-replaced with age.

If any individual has a dramatic change in their weight, that can change their breast density. Pregnancy can make a difference. So pregnant breasts on imaging tend to be much more dense. Menopause with a drop in estrogen will decrease your breast density. If you’re on hormone replacement therapy or hormone blocker therapy, those can either increase or lower your density.

So there are definitely things in our life that can make a little bit of difference, but it’s primarily genetics. And as we go through life, you will look back on a mammogram and you can compare to, and there may be a difference that you see, it’s not a like one year from the other, you’re seeing a dramatic difference unless we add in some of these other factors.

Courtney Collen:

What challenges do dense breasts present in detecting breast cancer through mammograms?

Dr. Andrea Kaster:

We know that the denser the breast tissue is, the whiter the background or the whiter the appearance on a mammogram. And cancers show up white on a mammogram, so if you have a very white background, it’s like a polar bear in a snowstorm. It’s just a lot harder to see a white change within that.

And so we find that cancers are found at a slightly larger size when women have denser breast tissue. They tend to have pathology with some more high risk features related to it. And we know that the sensitivity of the mammogram, meaning the number of cancers found on a positive test, is lower with dense breast tissue.

So whereas a mammogram in a woman who has a very fatty-replaced breast, their mammogram’s going to catch, we would say, and the numbers vary, but we would say a nine out of 10 breast cancers on initial. And that goes as low as 62% or 6.2 out of 10 breast cancers in extremely dense breast tissue. So the difference between the sensitivity of the mammogram is quite a bit.

And so a big take home message for patients is really that we know mammograms are great and a lot of this information that we share with women, because we’ve always talked about density, but it hasn’t always been something we talked about with patients.

But one of the things we want to drive home is that if you know you have denser breast tissue and that mammograms are still very valuable – they’re still the gold standard for screening – but we know that there are certain things that we cannot see on them and that it’s important to pay attention to your breast. Know what feels normal for you so that you’re more likely to notice a change. And if you do notice a change, we want you to come in and get it checked out.

The whole idea behind this started with a woman who was a stage 4 breast cancer diagnosis, and she felt a lump after a mammogram and sort of thought, well, I just had my mammogram, it’s going to be fine. This can’t be anything. And delayed going in with that sort of sense of security.

So for all densities, we want women to report changes, but that’s especially the case knowing in women with denser tissue that the mammograms are just not quite as sensitive as they are for women with less dense breasts.

Courtney Collen:

Are there any additional screening methods recommended for women who have dense breasts?

Dr. Andrea Kaster:

Yes, there have been some current guidelines that are suggesting that patients should at least talk to their providers about their density. And talk about if there are supplemental screening options for them that would be useful. So it kind of depends upon the area of the country you’re in or even what Sanford facility that you are going to and what those options are.

For women who have extremely dense breast tissue, or heterogeneously dense breast tissue, and have an increased risk of breast cancer, the best supplemental screening is an MRI. That’s kind of the most well-studied supplemental screen we have. We typically do that at about a six-month interval from the mammogram. So they’re actually, again then getting screened twice a year.

MRIs are a completely different type of study. They’re a magnet and they use a contrast material called gadolinium to look for areas of blood flow changes within the breast. And so they look at things totally differently. They do not replace mammograms. They are in addition to mammograms and so that is a good option for women who are higher risk.

For women who might have dense breast tissue, but don’t necessarily qualify for a breast MRI or to qualify for being higher risk, then we have other options. One of them that we use most commonly is a contrast enhanced mammogram that again, uses a contrast material to highlight any areas of increased blood flow.

Some facilities do whole-breast ultrasound. The sensitivity on whole-breast ultrasound is not as high as some of those other studies I talked about so we don’t use that here. And some do like a molecular test on the breasts as well. But again, that’s not something that we use here. So typically it’s either adding an MRI or a contrast enhanced mammogram.

Courtney Collen:

In talking about risk, which you mentioned a moment ago, how would breast density or how does breast density affect a woman’s risk of developing breast cancer?

Dr. Andrea Kaster:

Like we talked about, it does increase your risk probably about 1.2 to twofold increased risk of breast cancer in women who have denser breast tissue. So it does increase the risk and that is part of the overall picture.

There are many things that can affect your breast cancer risks. Some of them are much more kind of prominent than others. Certainly if you have a history of an early breast cancer yourself, if you’ve had an abnormal biopsy with you know, atypical hyperplasia or LCIS, if you have genes that increase your risk, all family history, that all can make a difference.

And so it really takes doing using a risk assessment tool that includes density as part of your risk in order to determine that cutoff. And typically we would use the cutoff at about 20%. So women whose lifetime risk is above 20% are considered to be high risk, and then there’s kind of a moderate risk category around 15 to 20%. And then the average risk below that.

We currently recommend starting annual mammograms at age 40 based on the fact that that is the way to save the most lives. And so that is our recommendation definitely for women who are identified at being higher risk or say for example, have a mammogram for diagnostic purposes because you wouldn’t necessarily know if you have dense breast tissue unless you’ve had a mammogram because we can only know by the mammogram findings.

And so say somebody comes in with a problem and they get a mammogram and they’re found to have extremely dense breast tissue, that is a patient who we may want to do a risk assessment model on to see if they would qualify for earlier screening. And there are many studies that show that for women who do have extremely dense breast tissue or heterogeneously dense breast tissue in their 40s, that there is a very high benefit to having that annual mammogram.

Some guidelines will say you can go every other year or you can wait till 45. That does not apply to women who have dense breast tissue.

Courtney Collen:

Can you determine dense breasts by like a physical exam or it needs to be determined by a mammogram?

Dr. Andrea Kaster:

It can only be determined by a mammogram. Because it really is, when we’re talking about density in this form, in the technical scientific form, it is the relative amount of fibrous tissue to fatty tissue. And you can’t tell by feeling.

Courtney Collen:

You can’t just touch your breast and say, you know, these feel dense.

Dr. Andrea Kaster:

(Laugh) No, and that’s a very common – I have people tell me all the time that they have dense breast tissue and they’re talking about the way that their breasts feel. Right? Sure.

So what breast density is not, it is not lumpy breasts, it is not firm feeling breasts, it is not size of the breast. All of those things are commonly kind of misconstrued as I have dense tissue because it’s really lumpy. Well, breasts are actually mostly lumpy and that does not have anything to do with what they’re going to necessarily look like on imaging.

Courtney Collen:

What should women with dense breasts know about their mammogram results?

Dr. Andrea Kaster:

I think that they should first of all know some of the things we talked about. Like we just know that it is not considered abnormal to have dense breast tissue. That it’s actually very common.

I think it’s important for them to know that yes, it does increase their risk, but it’s part of the whole picture. And so talking to your provider about what your other risk factors might be in order to get a better whole picture, I think it’s very important for them to know that mammograms still work. They are still considered to be the gold standard for screenings because a lot of times women will come in and think, well, I don’t need to have a mammogram because my breasts are too dense. And it’s like, and that is not the case.

We still want use mammograms as our best screening tool for breast cancer. 3D mammography is important in women who have dense breast tissue. So most facilities now use tomosynthesis or what is more commonly called 3D mammograms. That is really important for women with dense breasts.

So I’d say if you do know you have a denser half of tissue, that it’s very good idea to make sure you’re getting a mammogram where they have 3D mammography because that improves cancer detection rate. And it also reduces callbacks because that’s another very stressful time for women when getting mammograms. And if you have dense tissue, you’re more likely to have that overlapping effect of the tissue. And so 3D really helps with that. So I would definitely tell those women, make sure if you are getting it at a facility that whatever facility that is, that they’re using 3D mammography.

And then just to know that it might change a little bit. So one of the things that can be a little bit frustrating or hard to understand is that density can change from year to year or even radiologist to radiologist. So you could have two radiologists look at the same mammogram and one might give one category and one might give a different category. It’s not that your breast density is different in those different pictures or from, you know, even maybe from year to year. It has more to do with variations in the way that a radiologist actually reads those pictures.

And so you may get heterogeneously dense breast tissue one year and extremely dense breast tissue the next year and it doesn’t necessarily mean that your density has changed. It just means that it can vary slightly on lots of factors essentially. So the big overall picture would be that you’re in that denser half.

And then we talked about reporting changes and not, you know, for everybody not relying that if the mammogram is normal, you can’t have breast cancer. That’s never the case. And so we always want to make sure that you’re still paying attention to your breasts and reporting any changes.

Courtney Collen:

Good to know. Are there any recent advancements or studies related to breast density and mammograms?

Dr. Andrea Kaster:

Yes. There are a lot of ongoing studies. There’s still studies ongoing between using 3D mammography like we talked about, or 2D and also an abbreviated MRIs for screening women with dense breast tissue. So there’s all kinds of research going on how we can best screen these women.

There have been some new recommendations or guidelines. The Mammogram Quality Standards Act, which is through the FDA, in September of 2024 came out with guidelines suggesting that all women be advised of their breast density. So it kind of was state to state for a while and now it’s like, nope, all women need to know what their breast density is when they have a mammogram and that they should discuss supplemental screening with their primary care provider. So those are new guidelines that are pretty specific about that.

We need to be having these conversations and at least discussing options for supplemental screening. As far as the American college of Radiology in 2018, they recommended an annual MRI for women who have had a history of breast cancer and have dense breast tissue. And so that is new related to breast density specifically, new recommendations there.

So there have been these more recent changes. Along with people being more aware of it, they’re giving us guidelines on how to best utilize that information.

Courtney Collen:

It’s such valuable information and really the more that we know about our own bodies, the more proactive we can be about our health. Like now leaving this conversation, I want to know what my breast density is and I should probably wait until I’m 40 to get that mammogram. But no, it’s all fascinating. And we appreciate the update in those advancements and studies.

Dr. Kaster, if a woman is concerned about her breast density or the risk of developing cancer with dense breasts, what would you tell her?

Dr. Andrea Kaster:

So, I mean, I start by trying to make it seem that, to understand that it is more normal than we might realize, so that it’s not a bad thing. It’s not that there’s something wrong or that it’s even that unusual. That we just, it’s just more common than people realize. And so to try to think of it that way. A lot of people are relieved to find out that it’s actually not a rare thing and that there’s more women out there than they might realize.

And then just to talk to their providers about their overall risk because it is part of the picture but not the whole picture. And so that it’s important for them to talk with their primary care providers about if they need to have a more formal risk assessment or if they need to do any extra testing because of that.

And then continue with their breast awareness, continue with their annual mammograms, request a clinical breast exam if they feel like they have dense tissue and want to make sure that they’re getting checked out. That would be important as well.

Courtney Collen:

Well, this has been such valuable information, Dr. Kaster, learning so much about breast density, which is going to be great information for our patients listening.

Dr. Andrea Kaster:

We are here at the breast center anytime people have questions or providers have questions and they want to reach out, we’re happy to discuss this with them. I do think it’s important to have a good discussion about it kind of early on with realizing if you are in that denser half so that people have a good understanding of what the recommendations are going forward.

