GUNDERSENYOUR GUIDE TO HEALTH AND WELLNESS

MANAGING MENOPAUSE New Menopause Clinic helps women find answers –p. 5 KIDS & SOCIAL MEDIA Helpful tips to keep them safe and healthy – p. 6 TAKE CONTROL OF JOINT PAIN Check out our new online Self-Care Plan – p. 10

MEET OUR NEW CEO A letter from Scott Rathgaber, MD, Gundersen’s new Chief Executive Officer Dear Friends, We live in a region full of beauty, vibrancy and opportunity. Those qualities are all around us as the seasons transition from summer to fall and fall to winter.

Gundersen Health System is undergoing a period of transition, and opportunity, of its own. Our community-led Board of Trustees has granted me the honor and privilege to serve our patients, staff and community in the role of chief executive officer. I am excited to lead such a dynamic organization as Gundersen enters its 125th year of providing high-quality care in , and . In addition, I am grateful to Dr. Jeff Thompson for his inspired leadership, providing stability and momentum for our system to facilitate a smooth transition.

I have spent my first weeks listening to our staff and community leaders to understand their passion and vision for our future. In these conversations, it is clear so many people cherish the deep community roots Gundersen has throughout our service area. They also understand Gundersen’s future success depends upon engaging our staff and communities in solutions for healthcare excellence.

We are committed to leading a transformation from traditional healthcare to promotion of health and wellness in our communities. While Gundersen has made great strides in efforts to improve the health of our region, we will need current and new community partners to deliver health and well-being to our families, neighbors, and those who move to our region for a healthy, safe and rewarding quality of life.

Gundersen has supported a lifetime of health and wellness for so many people through a heritage of superior patient care, innovation and compassion. Our future is bright, and our goal is a healthier future, but we cannot achieve this goal on our own. Together, we have the opportunity to transform healthcare and create a healthier region, and world, for generations to come.

Thank you for your support. It will be a worthy and rewarding journey for us all.

Sincerely,

Scott Rathgaber, MD

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 Volume 4, Number 3 to the attention of your physician or health professional receiving more than one copy or if you’d like to be ©2015 Gundersen Health System taken off our mailing list, write to Gundersen Business EEO/AA/Veterans/Disabilities It’s back: Laughing gas for labor pain

Casandra Neperud of Fountain City, Wis., knew she wanted the concentration gets too an epidural to control pain during childbirth. But her plans high, her hand falls away. Benefits of nitrous oxide: changed rather quickly upon arriving at the hospital. • Safe for mothers and babies Because the gas clears • No need for fetal monitoring “When we got to Gundersen in La Crosse, I was already from the body with normal or an IV dilated to six centimeters,” recalls Casandra. Her labor breathing in 30-60 seconds, progressed so rapidly that there was no time for an it’s very safe for mothers and • Mother has control over frequency and dosage epidural or intravenous (IV) narcotics. Gundersen Health babies, Amy says. System certified nurse midwife Amy Belling-Dunn, • Quick pain relief CNM, offered Casandra an alternative—nitrous oxide, or Gundersen became the • Gas clears from body in a laughing gas. first hospital in Wisconsin minute or less to embrace the use of • Allows for freedom of “This colorless, odorless and tasteless gas is fast-acting nitrous oxide in June 2015, movement and allows women to get a break from the intensity of following the Food and Drug • Affordable contractions,” explains Amy. Administration’s approval of a machine to deliver the gas in It is self-administered 2012. But offering nitrous oxide during childbirth isn’t new. through a mask that the mother holds It was used frequently in the U.S. during the 1930s-1970s against her to manage labor pain, but fell out of favor when epidurals mouth. came into use in the 1980s. Nitrous oxide is often used for childbirth in countries like the United Kingdom, Finland, Sweden, Canada and New Zealand.

“Women are looking for alternatives, and nitrous oxide is a new option in our tool kit for managing pain,” says Amy.

“Though my contractions still hurt, I noticed that the pain was not as harsh and it went away faster,” Casandra says. “I’d definitely use it again.” There’s another reason the birth of her first child, Joshua, went smoothly. “The staff was so supportive and talked me through it all. I couldn’t have done it without them.”

