Volume 9, Issue 1 GUNDERSENWINTER 2020

Surgery close to home in NE 6 tips for a healthy 2020 Gundersen invests in rural healthcare

SPECIALIZED CARE FOR PROTIVIN COUPLE’S SPECIAL DELIVERY Gundersen Health System has the following locations in your area. For a complete listing, visit gundersenhealth.org.

Calmar • Medical Clinic: 106 E. Main St. Motivated by care, (563) 562-3211 Cresco • Rehab Services: 316 3rd Ave. E. relationships (563) 547-4400 Decorah As Gundersen Palmer Lutheran • Medical Clinic, Behavioral Health, General Surgery and Podiatry: Hospital and Clinics new 1830 State Highway. 9 administrator, I understand the (563) 382-3140 Eye Clinic: (563) 382-2639 power of positive relationships. • Orthodontics: 202 W. Main St. (563) 382-2525 • Rehab Services: 516 Montgomery St. Our patients’ needs and our (563) 382-4770 community’s health drives Fayette • Gundersen Palmer Lutheran Hospital and everything we do. Listening to Clinics Fayette: 110 King St. (563) 425-3381 our neighbors, caring for them Lansing and supporting them creates a • Medical Clinic: 50 N. Fourth St. (563) 538-4874 healthier community for everyone. Postville • Gundersen Palmer Lutheran Hospital and We’ve cared for patients and our community well for many Clinics Postville: years. I’m honored to be selected for this role, and I’m excited 111 S. Reynolds St. (563) 864-7512 to continue to work alongside our great Gundersen Palmer Waukon Lutheran clinicians and staff to support their care for our • 120 2nd Ave. SE Medical Clinic: (563) 568-3000 patients, their families and our community. Eye Clinic: (563) 568-3378 West Union We are excited to see where 2020 takes us. There are a lot of Gundersen Palmer Lutheran Hospital and Clinics great things happening at Gundersen Palmer Lutheran Hospital • Hospital: 112 Jefferson St. (563) 422-3811 and Clinics – with the addition of orthopaedic services and • Clinic: 110 Jefferson St. (563) 422-3817 adding another doctor to our primary care team. We continue to grow and strive to meet the needs of the communities we serve.

Thank you for allowing us to care for you and your families. Have a happy and healthy 2020!

Patrice Kuennen

Gundersen Palmer Lutheran Hospital and Clinics administrator

2 gundersenhealth.org VIRTUALVISIT: We’re ready when you need us

Getting sick seems to happen at some of the most diagnose, treat and send prescriptions, and/or inopportune times—the middle of the night, while recommendations for over-the-counter medicine, to the traveling, before an important meeting, or when you’re pharmacy of your choice. pressed for time. While VirtualVisit is convenient, it is not meant to That’s why Gundersen Health System offers live, on- replace every trip to the clinic. It is a good option for demand VirtualVisits using your smartphone or tablet. minor, temporary medical conditions and illnesses, Now you can skip the traffic, waiting room and time such as a cold, flu, sore throat, sinus infection, pink eye, off work but get the quality medical attention you rashes and urinary tract infections. need 24/7. To set up an account, download the free Gundersen Our secure VirtualVisit technology makes it possible for VirtualVisit app from Google Play or the App Store, patients, age 2 and older, to see a healthcare provider or go to gundersenhealth.org/virtualvisit. You’ll see face-to-face for many common medical conditions. a list of healthcare providers—including Gundersen Much like an office visit, a healthcare provider will providers—their biographies and experience before review your medical history, answer questions, starting your visit.