We will be keeping abreast of all new changes and changes in guidelines and making sure that we keep updating that all the time through our facility and through our Edith Sanford initiative and just making sure that we’re doing the best we can for screening.

We know that screening helps, but we also know that breast cancer is a very common cancer. It’s common in younger women and the sooner we can find it, the better options we have for treatment and the less aggressive treatment that is needed for cures. So it is important to try to find it as early as possible and that takes the whole team working together to do the best we can for women.

Also, just a reminder for patients too, is that you can get breast cancer before 40. So make sure that you’re paying attention to your breasts as well. If you have a family history, reaching out and trying to see if you might be a candidate to start screening sooner is also really important.

Courtney Collen:

So important. Dr. Kaster, thank you so much for all of your information and expertise on this topic and for all that you do for patients at Sanford Health.

Dr. Andrea Kaster:

Thanks for having me.

Courtney Collen:

This episode is part of the “One in Eight” podcast series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org. I’m Courtney Collen. Thanks for being here.

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What to expect with a low-intervention birth

Kayla Quinn:

Some people might think, “well, if I’m in the hospital, it has to be X, Y, Z, this way.” And that’s really not true. You don’t have to have Pitocin, you don’t have to have an IV, you don’t have to push on your back if you’re in the hospital. That natural birth experience really can happen. It can happen in the hospital just as well as it could at home.

Courtney Collen (host):

Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. We are starting new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living, and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.

In this episode, we are talking about a low-intervention birth and the options that you have at Sanford Health. I have two guests joining me for this conversation. Kayla Quinn and Stephanie Metzler are both certified nurse midwives at the Sanford Medical Center in Fargo, North Dakota. Kayla, Stephanie, welcome. Thank you both for being here.

Both guests:

Thanks for having us.

Courtney Collen:

Happy to have you. Let’s jump right in here. When we say low-intervention birth, what does that mean?

Stephanie Metzler (guest):

So low-intervention birth usually involves limiting the medical interventions. So I feel like that really starts with prenatal care, with providing education on pregnancy changes to be expected, what labor really looks like physiologically. And our goal really with low-intervention birth is to allow the body to go into labor on its own naturally and progressing through the birthing process without us adding a bunch of extra medical interventions that aren’t necessary.

So we do promote interventions when they’re appropriate for safe care, and we’re constantly evaluating that safety plan. So each individual client is different of what we’re doing, but the outcome is safety and best outcome for what Mom wants.

Courtney Collen:

Yeah, absolutely. Thank you for that. And at Sanford Health, what does that experience look like? In other words, how does a patient have a low-intervention birth? Like, what options do they have and how soon would they need to know that’s what they want?

Kayla Quinn (guest):

I think that it’s important to start thinking about those things early on in your pregnancy for a couple reasons. You know, at Sanford we have a lot of options for providers. You can see throughout your pregnancy, you have the options of OB/GYNs, obstetricians who are medical doctors, or you have the choice of certified nurse midwives. And a lot of it comes down to personality too, and really finding that provider that really meshes with you and someone you feel comfortable having a conversation with.

You know, low-interventional birth really comes down to planning and open communication more than anything. And so having the discussion in advance before you get to the labor part of, OK, what do you want? What does that mean to you? What does low intervention mean to you? Does that mean not breaking your water? Does that mean not having an induction? Does that mean no medication? Does that mean maybe just IV medication versus an epidural? It’s really kind of what does that mean for you?

And we do have all of those options at Sanford. You know, you can do low interventional with medication, you can have no medication and have interventions. And so you know, there really is a lot of options, but really having the conversation in advance is really important. What that might look like, though, would be if maybe … I don’t want to use the word avoiding, but kind of avoiding an elective induction or, like Steph said, trying to let labor just progress naturally on its own.

And there are things we can do to to help your body get ready for a natural labor, things like staying active, walking beyond the birth ball, using the miles circuit and spinning babies, raspberry leaf tea, pumping and nipple stimulation. These are all things you and your provider can work through prior to labor to try to get your body kind of set up in the best way possible to get it to go into labor naturally.

There are things during labor if you want low intervention, being up and moving, staying out of that bed is going to be really helpful. Being up and moving on the birth ball, walking, using the jacuzzi tubs and really just, you know, staying active up to that whole point. And being prepared before you come in is going to be the big thing.

Courtney Collen:

Yeah. Thanks, Kayla. Why would a woman opt for this type of birthing experience? And are you seeing an uptick in women wanting an unmedicated birth?

Stephanie Metzler:

Yeah, I feel like we are seeing more women that are seeking out this more natural, unmedicated birth option. And I know for each individual woman, it’s a very varied reason. It’s a very personal reason usually of why they’re wanting this natural birth. Sometimes they want to be more in control of their body throughout the labor experience. They want to experience the natural hormone cascade. They want that more bonding experience of being able to, you know, get up right away after having your baby and not having the epidural.

So there’s a lot of different reasons why people are wanting this experience. So I think it goes back to what Kayla had said – that communication piece of finding a provider that is wanting to support your experience and what that looks like for you.

And so having a low-intervention birth doesn’t necessarily mean you have to stick with not having any medications. You can go into labor with the plan of low intervention, and we can respect that and honor that. And sometimes that plan changes and evolves as labor progresses. And that looks like maybe adding a pain medication on board of labor, adding nitrous oxide to cope with the labor pains, or getting an epidural if it’s a longer labor. So I think, the choice of why you’re wanting that low intervention or unmedicated birth really is unique to each person. But we as providers, we want to come alongside and meet them where they’re at for what the reasonings are for that choice.

Kayla Quinn:

I do think that social media plays a part in this too. People see the good and the bad, right? I think a lot more patients have access to seeing other people’s stories. I think we talk about our birth stories a lot more now. And so if they see someone who had a poor birth experience or know someone who had a poor birth experience because of interventions, then they might be more wanting to have that low-intervention option.

So, I just think we’re talking about our birth experiences a lot more. And so it gives people the freedom to really think about, oh, I do have the options. What might that look like for me? And we see both sides. We see that “absolutely, I want nothing,” and we see the other side of “whatever you can do to get this baby out.”

Courtney Collen:

Yeah. Well, thank you for the insight there. And I would imagine social media and people sharing their stories does, you know, increases the conversation. Talk through the benefits of having this experience, like a more low-intervention experience, in a hospital setting.

Stephanie Metzler:

I think one of the biggest benefits of the hospital is the access to resources. If you’re needing interventions for either Mom or Baby, the resources are right there. You’re not having to wait for the drive time of either, you know, driving to the hospital to get those resources or a transfer with possibly EMS. So, I think that’s the biggest reason of choosing hospital versus home that some people like to consider.

Kayla Quinn:

I think we know that birth can be very natural in a very beautiful and peaceful process. But sometimes things can go wrong, and I think that the main benefit, like Steph said, is just being close if something does go wrong and having those options if you need them.

Courtney Collen:

Yeah. Thank you. At what point would more medical intervention be necessary?

Kayla Quinn:

There’s a few different points in a labor process. If it’s been a really prolonged labor and Mom’s been laboring for multiple days, but there’s really been no changes, that can be necessary for not necessarily even for fetal distress or anything, but just moms get exhausted. When you have a prolonged early labor phase like that, moms lose a lot of energy and sometimes need just a little help to get some of that energy back to make the rest of the process a little smoother.

Fetal distress is a big one where intervention might be necessary. I always tell my moms: you’re the boss of me. I want to make this a good experience for you. However, your baby is the boss of all of us. If Baby’s in distress, then that’s going to change how we react to things because our goal is just to have a healthy baby and healthy mom at the end of this.

Infection is another one. If Baby or Mom develops an infection throughout the process, that’s another big reason why we might discuss interventions.

Stephanie Metzler:

We’re constantly evaluating the safety of the labor, the safety of the birthing experience. So we’re listening to both Mom and Baby of what that looks like. So each labor is different and what we’re needing for interventions possibly could be different. So really just, you know, validating that everybody has a unique experience and if we see concerns, we’re talking about it. We’re constantly evaluating what plan of action is appropriate for this labor.

Courtney Collen:

Thank you. What questions do you hear most often from patients during their prenatal care journey about this topic as they look ahead to play in their own labor and delivery experience?

Stephanie Metzler:

Yeah, I think the biggest one that I hear from patients is do I need a high pain tolerance to be able to handle labor unmedicated? And the answer is no. I feel like somebody that can self-report saying that they have a very low pain tolerance, they can manage those contractions. The biggest thing that comes back to that is prepping yourself for labor. You know, doing that mental work ahead of time, knowing what it’s going to kind of take to have a vaginal birth and have a natural labor, low interventions.

So I think that’s the biggest question is like, do I need to have a high pain tolerance and how can I prepare myself for this natural birth? So that looks different for everybody.

Some people like a formal childbirth education class where they go in person and have structure of educating what labor looks like, what coping mechanisms, like how do we get from having labor to having a baby? What does that look like?

Other people choose online education, self-educating themselves, talking to their friend groups, looking at social media, kind of educating to prepare yourself for what labor and birth will look like and how you can best manage coping with it.

Kayla Quinn:

And I think sometimes people ask, OK, well what does Sanford have to help me with that? And we do, like Steph said, we’ve got the birthing classes. Once you get to the hospital, we have jacuzzi tubs, we have birth balls and peanut balls. We have combs that people can use to squeeze in their hands to help with counteracting the pain. We’ve got the peaceful music on for the room. You can bring your own music. We have Bluetooth speakers.

Stephanie Metzler:

We have an overhead star projector for like the calming atmosphere and battery-operated candle lights to kind of set the atmosphere a little bit calmer. We have little massage roller balls and like finger massage roller things. Coloring is an option. We do have interventions and tools with how to cope through those early labor, active labor pains.

And I think another question that sometimes comes up is, can I have an unmedicated or low-intervention birth for my first baby? Or do I have to have had a baby before to be able to do this? And the answer is yes, absolutely you can have an unmedicated, low-intervention birth for your first baby. I feel like women are so amazing and their bodies are amazing and they’re able to do it. So it’s definitely not something that’s off the table. You don’t have to have had a previous baby to be able to have an unmedicated or low-intervention birth.

Courtney Collen:

Sure. Thank you. Are there any common myths or misconceptions around a more natural birthing experience?

Kayla Quinn:

People might think you can’t have a natural birthing experience in the hospital, that that’s only something you can do as a home birth, which like we have talked about. We’ve got the tools to help you do it very naturally in the hospital as well.

Some other myths people have, well, as soon as I get there, they’ll put an IV in me. That’s a discussion you can have with your provider. Some providers are really comfortable with, if it’s not necessary, you don’t have to have one in until it becomes necessary, if it becomes necessary.

Other questions, you know, the myths of, well, if I’m in the hospital, I have to deliver on my back, and that’s absolutely not true either. Again, it’s having that conversation of I want to deliver in a different position, side lying, squatting hands and knees, whatever.

Some people might think, “well, if I’m in the hospital, it has to be X, Y, Z, this way.” And that’s really not true. You don’t have to have Pitocin, you don’t have to have an IV, you don’t have to push on your back if you’re in the hospital. That natural birth experience really can happen. It can happen in the hospital just as well as it could at home.

