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Parkinson’s disease can lock up WilliamStanziano’s muscles so quickly, he says itfeels like a crowbar thrust into a gearbox.

“Sometimes I walk into a Dunkin’Donuts and can’t walk out,” saidStanziano, who may have to wait patientlyfor hours until medication kicks in andloosens his limbs enough to get home.

Four months ago, the 51-year-oldWolcott man went to the University ofConnecticut Health Center, where doc-tors implanted a “brain pacemaker” —electrodes placed deepinside his brain that aredesigned to short-circuitthe errant signals that canimmobilize him.

The procedure, knownas deep brain stimulation,is one of many promisingtreatments that uses elec-tricity to treat ailing minds.

For Stanziano, deepbrain stimulation isdesigned to compensatefor the death of brain cellsthat produce the neuro-transmitter dopamine,essential for many musclemovements. The death ofdopamine-producing cellsis caused by Parkinson’sdisease.

Stanziano’s medicationhad stopped preventingthe muscular lockup thathis doctors call the “off”state, a period when mus-cles are not functioning.The advanced stage of hisdisease and his relativegood health made Stanziano eligible toreceive a brain pacemaker. People withmilder forms of Parkinson’s, dementiapatients and those in ill health are not eli-gible for the procedure, which carries aslight risk of internal bleeding or infection.

After more than a decade of successfultrials, deep brain stimulation has nowentered the mainstream of Parkinson’streatment. Deep brain stimulationrequires two separate operations — oneto implant electrodes deep into thepatient’s brain, and a second to implanttwo hockey-puck-size pulse generators onboth sides of the chest. A hand-held pulse

programmer controls the high-frequencyelectrical signals, which in Stanziano’s caseare sent to each side of the subthalamus,an area of the brain involved in move-ment.

The hardware costs $25,000. The tech-nology is similar to cardiac pacemakers,used to regulate the heart, and vagusnerve stimulation, used to control epilep-sy.

Although deep brain stimulation has ledto a few spectacular successes in unlock-

ing the frozen gaits and ending the debili-tating tremors of Parkinson’s patients, itdoes not cure the disease, said Dr. J.Antonelle “Toni” de Marcaida, director ofthe movement disorders program atUConn.

“There is no real evidence that it isneuro-protective,” she said.

And it doesn’t work for everyone,although in trials eight of 10 Parkinson’spatients have shown improvement thathas lasted more than five years, deMarcaida said.

Stanziano also now realizes that deepbrain stimulation does not work

overnight. Doctors must tinker, some-times for months, with the strength of theelectric pulses and the dosages ofdopamine-replacing medicine to get thebest results. Although doctors can adjustthe strength of the pulse with the hand-held programmer, patients can only turnthe pulse generators on or off.

For Stanziano, the results have beenmixed since he received his brain pace-maker last November. He no longer hasthe residual Parkinson’s symptoms when

he is in his “on,” or morefunctional, state.However, when he is inthe “off” state, his condi-tion is as bad as beforethe operation, he said.

Doctors can’t explainwhy the technologysometimes doesn’t work,because they don’t fullyunderstand why it worksat all.

Some researchers sug-gest electrical stimulationaffects the release of spe-cific neurotransmittersthat compensate for thelack of dopamine, whileothers have argued thatelectrical pulses resetabnormal electrical sig-nals in the brain.

Scientists have knownfor more than 70 yearsthat modifying electricalimpulses in the brain canhave therapeutic bene-fits, said Dr. Sara H.Lisanby, associate profes-

sor of clinical psychiatry and medicaldirector of Columbia University’s depres-sion center.

Deep brain stimulation is an indirectdescendant of some of those early treat-ments, she said.

The earliest use, in electric shock thera-py, has been condemned for the pain andside effects such as memory loss that itafflicted upon patients with mental illness.However, in the past two decades, scien-tists have rehabilitated the procedure, andtoday, targeted electrical convulsive thera-py “remains the most effective treatmentfor depression, period,” Lisanby said.

’Brain pacemaker’ helps Parkinson’s patients’ muscle controlStory/William HathawayHartford Courant

Bill Stanziano wears a "brain pacemaker" and pulse generators in his chest, which helpprovide deep brain stimulation to help his muscles stay loose, thereby counteractingthe effects of Parkinson's disease. Dr. J. Antonelle de Marcaida, at right, adjusts theelectrical signals to the pulse generators.

Photo/Tom Brown

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From the editorThe medical field never ceases to

amaze me. Even right here in theBrainerd lakes area, medical profes-sionals perform what I call miraclesevery single day.

To go to work and cure someone ofa plaguing disease or illness or to savelives through emergency surgery, issomething my mind can hardly grasp.For many in the medical profession,this is everyday life.

This issue of HealthWatch followsthe amazing acts performed at local

hospitof a sucuring

To thand evically don’t truly a

Publisher — Terry McColloughAdvertising Director — Mary PanzerEditor — Heidi LakeCopy Editor — DeLynn Howard

HealthWatch is a quarterly publica-tion of the Brainerd Dispatch.

Read HealthWatch online atwww.upnorthhealthwatch.com.

For advertising opportunities callMary Panzer at (218) 855-5844.

E-mail your comments toheidi.lake@brainerddispatch.com orwrite to:

Heidi LakeBrainerd DispatchPO Box 974Brainerd, MN 56401

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Any first-grader can tell you that if youdon’t brush your teeth, creepy sugar“bugs” will take over and cause cavities.

But not all of the bugs, or microbes, inthe mouth actually affect oral health. Andnot all of them are bad.

A vast and diverse community of micro-scopic organisms — including viruses,bacteria, fungi and protozoa — thrive inthe mouth, scientists are learning. Someof them may play important roles in pre-serving health and causing diseases, saysDr. David Relman, an associate professorof microbiology at Stanford University.