Benefits of VirtualVisit

Affordable No appointments Fast Open 24/7 $49 compared to the Sign into your account See a healthcare Care is provided average cost of $164+ and start your visit provider and get a 365 days a year, for a Gundersen urgent anywhere in the U.S. diagnosis in including nights, care visit; less than $49 No phone calls or 20 to 25 minutes. weekends and if covered by insurance. waiting rooms. holidays. Prefer a visit from your personal computer? No problem. Log into your account at gundersenvirtualvisit.org

WINTER 2020 3 New cancer treatment is RIGHT ON TARGET

Kristine (Kris) Loeser, 69, of Holmen, Wis., is a country girl at heart. Born and raised on a farm in La Crosse, Kris adores animals (especially her dog Smokey), flowers and gazing at the sky. Yet, even when the skies have been grey, Kris found a way to see through life’s challenges. In 2014, she was diagnosed with breast cancer after a routine mammogram at Gundersen Health System. “Fortunately, my cancer was detected early and was only the size of a grain of rice,” Kris recalls. Four years after finishing what she hoped would be curative treatment, the breast cancer spread to a lung and her bones. “The words metastatic breast cancer scared the living daylights out of me,” recalls Kris, who, days later, was introduced to Gundersen hematologist and medical oncologist Benjamin Parsons, DO.

4 gundersenhealth.org “We are entering an era of modern medical sciences where the next generation of treatments really are a significant step forward for patients, and clinical trials are the way to bring these to all of society,” states Benjamin Parsons, DO, Hematology and Medical Oncology.

A strong advocate for cancer research, Thanks to cutting-edge clinical trials Dr. Parsons and his colleague Paraic Kenny, and participants, like Kris, Gundersen’s PhD, director of Gundersen Medical Research team can help evaluate the safety BENJAMIN Foundation’s Kabara Cancer Research and effectiveness of new treatments. For PARSONS, DO Institute, recommended Kris enroll in a example, by opening the Strata Oncology clinical research trial known as APILOT screening protocol at Gundersen, close to (Adaptive Patient Instructed Longitudinal 440 patients in the Tri-state Region have Optimization of Therapy) that studies already participated in precision medicine new approaches to treat people with clinical trials. incurable cancers. “I can’t tell you how much this means to me “I had nothing to lose. If anything, I knew to be in an institution where you can go that my participation could help someone past what the standard of care is. You can else,” Kris shares. offer patients options that are not available Next-generation cancer genome in other places. To have Dr. Kenny and his sequencing—provided through research team working alongside us to PARAIC Gundersen Medical Foundation’s Research better understand the conditions affecting KENNY, PhD Department’s partnership with Strata our patients is very valuable. It’s something Oncology—found Kris’ tumor had a rare that I believe few institutions in the world mutation, or alteration, known as have, let alone here in . It puts us ROS1 fusion. in a very elite category,” Dr. Parsons says. Based on the identified mutation, Dr. For patients, precision medicine clinical Parsons prescribed targeted therapy rather trials offer newfound hope—sunshine on than standard-of-care chemotherapy. This a cloudy day. Support for research like this customized approach to cancer treatment, is made possible through the generosity of also known as precision medicine, targets grateful patients and philanthropic support mutated genes in a tumor rather than the of Gundersen Medical Foundation. part of the body affected by cancer. “Between God and Dr. Parsons, I’m still here. “Kris has been on targeted therapy on and God has me here for a reason. I would love off since May 2018, and it has been the only to talk someone through this because you thing that has worked against her cancer,” can’t do it alone,” Kris says. reports Dr. Parsons.

Your gifts give hope Thanks to the generosity of our community, Gundersen Medical Foundation can invest in cutting-edge laboratory research and Watch how clinical trials at the Kabara Cancer Research Institute to help Gundersen researchers are drive changes in how cancer is treated. personalizing cancer treatments at gundersenhealth.org/target-cancer.

WINTER 2020 5 foot problems you shouldn’t ignore

There are some situations in life where you’re better off grinning and bearing it. Foot and/or ankle pain isn’t one of them, says Gundersen Health System podiatrist Bradley Abicht, DPM, who specializes in diagnosing, treating and managing conditions of the feet and ankles. If your feet or ankles are causing pain, don’t ignore it. “Pain, in any part of the body, is simply not normal. It may be an indication that there is a problem that should at least be assessed,” Dr. Abicht says. Seek expert attention for:

1) Foot or ankle injuries 2) Flat feet especially if 3) Great toe joint pain, 4) Diabetic foot ulcers, including sprains, cuts, accompanied by pain such as bunions or or open wounds on puncture wounds and or stiffness arthritis, that cause you the bottom of the feet, broken bones to change the way you which put patients walk or limit your daily with diabetes at activities increased risk for non- healing, infection and/ or amputation

“Our non-surgical treatments are effective when foot and ankle problems are identified early,” Dr. Abicht says. Treatment can range from establishing a diagnosis and monitoring the condition without any intervention to conservative treatment (such as physical therapy or a brace) to help with symptoms and lessen the likelihood of them worsening or progressing. In some situations, surgery is the best option. You don’t need to live with lingering pain. Gundersen foot and ankle specialists see patients at more than a dozen locations in Wisconsin, and Iowa.