About one third of labor patients at Gundersen have chosen nitrous oxide to relieve pain since June 2015.

“Every woman tolerates pain differently and has an idea of her ideal birth experience. As a midwife, I’m here to help them have a good experience,” concludes Amy.

If you’re expecting a little one, ask your Gundersen Development and Marketing at 1900 South Avenue, Casandra Neperud of La Crosse, WI 54601, or call (608) 775-3089 or Fountain City, Wis., doctor or midwife about the use of nitrous oxide (800) 362-9567, ext. 53089. If with her son, Joshua. during labor. Volume 4, Number 3 ©2015 Gundersen Health System EEO/AA/Veterans/Disabilities YOUR GUIDE TO HEALTH AND WELLNESS | 2 Celebrating 10 incredible years!

to our 100+ community sponsors and thousands of participants who have helped raise over $3.8 million THANK YOU for local breast cancer research and awareness.

National collaborative Steppin’ Out in breast cancer research Pink participation occurs between has more than Gundersen Medical DOUBLED. Foundation and 36+ institutions across 2006 – 2,980 WALKERS the U.S. 2015 – 6,400 WALKERS

$160,000 in free mammograms 218 local breast cancer patients received help provided to uninsured or paying for basic needs during treatment since 2012. underinsured women in our community.

full-time cancer 2008 researchers joined The year Gundersen Medical Foundation’s Gundersen Oncology Oncology Research Laboratory and Research Lab at the BioBank were established, thanks in Karbara Cancer Research part to Steppin’ Out in Pink. Institute in fall 2015.

Join us 9/10/16 at our 11th annual Steppin’ Out in Pink. steppinoutinpink.org

3 | GUNDERSEN HEALTH SYSTEM Gundersen launches new Integrative Medicine Center

At Gundersen, care is never one-size- • Chiropractic manipulation techniques help reduce fits-all. In fact, in addition to more muscle and joint pain and improve function, and are conventional treatment options, we used independently or in conjunction with other have offered our patients a variety of treatments, such as physical therapy or more advanced alternative medical services for years. medical interventions. These services complement or assist • Massage therapy helps relieve stress, relax muscle with wellness as part of an integrated tension, improve circulation, reduce blood pressure, Kim Dowat, PhD, treatment plan. Now patients can find lessen anxiety and promote a relaxed state of mental CNM, Gundersen many of these alternative services awareness. A variety of massage is offered, including Integrative Medicine together in one place at the Integrative relaxation, therapeutic, Swedish, deep tissue, sports, Medicine Center in the Gundersen Onalaska Clinic. prenatal and others.

So what is integrative medicine? Medical consultation with Dr. McMullen, who is trained in “For some patients, integrative medicine offers relief of integrative and holistic medicine, can help answer your symptoms or side effects while undergoing standard/ questions about the safety and effectiveness of over-the- conventional treatments, such as nausea relief during counter supplements, as well as the interactions between cancer treatments. Many seek these services to treat pain herbs, vitamins, prescriptions and foods. She’ll also work or symptoms not alleviated by conventional medicine. with you to create a customized self-care plan. Others use these therapies to relieve stress and increase a sense of well-being,” explains Kim Dowat, PhD, CNM, who Other natural approaches to dealing with pain, illness offers acupuncture and holistic therapies. and stress “We’re also available to offer advice, provide information “To build health and wellness, I may use acupuncture, and help coordinate other integrative therapies, such as herbal therapy, bio-identical hormones, Chinese and biofeedback, herbal therapy and nutraceuticals, essential Ayurvedic principles (holistic healing based on a balance oils, wellness programs and more,” Dr. Dowat explains. of mind, body and spirit) and other complementary therapies,” she adds. For patient convenience, many integrative medicine services are also available from other departments and Medical consultant Jill McMullen, MD, ABIHM and clinics. Please be aware that not all integrative medicine chiropractor Joshua Potaracke, DC, join Dr. Dowat in the services may be covered by your insurance, so you should new Integrative Medicine Center to offer these services: check with your insurance provider. • Acupuncture is believed to stimulate the body’s natural healing abilities and promote physical and emotional Visit gundersenhealth.org/integrative-medicine for well-being. It’s used to relieve chronic pain, nausea a full listing of services. To learn more or to schedule from anesthesia or chemotherapy, menstrual cramps, an appointment, contact Gundersen’s Integrative fibromyalgia, carpal tunnel and more. Medicine Center at (608) 775-8926.