Courtney Collen:

Well, thank you for clarifying, because that is such an important piece to this conversation as well. Earlier, Kayla, you mentioned Baby’s the boss. If Baby is in distress, then you know, you and your team intervene as necessary. So for a mom and partner, this is maybe not part of the birth plan.

So when it’s time to kind of shift gears a little bit and you really need to ease any anxieties or fears because this is not going according to their plan, what do women, what do partners need to hear in those moments, and what do you tell them to ease their anxieties, to calm their fears, to keep them going?

Kayla Quinn:

A big thing for them to hear is, you know, our goal is to keep you and this baby safe. We’re all here to protect both of you. And it’s OK. It’s not their fault. I think sometimes when things don’t go according to a birth plan, moms feel guilty like they did something wrong, or it’s their fault that it’s not going right. And that’s absolutely not true. Although we know what our body should do, it doesn’t mean it always does do what it’s supposed to.

And so I think really just being reassuring and letting them know we’re here, our goal is still to have a healthy delivery, healthy baby, healthy mom.

And sometimes some interventions are just short-term. Maybe we just have to do a quick short-term intervention and then we can continue with the birth plan. Really just being there and then also, when we can, giving them the time and space to come to terms with the fact that things have changed.

But also I think it’s really important when things happen quickly, which we know they can, to give those parents the ability to talk about it afterwards and just be able to talk about what maybe didn’t go according to their plan so they’re not bottling it up because it can be a little traumatizing if things don’t go the way they want it to. And so really just, again, open communication, having the conversations with them about, you know, let’s talk about maybe why things didn’t go according to plan, or tell me how you’re feeling about it.

Stephanie Metzler:

I love that. Yeah. The open communication and talking through what we’re seeing, why we are making recommendations to do interventions when it’s happening. So things aren’t just being done to the woman. Like things aren’t out of their control. They’re still in control of things.

Maybe we’re making a recommendation that’s different than what their birth plan has, but this is why we’re making this recommendation. This is what we’re seeing, and yeah, we want a safe baby, we a safe, healthy delivery. That’s our ultimate goal.

But talking that through and then going back full circle after the delivery and say, “I know that X, Y, Z happened. This is why we had to move to this plan. You know, what are your feelings on this? How are you processing through this?” And making that space so they have that time to validate their feelings and feel heard and respected.

Courtney Collen:

Yeah. So important. Absolutely. What advice do each of you have for listeners of this podcast who might be looking ahead to their own birthing experience and may choose a more natural, unmedicated option?

Stephanie Metzler:

I feel like the most important thing is doing your research of what you want and what you want your labor to look like. Interview with providers. Have your first meeting for your initial OB appointment. And if you don’t jive with that provider, don’t be afraid to seek a different provider. Switch options and gather more information. Get recommendations from your friends, from family members of who they had for their experiences, and find somebody that you fit well with and somebody that, as a provider, will respect your wishes for what your labor plans look like.

If you’re wanting that low-intervention unmedicated birth and you’re low risk, maybe looking at a midwifery team and seeing if we’re a good option for you. There’s so many resources that we have available during pregnancy to prepare you for that labor and birth that making those decisions like Kayla had mentioned in the beginning of your pregnancy kind of helps guide the rest of the pregnancy.

Kayla Quinn:

And also really just doing your research about what to expect within unmedicated or low-intervention birth. And like we talked about – prepping for those things in advance. Looking at what are focal points or what breathing techniques are there. Talking with your partner, your support person, who’s going to be there on, how can they help? And starting to have those conversations. You know, how are they going to be able to help throughout your labor to keep you on track and help you through the pain of the labor.

And like Steph said, the conversations with your providers and kind of just that it’s really open communication. I think the absolute key point of having a low-intervention or an unmedicated birth is truly communication and just being prepared.

Stephanie Metzler:

The greatest birth plans sometimes don’t happen and that’s OK. We pivot all the time in the health care field during labors and births. And if you have this beautiful plan laid out and things have to shift, that’s OK. At the end of the day, knowing that, like Kayla said, it is not your fault that things had to shift. Baby is ultimately in control and it will help you process the shift in those plans. But we want to be there and support you along whatever journey that you have as providers to have a baby.

Courtney Collen:

That’s the beauty of the journey. Every pregnancy, prenatal journey looks different. Every labor and delivery experience looks different, and I’m sure the two of you have seen it all. Anything else that I didn’t ask you, Stephanie, Kayla, that you’d like to share on this topic?

Stephanie Metzler:

My biggest recommendation as a provider is those childbirth education courses. If you’re planning that unmedicated birth or more natural birth, being well-informed of what to expect is really helpful in achieving that goal.

Kayla Quinn:

And the beauty of it is, is you can do them in person, you can live online. There’s a lot of options now. And I agree, just having that preparation in place beforehand is really key.

Courtney Collen:

Well, this has been so insightful. Stephanie, Kayla, thank you so much for your expertise on this topic, for all that you do as certified nurse midwives in Fargo, North Dakota. We appreciate you and appreciate your time today.

Stephanie Metzler:

Thank you so much for having us.

Kayla Quinn:

Thanks.

Courtney Collen:

This episode was part of the “Her Kind of Healthy” podcast series by Sanford Health. For more by Sanford Health, visit Apple, Spotify and news.sanfordhealth.org.

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Make consistency a ‘trend’ when it comes to your diet

Simon Floss (host):

Hello and welcome to the “Health and Wellness” podcast series, brought to you by Sanford Health. I’m your host, Simon Floss with Sanford Health News.

Various studies suggest that nearly half of Americans say that they want to lose weight. If you simply scroll any social media feed, there’s countless people touting different diets as the best way to shed a few pounds or simply achieve your best health.

And I’m sure you’ve heard of them – diets like keto, plant-based, carnivore, Mediterranean, intermittent fasting – and I’m sure you actually probably know someone who is on one of those diets right now. It can be hard to find a diet that fits you best and sets you up for success.

So, to talk through all of the trendy diets you see online and weigh the pros and cons is the one and only Natasha Hansen. She’s the senior sports dietitian at Sanford Sports. Natasha, how are you doing today?

Natasha Hansen, RD, LRD (guest):

I’m great. Thanks for having me.

Simon Floss:

Yeah. So last time we spoke, I think you said that you were like in the middle of training for a marathon or a half marathon. Is that right?

Natasha Hansen, RD, LRD:

Yeah, I did. I ran the half marathon, the Sioux Falls half marathon in August.

Simon Floss:

How did it go?

Natasha Hansen, RD, LRD:

Well, it was really hot. They actually canceled the full marathon.

Simon Floss:

I remember that now.

Natasha Hansen, RD, LRD:

So, I was like, well, good thing I didn’t sign up for the full, even though after I finished the half I was like, I can’t even imagine this being half. Like it blows my mind.

Simon Floss:

For the people, I don’t know where you’re listening from, but we’re recording from Sioux Falls, South Dakota, where like in the Midwest, that humidity in the summer is just ruthless, you know?

Natasha Hansen, RD, LRD:

But I finished it, and it was my first half, so I didn’t really have a time expectation, so that was kind of nice. I just finished it.

Simon Floss:

I’m sure, I’m sure you were flying, my friend. Well, let’s get started here. So, we’re going to talk about a handful of diets here. Wondering if you could first give a brief overview of each diet that we’re going to talk about and a big one that’s been around for the last five, six years-ish, is the ketogenic diet or keto diet. Quite a few folks listening to this have heard of it, but can you give us a brief overview of what keto is?

Natasha Hansen, RD, LRD:

Yeah, the keto diet is essentially a low-carb diet where you kind of put your body into what we call ketosis, and you start using ketones as energy instead of carbohydrates. And then essentially you’re using more fats for energy instead of those carbs. The thought process behind it is that you’re burning more fat.

Simon Floss:

I’ve seen people online and I’ve personally tried every single one of these diets myself, but I’ve seen a lot of people like have great success if they’re looking for like weight loss specifically with the keto diet. But how might that diet impact overall health and wellness?

Natasha Hansen, RD, LRD:

What I’ve seen is that it will lead to a big initial significant drop in weight, but it’s really hard to sustain that diet. Carbs are the energy source literally for your brain and for your muscles – the preferred energy source I should say, because then you start using fats. But since carbs are kind of that energy source to the brain and the muscles, fatigue is a huge symptom or side effect that I hear about a lot.

Simon Floss:

And especially if you’re going to pair that with training, like athletic training and performance, you need energy. So if you’re fatigued going into your workouts, imagine how hard that’s going to be and how bad you might feel afterwards.

Natasha Hansen, RD, LRD:

Yeah. It’s definitely not a diet that I’m recommending to athletes. And actually the ketogenic diet was originally designed for epilepsy, which is super interesting. And when I tell people that, they have no idea, but that’s actually what the diet was originally designed for. I don’t know the science behind it necessarily, but that is what it was originally designed for.

Simon Floss:

Fascinating. I am today years old learning that information.

So, with keto, like you said, it’s primarily fats. And what would be the percentage of people who are listening to this and macro tracking? What’s like the percentage of fat out of the diet? I’ve heard some people say 70 to 80% and I’m like, are you only eating avocados?

Natasha Hansen, RD, LRD:

Yeah, it’s definitely super high in fats. Percentage, I think people are going as low as like 10% of their calories from carbs. General recommendations are usually about 50%. So going down to 10% and then you’re increasing your fats and proteins. But I think it is more heavily focused on fats.

Simon Floss:

I’ve heard of people felt going into like when they get into ketosis, the keto flu. Have you heard of that? How can that be healthy? You know, if like your body gets sick doing a diet –

Natasha Hansen, RD, LRD:

Yeah. And I think that’s all that fatigue, you know? The fatigue kind of setting in almost making you feel like ill.

Simon Floss:

Ugh, yuck. So what are maybe some pros and cons to this diet?

Natasha Hansen, RD, LRD:

It may lead to some of that quick initial weight loss because you are using more fats as energy, but there are nutritional deficiencies that can go along with this diet as well because you’re not getting much fiber, you’re not getting many of those B vitamins that come in our whole grain carbohydrates. So again, that fatigue, the increase in fats, ideally, you’re increasing your healthy fats, but if your fat percentage is 75% of your intake’s coming from fats, you’re likely increasing your saturated fats in those unhealthy fats as well. So, those would be some of the cons.

Simon Floss:

What are examples of like saturated fats or unhealthy fats?

Natasha Hansen, RD, LRD:

Sure. Yeah. So anything, unfortunately it’s a lot of foods. (Laugh) It’s really unfortunate because there’s a lot more saturated fats than there are unsaturated fats, which are going to be your healthy fats.

But anything that’s fried is going to be higher in saturated fats. There’re certain condiments like ranch and mayo, and alfredo, really tasty things, that are high in saturated fats, certain cuts of meat. You can actually see the fat on some cuts of meat. And those are going to be higher in saturated fats.