BRADLEY ABICHT, DPM To find a clinic near you, visit gundersenhealth.org/services/foot-care

6 gundersenhealth.org OFFERING SURGERY, close to home ELLESON SCHURTZ, MD What do appendectomies, colonoscopies and C-sections have in common? They are all surgical procedures performed by Gundersen Decorah surgeons in northeast Iowa. “There are many reasons people prefer to receive their care locally compared to the difficult logistics of commuting to a larger city,” explains Elleson Schurtz, MD, a general surgeon at Gundersen Decorah Clinic. “Anytime a patient can have their procedure performed close to home, it is a benefit to them. Not only does it save time and money by traveling a shorter distance, patients are also closer to family and their support systems.” Dr. Schurtz joins Gundersen Decorah surgeons Scott Bierman, MD; Philip Yee, MD; and Michael LaBelle, MD; in providing surgical procedures in Decorah, Waukon, West SCOTT Union and Cresco. BIERMAN, MD Patients in northeast Iowa have access to many of the same surgical procedures offered in larger cities. The Gundersen Decorah surgery team offers: • Appendectomies • C-sections • Colonoscopies • Endoscopies • Gall bladder surgery • Lesion removals • Vasectomies • And many more Many of the procedures performed by Gundersen Decorah surgeons use a minimally PHILIP invasive technique, which means smaller incisions and a faster recovery. YEE, MD Our surgeons work closely with your primary care provider, no matter where you receive care, and keep providers updated after surgery.

For more information on Gundersen surgery services in northeast Iowa, talk with your primary care provider or

call Gundersen Decorah Clinic at MICHAEL (563) 382-3140. LaBELLE, MD WINTER 2020 7 CARE ACROSS THE SYSTEM

A West Union, Iowa, Emergency Room clinician, Asher and what to do to make him healthy,” Renessa specialists at Gundersen Health System in La Crosse, says. and parents with a strong instinct and faith in God In the emergency department, Lana Schmitt, NP, converged to save 6-year-old Asher Zurbriggen in immediately went to work to stabilize Asher and find March 2019. answers. In the days before, his mother, Renessa, reports “I believe God heard our prayers,” Renessa adds. “I that Asher had not been feeling well or acting like mentioned to Lana that I thought Asher had been himself. She thought Asher had the flu or a cold— losing weight over the past few weeks despite being typical kid stuff. But his condition didn’t improve hungry and thirsty all the time. I had assumed it was after a couple days. because of a growth spurt.” On that fateful day, Asher didn’t want to get out of This was the clue Lana needed. A blood sugar test bed. detected type 1 diabetes. “He was vomiting and very lethargic,” his mom Type 1 diabetes, usually diagnosed in children, is a remembers. life-long and potentially life-threatening condition. She knew it was time to seek medical help and took The body does not produce the insulin needed to Asher to Gundersen Palmer Lutheran Hospital and move blood sugar (glucose) into cells where it is Clinics in West Union, Iowa, minutes from the family’s stored and used for energy. home in Elgin. The Hospital in West Union is part of the larger “On our way to the hospital I asked God to give the Tri-state Gundersen Health System, which means doctors the wisdom to know what was wrong with patients like Asher have access to specialized care