“We already know so much about somany disease-causing agents that it tendsto give you the feeling that there is no rea-son to be going out and trying to find oth-ers,” he says.

But the causes of many diseases remainunknown — and the mouth appears to bea good place to look for clues.

“We are increasingly becoming awareof the connection between the oral cavityand the body,” says Donna Mager, aresearcher at the Forsyth Institute, an

independent research center in Boston.“Whatever grows in the oral cavity couldhave an impact on what happens to thebody.”

Research by Relman and Mager is help-ing to advance this notion.

In his lab, Relman samples the region inthe mouth called the subgingival crevice,the deep space between the gum andtooth. So far, scientists have found morethan 500 bacterial strains or microbes inthis area, and Relman has identified 37others. Other mouth microbes have yet tobe identified, he believes.

Ultimately, researchers want to betterunderstand the patterns and prevalenceof particular microbes and what those pat-terns suggest about a person’s health.

“I think it’s fair to say that the vast major-ity of members of the oral microbial floraare not disease-causing agents. They maybe necessary or important for maintaininghealth,” he says. “Some small subset maybe involved in disease.”

Gum disease, in which gums becomeinflamed, red and swollen because of

plaque deposits on teeth, is probablycaused by several organisms, but no onehas identified all the microbes responsiblefor this common disorder.

Some microbes found in the mouthmay even contribute to disease in otherparts of the body, such as the heart,although those links are still tenuous.

Mager is trying to identify possibly pre-cancerous changes in the mouth’s bacte-ria colony. About half of all people diag-nosed with oral cancer die within fiveyears because the disease is detected atadvanced stages. But if scientists couldfind clues that disease could develop —based on changes in bacteria — theymight be able to intervene earlier, shesays.

“We are tracking the changes in thosecolonization patterns,” says Mager, whoseresearch is in collaboration with the DanaFarber Cancer Institute. “Hopefully, wewill be able to predict which people willdevelop cancer.”

What lives in your mouth Story/Shari RoanLos Angeles Times

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S

Appointments with a midwife atCentraCare clinic are 20-30 minuteslong, giving Wingeier and her patientsplenty of time to talk and get to knowone another, something both Wingeierand her patients enjoy.

“Right now I’m delivering the daugh-ters I delivered,” Wingeier said with asmile.

With a bachelor’s degree in nursingand a master’s in nurse-midwifery,Wingeier spends much of her day pro-viding prenatal, postpartum and new-born care, and also provides routinegynecological care.

Wingeier is on call 24-hours a day andrarely has time to catch her breathbetween laboring and birthing patientsas well as doing regular patient check-ups. She gets calls in the middle of thenight, regardless of weekends or holi-days. But with more than 20 years expe-rience as a midwife, Wingeier said help-ing women stay comfortable while giv-ing birth to healthy babies makes it allworth while.

Ruth Wingeier, cer-tified nurse-mid-wife at CentraCareclinic in LongPrairie, checkedSheila McCoy’sbaby for problemsfollowing a car acci-dent the previousnight.

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. CLOUD — All Carissa Petersoned to do was live a normal life — a lifee this bubbly 17-year-old could be

to wear clothes of her choice withoutnstant feeling of self-consciousness.ad, the Sartell High School studentforced to wear sweatshirts and darkto hide an embarrassing excessiveting condition, also known as hyper-osis. That is, until she learned about

edical uses for the increasingly pop-drug, Botox. was the eighth grade when Carissason realized her excessive sweating’t normal. ’s not something you really talk to friends about,” the blond-haired,-eyed girl said. But after literally beingched in sweat during stationary activ-from watching movies to sitting in, Peterson said she’d had enough. “Allted to do was be able to wear a little

T-shirt,” she commented, adding theting condition forced her to hider bulky sweatshirts and dark colors. r involvement in the Sartell Sabrese Team was even affected as hert glands were kicked into an evener gear when active and sweat was vis-

ibly obvious on costumes.“Literally, every shirt she bought before

this was based on the excess sweating,”said mom Cindy Peterson. “I started wor-rying about her wearing sweatshirts all thetime. And I knew (the sweating) wasn’tcaused by her being hot.”

Cindy contacted Carissa’s pediatricianwho diagnosed the hyperhydrosis andprescribed her a heavy duty antiperspi-rant. Carissa even tried an electronicdevice that, when applied, would send aseries of painful shocks into her arm. Butnothing seemed to help.

Until one day, paging through aSeventeen magazine, Carissa says shecame across an article regarding the use ofBotox to treat conditions like hers. Afterconsulting her pediatrician on the infor-mation she read, Peterson was referred tothe Midwest Clinic of Dermatology Laserand Cosmetic Surgery in St. Cloud.

Dr. Daniel Elieff, owner of the eight-year-old private practice with offices in St.Cloud and Alexandria, gave this young girlhope that with the use of Botox, the sweatproduction could be controlled.

For the last two years Peterson hasundergone Botox injections every three to

four months. Each session entails approxi-mately 20 to 30 punctures into eacharmpit. Once injected, the Botox partiallyparalyzes the muscle that is to blame forputting pressure on the sweat glands andcausing them to contract. Each injection isdone with a 30 gauge needle, smaller indiameter than an insulin syringe, to mini-mize invasion and discomfort.

Lying flat on an exam table while eachinjection is made, Peterson takes eachpoke and prod in stride.

“You just have to tell yourself that it’snot that bad,” she said, likening it torepeated pricks with a safety pin. “But it’stotally worth it.”

Each injection is superficial, Elieff said,explaining the small needle penetrates thedermis, or second layer of the skin.

Because the treatments have provenclinical benefits, each of Peterson’s visitsare covered under her family’s healthinsurance policy.