And that’s actually the difference between like your whole milk and skim milk is the amount of saturated fats.

Simon Floss:

Whole milk obviously would have more.

Natasha Hansen, RD, LRD:

Correct.

Simon Floss:

So, are there any, I mean other than initial weight loss, are there any positives? I’ve heard a lot of diabetics go on the keto diet and obviously they would have to have that guidance from someone like you or medical provider, you know. But are there any positives to this diet?

Natasha Hansen, RD, LRD:

It’s also not a diet that I would recommend for diabetics, and I’m certainly not an expert in diabetes, but with diabetes, you want to have a consistent carbohydrate diet, not necessarily a very low carbohydrate diet because then you can go into hypoglycemia as well. And so, and that’s a concern for diabetics as well. So, I don’t think it would be a diet that I would recommend for those with diabetes either.

Simon Floss:

So, we sort of already alluded to it, but how does that diet affect fitness? Some folks say that when they quote, “know that they’re in ketosis,” they actually feel better as far as being endurance athletes, but as we’ve talked about, carbs are super beneficial in overall athletic performance and training.

Natasha Hansen, RD, LRD:

Yeah, I think eventually, it depends if you’re more of an endurance athlete, depending on the duration of your event or what you’re training for, you’re eventually going to hit a wall and you’re eventually going to hit that fatigue that’s going to set in without those carbohydrates. And so I don’t think it’s sustainable for especially endurance type training.

Simon Floss:

So, switching gears here, with both of these two diets sounding pretty fat forward, would you classify the BBBE diet or that stands for beef, butter, bacon and eggs diet, technically as a keto diet?

Natasha Hansen, RD, LRD:

Yeah, so the carnivore, the BBBE diet, the keto diet, they’re all very low in carbs. And I think that’s the overarching theme. And I will say too, like I think carbs get a bad rep. There’re so many different types of carbs, right? Sugar is technically a carb, so like the sugar in your soda is a carb, probably not the best carb, probably going to lead to weight gain. But then you have your whole grain type carbohydrates that are higher in fiber.

Simon Floss:

And sweet potato. Yeah, sweet potatoes: amazing. And healthy.

Natasha Hansen, RD, LRD:

Exactly. There’s better carb choices and I think that’s where maybe we get this idea that all carbs are bad, and I just don’t agree with that. So, that’s essentially the overarching theme I think of the carnivore and the BBBE diet as well.

Simon Floss:

I actually had never heard of that (BBBE) diet.

Natasha Hansen, RD, LRD:

I had to look it up too. I didn’t know what it was, and I think my jaw dropped to the floor. This is all you’re eating? Sounds like a heart attack to me.

Simon Floss:

Seriously. Like, and how can that taste good? I imagine you get sick of that. Like I could maybe do that for like two days tops and then I would be miserable. How does BBBE diet, how would that affect your overall health and wellness? And would it have any positives or negatives to sports performance?

Natasha Hansen, RD, LRD:

Well, I think just to compare it to keto too, at least with the keto, you’re getting some fruits and vegetables in there as well. With the carnivore and the BBBE diet, there’s no fruit or vegetable intake because it’s just animal proteins.

So, that’s even more risky for your saturated fats. I mean the bacon, beef, butter and egg, all of those have saturated fats in them. And so, to me, that’s going to increase your risk for heart disease. And then you’re not getting all those nutrients from fruits and vegetables, so you’re missing out on all these nutrients.

Simon Floss:

I’m sure some people are listening and would say something like, oh, well I could just take a multivitamin or a handful of supplements. How would you respond to that?

Natasha Hansen, RD, LRD:

Supplements, there are certain cases where I recommend supplements, but supplements certainly don’t replace food. The nutrients, vitamins, and minerals from your food are way better absorbed than from a supplement.

Simon Floss:

What are some of those instances where you would recommend a supplement?

Natasha Hansen, RD, LRD:

If somebody’s deficient. If we’ve actually gotten some blood work, somebody’s deficient in a certain nutrient, then we definitely need to think about adding some sort of supplement or adding that.

Iron deficiencies are a common one that I see. Then we’re adding a specific iron, not necessarily a multivitamin. If somebody, and this happens sometimes, they get clients that just refuse to eat, you know, vegetables and so this is a case where at least let’s get that multivitamin in.

Simon Floss:

Why wouldn’t you eat vegetables? Veggies are great.

Natasha Hansen, RD, LRD:

It’s all about how you cook them.

Simon Floss:

OK, so I’m curious. What’s technically better for you? Cooked or raw vegetables?

Natasha Hansen, RD, LRD:

The cooking process does decrease some of the nutritional value, but you’re still getting such a great value from a nutritional standpoint, even if you’re cooking your vegetables. So, most people prefer cooked vegetables over raw vegetables. We’re still getting a good value of nutrients from cooked vegetables.

Simon Floss:

And are cooked vegetables easier to digest?

Natasha Hansen, RD, LRD:

Yeah, you could say that part of the reason is because, so this could be a positive or a negative I guess, but part of the reason is because you’re decreasing that fiber. Fiber takes a little bit longer to digest. And so, it could be easier to digest if you’re cooking them.

Simon Floss:

Talking about vegetables. Well, I don’t want to glance over the carnivore diet, so maybe really quickly we could go back to that, but I feel like we’ve already talked a lot about it. But what is the carnivore diet and how can it impact health and wellness?

Natasha Hansen, RD, LRD:

Yeah. The carnivore diet is really only eating foods that come from an animal. So, you’ve got any sort of animal meat, right? But dairy products as well, eggs, milk, and you’re missing out on the nutrients from fruits and vegetables and plant foods as well. And ultimately compromising immunity when you’re missing out on all those nutrients from fruits and vegetables.

Simon Floss:

So, talking about fruits and vegetables, let’s talk about a plant-based diet. Walk me through that and weigh out some of the positives and negatives.

Natasha Hansen, RD, LRD:

There are definitely a lot of positives of trying to eat more of a plant-based diet. You’re getting your fruits and vegetables. Most plant-based diets also include like more of those whole grain, those better carbohydrates that I mentioned. And the only risk that I really see with the plant-based diet is not getting enough protein, if you think about it.

There’s protein in plant sources. There’s certainly a lot of like plant sources that have protein, but the best way to explain that to people sometimes is like, OK, if you take let’s say a turkey burger or a veggie burger, you’re probably going to have to have like three veggie burgers to get as much protein in a turkey burger. So, I’ll talk that through with people who are considering the plant-based diet. You might have to eat more to be able to get the amount of protein that you need.

Simon Floss:

And if people are trying to, you know, lose weight –

Natasha Hansen, RD, LRD:

Correct. I mean, you’re technically having to eat more quantity to get all the protein that you need. And then we’re risking loss of muscle mass and things like that too.

Simon Floss:

I’ve heard people who say like, oh yeah, I switched to vegan, or I switched to plant-based, and I’ve just never felt better in my life. When it comes to vegetables and fruits, there are a lot of like quote unquote, and we should get to this later, “superfoods.” So, of course you’re going to feel better because you’re eating a wider variety of fruits and vegetables are quote unquote “superfoods.” But in the long run, much like the diets that we’ve discussed, it might not be the best for you. Is that right?

Natasha Hansen, RD, LRD:

Yeah, I mean, you’re missing out on an entire food group. And that’s what I always come back to is OK, are we missing out on any food groups here? And then which nutrients from that food group? So, what specific nutrients are we missing from there? Which, from animal proteins, would be like vitamin B12. So yeah, always kind of coming back to like, what are we missing from this, from this fad diet?

Simon Floss:

The buzzword “superfood.” Are there any actual superfoods? I’ve heard that like kiwi and blueberries are the greatest superfoods that you can possibly have. But we obviously need to talk to the pro.

Natasha Hansen, RD, LRD:

I’m not a big fan of this word, and I do get asked this a lot. There’s not one food that is going to give you everything that you need. And so, I’m just not a big fan of that word. There’s certain, especially when it comes to a lot of fruits and vegetables that are super high in like antioxidants. And I think a lot of people use superfoods and antioxidants. Like typically when I hear of a food being a superfood, it’s high in antioxidants, but it’s always good to get a well-balanced of all foods.

Simon Floss:

(Laugh) And speaking of well-balanced, let’s talk about the Mediterranean diet. A lot of places online say that this is the best overall diet one can follow. What comprises of this diet?

Natasha Hansen, RD, LRD:

Yeah, so this diet limits red meats and added sugar and it emphasizes on like healthy fats and whole grains. This out of the diets we’ve talked about so far, I like this diet the best because you’re not eliminating any specific food group, you’re increasing your healthy fats, you’re limiting your red meat. It doesn’t say you have to completely eliminate; you’re just limiting your red meats and red meats are going to be higher in those saturated fats like I mentioned. And so I think this is a good, well-balanced diet.

Simon Floss:

And increasing your healthy fats. What are examples of healthy fats?

Natasha Hansen, RD, LRD:

So, healthy fats (include) avocados, olive oils, olives, nuts and seeds, any sort of nut butter. So, you know, you got peanuts, peanut butter, any sort of seed, sunflower seeds, pumpkin seeds, flax seeds, chia seeds, any sort of nut or seed is going to be a good healthy fat as well. And fish.

Simon Floss:

Ugh, I love fish. If I had it my way, I would eat salmon every single day of my life.

Natasha Hansen, RD, LRD:

Good for you. A lot of people are not like that.

Simon Floss:

I love it. It’s really good. So, speaking of like nut butters, I’m curious, have you ever had, it’s from this brand called 88 Acres. It’s pumpkin seed butter and they like grind up pumpkin seeds until it has the consistency of like butter and it’s green. It’s so good. I’m not sure if you’re a fan of nut butters?

Natasha Hansen, RD, LRD:

I am a fan of nut butters. I’ve heard of that brand, 88 Acres. Yeah. They have good granola bars that I’m often recommending to clients because they’re really low in added sugar. They’re higher in fiber, a little bit higher in protein. But I have not tried their nut butter. But I do think that sounds like something I would like.

Simon Floss:

Well, I will also caveat it by say by saying you know be careful because it’s so good (that you can end up eating the whole jar).

Natasha Hansen, RD, LRD:

Probably not very cheap either.

Simon Floss:

No, no it’s not. But you know, no good things are. Lastly here as we’re rounding third, the intermittent fasting, what is that?

Natasha Hansen, RD, LRD:

Intermittent fasting. There’s so many different variations to this diet, but basically, you’re limiting what I call fueling window. You’re limiting that to like a certain timeframe. Sometimes people even go like, I’m going to fast every other day, so I’m only going to eat every other day. Or sometimes it’s like, I’m only going to eat between like 10:00 AM and 6:00 PM so you’re kind of limiting your fueling hours.

Simon Floss:

I was huge into intermittent fasting. And I feel like there might be some pros and cons that we could talk about, but maybe one of the cons, if you’re only giving your body a specific window to eat, then in theory your body’s hanging on to what you just gave it for as long as possible, because it’s like, oh, I don’t know when we’re going to eat next. So, in theory, could your metabolism actually slow down because of intermittent fasting?