8 gundersenhealth.org across the system. Pediatric diabetes specialists “A diagnosis of type 1 at Gundersen Health System in La Crosse, Wis., diabetes requires an confirmed the diagnosis and provided expert care. extreme lifestyle change for “Asher stayed in the hospital for three days,” Renessa any child,” says Asher’s local says. “God put the right staff in the right place to primary care provider, Sam help us. The diabetes educators met with us and Brauer, PA. “Asher has done they were tremendous. They were very patient and well accepting this and is answered all our questions. To this day I can call them working with his parents or contact them through MyCare if I have questions and his care team for daily control of his diabetes.” or concerns.” SAM Gundersen’s specially trained diabetes educators Gundersen diabetes BRAUER, PA worked with Asher and his family to come up specialists Kathleen with a plan to manage his diabetes. This includes Marquart, MD, and Morgan nutrition planning, blood glucose monitoring, insulin Grabinoski, RN, NP, also have regular contact with injections and lifestyle modifications. Asher—including outreach visits at the Gundersen Decorah Clinic—to monitor his diabetes. The diabetes specialists in La Crosse remain in contact with Asher’s primary care provider in West Union. “I receive an update every time Asher is seen in La Crosse or at an outreach visit. I review these updates and contact the clinicians if I have any further input or questions,” Sam reports.

Asher wants kids to know that if they are ever diagnosed with type 1 diabetes, they can still be just like other kids. He should know. Asher enjoys playing, school, sports and many other activities—just like a typical kid.

WINTER 2020 9 6 tips for a healthy 2020 In our fast-paced world, it’s easy to overlook the task of self-care. As the new year begins, make a resolution to take time to fuel yourself as you bustle through your day. According to Stephanie Cenek, DNP, nurse practitioner at Gundersen Calmar Clinic, “Adopting and maintaining a healthy lifestyle can help prevent obesity, high blood sugar, high cholesterol and high blood pressure, which are risk factors for diabetes, kidney disease and heart disease.” A healthy lifestyle is a way of living based on your daily choices regarding physical activity, STEPHANIE nutrition, stress management and mental health. CENEK, DNP Stephanie suggests these six daily practices to help fuel you and lead a healthier lifestyle:

Get seven to eight hours of quality Focus on spending time with people sleep. Not enough sleep can lower your who fill you up, not leave you feeling immune system. drained.

Eat a nutritious, well-balanced diet that Manage your stress. Take some time to includes plenty of nutrient-rich fruits and quiet your mind and try spending 30 vegetables. seconds taking a slow deep breath.

Add regular physical activity. Getting Don’t smoke. If you use any tobacco 30 minutes of moderate exercise a day products, make a plan to quit in 2020. can help lower blood pressure, manage Using tobacco products weakens your weight and protect against some body’s natural ability to avoid and fight diseases. infections. These basic daily practices are the foundation for managing your resilience and boosting your energy. Visit gundersenhealth.org/wellness for more information on improving your health or contact your Gundersen primary care provider. 10 gundersenhealth.org Bringing quality healthcare TO RURAL COMMUNITIES About 25% of the U.S. population lives in rural areas, Medicine Residency program. “Our residents receive but only 10% of physicians practice in those areas. extensive training in rural settings, including rural Gundersen Health System and Gundersen Medical emergency medicine, surgery, primary care and Foundation launched a Family Medicine Residency obstetrics.” program and clinic in July 2016 to address the The first class of family medicine residents graduated shortage of rural healthcare providers in the Tri-state in 2019. One of the graduates, Elizabeth White, MD, is Region. The program trains doctors interested in now at the Gundersen Viroqua Clinic. practicing family medicine, “I grew up on a family dairy farm in southeast especially in rural Midwest Wisconsin,” Dr. White says. “By practicing medicine communities. here, I am returning to my roots and serving the kind “The training and real- of community that raised me. I understand the hard world experience they work and challenges that are often part of the rural gain leads to independent experience, and I hope my roots will create common practice across the full ground with my patients.” spectrum of care and at Victoria Bodendorfer, MD, Gundersen La Crescent every life stage,” explains Clinic, was also a member of the 2019 graduating Paul Klas, MD, director PAUL KLAS, MD of Gundersen’s Family Continued on page 14