Other medical purposes for Botox haveincluded treating lazy or crossed eyes,headaches, club foot disorder and evenfor Peterson’s cousin who has cerebralpalsy and finds relief from chronic muscletension with help from the powerful drug.

aniel Elieff of Midwest of Dermatology Laser andetic Surgery in St. Cloud,istered Botox injections in

sa Peterson’s underarmPeterson, 17, suffers from

rhydrosis, or excessiveing, and found Botox helpsol the condition.

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ous page photo: Tracyberg, 28, has received Botox

ents in her forehead anden her eyes for the past

ears. The St. Cloud residenthe procedure has becomective.”

The nurse-midwifery program atCentraCare clinic in Long Prairie pridesitself at putting the comfort and well-being of moms and their families first.

“I want to help people be healthy andhave healthy babies,” said Ruth Wingeier,Long Prairie’s certified nurse-midwife.

Two large birthing suites resemble hotelrooms, complete with a couch and nightstand. Medical equipment is hiddenbehind pictures on the wall, making therooms feel inviting.

“We try to keep moms from beingafraid (of giving birth) because it tends tomake labor take longer,” Wingeier said.“The rooms are calm, relaxed and com-fortable.”

Wingeier said she averages 11 or 12deliveries per month, and the interest inmidwife-aided births seems to be on therise, with more than 20 babies born underWingeier’s care in the month of March.

Long Prairie’s clinic will soon be hiring asecond midwife and will possibly addanother birthing suite, due to the contin-ued popularity of midwife-assisted births.

The birthing suites have private bath-rooms with whirlpool bathtubs allowingexpectant mothers to labor, or actuallygive birth in the water.

Wingeier said about one-third of herexpecting patients choose to give birthunder water, an option first offered atLong Prairie three years ago.

“(The water) helps moms relax and ismore calming for the baby,” she said.

Babies are in water while in the womb,and to be born under water eases theirtransition of entering the world andbreathing on their own, Wingeier said.

CentraCare clinic in Long Prairie, havingone of the oldest midwifery programs inMinnesota, even makes house calls.

Wingeier said women who have had nocomplications during their pregnancy, orhave many children and are prone to hav-ing quick, easy labors often opt to givebirth at home, with the assistance of amidwife.

“Some people just don’t like all theintervention they get at a hospital,”Wingeier said.

Others just like the feeling of gettingpersonalized health care.

Debbie Sauer, 42, on the verge of havingher eighth baby, used a midwife while hav-ing all but two of her children.

“(Midwives) are less routine than doc-tors,” Sauer said. “They give you optionsand respect your wishes. I feel more con-

fident in their care.”Wingeier said she educates women and

encourages them to make their own deci-sions during pregnancy, often times usingalternative methods such as herbs andnutrition instead of medication.

“Midwives attract people who wantalternative methods,” Wingeier said.

Shelly Crenna wanted to give birth toher second child at home, but her hus-band, Brian, wasn’t comfortable with theidea. So the Royalton couple decided tocompromise and use Long Prairie’s mid-wifery program.

“I wanted a home birth because hospi-tals scare me,” Shelly Crenna said. “I want-ed something more personable (than adoctor’s office).”

Fifteen days overdue, weighing in at 10pounds, 6 ounces, Levi Thomas Crennaentered the world via Cesarean Section.

Each mom under midwives care has aconsulting physician in case of complica-tions.

If a C-section is required, if pregnantwith multiples, or if there are other riskfactors, the doctor is called in and the mid-wife assists during the birthing process.

“Sometimes you just need two sets ofhands,” Wingeier said.

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Midwifery

Brian and Shelly Crenna ofRoyalton welcomed thenewest addition to their fam-ily, Levi Thomas Crenna, atCentraCare clinic in LongPrairie. The Crenna’s used themidwifery program duringtheir pregnancy, but when aCesarean Section was need-ed, a doctor was called in toperform the procedure.

A parent’s alternative to hospital birthing

Story and photos/Heidi Lake

LONG PRAIRIE — With teary eyes you clutchyour coach’s hand. Sweat beads gather on yourbrow and you can’t help but smile at the thoughtof your child being born.

Having a baby is the happiest day of many peo-ple’s lives. Although known for being ratherpainful, giving birth in a calm and relaxing atmos-phere could help ease the stress of the laboringsituation.

The other side of BotoxWhile Botox has provided relief to

those suffering with chronic disorders,the drug has gained popularity mostly forits cosmetic contributions.

Hollywood stars have helped launchthis drug into superstardom. Accordingto the Cosmetic Surgery Times publica-tion, more than 2 million Botox proce-dures were done in the United Statesduring 2003 alone. And Elieff predicts thatnumber will double after the turn of 2004.

Elieff explained Botox temporarily par-alyzes muscles at the injection site dis-abling the individual to create the linescaused when raising their eyebrows,squinting or frowning. Botox is used bymany newscasters, actors and politicians“to eliminate those facial miscues peoplecan see,” he added.

Tracy Blumberg, a 28-year-old St. Cloudwoman, began having regular Botoxinjections about two years ago after beingtold she had hyperanimation of her facialmuscles. Without being consciouslyaware, Blumberg would excessivelysquint or frown, giving those around hermiscues about her temperament.

“People would think I was mad when Iwasn’t,” she said.

Elieff suggested Blumberg try Botox to

prevent her facial musclesing.

“I’d heard a lot of good tBlumberg said. “So, I triedit.”

And now, she admits, Results, which typically thours to appear, last bethree months before anothnecessary.

“It doesn’t hurt at all,” B“The first sensation, whegoes in, feels like a pin pricfeel the Botox being injemuscles. But it’s just so Botox. It’s my best friend.”

An admitted Botox user past 10 years, Elieff said tpopular areas where Botinto the face include theglabellar, or area betweenon the outside of either eynicknamed crow’s feet, number of necessary injesion to treat lines dependcles and areas being treateindividual, but usually ranseven.

“It’s just super, super dElieff said, adding each Bothe facial area is done in a

Before . . .