YOUR GUIDE TO HEALTH AND WELLNESS | 4 New Menopause Clinic is helping women find answers

“I just feel fantastic. I feel like a totally different person.”

Those were Pam Clark’s words in May 2015 after resuming hormone replacement therapy (HRT) to control her hot flashes. Pam used HRT for nine years following menopause, but was advised by her doctor to gradually wean herself off hormones.

“When I stopped using the hormones, the hot flashes got worse. It was hard to function throughout the day,” recalls Pam, who experienced six to eight hot flashes a day, and slept only a few hours each night.

Pam started searching for answers online and came across the North American Menopause Society. There she found the name of Gundersen obstetrician/gynecologist Jill Davidson, MD, the only nationally-certified menopause practitioner within a 50-mile radius of La Crosse.

“I was surprised that we had an expert here in La Crosse Gundersen obstetrician/gynecologist Jill Davidson, MD, helps women and scheduled an appointment right away,” Pam says. Like understand the symptoms and treatment options available to safely manage menopause. many women, Pam was concerned about hormone use and her risk of developing breast cancer. from medical providers who don’t feel comfortable prescribing hormone therapy and patients who are “In the 1990s, hormone therapy was prescribed almost unaware that it can be a safe way to manage symptoms,” universally to women going through menopause,” states says Dr. Davidson. Dr. Davidson. “However, it fell out of favor in 2002 following a large controversial research study [Women’s Health The Menopause Clinic helps patients weigh the benefits Initiative] because of concerns raised about medical risks, and risks of hormone therapy, answer questions and such as an increased risk of breast cancer. Since then, many discuss all of the treatment alternatives. studies have shown that there are women who can benefit from hormone therapy without taking on significant “I never learned so much in 30 minutes as I did talking medical risk.” to Dr. Davidson. It was a relief to have answers to all my questions. When I left that appointment, it felt like a To help women safely manage the symptoms and long- burden had been lifted from my shoulders,” says Pam, who term effects of menopause, Gundersen has created a is on a new hormone replacement regimen and is feeling Menopause Clinic. The clinic brings together several like herself again. experts in one location at the Center for Women in the Gundersen Onalaska Clinic. If symptoms of menopause are affecting your quality of life, or if you have questions about HRT, call “Prescribing hormone therapy is no longer a one-size- (608) 775-8181 to schedule an appointment fits-all approach. Now it has to be individualized to each in the Menopause Clinic. To learn more, visit patient. Because of this, there have been many questions gundersenhealth.org/menopause.

5 | GUNDERSEN HEALTH SYSTEM Be a partner in your child’s online life

Children take cues from their parents When you get involved and stay involved in your child’s for many behaviors. Social media online life, you’ll help them reap its many benefits. But behavior is no exception. Are you when allowed to use social media alone, your child can setting a good example for your easily be exposed to the dark side of this technology, school-aged child? Is social media a including cyberbullying, less face-to-face time with family minor part of your life or a major part? and friends and exposure to online predators. Are your posts respectful to others, Jeff Reiland, MS, positive and suitable for all audiences? Your child’s annual wellness exam is an ideal time to CSAC discuss social media use and other topics. Gundersen’s Gundersen family and child therapist Most social media sites require active TogetherAgainstBullying.org website and new “Caring members to be at least 13 years old. For Kids” Facebook page are also excellent resources Unfortunately, some children find ways around that. On for kids and parents. Facebook alone, it’s estimated five million children under age 10 have accounts.

“This gets to be a problem, for example, when an eight year old creates an account and lists their age as 14,” explains Jeff Reiland, MS, CSAC, Gundersen Family and Child Therapist. “When that same child is 18 years old in Facebook’s eyes, they’re actually only 12. But the advertising Facebook provides is geared toward an 18-year-old audience and not a 12-year-old audience. What that child sees can influence their behavior and choices.