Natasha Hansen, RD, LRD:

Definitely. Yep. So, if you get to the point where your body kind of starts to switch into starvation mode, no matter what you’re eating, your body’s going to store that as fat because it’s in starvation mode. And it’s like, and when you store things as fat, your body can hang on to that energy a little bit longer. And so that’s why our body does that when we’re in starvation mode.

But yeah, you’re kind of tanking your metabolism, or there’s certainly better ways to do the intermittent fasting. But I think essentially the overall thought process behind it is like, if you’re decreasing your window of eating, you are decreasing your calorie intake, which isn’t always the case. I’ve ran into situations with clients where it’s like, you’re eating a lot (laugh) in a short, short period of time. Yeah. Like that cannot feel good on your stomach.

So, I think since there are so many different variations of this diet. It really just depends how somebody’s doing it.

Simon Floss:

You said there’s good ways to do it, or a smart way to do it. What’s a smart way to do it? I’ve heard that you shouldn’t eat three hours before bed or something like that. Is there any truth to that or merit to that?

Natasha Hansen, RD, LRD:

Yeah, I do get asked what time should I stop eating? I get asked that a lot. And it really depends what time you’re going to bed, because I don’t give people a specific time – you should stop at 7:00 p.m. – because it depends on your work schedule. Like what if you’re not going to bed until 2:00 a.m.? Well, that’s a really long time to go without having some sort of snack.

I generally don’t recommend the intermittent fasting diet. There’s really no scientific proof that it’s any more effective than your traditional low-calorie diet because again, I think that’s the overarching idea is that OK, you’re consuming less calories, but there’s no difference between that or the intermittent fasting or just going on a lower calorie diet.

Simon Floss:

Everybody talks about whole foods. And not just the, you know, the grocery store. Although I love Whole Foods grocery stores.

Natasha Hansen, RD, LRD:

I do too. It’s incredible.

Simon Floss:

Those macaroons. Oh my gosh.

Natasha Hansen, RD, LRD:

I also love Trader Joe’s, and I wish we had one here in Sioux Falls.

Simon Floss:

Man, I know. I think there’s been like some sort of like write to the mayor movement to get a Trader Joe’s into Sioux Falls and, you know –

Natasha Hansen, RD, LRD:

Well, I will join (laugh). I’ll be right out there if anyone else wants to join me (laugh).

Simon Floss:

And all of their stuff’s actually like really cheap too.

Natasha Hansen, RD, LRD:

Exactly. It’s amazing.

Simon Floss:

So, “whole foods,” very high search volume online. What are whole foods and how are they incorporated or not incorporated into these diet trends that we’ve discussed?

Natasha Hansen, RD, LRD:

I would say when you’re, when referring to whole foods, it’s a really broad terminology. It really means like unprocessed or minimally processed foods that are close to their natural state. So basically, you’re choosing less processed, less packaged, less fast foods.

And also another thing that I think of when I think of whole foods is like one ingredient foods. Sometimes I’ll talk to my clients about this, like, OK, chicken, egg, fruit, a piece of fruit, a vegetable, you know, one ingredient foods. And try to incorporate those more into your diet.

Simon Floss:

We’ve already talked about it a little bit, but which of these diets that we discussed are good and which ones should maybe consumers ditch? Or is it maybe more about just finding out what works for you based on your individual needs?

Natasha Hansen, RD, LRD:

Nutrition is very individualized, and that’s, I honestly take pride when I work with my clients of taking a very individualized approach.

But really the best diet is the one that you can sustain for the longest period of time and one that’s going to fit within your life.

Based on the diets that we’ve talked about, I like the Mediterranean diet. Again, you’re not excluding any specific foods. And I like the idea of like eating more of a plant-based diet, but maybe not only limiting yourself to just plant-based foods, but maybe your diet is higher in plant-based items.

Simon Floss:

And you talk about taking an individual approach for each of your clients. How do people contact you or other dietitians at Sanford and why should someone choose Sanford for their nutritional needs?

Natasha Hansen, RD, LRD:

Yeah, so people can just call the Sanford Fieldhouse front desk. The Sanford Fieldhouse is just located right across from the Pentagon. I’ve also had people just stop in, ask about me at the front desk, and if I’m available, I’ll just come out and talk. We also have a webpage, the Sanford Sports webpage, where you can find, if you go under nutrition, there’s a way where you can contact me directly right through there as well. And then I’ll get that email and then I’ll reach out.

But you know, I’ve been a registered dietitian for nine years now. I have lots of experience with a wide variety of population. I’ve had a 9-year-old and I’ve had a 70-year-old. So, I have worked everywhere in between too.

Simon Floss:

Didn’t this summer, didn’t you say you were the lead sports nutritionist for Kansas University or something?

Natasha Hansen, RD, LRD:

Yeah. So, before starting at Sanford Sports in November of (20)23, I was the director of performance and nutrition at KU from 2018 to 2023. So, a lot of experience within the collegiate athletic setting as well.

Simon Floss:

Did you did you meet, oh, what’s his name? He plays for the Raptors now. Grady Dick?

Natasha Hansen, RD, LRD:

Yeah.

 Simon Floss:

Cool. Nice. Wow, small world.

Natasha Hansen, RD, LRD:

He was only on the KU team for one year, so I got to know him as much as I could in that one year, but yes, I did work with him. Yeah.

Simon Floss:

I watched the Raptors game last night and I was like, oh, yeah. I went to a KU game once and I got to see him play, so it was kind of cool. But I’m so sorry I interrupted. But that’s just a very cool thing that I think a lot of people would want to know. You really know your stuff.

Natasha Hansen, RD, LRD:

Yeah. And I think another reason to work with me is just because I take that individualized approach. And what I mean by that is like, I want to work with my clients, whatever’s going to work best with them.

And I’m very flexible. I’m not someone who’s going to be like, super strict. I really do think that all foods fit within your diet. It really is about moderation and being able to not overindulge. And so, I’m never going to say like, you can’t eat this. And I think people really appreciate that.

Simon Floss:

I was listening to something online and the someone said, “I don’t view like, cheat meals as like a cheat meal. I call it a treat meal,” so that way there’s like a little bit of positivity associated.

Natasha Hansen, RD, LRD:

I do like that better.

Simon Floss:

Well, we actually ran out of time. I could talk about this for hours and hours and hours but thank you so much for letting us come out and talk to you today.

Natasha Hansen, RD, LRD:

Thanks so much for having me.

Simon Floss:

A reminder that you can find this podcast and many others on your favorite podcast apps like Apple, Spotify, YouTube, or by heading on over to our website, news.sanfordhealth.org. Thanks again for listening. I’m Simon Floss with Sanford Health News.

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What it means to get your tubes tied

Dr. Erica Schipper:

A woman who is wanting to make this decision for herself is able to do so. We certainly encourage you to have conversations with loved ones who are important to you, but that is your decision.

Courtney Collen (host):

Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. These are new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living, and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.

In this episode, we are talking about the tubal ligation procedure to prevent pregnancy, most commonly referred to as getting your tubes tied. I have Dr. Erica Schipper joining me for this conversation. She is chief medical officer at Sanford Health in the Sioux Falls region and a practicing gynecologist. Dr. Schipper, hello. Welcome.

Dr. Erica Schipper (guest):

Hello, Courtney. I’m glad to be here.

Courtney Collen:

I so appreciate you being here to talk through this with me. Starting really broadly here to define tubal ligation. What happens during this procedure, Dr. Schipper? Are we actually tying tubes?

Dr. Erica Schipper:

So sometimes yes. We tend to refer to it more generally as tubal sterilization. The idea being that we are somehow disrupting the fallopian tube to prevent the egg and the sperm from coming together in order to prevent pregnancy. And there’s multiple techniques by which that can be done.

We can sometimes tie the tubes. We can cut or burn the tubes. More often now, we are frequently removing the tubes completely. And the reason for that is, first, when we just cut or tie or burn the tubes, there is a risk of failure. It’s less than 1% in most cases, but, you know, if a tubal sterilization fails, there’s a higher risk of having a future pregnancy that could either be a normal pregnancy or it could be an ectopic pregnancy. That’s a pregnancy in the tube, and that is, that’s an emergency.

And so, we learned one that if we take out the tubes, that’s much less likely of course, but also we’ve learned that removing the tubes can lower a woman’s risk of ovarian cancer. So even though she’ll still have her ovaries and she’ll still have her hormones, she will not have those tubes.

And a lot of what we thought were ovarian cancers, we now know start in the tube. So, the society of gynecologic oncologists, the cancer surgeons told us that, “Hey, if a woman does not want to be able to get pregnant in the future, perhaps removing the tubes would be a better option than just tying them.”

Courtney Collen:

Is it effective for women who really do not want to get pregnant anymore?

Dr. Erica Schipper:

It is extremely effective, particularly if the tubes are removed. Risk of pregnancy, I will never say zero. There are always weird cases where strange things happen. But it’s very close to zero.

Courtney Collen:

Is it reversible?

Dr. Erica Schipper:

If the tubes are removed, it is not reversible. Pregnancy would still be possible, but it would only be through in vitro fertilization if the tubes are quote “tied” or cut or burned. Sometimes it’s reversible, but not always. And that’s kind of an intricate procedure. A limited number of physicians do that, and it doesn’t always work. So I do tell my patients, you should be very sure that you want a permanent form of contraception if you go ahead with this.

And the other thing to consider is that we do have great forms of long-acting reversible contraception. So if you want highly dependable contraception that isn’t permanent, those are out there.

For example, an intrauterine device or the Nexplanon arm implant or even the Depo-Provera shot are things you don’t have to worry about every day that are very effective in preventing pregnancy. The IUD is actually as effective as a traditional tubal ligation.

Courtney Collen:

Let’s talk through some of the benefits of a tubal ligation. Why would a woman want to get this done?

Dr. Erica Schipper:

I think first is just to not have to worry about an unplanned pregnancy. I think for some women, one of the reasons it comes to mind, and I’ve seen this in my practice, is, you know, maybe they’re not in a stable relationship or maybe they’ve been a victim of sexual violence. And we know for women, sometimes sex is not always their choice. And so this is a way for them to have that control if they don’t want to be pregnant in the future.

And for some women, it’s just a matter of they don’t tolerate hormonal birth control very well, and they know their family is complete, and so this is just the most logical option.

Finally, there are some reasons that women would do a tubal instead of hormonal birth control. For example, a woman who’s had an endometrial ablation or is having an ablation for heavy periods, pregnancy is contraindicated after an ablation, but it’s not in itself a form of birth control. So we’ll often do those two things together.

And then some women who have to be on long-term medications that could be harmful to a fetus would potentially want to have reliable long-term contraception. Some women who know they have an inherited condition in their genetics that they don’t want to pass on may choose a permanent form of contraception, and then choose to either do donor egg or adoption if they want to have a family.

Courtney Collen:

What would qualify a woman for this procedure?