After getting Botox injected in her forehead, Tracy Blumberg was unableto use the muscles that move her eyebrows. The Botox procedure weak-ens facial muscles that are related to expression lines. Botox works byblocking the impulses from the nerves to the facial muscles, relaxingthem. The result is a smooth, unwrinkled look.

7

from contract-

hings about it,” it. And I loved

she’s hooked.ake about 72tween two toer treatment is

lumberg said.n the needlek. And you cancted into thequick. I love

himself for thehe three mostox is injected forehead; the the eyes; ande where lines,develop. The

ctions per ses-s on the mus-d as well as thege from five to

ramatic stuff,”tox session inmatter of min-

utes with affects to be seen for months.Other areas that can be injected for

cosmetic purposes include the tip of thenose, drooped lower lips, in aging neckmuscles and, believe it or not, to saggingbreasts to provide more lift.

When opening his practice eight yearsago, Elieff said only a couple viles of Botoxwere kept in stock. Now, his clinic keepsa couple dozen in the refrigerator fortheir continually growing client base.

While approximately 90 percent of hisBotox clients are female, Elieff said moremen are catching on to the craze. Theaverage Botox users at this St. Cloud clin-ic are women in their mid-30s to mid-40swho are concerned with reducing thesigns of aging.

“One thing we see a lot of is the peoplewho come in for Botox don’t want to cre-ate a stroked-out, paralyzed face,” Elieffsaid. “They want to retain some motion ofthe facial muscles, but soften the wrinklesand lines.”

Elieff stressed the importance of agood overall familiarity with the anatomywhen administering Botox. If injectedinto the wrong place, Botox can causestroke-like affects, including paralysis oflimbs and facial muscles as well as droop-ing eyelids.

. . . and after

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• In clinical setting, massage is often covered by insurance.

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A job well doneThe fact that Botox injections are now

the No. 1 non-surgical cosmetic proce-dure in the United States proves the drugis getting and giving not only the aesthet-ic, but also the medical results people areseeking.

Carissa Peterson’s story has especiallyreinforced Elieff’s confidence in this oftencontroversial drug. Elieff said he treatsseveral patients with conditions similar toPeterson’s, but says her case was one ofhis first and remains one of his favoritesuccess stories.

“It’s something people need to knowabout,” Peterson added. “Had I not dis-covered (Botox) I’d be miserable. If some-thing can help you, you don’t really haveto be ashamed of it.”

Not only is Peterson free of shame,she’s also ready to show off what has beenhidden under bulky shirts for too long,noting she will be wearing a straplessblack dress to prom this spring.

“It has changed my self-esteem andconfidence,”Peterson said. “Getting stuckfor 15 minutes can change the rest of yourlife.”

What is Botox?Botulinium Toxin, or Botox, wa

covered by accident at a Belgian in 1895 when 34 people ate saucontaminated with a lethal subs(later known as Botulism) and, squently, three died. Botulisdefined as an anaerobic, spore-ing bacteria that, under the righditions, can germinate and creatins. After being isolated, purifieexperimented with by scientistfirst batch of toxin for human usprepared in 1979. The Botox prochas been widely used and is coered a safe, effective way of traging skin. Previously approved ftreatment of lazy eye and eye spBotox was approved by the FooDrug Administration for the treaof frown lines between the eyesknown as glabellar lines, in 2002.

How does it work?The Botox procedure work

weakening facial muscles relat

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s dis-picnicsagestanceubse-m isform-t con-e tox-d ands, thee wasedurensid-

eatingor theasms,d andtment, also

s byed to

expression lines. The constant contrac-tions of those muscles result in wrin-kles. Botox blocks the impulses fromthe nerves to the facial muscles there-by relaxing them, resulting in asmooth, unwrinkled look.

What does it cost?Each treatment can cost anywhere

between $100 and $800, or more,depending on the affected area to betreated and the units of Botox used.

Where is Botox available?Any authorized health care profes-

sional can administer Botox, includingdermatologists, plastic surgeons andother cosmetic physicians. Localproviders include Dr. Kurt Waters atFacial Plastics at Brainerd MedicalCenter; Dr. Daniel Elieff of MidwestClinic of Dermatology, Laser andCosmetic Surgery in St. Cloud; andMidsota Plastic and ReconstructiveSurgeons with physician servicesoffered at St. Joseph’s Medical Center.

Centers of excellenceThe decision to open an ambulatory

surgery center has been a long time in themaking. Waters said he and several othersurgeons decided to pursue the opportu-nity with the support of SJMC.

“Obviously there are communitieswhere hospitals and doctors compete,but that’s not the case here,” Waters said.

Thomas K. Prusak, SJMC president,said, “SJMC and the physicians are veryexcited about the future of the ambulato-ry surgery center and the development ofa medical park to meet the current andfuture needs of the community.”

Prusak said the development of thesurgical center will enable SJMC and thephysicians to develop two centers ofexcellence for the area.

“It was more patient driven than any-thing,” Waters explained. “This center willprovide convenient, easy access and willcontinue to uphold patient privacy.”

Along with the operating and proce-dure rooms, the center will providepatient care suites where the patient andtheir family will begin the process and pre-pare for surgery. The family will also beallowed to wait in that suite until theirloved one is returned from recovery.

There will also be a refreshment center forfamilies to utilize and a children’s playarea. Waters also noted a separate recov-ery area for pediatric patients where fami-lies will be allowed to rejoin their childrenfollowing surgery.

Minimally invasive proceduresWaters said the surgical center will give

surgeons the opportunity to perform min-imally invasive procedures, making small-er incisions and performing surgeries tele-scopically. That means less discomfort anda quicker healing time.

“We’re all trying to reduce health carecosts,” Waters noted. “Surgical centers

have the ability to reduce those coststhrough copays and deductibles. So thatwill also be nice for our community.”