“As in all other parts of life, parents are the best teachers for their kids,” Reiland continues. He offers the following suggestions to help ensure a successful social media experience for your child: • Be a part of their online life. Set aside time to visit their account together. • Protect them by establishing privacy settings on their ‘Caring For Kids’ on Facebook account. Check out Gundersen’s new parent-focused Facebook page, • Allow them to “connect” only with people they know, “Caring for Kids,” for useful information to keep kids healthy, and be sure you’re one of them. happy and safe: • Review all posts and reserve the right to approve or • Quick tips for healthy eating and activities disapprove each one. • What’s going around or in the news • Watch what your child’s friends post to your child’s • Upcoming classes and events account. If concerning items appear, discuss why you • Advice about immunizations, illness, safety, stress believe they’re a problem immediately. and more • Limit time on sites and don’t allow them to be used in • Recommended books, apps and resources your child’s bedroom. • View and share comments with other page followers

Search “Caring for Kids – Gundersen Health System” and be sure to “share” with others!

YOUR GUIDE TO HEALTH AND WELLNESS | 6 Exercise + physical activity: The best recipe for improved health

half-Ironman distance triathlons and a full Ironman triathlon.

“You might think you could never do what I’ve done, but it is possible and doesn’t start with anything dramatic,” Christina assures. “And you can take it as far as you want. You’d be surprised how much better you’ll feel from just a few small changes in your life.”

Christina uses her smart phone to track daily movement and steps. To stay active at work, she takes walks at lunch, has participated in noon exercise classes, keeps tennis shoes at her desk (so she can change and walk comfortably) and when possible, holds walking meetings.

Family time with her husband and children almost always involves physical activity or exercise for Christina.

Gundersen family medicine physician Robyn Borge, MD, is shown with “As they’ve seen me commit to this lifestyle, they’ve asked two patients who have added physical activity into their lives and if they can join in my activities. My son bikes with me, one improved their health, Julie Gran, Onalaska (left) and Christina Flisram, daughter likes to run, and both girls like to swim with me. La Crosse (right). We regularly take walks with our dog and mountain bike or We all know regular exercise is a key component in bike on the great trails we have here. ensuring good health. But did you know physical activity – the simple action of moving – is just as important? “Movement is just refreshing,” Christina summarizes. “It gives you a chance to clear your mind, think, plan or even “In the past we focused primarily on recommending just enjoy the moment. I have some of my best thoughts exercise, and that’s still critical,” explains Robyn Borge, MD, while moving. If you’re stressed, it helps calm everything Gundersen Family Medicine Residency Clinic. “But if you down and gain a little perspective on the situation.” exercise for 30 minutes and then spend the rest of your day being sedentary, sitting at a desk for example, there may be health hazards associated with that. Physical activity at home “Our bodies were meant to move!” Dr. Borge emphasizes. • Mow your grass, work in your garden, rake leaves or prune. “Movement throughout the day may be just as important • Do housework yourself instead of hiring it out. as exercise when it comes to lowering the risk of heart • Go for a 5-10 minute walk before every meal. disease, diabetes, and obesity and related complications. It can also help lighten your mood and reduce stress.” Physical activity at work • Park farther away than normal and walk the extra distance. Christina Flisram of La Crosse knows firsthand the • Use the stairs, not the elevator. difference physical activity and exercise make in a person’s • Stand while you’re talking on the phone. Even better, get a life. In 2007 Christina lost 65 pounds and has kept it off stand-up desk. since. Today she is physically active, exercises daily and has • If you sit all day, get up at least once an hour to stand or crossed the finish line at more than a dozen Olympic and walk for a minute or two.

7 | GUNDERSEN HEALTH SYSTEM Vaccinations aren’t just for kids

Protect yourself. Protect your family. Protect others.

That’s the simple message from medical providers on vaccines that help our bodies boost immunity against diseases that can be dangerous and Brenda Rooney, PhD even deadly in people of all ages. Gundersen epidemiologist Vaccines are common for children to help them build immunity against diseases like measles, mumps, polio and tetanus, but it’s also important for adults, especially older adults, to follow the immunization schedule recommended by the Centers for Disease Control and Prevention (CDC).