WINTER 2020 11 Shared OB care gives Protivin baby the best start

Ashley and Brian Jestrab, of Protivin, Iowa, welcomed firstborn twins to the world by cesarean delivery, just two weeks shy of their due date. When they conceived a second time, Ashley knew she wanted to try vaginal birth after cesarean (VBAC). “I didn’t get that option with the twins,” shares Ashley, a labor and delivery nurse at Winneshiek Medical Center in Decorah, Iowa. “My decision to try VBAC was what brought us to Gundersen in La Crosse.” Gundersen Health System delivers more than 1,600 babies each year and has a VBAC success rate of 94 percent*. That was one factor Ashley considered when choosing Gundersen; another was shared obstetrics care. Shared obstetrics care means two healthcare providers partner to provide care for a mother during pregnancy and delivery. For Ashley, that meant seeing her primary care provider Kristy Schilling, MD, locally at Gundersen Decorah Clinic for prenatal care, then transferring to an obstetrician in La Crosse for labor and delivery. “Shared prenatal care was a huge convenience for us,” says Ashley, who lives 77 miles from La Crosse and already had her hands full with twins. But, the commute to La Crosse was well worth it on March 19, 2019, when the Jestrabs welcomed 7-pound, 3-ounce Ava Evelyn to their family. “I had an uncomplicated VBAC. The experience was wonderful,” Ashley says

*For women who are medically eligible for VBAC and choose to have one

12 gundersenhealth.orggundersenhealth.org Within 12 hours of Ava’s birth, Ashley noticed something unusual. “I kept trying to nurse my daughter. I couldn’t figure out why she wasn’t staying latched. When she was latched, she sounded like a squeaky sneaker,” shares Ashley. A visit from Gundersen Lactation Services revealed Ava had a cleft soft palate. “It completely caught us off guard. Physically, Ava looked like this perfect baby, but then to hear she had a birth defect was hard to accept,” Ashley recalls. Specialists from Otolaryngology and Speech Pathology met with Ashley and Brian in their postpartum room to answer their questions and explain Ava’s future care plan. Certified lactation consultant Jamie Kotsmith, RN, IBCLC, was also by Ashley’s side to address her most immediate concern: “How will I feed my baby?” “There are times when direct breastfeeding can be very difficult to achieve. I remind mothers the top priority is to feed their baby, then to protect their milk supply. A happy, healthy, growing baby is best,” shares Jamie. JAMIE KOTSMITH, Gundersen lactation consultants at the La Crosse Hospital and Gundersen Palmer RN, IBCLC Lutheran Hospital visit with new mothers desiring lactation during their postpartum hospital stay. Upon discharge, they see moms and babies in the clinic setting, as often as needed, until the family feels confident about feeding. “I so badly wanted to breastfeed,” recalls Ashley. “Jamie spent hours with me determining individualized methods and techniques I could use to try to nurse my little girl.” During Ava’s first weeks, Ashley breastfed and supplemented additional breastmilk by bottle. As her nutritional needs grew, she switched to pumping and bottle feeding exclusively—giving Ava all the nutritional benefits she needed. “I’m so very grateful for all the hard work Jamie put in with us. I couldn’t have done it without her,” says Ashley.

We deliver babies in West Union Gundersen Palmer Lutheran Hospital offers maternity care and breastfeeding support conveniently in West Union. Gundersen Palmer provides a comfortable atmosphere for your “special delivery,” complete with private Labor, Delivery, Recovery and Postpartum rooms, which include whirlpool tubs, sleeping arrangements for significant others, a family day room for visits and a kitchen for family use. Plus, you’ll have the on-site support of our certified lactation consultant, even after you’ve returned home. To speak to a lactation consultant or to schedule an appointment, call (563) 422-3811. To learn more about delivering at Gundersen Palmer, visit gundersenhealth.org/palmer/hospital/birthing-center/