But the bottom line is continuing toprovide quality services in a timely man-ner to the entire community, Waters

emphasized.“This center coincides with what’s

going on in other communities. Wehave the same quality surgeons as inother cities. We just want the same facil-ities to offer those services in.”

And the medical community’s growthwon’t necessarily stop with the comple-tion of the surgical center. Prusak out-lined SJMC’s plans for a medical park inBaxter.

“The lakes area is growing and so isthe demand for medical services,” hesaid. “To meet the long-term needs ofthe community, we are developing a

medical park located close to the majorhighways and retail outlets so that we canprovide services that are convenient andeasily accessible.”

Examples of future services at the med-ical park, Prusak said, include a clinic,physician offices and other outpatientmedical services.

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Residents of the lakes area will soonhave another choice when making healthcare decisions.

The Brainerd Lakes Surgery Center isslated to open this fall in Baxter, providingoutpatient, or same day, surgery servicesto the community.

The surgery center, currently being con-structed, is located off Highway 371 nearthe bypass. It will house four operatingrooms as well as one procedure room.

Dr. Kurt Waters, a physician and facialplastics surgeon at Brainerd MedicalCenter, is a surgical partner in the facility.Waters explained the facility is a joint ven-

ture between the surgical community andSt. Joseph’s Medical Center in Brainerd.

Waters said the facility will offer state-of-the-science technologies in a conven-ient location.

“From a convenience standpoint, it’ll begreat for patients,” he said. “It’s ourresponse to the growing needs of ourmedical staff and our community.”

The services to be offered at the surgi-cal center mirror many of those currentlyoffered on a same day surgery level atSJMC, including general surgeries, oph-thalmology, ear nose and throat, orthope-dics, podiatry, plastics, and urology.

Waters said he hopes the center willexpand in the near future to also includepain management and various women’sservices.

All minimally invasive and outpatientsurgical procedures will be done at thesurgical center. All invasive proceduresthat require a hospital stay will remain atSJMC where inpatient and outpatientcare, as well as additional technology andsupport services are available to ensurethe patient receives the best possible care.One thing that will be a constant at bothsites is that a board-certified anesthesiolo-gist will oversee each case.

Local doctors team up to openoutpatient surgical center

The Brainerd Lakes Surgery Center will open this fall in Baxter, providing outpatient surgery services to the communi-ty. The surgery center will be located off Highway 371 near the bypass. The facility is a joint venture between the sur-gical community and St. Joseph’s Medical Center in Brainerd and will offer state-of-the-science technologies.

Story/Jenny Kringen-Holmes

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Ahh, the feeling of utter exhaustion. Whenyou’re so tired it takes all your might to even pull

the bed sheets back. After sliding into the comfortzone, your head gets lost in your pillow and you

can’t help but let out a sigh. We’ve all been there.

Suddenly a permeating noise comes out of the lumpon the other side of the bed. In and out. In and out. With

each breath you lose a little more of that comfort and relax-ation you felt when you first climbed into bed.We’ve all been there too.

Snoring. About 10 to 30 percent of adults do it, and for somesnoring is more serious than just being an annoyance to their bed

partner.When Ann Tousignant and her family vacationed together they’d sleep

in separate hotel rooms.For as long as she could remember, Tousignant said her family and friends

would tease her about snoring so loudly no one within an earshot could sleep.But it wasn’t until about a year and a half ago that Tousignant realized some-

thing was wrong.She’d toss and turn all night. She’d go to bed at 8:30 p.m. and have to drag

herself to get up at 7 in the morning, never feeling the least bitrefreshed.

The 49-year-old daycare provider had no energy and was so worn-out it was starting to affect her personal and professional life.

“Finally, I just got tired of being tired,” she said.So Tousignant met with Dr. Todd Greatens who specializes in sleep and

pulmonary medicine at Brainerd Medical Center. Greatens rec-ommended Tousignant undergo a sleep study at BrainerdLakes Sleep Health Center, BMC’s new sleep center.

Before a patient such as Tousignant visits Greatens,a 10-question survey regarding sleeping habits mustbe done. A patient also has to complete a sleep log,

stating when they go to bed and wake up and how many hoursthey thought they actually slept. At the initial consultation, Greatens

goes over the questionnaire and talks with the patient, trying to figure

marketing manager for WeightWatchers International Inc.

A study last year of the Amish, a ruralpeople whose culture forgoes the luxu-ries of modern technology, showedthey are far leaner than mostAmericans as a result of the lifestyle. Astudy published by the AmericanCollege of Sports Medicine inIndianapolis concluded that only 4 per-cent of Amish were obese and 26 per-cent were overweight, compared to thegeneral population, in which 31 per-cent registered as obese and 65 percentas overweight. Some of the Amish, whoagreed to wear pedometers for thestudy, walked as many as 18,000 steps —the equivalent of nine miles a day.

The work-weight connection is notmerely about lack of physical activity.Many workers are spending more timeat the office. A survey by the Web clas-sified site Monster.com of more than17,500 people concluded that 46 per-cent work about 40 to 50 hours perweek and 25 percent said they work 50hours or more.

“We certainly have more stressed

lives, longer work hours for many of us,and less opportunity for being physi-cally active,” said Lawrence J. Cheskin,associate professor at the JohnsHopkins Bloomberg School of Healthand director of the Johns HopkinsWeight Management Center inBaltimore.

Poor eating habits at work com-pound the problem. About two-thirdsof Americans eat lunch at their desk,while more than 60 percent of workerssnack throughout the day, according toa survey last year by the AmericanDietetic Association and ConAgraFoods, the Omaha, Neb., food con-glomerate.

Moreover, with a preponderance ofboth sexes working outside the home,people turn more to prepared foodsfrom groceries or restaurants. Carryoutfoods in general contain more fat andsugar than home-cooked meals, andoften come in larger portions. Theoffice itself is laden with opportunitiesfor eating, from birthday cakes togoing-away celebrations.