While vaccination rates for children have risen steadily, adult vaccination rates lag behind, leaving millions at risk ✔ Influenza of suffering through shingles and other conditions. ✔ Shingles Recent data from the CDC tells a startling story: ✔ Diptheria • Each year, people ages 65 and older account for about ✔ Tetanus half of all flu-related hospitalizations and 90 percent of ✔ Pertussis (Whooping Cough) flu-related deaths. ✔ Pneumonia (Pneumococcal) • Despite it being free to those on Medicare, one-third of seniors did not get a flu shot. Older adults should also receive a booster every 10 years to “Infectious disease prevention has significantly improved help prevent tetanus and diphtheria. over the years, due in large part to vaccines,” says Brenda Rooney, PhD, Gundersen Health System Community Two pneumonia vaccinations are also recommended for and Preventive Care Services. “Along with hand washing, adults ages 65 and older and those with certain medical vaccines are the most simple, cost-effective way to protect conditions that increase the risk of pneumonia. These yourself, your loved ones and the health of the population.” vaccines help prevent pneumonia, meningitis and blood infections. In addition to the annual flu vaccine, the shingles vaccine is recommended for adults 60 years and older to help Older adults who have heart disease, diabetes and other prevent new and future occurrences of the painful viral conditions may require additional doses of these vaccines. infection similar to chickenpox. Nearly one out of every three people in the will develop shingles in Visit gundesenhealth.org/infectious-disease and talk their lifetime, but about 75 percent of older adults have not to your primary care provider for more information. been immunized against the virus.

YOUR GUIDE TO HEALTH AND WELLNESS | 8 ‘Micro surgery’ offers back pain relief

Susan Stark of Winona, Minn., is a licensed practical nurse who has worked in long-term care for 44 years. It’s a job that required her to be on her feet and do a lot of bending and lifting in the care of her patients.

Jason Waddell, DO “It was almost inevitable that I would Gundersen develop back pain, but I had pain, neurosurgeon numbness and tingling radiating down my left leg from my buttock to my ankle and foot. It made it difficult to do my job and everyday activities,” recalls Susan. Susan was diagnosed with a herniated disc in her lower back.

Vertebrae that make up the backbone are separated by spongy discs that act as shock absorbers. These discs have “Since Susan had tried conservative treatments and her a tough outer shell of fibrous cartilage filled with a softer symptoms hadn’t improved, it was time to discuss surgery,” jelly-like material. The outer shell can rupture for a variety recalls Dr. Waddell. of reasons, including age, injury or strain, allowing the inner core to bulge or herniate out. Susan appreciates that Dr. Waddell and his staff, including Molly Cerniglia, PA-C and Krista Kirchner, RN, did a “A herniated disc can put pressure on nerves behind the thorough job of explaining everything before her surgery. disc, causing pain and numbness. Most herniated discs “I was very well-informed about what to expect,” says occur toward the bottom of the spine, as in Susan’s case. Susan. When the nerve is pinched or irritated, pain radiates along the nerve pathway down the leg,” reports Gundersen Dr. Waddell explains, “Susan had a microdiscectomy, a neurosurgeon Jason Waddell, DO. minimally invasive, same-day surgery. We removed a portion of the herniated disc and vertebra to help relieve A herniated disc will often heal on its own without the the pressure and provide room for the nerve to heal. The need for surgery. In most cases it should start to improve procedure is performed through an incision, less than within about six weeks. Meanwhile, there are non-surgical 1” long, in the lower back. There’s less manipulation to treatments that may help alleviate the pain such as: the muscles and spine so there’s less pain and a faster • Exercise/physical therapy recovery.” • Chiropractic manipulation • Rest Susan agrees, “Everything went flawlessly. I went home • Use of a back support the same day as my surgery, there were no stitches and I • Medications to control pain and relax muscles needed very little medicine for pain.” Before coming to Gundersen, Susan tried steroid spinal If you have unresolved back or leg pain, talk with injections, but they didn’t give her much relief. She was your doctor about a referral to the back experts at then referred to Dr. Waddell. Gundersen Neurosciences or call (608) 775-9000.