Dr. Erica Schipper:

Any woman who is of course, an adult and can make her own medical decisions and who is certain that her childbearing is complete and she doesn’t want any more children or in some cases any children at all, and who is a reasonable candidate to undergo a general anesthesia and have surgery would all be reasonable candidates for a tubal sterilization procedure.

Courtney Collen:

Thank you. What should a patient consider or know before having this done? Are there any risks involved?

Dr. Erica Schipper:

There are risks. Tubal ligation or tubal removal called salpingectomy is a surgical procedure. It does require that the woman go under general anesthesia and then it’s done laparoscopically. So if it’s just a tubal ligation, it’s usually two incisions in the abdomen. If it’s a tubal removal, it’s usually three.

And so it carries all the surgical risks of any abdominal surgery. So there’s a risk of bleeding, there’s a risk of infection, and then there’s a risk of injury to anything else in the abdomen. There’s always a risk of needing a larger incision or encountering scar tissue, meaning we can’t complete the procedure. Any risk that comes with any laparoscopic surgery comes with this one.

That said, this is a procedure that is done quite frequently and usually goes very well.

So the risk of regret is something to take into consideration. We know that the rate of regret is higher under the age of 30 and even higher under the age of, say, 25. And those are the times to maybe think about doing a long acting reversible until you’ve had more time to be sure. But that is very much a patient decision. One of the things I will ask my patients, because I want to ensure that they’ve really thought about this, is, you know, if something were to happen to your partner and maybe you would meet someone else and they wanted a child, would you still be sure that wasn’t what you wanted?

Courtney Collen:

Yeah. If a woman just gave birth, she’s certain that her childbearing years are over, can this be done right after childbirth?

Dr. Erica Schipper:

Yes, it can. In fact, sometimes we do it when if a woman has an epidural in labor, we can even leave the epidural in place and use it to help with pain management. It’s done a little bit differently immediately postpartum because the uterus is enlarged. Oftentimes, it’s done through a very small incision just below the belly button rather than laparoscopically.

Courtney Collen:

Let’s talk through recovery and what this looks like.

Dr. Erica Schipper:

Yeah, so this varies a little bit from patient to patient, but for most patients it’s typically about a week off of work or resting. I usually tell patients you might want to limit your lifting for about two weeks to really allow those incisions to heal.

Now, that can be a little hard on new moms, so you want to take into consideration lifting a baby in a child carrier seat. But that can usually be accommodated.

Typically, there will be a little bit of pain, some incisional pain, and so you’ll be on some pain medicine. Some women only need, say, Tylenol and ibuprofen, while some women do need a little bit stronger medication for a little while. And so as OB/GYNs, we’re very careful to ensure we prescribe something that’s safe in breastfeeding if we have a breastfeeding mom.

Courtney Collen:

Now let’s talk about life after the procedure. Any side effects, hormone changes, like will a woman continue having a period or need any birth control after a tubal ligation?

Dr. Erica Schipper:

That’s a great question and really important to consider. So first of all, because we’re removing the tube, we’re really not disrupting the whole hormonal cycle. Hormones are produced from the brain to the ovaries, and really the uterus and the tubes are not involved in the hormones themselves. The hormones do talk to the uterus, which is how we have our periods.

So a woman who’s had her tubes tied or removed will continue to have periods the way she would have otherwise. Some women, when they get their tubes tied, they’re coming off of having been on hormonal birth control. And often that’s a pretty big change.

So if you’ve been on, say, a birth control pill or you’ve had a progesterone-based therapy like an IUD or the shot, you might find that your periods are heavier or maybe a little more painful because the hormonal birth control was keeping them a little bit better under control for you.

Additionally, a lot of women undergo tubal sterilization at a time in their lives when periods are starting to change anyway. Often in that sort of early perimenopausal period where periods can get a little bit heavier or irregular, there’s not really an obvious medical reason why a tubal itself should affect periods. But some patients do report that they feel their periods are different after their tubal and that’s still something we don’t fully understand.

Courtney Collen:

What about birth control?

Dr. Erica Schipper:

You should not need birth control. Once again, there is a small risk of failure if the tubes are ligated as opposed to being removed. And so if you wanted extra reassurance, you could certainly use additional birth control.

And of course the other option that we haven’t talked about yet is the option of a vasectomy. For a woman who’s in a monogamous heterosexual relationship, her partner can certainly get a vasectomy, which is really as effective as a tubal and less invasive. And so that’s something to consider when you’re thinking about your options, if you as a couple have decided you’ve completed your family.

Courtney Collen:

If a patient is interested in getting this done, where should they start?

Dr. Erica Schipper:

Generally, you want to start with your OB/GYN, and if you don’t have an OB/GYN, you can certainly ask your primary care provider for a referral.

Courtney Collen:

And is there a consultation involved? Like what does the conversation look like at the beginning? And maybe what questions should a patient bring to the table?

Dr. Erica Schipper:

So when they first meet with the OB/GYN, there will be a pre-surgical consultation. Questions about, for instance, your periods. Are you having undiagnosed abnormal bleeding or pelvic pain, things that we should address before we do a surgery?

And of course, if you’re absolutely certain that your childbearing is complete, one of the other risks of tubal sterilization is regret. And we know that regret is greater in women under the age of 30. That doesn’t mean you can’t do it before the age of 30, but you just want to be really sure about your decision.

And so I think some good questions for women to bring are, you know, certainly go over those surgical risks and ensure that your questions are all answered about what those risks entail and what your recovery’s going to be like.

And then I think the bigger conversation really needs to happen before you get to your consultation with whoever’s important in your life, that needs to be a part of that decision. So whether that’s a spouse or a partner or a supportive friend or family member or your faith leader, it’s critical to have those conversations that weigh on your decision before you move forward.

Courtney Collen:

Thank you for that. Is there anything else that we didn’t talk about here that you hear from patients topics around a tubal ligation that are important to share?

Dr. Erica Schipper:

I would say historically there was some misunderstanding, and historically there has been some paternalism by the medical community around tubal ligation. It used to be that a woman had to get her husband’s permission to have her tubes tied. There were physicians who would not do a tubal in a woman who’d never had children. That is not a requirement.

So a woman who is wanting to make this decision for herself is able to do so. We certainly encourage you to have conversations with loved ones who are important to you, but that is your decision. There’s no requirement to have a partner sign a piece of paper saying that you can do this. There’s no requirement that you have to have had a child before saying that you can have your tubes tied.

Courtney Collen:

Very insightful. Such good information and really appreciate your time and all of your insights and all that you do here at Sanford.

Dr. Erica Schipper:

Well, thank you, Courtney. It was a pleasure to do this.

Courtney Collen:

Thank you. I sure hope you learned as much as I did from our conversation today. This was another episode of the “Her Kind of Healthy” podcast series, brought to you by Sanford Health. For Sanford Health News, I’m Courtney Collen. Thanks for being here.

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Best innovations address patient needs, says Yale Health CEO

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, host Courtney Collen with Sanford Health News talks with Christopher O’Connor, CEO of Yale New Haven Health System. Christopher is a speaker at the 2024 Summit on the Future of Rural Health Care.

Christopher O’Connor (guest):

It’s a delight to be here.

Courtney Collen (host):

Good to meet you. “Leading Through Change: Driving Innovation and Collaboration to Strengthen Access, Quality and Sustainability” was a panel that you participated in here at the summit. I’d love to know a takeaway or two that you wanted to drive home.

Christopher O’Connor:

One of the things I walked away with is that really, regardless of where your environment is, rural, urban, I mean, the challenges that we are facing and potential solutions are pretty ubiquitous. And that’s where the collaboration and working across I think the field is going to be really essential to drive that change and to drive improvements that ultimately benefit, as Bill (Gassen, Sanford Health president and CEO) said eloquently, around the patient at the center of that change.

Watch the Sanford Health News vodcast of this episode

Courtney Collen:

What has been your most surprising, hottest take or something that you’re looking to take away from the dialogue today?

Christopher O’Connor:

Well, you know, I think that obviously listening to Dr. Shereef Elnahal and hearing about the veteran structure is obviously a very different component to what I think Bill and I are used to dealing with. And so hearing some of those challenges is sobering, but also really invigorating to know that you have people like Shereef who are trying to drive that change and improve the health of the veterans. And I think Bill and my perspective is a little bit different in our communities and so I think that was a big takeaway for me.

Courtney Collen:

What do you think is the biggest misperception about rural America?

Christopher O’Connor:

Well, I think, first that there’s no care, and you have great entities like Sanford that are out there providing care and enabling the technology and the access that I think people need and deserve.

Courtney Collen:

How do we strengthen trust in health care during this time of rapid disruption?

Christopher O’Connor:

I still believe there’s enormous trust that the sanctity of the relationship between a provider and the patient is still sanctimonious, is still the premier driver of what trust is all about. And so I think as a health system, our job is to support that relationship, enable it to have, one, immediate access or one, appropriate access, and two, different mechanisms to gain access to that trustful relationship. So whether it’s in-person or whether it’s via virtual systems, we support that technology.

Courtney Collen:

Thank you. Let’s talk about AI in health care for a moment. What do you think – overhyped? Real? Where do you stand on how it’s impacting health care?

Christopher O’Connor:

It certainly is the bright, shiny object of the day. But, I absolutely believe it’s real. I mean, we have implemented Abridge, the ambient listening software that has really done wonders for physicians and creating these amazing comprehensive notes that have just tremendous value and efficiencies to providers.

But it’s not going to solve everything. And so, while it certainly is a technology we’re going to gain great deal of insight and innovation around, I don’t think it’s a panacea for all the challenges that we face.

Courtney Collen:

Thank you for the insight. Now stepping away from the office for a moment, what book are you reading right now? What’s on your shelf? And, I’d love to know what has had the biggest impact on your career thus far?

Christopher O’Connor:

Wow … The book I’m reading now is “Power in the Middle,” and so it’s a book that was recommended by my president of the health system, Pam Sutton-Wallace, around the power of middle management and the importance of it. So I read a bit on the flights out. I’m going to hopefully finish it on the way back.

Most influential, I think it’s been the relationships. I have been fortunate to have just tremendous relationships with mentors and colleagues. And I think that has been the greatest influence on who I am and how I can evolve as a leader going forward

Courtney Collen:

As the CEO of Yale New Haven Health System, what do you love most about what you do?

Christopher O’Connor:

I love everything. Honestly. I tell my kids who are in that space where they’re beginning to move into careers. I truly embrace that saying that “if you love what you do, you’ll never work a day in your life.” And I’ve been extraordinarily fortunate to be in this field and to work amongst amazing colleagues that we have working in this field.

Courtney Collen:

Wonderful. Well, we’re so grateful for you, Christopher, for being here in Sioux Falls for our third rural health summit. Safe travels home and appreciate all that you do.

Christopher O’Connor:

Thank you very much.

Courtney Collen:

Thank you.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org.

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What does a heart attack feel like?

Cassie Alvine (announcer):

This is the “Health and Wellness” Podcast brought to you by Sanford Health. The conversation today is about heart health and the question, what does a heart attack feel like? Our guest is Dr. Nayan Desai, interventional cardiologist with Sanford Heart Bismarck. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

A note for our listeners: At the time we recorded this interview, Dr. Desai was on his way to provide outreach care at another Sanford location, so you might hear highway traffic noise in the background.