A desk can even become a psycho-

logical cue for food cravings — likepopcorn at the movies, said ThomasWadden, director of the weight andeating disorders program at theUniversity of Pennsylvania School ofMedicine.

While businesses frequently requesthealthier foods in their vendingmachines, those snacks often costmore and don’t sell as well as thecheaper, more caloric items.

“They’re still big candy eaters. Theystill drink a lot of soda,” said GaryDesenberg, a sales and service manag-er at A. Kovens Vending, a Pennsylvaniacompany that supplies and stocksvending machines.

Some workplaces are trying tobecome part of the solution.Offices,factories — even sawmills — are host-ing aerobics workouts or contractingwith groups like Weight Watchers toconduct weight-loss classes. Someemployers now distribute pedometersto motivate workers to walk, even if itmeans taking a bathroom break onanother floor to squeeze in some extrasteps.

Story and photos/Heidi Lake

CPAP provides restful nightsfor sleep apnea sufferers

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When Paul M. Ribisl needed his secre-tary to photocopy exams at Wake ForestUniversity 30 years ago, she had to typethe questions, walk them to a mimeo-graph machine, then manually crank outcopies. When he needed a letter typed,she would walk to his desk, take short-hand, return to her desk to type the letter,walk it back to him to proofread, then walkback to retype it if there were corrections.

Today, however, a copy machine col-lates, staples and bundles exams in min-utes, and Ribisl can type letters and e-mailthem to colleagues, saving his secretary allthose steps.

“You can look at every part of some-one’s life and see that the physical drudg-ery has been taken out of it,” said Ribisl,who now chairs the health and exercisescience department at the university inNorth Carolina. “People are stuck at theirdesks more.”

Along with super-size fries and the TVremote, the workplace has become a cul-

prit in the great American weight gain. Arecent study released in the Journal of theAmerican Medical Association concludedthat poor diet and lack of exercise couldsoon surpass tobacco as the leading pre-ventable cause of premature death in theUnited States.

The economy has become dominatedby sedentary office work. Technologyallows — even requires — workers toremain in a chair all day, staring at a screen.Ever pressed for time, workers seem con-stantly to be scarfing down junk food onthe run or grazing at their desks. Improvedtechnology — from conference calling toinstant messaging to Internet-cams —makes communication ever more possi-ble without leaving one’s seat.

The result: Gaining weight has becomethe latest occupational hazard.

Americans on average expend about200 to 300 fewer calories a day than theydid 25 years ago — or about 7,000 fewercalories a month, he said. The change

years ago from manual typewriters tocomputers, by one estimate, caused theaverage full-time secretary to gain 5 to 10pounds a year.

“There’s a huge decrease in metabolismthat you get when you’re just sitting atyour desk all the time,” said Scott Collier,an adviser and instructor in SyracuseUniversity’s exercise science departmentwho directs an exercise program for theuniversity’s staff.

Stress from work, many experts say, isalso greater, fueled by such things as thepush for greater productivity and thethreat of outsourcing and downsizing.Stress lowers metabolism, making ittougher to burn calories. And cell phonesand e-mail at home and on the road canmake work seem omnipresent.

“Our work force has become more andmore sedentary every single year as tech-nology advances. I think at this point we’revery chair-bound, between the phone andthe computer,”said Chris Corcoran, senior

Sitting is a spreading occupational hazardStory/Stacey HirshBaltimore Sun

11

out what the underlying problem may be.Overnight sleep studies are done three

nights per week at the center. Overnightstudies are recommended for most sleepdisorder sufferers in order to find out theextent of their problem and how it can befixed.

“We try to know what the problem isbefore the sleep study,” Greatens said.

Of the more than 80 sleep disordersout there, including insomnia, narcolep-sy, sleep walking and recurring night-mares, obstructive sleep apnea syn-drome is the most common disordertreated at BMC’s sleep clinic.

“That’s probably the bread and butterof the lab,” John Wills, sleep lab managersaid.

Extremely loud snoring, pauses inbreathing and falling asleep at inappro-priate times are signs of sleep apnea, apotentially life-threatening disorder.

Snoring occurs when the muscles in aperson’s throat relax too much, narrow-ing the airway. When air is forcedthrough the narrowed passageway, itresults in a snoring sound. For most peo-ple the narrowing is not a problem, but

for people with sleep apnea it makesbreathing difficult, causing them to stopbreathing for a period of time whilesleeping. When the brain senses theincreased difficulty to breathe, it wakesup just enough to tighten the throat mus-cles, allowing air to get through effort-lessly.

Tousignant’s brain had to remind her tobreathe 112 times per hour during hersleep study, Greatens said, resulting inher never feeling like she got a goodnight’s sleep.

Before being diagnosed with sleepapnea, Tousignant took a nighttime coldmedication to help her sleep at night.

“It helped some, but not with the toss-ing and turning,” she said. “I’d have todrag myself out of bed in the morning. Ihad no energy whatsoever.”

Tousignant admitted when she andGreatens decided a sleep study neededto be done she was nervous, but anxiousby the mere thought of sleeping well.

Patients arrive at the sleep clinic at 8:30p.m., change into their pajamas and relax.A sleep technician places sensors on thepatient’s head, temple, jaw, neck, chin,

nose, chest and legs to monitor the bodyand its sleeping habits, such as heart rate,breathing, snoring and leg movement.The sensors transmit information into acontrol room, manned by sleep techni-cians all night long.

“I thought I would fight with the wiresall night, but I couldn’t even tell I hadthem on,” Tousignant said.

The sleep center, part of BMC’s newlycompleted $9 million expansion project,has a hotel-like feel, with a lounging area,kitchen and four private bedrooms withtelevisions and attached private bath-rooms. The comfortable beds and casualdecor gives the sleep center a homeyfeel, except for the microphone abovethe bed and the infrared camera attachedto the bedroom wall. Although the hard-ware looks discreet, it plays a major partin the sleep study’s success.