9 | GUNDERSEN HEALTH SYSTEM Self-Care Plan puts you in control of joint pain

What’s the cause of your aching hip don’t improve, the Self-Care Plan alerts you to make an or nagging knee pain? For millions appointment. Many patients, especially with early arthritis, of Americans, it is pain due to can significantly improve or completely control their osteoarthritis, the most common symptoms using this tool,” adds Dr. Lawrence. chronic condition of the joints. Each person’s plan will look differently based on his or her “Osteoarthritis occurs when the current joint function, level of pain, etc. There are videos, Joseph Endrizzi, MD protective cartilage or cushion written descriptions and tracking tools which make it easy Gundersen between the bones breaks down over to use and measure progress. Results can be printed or urologist time leading to pain, stiffness and emailed, and shared with a healthcare provider at any time. swelling. This common disabling condition is primarily an inherited disorder, though it usually does not show up Self-Care Plans do not replace medical help. If at any until middle age or the later years. Arthritis can also be point you feel your symptoms are not improving, caused by many other conditions ranging from gout to a contact your primary care provider or Gundersen’s previous sports injury,” explains Gundersen Health System orthopaedic specialists at (608) 775-2276 who offer orthopaedic surgeon Edward Riley, MD. a full range of treatment options, including oral medications, joint injections or surgical interventions. But no matter the cause, osteoarthritis keeps many people from performing everyday tasks, engaging in physical activity and enjoying their favorite hobbies. Fortunately, Gundersen offers a full range of treatment options, SELFCARE TOOL including a free, first-of-its-kind Self-Care Plan that puts Joint Pain people in control of joint pain.

A Self-Care Plan is a web-based tool that is meant to be a patient’s first step in managing symptoms before visiting their healthcare provider.

“Self-care plans allow patients to manage their medical problem at their own pace and according to their abilities. It gives people control over their health and can be more convenient and economical than visiting the doctor right away,” reports Gundersen Viroqua orthopaedic surgeon Jeffrey Lawrence, MD, who was instrumental in developing the Self-Care Plan for patients.

The Self-Care Plan, available via gundersenhealth.org/self- care, includes six weeks of exercises and other interventions recommended by Gundersen’s Physical Therapy team to Try our free online Self-Care Plan today! improve various aspects of joint functioning. Gundersen offers Self-Care Plans for knee and hip pain as well as urinary incontinence. It’s easy to get started! Visit “If your symptoms are severe, the Self-Care Plan directs gundersenhealth.org/self-care where you’ll be prompted to you to see your doctor. If the symptoms are mild, you will complete a brief questionnaire to assess your condition and to get instructions you can try on your own. If the symptoms register for the Self-Care Plan.

YOUR GUIDE TO HEALTH AND WELLNESS | 10 Creating a healthy holiday season

For many people, the holiday season can be stressful. sending out cards isn’t at the top of the list and you find Shopping, decorating, writing cards, baking holiday treats, you don’t have time to get to them, don’t worry about it. making travel plans and entertaining family and friends all add to a list that’s already full. You can help manage It’s ok to delegate duties, too. For example, you don’t holiday stress with the following suggestions and enjoy have to cook the entire holiday dinner. Ask other family this wonderful time of the year. members to bring a dish for the meal.

Avoid overeating and drinking Budget, budget, budget! Big family meals and holiday To avoid the stress of overspending treats of every variety can make this holiday season, develop a overeating and drinking tough budget. Have conversations with to avoid, but there are simple your family about realistic gift steps you can take to consume in giving. Also, don’t spend more moderation and avoid packing on than you can afford. extra pounds. Instead of buying gifts, give the gift of time by offering • Eat something light before leaving for a holiday party to clean, shovel snow or help a loved one, friend or so you don’t overeat once you get there. neighbor with other projects around their home. Other gift • For a potluck party, bring a healthy dish to pass. alternatives include baked goods, crafts or a donation to • Don’t deprive yourself. It’s fine to sample holiday someone’s favorite charity. goodies, but remember portion size. • If you drink alcoholic beverages, drink in moderation. Care for your body Don’t drive after drinking, and don’t ride with a driver If you take care of your body, your who has been drinking. body will take care of you. Avoid • If you are hosting a holiday party, serve creative and fatigue and a lowered immune enticing non-alcoholic options. system by getting enough sleep and keeping a regular exercise Prioritize tasks routine. Set reasonable expectations about what you can or cannot accomplish during the holidays. The holiday season should be enjoyable. Take pleasure in what’s around you and make the holiday season the Ask yourself, “What do I need celebration it’s meant to be! to check off my list to enjoy the holidays?” If baking treats and