Dr. Desai, thank you for joining us today and very important stuff that we’re talking about as we talk heart health, and let’s get right to it. People are always wondering, they’re always wanting to know about a heart attack. We hear so much about it, so let’s ask that question. It’s a big one, and we can dive into all the details. What does a heart attack feel like?

Dr. Nayan Desai (guest):

Sure, yeah. Thank you Alan for having me. My name is Dr. Nayan Desai, one of the interventional cardiologists here at Sanford Hospital in Bismarck.

When we think about a heart attack, it basically, in common terms what’s happening is the artery is getting clogged off with either a blood clot or a blockage, and that is causing low blood flow to the heart muscle itself. And that’s why some of the symptoms which you are feeling are coming from that. Symptoms or common problems which people will experience will include chest pain, chest tightness, shortness of breath.

Pain is kind of very nonspecific and pain differs in different individuals. Every patient has a fingerprint of their chest pain description in terms of where it’s going to go. Typically we hear the description of elephant sitting on the chest, but that’s not always the common feature when patients come into the hospital.

Alan Helgeson:

This is a question, kind of a follow up to that. How long does your body warn you before a heart attack?

Dr. Nayan Desai:

There are two variations of heart attack if you will. Some patients would have chest pain, chest tightness, or shortness of breath going on for a period of months. And if they ignore those symptoms, they would come into the hospital with the heart attack or in myocardial infarction if you talk it in medical terms.

The other variation of it would be suddenly somebody wokes up and has a heart attack. It’s very sudden and severe and acute.

Symptoms can vary. Some patients may just have minimal shortness of breath or chest pain. Indigestion is more frequent in women as well as men might describe that. I typically like to ask the question to patients is if you have had heartburn before, is this similar? There is always something different if that heartburn is coming from a heart attack, right? It does not feel the same reflux pain you have had before. And if that’s the case, you need to go and see your doctor. Get checked out.

Alan Helgeson:

This question, I know what the answer is, should I ever ignore symptoms?

Dr. Nayan Desai:

It’s human nature, right? I think to kind of chuck it off to something else, “oh, it’s just my heartburn. I’m going to take some antiacid medications and sleep and it’s all going to go well.” The downside of that is you might not wake up next morning. So if you are experiencing any symptoms from the jaw to the tightness right within that territory could be related to any pain in that area.

Typically, chest tightness is commonly described, but it does not always have to be chest pain. Yesterday I saw a patient with a heart attack had just throat pain and passed out at work. Sometimes it could be back pain. Men often describe it also as a pain in their arm. And again, it can go to both right or left arm, but left arm strikes more with common population thinking that, oh, if it’s going to the left arm, maybe I need to worry about it because it could be more heart related.

Sometimes, unfortunately, when we say silent heart attacks, people don’t usually recognize their symptoms and that’s why it’s silent. If you pay close attention to your body in that last two to three months when you’ve had a silent heart attack, there were some symptoms, but likely you ignored it. You just thought that I’m more tired, I’m more fatigued, I’m stressed. I could have had some chest pain, chest tightness. It could be my muscles acting up. I took something because I thought it was from the acid building up in my stomach.

So yes, there are some true silent heart attacks, which typically happen in patients with diabetes or in women. Women have atypical symptoms that men do. So I would say never ignore your symptoms with heart attack. Always, you know, Sanford Health has walk-in clinics, urgent cares, emergency room departments, as well as your regular clinic provider, always available to get you seen that same day.

We want to act fast on it. We want to get you to the right treatment and make sure that it is up to the experts for us to decide if it is your heart or not. And it’s OK to be wrong. It’s OK that you’re going to an emergency department or a cardiology clinic and they tell you that it’s not your heart, it’s likely your muscle or something else, but it’s OK for a medical personnel to make that decision rather than patients taking that decision on their own.

Alan Helgeson:

And I’ve experienced family members that have come in and they’ve had something like that where they’ve said, I’ve had some of these symptoms. The orchestrated medical team that comes in, I mean, they move like lightning in taking care of something like that. There’s no messing around with that and it’s something to see how they take care of things like that. So thank you again for reiterating the importance of that.

You’d mentioned early on when I asked you that question about times of day and seeing some things at various times. So I want to get right into that. Are there times of the day that are worse? And then a follow up to that, are there times of the year that are worse for heart attack?

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Dr. Nayan Desai:

Most of the heart attacks do happen in the early morning hours. So typically from 5:00 a.m. to up to, I would say noon. And the reason for that is your blood pressure is higher that morning. Your cortisol, which is a stress hormone, is high in the morning and that predisposes the blood to clot more. So heart attacks are definitely more happening earlier in the day, but again, if you have ignored your symptom earlier in the day, you could present to the hospital much later in that evening or afternoon. So with the diagonal variation more common in the morning as compared to evening, but again, early morning heart attacks, it’s not uncommon for us to jump in our car and go to the hospital to take care of a heart attack patient, typically between the hours of four to seven.

And then when we think about the times of the year when a heart attack can happen, we’re right in the middle of the winter.

So heart attacks are definitely more common and more prevalent during the winter months. And the reasoning behind that would be the cold weather stress and activity like shoveling, contributing to a plaque rupturing, which means that a blood clot forming in those arteries in the heart and causing a heart attack. So more common in winters and more common during the early morning hours during wintertime.

As we’re right here we’re talking about should we shovel, what symptoms are we looking for? You know, if you’re trying to shovel and you smoke a cigarette before shoveling, definitely a no-no. Because that’s going to increase your risk of a heart attack. After a heavy meal, most of your blood circulation is going into your gut at that time and then it’s depriving the heart of some blood flow. It’s causing like a steel phenomenon.

So some of the “do nots” is when you’re trying to shovel, if you have any cardiac condition, I would recommend not extreme shoveling, especially when it’s freezing cold. Definitely no smoking cigarettes and not eating a heavy meal before shoveling. That would be some good common practice.

Alan Helgeson:

You’ve talked a little bit about times of day, times of year and we’ve talked a little bit about symptoms and more to come on that. If someone is having a heart attack, is there anything that a person can do or a loved one can do until medical help arrives?

Dr. Nayan Desai:

That’s an excellent question. If you are experiencing a symptom of heart attack the first response would be to call 911. This is not the time waiting for a family member to arrive, get you in a car and then drive you to the emergency department. This week I have taken care of at least five or six patients with heart attacks.

One patient comes to mind where, you know, he is at home, he’s a young man in his sixties having dizziness and some chest pain, not really your typical symptoms of a heart attack. Calls 911, fire arrives, his front door is open and they go ahead and shock, write him in and save his life. Comes to me, put a stent in his widowmaker and open up the blockages of his heart. So when you’re experiencing a heart attack, I would say call 911. Even if you have five minutes away from the emergency department, if you’re coding in the passenger seat, your wife or your spouse or your friend cannot help you. That’s why medical help is so important.

The second thing which brings you in is of course do not drive yourself. Right? That would be the worst thing you would be putting yourself and more importantly, others in danger. When you’re having active chest pain, we had a patient come in taking nitroglycerin in the car and driving to the emergency department. That’s a total no-no.

Medication wise, I think it’s more selective. It all depends on the patient’s bleeding risk. If you have an aspirin at home, it’s not a bad idea to chew it, but again, that depends on your individual risk factors. I’m not making a common advice for somebody to just start doing aspirin every time they’re having chest pain.

So while you’re having that, sit down, definitely if you are getting a strong urge to go to the bathroom and you’re super sick, that’s also a bad sign. Just wait there. People can pass out or die if they’re trying to pee or go to the bathroom when they’re experiencing a heart attack. Let the medical personnel come in and take good care of you. EMS medical people come and get you to the nearest hospital.

But recognize the symptoms. I think the biggest message I want to convey with this question is recognize the symptom that you’re having a heart attack. You have to come to terms with your own body and not be in a state of denial. We all, as humans try to always think that it’s not something significant, right? We think it’s my acid reflux, it’s my muscles, it’s my nerves, it’s not my heart. So patients usually, and you know, general population, know their body the best even more than their regular doctors.

If you’re aware about your body and if that symptom is not making sense, like this is not feeling like my heartburn, I’m just sweating profusely, something is not feeling right, my chest is, you know, knotting up, call 911 if that is happening, especially at rest.

Alan Helgeson:

Dr. Desai, are there any myths about heart attacks?

Dr. Nayan Desai:

That’s a great question. As I said, the most common myth is I was just having heartburn and not realize that.

Some of the other common myths are that every time the chest pain has to happen in the center of the chest and go to the left arm.

That’s also a common myth and that is something which people need to know about – men and women present differently with chest pain.

Americans, number one cause of death in our country is still heart attacks or myocardial infarction. And the main reason is not recognizing the symptom.

One of the myths about symptoms and as you were kind of alluding to, you’re going to dive into what about the treatments, right? If you are having a heart disease, what about the treatments? “I’m on a cholesterol medicine and a blood thinner. I could not have a heart attack.” That is not true. People can still have heart attacks if they are on cholesterol medications or blood thinners.

Some of the other myths: I have never had blood pressure issues or have not been a diabetic. I don’t smoke. I could not have a heart attack. That is not true as well. Heart attacks can affect any age of person. I have seen with a heart attack as recent as in their 20s.

Diabetes won’t cause heart disease. That’s the common myth: because I’m taking diabetes medication or trying to say that my diabetes is well controlled, I don’t have diabetes or my blood pressure is well controlled, I don’t have high blood pressure. That’s not why your blood pressure is controlled on medications. That is a strong risk factor for having a heart attack.

Taking vitamins and supplements. People believe in natural medications, believe in heart healthy diet is one thing, but trying to take supplements and thinking that, oh, I’m on this good supplement, it’s going to take my blood and clean up all my arteries and keep me free of any heart diseases.

I always tell my patients if something was so good, the FDA would’ve approved it as medication. So yes if you are believing in vitamin and supplements, make sure you know the contents but also recognize your symptoms. Just because you’re taking a supplement or over the counter pill. Or let’s go to a chiropractor or doctor because I think it’s more my muscle in the neck which is hurting me and it’s not my heart. Get it checked out first. Get a professional opinion and then do massages or something else once you have had a clear answer from your doctor that it’s not your heart.

Well, I have not smoked for years and now there is no chance that I’m going to get a heart attack. That’s also one of the common myth which men come in with and that’s not true either. Any history of smoking in your lifespan increases your risk of having heart diseases and heart attack. Heart attack is still the leading cause of death in men and women. So how can you prevent that is by taking appropriate precautions.

Alan Helgeson:

We learn all sorts of things on social media and I’m guessing as a physician you just roll your eyes probably 20 times a day when people come in and hear things, see things. But I got to ask you this question. Is there such a thing as a pre-heart attack?