For two hours technicians closely mon-itor each patient, watching them on asmall TV screen, listening to their breath-ing, snoring and studying the informationthe sensors reveal.

When two hours is up, enough infor-mation is gathered to determine the

John Wills, sleep lab manager, studied the information gatheredduring an overnight sleep study. A video camera and microphoneare in each sleeping room, allowing sleep technicians to carefullymonitor the patient’s sleeping and snoring habits.

Patient rooms at Brainerd Lakes Sleep Health Center resemble a hotel roomwith a private bathroom and television.

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severity of a patient’s sleep certain criteria is met, technicly enter the patient’s room,them up just enough to slip ouous positive airway pressuCPAP.

CPAP is a machine that into the airway through a mover the nose. The mask’s airfenough pressure that wheninhales their airway stays opethem to breathe easily, witho

CPAP is considered the mon and most effective ntreatment for the alleviationand sleep apnea. Even GreWills wear CPAP at night.

“I used to wake up with bmy wife elbowing me,”Wills jhis loud snoring that accomsleep apnea. “Now it’s a wlifestyle. It can change people

Tousignant agreed.“It was just like a differen

said following her night at theter where she used CPAP ftime. “I felt very refreshed.”

After looking over the test discussing options with Grmorning after the study, Toussold on CPAP. She got one th

Continuous positive airway pressure mask, orCPAP, is considered the most common and mosteffective non-surgical treatment for the alleviationof snoring and sleep apnea.

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The brain’s other reaction comes through the pituitarygland, which sends signals through the bloodstreaminstructing the adrenal glands to release the stress hor-mone cortisol and other steroids. In the right amounts,cortisol helps the body recharge, enhances disease resist-ance, fights inflammation and improves memory.

In excess, however, cortisol promotes the accumulationof abdominal fat, suppresses immunity, shrinks brain cellsand impairs memory.

Over time, cells become less sensitive to the protectiveeffects of cortisol, and inflammation goes unchecked.

Scientists are only now beginning to understand whathappens when stress disrupts the delicate interplaybetween the brain, the endocrine system — the glands andorgans that make and release hormones — and theimmune system, stimulating the release of compoundsthat cause inflammation.

They’re also beginning to identify ways to stop thisinflammation and other stress-related biological effects.

“New treatments that teach us ways to relax and copewith daily stress offer great promise in decreasing the riskfor many preventable illnesses,” Irwin said.

Recent research has identified some of the followingways in which stress influences the course of illnesseslinked to viruses, aging or the body’s misguided attack onits own tissues.

Physical or mental stress can take an enormous andsometimes deadly toll on the heart. It increases bloodpressure, narrows blood vessels and causes blood tobecome stickier and more likely to clot, increasing the like-lihood of a heart attack or stroke.

In February, Irwin published a study in the AmericanJournal of Psychiatry showing that stress and depression inheart attack patients increase amounts of chemicals thatmake certain immune cells sticky and help them travel toartery linings, where they produce inflammation and pro-mote coronary artery disease.

A study published last week in the journal Circulationfound that mental stress also triggers irregular heartbeats,which can be deadly.

Stress can certainly give you butterflies or a stom-achache, but chronic stress can trigger flare-ups of irritablebowel syndrome, an intestinal condition that includescramping, gas, diarrhea and constipation.

Women with the condition (who vastly outnumber men)not only have elevated levels of cortisol, but also haveexaggerated differences between the higher morning andlower evening levels found in healthy people, Italianresearchers reported in 2001.

Although stress is no longer believed to cause ulcers(they’re sparked by an infection of the bacterium H. pylori),it can worsen symptoms.

HIV-infected gay men who keep their sexual orientationsecret get sicker and have shorter life spans than gay menwho are more open about their sexuality, a 1996 studyfound. Closeted gay men tend to be shyer and their nerv-ous systems overreact to stress; as a result, their bodiespump out more stress hormones, which encourage thevirus to multiply.

apnea. If aians quiet-

and waken a contin-

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delivers airask worn

low creates a patientn, allowingut snoring.most com-on-surgical of snoringatens and

ruises fromoked aboutpanied hishole new’s lives.”

t me,” she sleep cen-

or the first

results andeatens theignant wase very next

day.“I was almost anxious to go to bed just

to put it on,” she said.Other sleep apnea treatment options

include surgery and oral applianceswhich pull the lower jaw forward, keep-ing the airway open. Greatens said othersleep disorders can be treated withmedication.

Sleep apnea affects 14 percent of menand more than 2 percent of women.Obesity, smoking and drinking alcoholcan contribute to sleep apnea, whichcan affect cardiovascular health by caus-ing high blood pressure, heart diseaseand stroke. Greatens said anyone withsleeping problems is prone to depres-sion as well.

“Education is a big part of what wedo,” Wills said, encouraging people tolearn about and get treated for theirsleep disorder early.

Tousignant said getting treated forsleep apnea has changed her life.

“Don’t drag your feet — if you thinkyou have a (sleeping disorder), getchecked,” she said.

Other sleep labs are located inDuluth, St. Cloud and the Twin Cities.

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Inside the stressed outStory/Jane E. AllenLos Angeles Times

As a high-level executive for a large computer manufac-turer, Dan Bishop was a self-described workaholic whothought he was ably juggling daily demands and corporatepressures. Then he woke up one night with tightness in hischest, barely able to breathe. At first he suspected a heartattack. The tightness quickly passed, but he was frightenedenough to see his doctor.

The doctor diagnosed an anxiety attack — caused bystress — and told him to “stop being so driven.”

“I didn’t know what stress was; I didn’t think I had stress,”said Bishop, now 52, referring to the 1990 diagnosis.

As Bishop found, stress can be insidious.The pressures of daily life — jobs, relationships, money,

raising children and now, war and terrorism — havebecome such constant companions that many of us oper-ate with ever-present feelings of pressure, anxiety orburnout.