11 | GUNDERSEN HEALTH SYSTEM Get the most out of your grains

Grains are an important part of a daily “For example, the fiber in whole grains helps you feel full diet. A staple food around the world, longer, leading to improved weight management,” Valerie they can pack a healthy dose of food continues. “It also helps prevent heart disease and some energy. Grains and grain products are cancers, and reduces blood pressure and regulates blood excellent sources of fiber, protein, iron, sugar.” carbohydrate, vitamins and more. While the benefits are optimal with three servings daily, Valerie Pampuch, RD Examples of common grains and grain even one serving of whole grain a day helps. Gundersen products include oatmeal, breakfast registered dietitian cereals, bread, wild rice, noodles, To ensure the best nutritional benefits from grains in your couscous, pretzels, popcorn, crackers and corn tortillas. diet, try switching from refined grains to whole grains. For example, at your next visit to the grocery store, if you There are two subgroups of grains: whole and refined. typically purchase: Whole grains contain the full grain kernel – the bran, • White bread, sandwich buns or rolls, try whole wheat germ and endosperm. Refined grains have been milled, versions of all three. smoothing their texture and extending their shelf life. But • Spaghetti, macaroni or noodles, try whole wheat pasta. the processing also removes the bran and germ, reducing • White rice, try wild or brown rice. the amount of fiber, iron and many B vitamins. • Pretzels, try popcorn. • Crackers, try whole wheat crackers. “To gain the highest nutritional value, it’s best to consume • White tortillas, try corn or whole wheat tortillas. whole grains,” recommends Valerie Pampuch, RD, 500 Club Specialist, Gundersen Nutrition and Hospitality For more information about whole grains, visit Services. “In whole form, grains are an excellent source of wholegrainscouncil.org. protein, carbohydrate, fiber, B vitamins, iron, zinc and other essential minerals.

Roasted Red Pepper Pesto Savory Oatmeal ½ cup oatmeal, dry ½ cup water 2 eggs ½ medium zucchini, sliced ¼ avocado, sliced ½ tbsp. roasted red pepper pesto

Heat a lightly sprayed pan to medium high heat and cook eggs to your preference. While eggs are frying, slice zucchini and avocado. Place zucchini in pan with eggs to brown. Place oats and water in a bowl and microwave for 1 minute.

Place cooked eggs atop oats and add remaining ingredients.

Per serving: 396 calories, 20 g fat (contains heart healthy fat), 20 g protein, 37 g carbohydrates, 8.5 g fiber, 200 mg sodium

YOUR GUIDE TO HEALTH AND WELLNESS | 12 Telemedicine offers convenient access to specialists

The Gundersen specialist acts as a consultant in collaboration with the patient’s primary healthcare provider. They use telemedicine for exams and post- operative follow-up, or to monitor ongoing treatments, interpret diagnostic tests or discuss prognosis and treatment options. Telemedicine makes it possible to share information on vitals, symptoms and other case details in a virtual office visit.

“The clinical telemedicine cart has a stethoscope, otoscope and patient examination camera that allows the consultant in La Crosse or Onalaska to see the patient as if in person,” says Jessica Miller, manager, Gundersen Telemedicine. “For example, a nurse may listen to a patient’s heart or look in their ears, and the consultant hears or sees the same thing. The patients are also able to view and interact with the Gundersen specialist.”