WINTER 2020 13 Rural healthcare continued from page 11

class. Her path was and I clearly saw the need was there,” different. Dr. Bodendorfer Dr. Bodendorfer explains. “I learned many grew up in the Milwaukee procedures, saw a variety of patients, and developed area, but she wasn’t the skills and confidence to be a better doctor.” convinced she wanted to While the Family Medicine Residency program is practice medicine in an a major ongoing investment, Gundersen is also urban area. addressing the need for rural healthcare with: “I liked the idea of rural • 36 regional medical clinics and hospitals medicine because I (gundersenhealth.org/locations) VICTORIA wanted to practice the full • 22 telemedicine and 28 outreach locations for BODENDORFER, MD spectrum of care, feel part easier access to medical specialists of a community and build • Regional eye clinics, behavioral health centers, lasting relationships with my patients,” she recalls. renal dialysis centers, sports medicine and Gundersen’s Family Medicine Residency program orthopaedic centers, and more allowed her to experience this. • Telephone Nurse Advisor (608) 775-4454 and VirtualVisit gundersenhealth.org/virtualvisit “During my residency I worked in West Union, Iowa, available to anyone, anytime in all aspects of care. My schedule was always full,

Medical students experience rural practice To address the shortage of rural physicians, Gundersen Medical Foundation joined the University of Wisconsin School of Medicine and Public Health (UWSMPH) in a program called the Wisconsin Academy for Rural Medicine (WARM) nearly a decade ago. Gundersen’s WARM teaching campus was one of the first in the state.

Through WARM, Gundersen helps train third- and fourth-year medical students who have an interest in rural medicine. Students spend part of their time training at Gundersen’s regional clinics, where they are exposed to rural medicine and what it’s like practicing in small communities. Students experience continuity of care while participating in all aspects of healthcare that regional rural campuses offer.

An ongoing commitment to WARM reflects Gundersen’s investment in the future of healthcare in the region since many WARM students have gone on to practice medicine in the rural communities it serves.

To learn more about Gundersen’s efforts to train the next generation of rural family medicine doctors and to show your support, visit gundersenhealth.org/medical-education

14 gundersenhealth.org benefits  of physical and occupational therapy

A safe and effective way to reduce and manage 1. chronic pain—not just mask pain like opioids.

Reduce or eliminate the need for prescription 2. drugs, including pain-killers, and may help avoid surgery.

Is therapy right for you? We Improves or restores mobility. can help with orthopaedic 3. 9problems, neurological conditions, cognitive limitations, pelvic health Recover faster from injury or surgery. issues, sports injuries, work- 4. related injuries and more. Call to schedule today: Suitable for most patients • Cresco 5. regardless of age, fitness or mobility level, and whether or not (563) 547-4400 you get you care at Gundersen. • Decorah (563) 382-4770 No referral needed.* • West Union 6. (563) 422-9729 Sometimes it costs less to use our cash-based affordable • Harmony flat rates than to go through insurance.** (507) 886-6544 7. • Spring Grove Many of our physical and occupational therapists have (507) 498-3211 advanced specialized training in assistive • For La Crosse, 8. technology and therapies for scoliosis, sports injuries, pelvic Onalaska and other health, neurological problems, dizziness/balance (vestibular regional locations visit gundersenhealth.org/ rehab), lymphedema, hands and more. locations Our clinicians have direct access to other Gundersen 9. specialists for those who may need additional treatments. * Check with your insurance to verify coverage and eligibility. ** Cash pay not available for those on Medicare/Medicaid/government insurance.

WINTER 2020 15 Gundersen Health System Non-Profit Org. 1900 South Avenue U.S. Postage La Crosse, WI 54601 PAID Permit # 395 La Crosse, WI

POLISHED and ready for surgery “When the nurse told us Lauryn needed an IV, all our hearts were racing. But, in stepped a child life specialist who offered just the right distraction—perfectly painted pink fingernails. It was just the ‘cure’ she needed!” Adding some color to difficult situations is one way we practice Love + Medicine.

Gundersen is published by Gundersen Health System. prior to any change in medical treatment, exercise Development and Marketing at 1900 South Avenue, The information contained in the magazine is to routine or diet. La Crosse, WI 54601, or call (608) 775-3089 or educate consumers about various health subjects and (800) 362-9567, ext. 53089. is not intended to replace professional medical advice For permission to reprint any portion of this magazine, or service. Personal health concerns should be brought to change your address, to let us know if you are ©2020 Gundersen Health System to the16 attention gundersenhealth.org of your physician or health professional receiving more than one copy or to be taken off Equal Opportunity Employer our mailing list, write to Gundersen Business