Dr. Nayan Desai:

Yes. I would say pre-heart attack, what we call is an impending heart attack or something which is leading to a heart attack, right? And again, that those are symptoms which you would start experiencing a little bit of chest tightness with walking and now it’s getting worse. Initially it just started to happen with walking, but now I’m having chest pain, even going to the bathroom, I’m getting chest pain and I’m going to the kitchen. That’s a sign that something is getting worse, that you don’t need to ignore that heart attack or pre-heart attack warning symptoms.

Alan Helgeson:

Let’s switch gears a little bit and we hear about different things relating to men and women and their health needs. Let’s talk about specifically heart attack. Are there signs, symptoms that are different for men and women?

Dr. Nayan Desai:

Men, as we just touched briefly on in our prior questions, would have those typical symptoms, right? They would have that chest tightness, chest discomfort, a feeling of pressure in their chest associated with shortness of breath, sweating, as well as some nausea and vomiting. If they’re experiencing some bad air weakness, which means a bad electrical problem during their heart attack, they can pass out, feel dizzy.

Women typically don’t have the typical just pain symptoms. They would come in with, you know, feeling tired or fatigue related to physical exertion being more in the upper back or the jaw area, the throat becoming tight, heartburn symptoms, symptoms of having indigestion like pain in the upper part of their abdominal area. And then they would think like, oh, it’s maybe gallbladder, it’s my acid. But as we said, the heart pain symptoms can go all the way from their neck or the jaw to the middle of the abdominal. So any pain in that area is or should be ruled out for having a heart attack first before we label it to something else. And the reason to do that is that’s going to kill you versus some of the other things.

Alan Helgeson:

Let’s move on to risks. And we always hear about the health risk, about heart health, but it’s always good to talk about these things and go back into risks that increase a chance of a heart attack. You can never talk about this enough.

Dr. Nayan Desai:

Being an interventional cardiologist, I do procedures in the hospital and see patients in the clinic as well as educating patients every day about their risk of having a heart attack, right? And the main risk, which we think or talk about, it’s a combination: it’s lifestyle, it’s medical risk factors, it’s genetics and it’s something in the environment. And let’s kind of break these down because it’s just going to be a lot of good information.

Talking more about lifestyle. This is something new our patients can do on a day-to-day basis to prevent a heart attack. And that’s where lifestyle comes in as the most important choice. Every day, your goal should be, how can I live a heart healthy lifestyle? Right? What that means is no smoking, we talked about smoking, damaging the blood vessels, decreasing the oxygen supply to your capillaries, to your heart, increasing the buildup of cholesterol plaque in those arteries contributing to heart death.

So no smoking should be the key message in the lifestyle choice.

The next one is heart-healthy diet. We all know what is good for our body. Whatever is good for our tongue, as commonly said, is not good for our heart. But that’s not true all the time. High fat, saturated fats which are high in sodium content leading to obesity, high cholesterol and high blood pressure, those should be avoided. Common examples would be, I would say, seeing a patient in the clinic, just replace one bad habit. If you’re trying to have that ice cream bowl every night, replace that with nuts on the counter. If you’re having, you know, a cookie, replace that with some seeds like flax seeds, walnuts, pistachios, avocados, those are all heart healthy and good if taken in an appropriate amount.

Next is going to be physical activity. Trying to have a sedentary lifestyle is not helping your heart. Movement, you know, doing household chores, moving around the house, setting apart a regular time in your daily behavior. I’m going to be walking for 20 minutes or 30 minutes a day. Getting my heart rate up is good for your heart. Your heart being a muscle leads that exercise to work efficiently. And excessive alcohol consumption, excessive alcohol can contribute to, you know, high blood pressure, depression as well as leading to alcoholism.

So these are the four factors which I would like to highlight in the lifestyle factors. Trying to avoid smoking, trying to avoid alcohol, have a heart healthy lifestyle and walk and move more.

Next thing we would move on to, what about some of the medical risk factors we see which contribute to having heart attacks? That’s where comes in your diabetes, your cholesterol, blood pressure, as well as obesity. So getting a blood pressure checked, we have a fantastic program here at Sanford with heart screenings and that’s where we talk about this combination of factors, which is a prevention with heart screening, which means we want to screen the heart of healthy adults between the ages of 40 and 75.

Do a good examination of their cardiovascular system, get a good history, check their blood pressure in the clinic, check their cholesterol numbers, make sure they don’t have diabetes, and then if indicated do a special test to screen if they have plaque in their arteries of the heart. So medical conditions is very important.

Go to your regular doctor. High blood pressure can often be silent. If it’s not checked, you won’t know about it. Same thing about your cholesterol. You might think that you might be following a very heart-healthy lifestyle, but you might still have high cholesterol because of either genetic factors or from lifestyle choices and stress. Trying to take time away from work. Meditate. Stress level increases the risk of hormones in the body and also causes increase in the risk of heart attacks. So these are some of the modifiable factors, which means that you yourself can take charge of these factors and change it.

What about family history? That’s why we talk about non-modifiable factors. Your age, you cannot control that. If you’re a man or a woman, you’re not going to control that. Same thing about your family history. You cannot choose who your parents are and what genetics you inherited from that, but that’s a small proportion. If you are following a heart-healthy lifestyle, taking care of your risk factors, your risk of heart attack still decreases. Even though you have genetic history, you get older and as we know men have higher risk of having a heart attack.

Alan Helgeson:

Dr. Desai, what would you want someone to do if they think they’re having a heart attack?

Dr. Nayan Desai:

As we have talked about, if you are having any symptoms at rest – chest pain, chest tightness, shortness of breath – even if you don’t think it’s your heart, sit down and call 911. You might not have a lot of time left before making that call. If you are not prompt enough, call emergency services immediately. Do not delay seeking help even if the symptoms are mild or unclear. Any symptom at rest is not a good sign.

Sit or lie down in a comfortable position. Make sure your front door is open. If you are passed out or if you have died and your heart needs to be shocked, EMS and fire can come in and appropriately save your lives.

Take that aspirin 25 if you have it at home. I don’t want to get this message out routinely that people should be chewing aspirin, but taking an aspirin if you believe or think that it’s heart attack related, unless you have an allergy to that medication or if you have any bleeding issues. Then of course don’t take aspirin. If you have nitroglycerin at home and you have been prescribed that by your doctor, take it as per their instructions.

Avoid driving yourself to the hospital, stay calm, monitor for symptoms and call for help.

Alan Helgeson:

Can you talk about some of the recent advancements in the treatment and management of heart attacks?

Dr. Nayan Desai:

Sure. Sanford, being a leader in cardiac care, significant advances have been made in the treatment and management of heart attacks in recent years. These innovations have allowed us to make not only rapid diagnosis for our patients, but also improved treatment with personalized care.

And talking about some of the recent advances we have is if you come into our emergency department with any symptoms of chest pain, we just rolled out something called a high sensitivity troponin. It’s a blood test which tells us if there is any sign of heart damage and that makes us easy to have a diagnosis of heart attack early on and quickly.

AI is everywhere these days. AI and machine learning and EKG rhythm analysis, that also helps us to vastly improve the diagnosis of if somebody’s having a heart attack.

Pre-hospital care. Faster door to balloon time. And that’s the mantra which I strive for, is what is my door to balloon time? And to explain that if that is the time when somebody hits their door in the emergency department till I blow open the balloon in their artery, that is the time we are monitoring. We’re trying to make that time as shorter as possible because every minute wasted while somebody’s having a heart attack is going to increase the risk of heart damage. So that’s why we want to act fast. We want to act promptly, we want to make sure we decrease our door to balloon time which means we’re trying to open up the balloon in that artery.

So I would just run your, typically what happens when our patient comes in, they get an EKG. If the EKG is showing a sign of a heart attack, I get a call immediately. I and my team of our nurses and technicians in the cardiac cath lab are there in the hospital in 10 minutes, even in the middle of the night.

That’s how we have our system operated. We can even kind of have an EKG sent directly from the EMS or our referring outlying hospitals in our community right away to my phone without going the operator or without trying to figure out which doctor to call.

We have tried to make it easy for a community so that we recognize heart attack early on and then get them right away to my hospital or any nearby hospital, make sure they get that aspirin, they get a blood thinner and off we roll them to a cardiac cath lab. And what a cath lab is, is where we do a procedure with an X-ray machine or a camera, I put a small IV in their artery, in the wrist. Typically go up in their heart, check if there is a sign of a blood clot in their arteries and then open up for us to the balloon and then a stent.

Alan Helgeson:

At Sanford Health, heart screenings are an important tool in prevention when it comes to heart care. Could you explain what that is and who it’s intended for, Dr. Desai?

Dr. Nayan Desai:

The heart screening is a unique program which is rolled out by Sanford Health and it’s available to anybody who thinks or believes they need to take care of their heart or just need some more answers. So I want to emphasize heart screening is for healthy people. It’s for people in the age group of 35 to 75 and more importantly, trying to help them understand what risk factors do they have for heart diseases.

What we do in that clinic is anybody can sign up through any of our programs at any of the Sanford locations, you come in, you get examined by a nurse, you get your blood pressure checked, you get an EKG done at that time. The EKG is reviewed by the cardiologist. We go over talking about your risk factors, about checking your cholesterol number that same day. Of course getting your blood pressure as well as getting your sugars checked.

And then we make the personalized plan based on that factors. We put that in a calculator and try and estimate what is the risk factor of that individual patient. If that patient is at high risk, we offer a cardiac screening test called calcium score. And that is basically a specialized CT. It takes about 15 minutes. There is no prep required for that cardiac CT. You come into the hospital, go straight into the scanner, and 15 to 20 minutes you are checked out. That CT scan does not need any contrast or dye to be administered.

And in that, what we are looking for is if there is any plaque or cholesterol or calcium particles built up in their heart because any plaque in their arteries would be a risk factor for having a heart attack. We would like patients to have a score of zero, but we don’t live in a perfect world.

Some of our patients who are heart healthy have a score of zero. But if your score is not zero, then you get to see a cardiologist and we make a personalized plan about which direction we need to go with regards to your heart care. I would say everybody, I encourage you to get a heart screen at least once in your lifetime if you have not had it. And if you want to be in charge of your cardiac health, give this yourself as a birthday gift. Do it on your birthday.

Alan Helgeson:

Dr. Desai, as we come to a close, what would be that one thing you want someone to take away from this conversation on heart health?

Dr. Nayan Desai:

I’m going to say two things, Alan, instead of one thing. The first thing is recognize symptoms and get checked out immediately. There is not enough, which we can emphasize on this message. If you do not come and get medical attention, there is no way I’m going to know that somebody is having heart attack. They need to make that phone call and be in charge of their health. Any symptoms, do not ignore if you think are related or unrelated even to your heart.

And make a healthy lifestyle choice. Before getting to that heart attack phase, make sure you can do some preventive stuff as we talked about, trying to move more, no smoking, no alcohol, as well as eat a heart healthy diet.

Alan Helgeson:

We thank Dr. Nayan Desai, interventional cardiologist with Sanford Heart in Bismarck, North Dakota for joining us on this very important conversation on heart health.

Cassie Alvine:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.

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