Gundersen obstetrician/gynecologist Mary Kuffel, MD, and pediatric Gundersen launched telemedicine services in 2005 to hospitalist Kathryn Richmond, MD, consult with a regional provider using Gundersen’s NeoNET telemedicine service. improve experiences for cancer patients. Telemedicine has since expanded to offer a wide range of specialty services, Traveling to La Crosse to see a Gundersen specialist can be including Behavioral Health, Cardiology, Dermatology, difficult for some patients, especially when illness, distance, Pediatric Allergy and Asthma, Nephrology, Neurology, weather or transportation is an issue. Orthopaedics and Endocrinology. ✁ Gundersen specialists are using the latest interactive Area hospital emergency departments also have access to technology to make it easier for patients to receive Gundersen’s Telestroke Program, which assists hospitals specialty care closer to home. Telemedicine uses video, with patients showing signs of stroke. A growing number audio and a secure, high-speed connection to link a patient of critical access hospitals can also link to Gundersen’s at a regional clinic or hospital with a medical consultant at NeoNET service – a program which allows real-time Gundersen in La Crosse or Onalaska—in real time. connection to Gundersen’s Level III Neonatal Intensive Care Unit. Gundersen currently has 33 telemedicine locations “Telemedicine allows for more intensive management in 23 communities throughout southwest Wisconsin, of certain diseases, such as cancer or diabetes, while southeast Minnesota and northeast Iowa. saving the patients time, money and stress of traveling to appointments,” explains David Guggenbuehl, If you have questions or are interested in using director, Gundersen Regional Services and Telemedicine. telemedicine, talk with your primary care provider or “Telemedicine can save patients two hours or more of visit gundersenhealth.org/telemedicine. travel time for what could be a 10- or 15-minute follow- up appointment. In some cases, it also makes sense to provide an initial consult with a specialist early in the clinical process to order tests or treatments.”

13 | GUNDERSEN HEALTH SYSTEM Is it heartburn... or a heart attack?

You’re raking leaves or shoveling snow after a big meal. Or these risk factors: you’re watching football while snacking on Buffalo wings • Smoking and nachos. Suddenly you experience pain in your chest. Is • Overweight/obesity it a heart attack or an attack of heartburn? • High cholesterol and/or blood pressure • Family history When in doubt, call 9-1-1 right away • Previous heart attack or heart disease Anytime you have chest pain and you’re not sure if it’s a heart attack, don’t take chances. Seek medical help right Some risk factors, like family history, cannot be changed. away. With a heart attack, time lost is heart muscle lost. But with many risks, once you’ve identified them, you can take steps to change them. Chest pain is serious business. So serious, in fact, Learn more at gundersenhealth.org/heart-age and Gundersen Health System provides priority care to patients gundersenhealth.org/know-your-risk. with chest pain or other symptoms that may indicate a heart attack. Patients receive treatment within the critical Heartburn window of time that not only saves lives, but prevents or Your chest pain may be heartburn caused by acid reflux, minimizes damage to the heart. an ulcer or hernia, muscle spasms, gallbladder attack or pancreatitis. Most people get occasional heartburn, but Heart attack frequent, chronic heartburn can damage the lining of your Before chest pain strikes, read, clip and save the symptom esophagus over time and increase your risks for serious card below. It’s important to not only know the symptoms health problems, including cancer. If you suffer from of a heart attack, but also to know your risks for heart frequent heartburn, talk with your doctor. disease. Chest pain is more likely heart trouble if you have Learn more at gundersenhealth.org/heartburn.

✁CLIP, SAVE AND POST SYMPTOMS OF A HEART ATTACK SYMPTOMS OF HEARTBURN

• Chest pain, pressure or tightness lasting more than a few minutes • Burning or pain—may start lower and move up to the –More noticeable during physical activity or stress chest and throat –Spreading to the back, neck, jaw, shoulders or arms • Pain can last a few minutes or a few hours • Chest pain with other symptoms such as: • Sour/unpleasant taste in the mouth –Trouble breathing –Sweating • Pain may be more pronounced after eating fatty or spicy –Feeling dizzy foods, or a large meal –Nausea/vomiting • Worse when lying down or bending over –Irregular pulse • Antacids should provide some relief –Unusual fatigue or weakness • Difficulty or pain with swallowing –Tingling in hands or feet • Frequent burping, coughing or choking while swallowing CALL 9-1-1 IMMEDIATELY! • Burning or lump in the throat • Hoarseness When in doubt, don’t take chances–seek medical help.

YOUR GUIDE TO HEALTH AND WELLNESS | 14 Gundersen Health System Non-Profit Org. 1900 South Avenue U.S. Postage La Crosse, WI 54601 PAID Permit # 395 La Crosse, WI

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