The stress can become so unflagging that many peoplehave accepted it as a standard part of life. Although we maytry to ignore its presence, stress doesn’t go away. It justgoes to work inside the body.

Prolonged stress contributes to many physical and psy-chological ills. It overrides natural defenses against virusesthat cause AIDS, chickenpox and the common cold;encourages the production of inflammatory hormonesthat drive heart disease, obesity and diabetes; sparks flare-ups of rheumatoid arthritis and digestive disorders; createsdepression and ages the brain.

“Numerous studies show that psychological stress canlead to illness, or even death,”said Dr. Michael Irwin, direc-tor of the Norman Cousins Center forPsychoneuroimmunology at the University of California,Los Angeles’ Neuropsychiatric Institute. “How we copewith stress and whether or not we get depressed is crucialfor our health.”

Unchecked stress sends out complex signals thatunleash a cascade of activity throughout the body.

When someone is confronted with stress — whetherphysical or psychological — the brain is the first part of thebody to respond, reacting in two distinct ways.

In one of the reactions, a regulatory part of the braincalled the hypothalamus sends signals through sympathet-ic nerves near the spinal cord to the adrenal glands, com-manding them to release the stress hormones epinephrineand norepinephrine (also called adrenaline and noradren-aline).

These hormones gird the body for action. They boostheart rate, blood pressure, breathing and blood flow to themuscles and brain, providing an extra surge of energy intimes of physical danger. They can also keep athletes,entertainers and others on their toes, keeping them alertand productive when performance counts.

But chronic stress opens the floodgates to epinephrineand norepinephrine, regardless of whether there’s a threat,allowing bacteria, viruses or tumors to flourish and makingblood more prone to clotting.

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day in the life of a surgeon

aring special glasses to magnify images, Dr. Ross Bengtson cut through layers of tissue while he made his way to the carotid arteryis patient’s neck, being careful of nerves en route.

Story/Jenny Kringen-HolmesPhotos/Nels Norquist

With a John Mayer CD playing in the back-ound, Dr. Ross Bengtson makes his first inci-n along a 53-year-old man’s neck, working

s way through the layers of tissue to therotid artery. It’s the first of four surgeries on Bengtson'shedule at St. Joseph’s Medical Center inainerd on this Thursday afternoon. The 32-year-old surgeon may look young at

first glance, but Bengtson’s knowledge and tal-ent far exceed his age.

With the consent of Brainerd MedicalCenter, St. Joseph’s Medical Center and sever-al patients, this reporter followed a local gen-eral surgeon during a typical Thursday shift inMarch.

This is just a glimpse into a day in the life of asurgeon.

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AMARILLO, Texas — No hospital roomcompares to your own bedroom — espe-cially when your room has red, orange,yellow and green walls.

That’s 12-year-old Wendy Weatherly’sroom, and she was glad to return to it.

“It was so great,” Wendy said. “There’snothing like home.”

Wendy, a seventh-grader, returned toAmarillo on March 27 after undergoing 13hours of surgery in Philadelphia tostraighten her spine curved by scoliosis.

Surgeons removed staples from a previ-ous procedure, then inserted rods intoher spine to straighten it.

Doctors had hoped that fall’s pioneer-ing procedure would straighten Wendy’sspine without the traditional rods, but X-rays earlier this year showed that hercurve was getting worse and she’d needthe rods.

For now, Wendy is continuing her stud-ies at home as her spine fuses perfectly

straight.“Every day is a little bit better, but every

day has its challenges,” Wendy said.She doesn’t remember much about the

first few days after surgery. But that didn’tstop her from communicating with family— her fingers remembered sign language,even when a tube in her throat wouldn’tlet her talk.

“I guess God just provided a way to talkto my parents through sign language,”Wendy said.

Family members back in Amarillo alsocontributed to her recovery, said hermother, Karla Weatherly. When Wendy’sblood count was low, a local blood bankshipped blood that her grandfathers haddonated.

Four hours after the transfusion started,the 12-year-old felt much better and wasready to watch some television.

“She got some very powerful grandfa-ther blood,” Karla Weatherly said.

But Wendy also gets strength from ahigher source, the family said.

“It comes from God — really it does,”Wendy said.

She doesn’t know why all this has hap-pened to her, but Wendy trusts that she’llfind out someday.

“(God) has a reason, and he’ll tell mewhen I get to heaven,” she said.

Wendy has also been comforted by thephone calls and cards from people literal-ly around the globe — even from perfectstrangers.

“It’s such a nice feeling to know thatpeople care,” she said.

Wendy will wear her brace — now apsychedelic pink and purple one — forthree more months, she said.

Her dad, Brent Weatherly, said he’s gladhis daughter is home.

He is grateful for all of Wendy’s doctors.“I’m glad there’s people like that

around,” he said.

Story/Jennifer Wilson Morris News Service

Life after spinal surgery: A 12-year-old’s recovery

15

8 a.m. — While many are just arrivingfor a day’s work, Dr. Ross Bengtson hasbeen at his job for more than an houralready. Bengtson, 32, a physician and sur-geon who splits his time betweenBrainerd Medical Center and St. Joseph’sMedical Center, says he made his first stopof the day at 6:45 a.m. to visit his post-oper-ative patients at SJMC. Now at BMC for amorning of office visits, Bengtson pre-pares for the full day that lies ahead.Bengtson, a Brainerd resident, has beenwith BMC/SJMC for nearly one year. Heand Dr. Jim Dehen work together at boththe clinic and hospital, conferring withone another and assisting when neededon surgical procedures. Much like Dehen,Bengtson is a general surgeon with carelevels ranging from vascular and laparo-scopic to thoracic and more.

8:15 a.m. — A middle-aged womanmeets with Bengtson as a follow-up to arecent diagnosis of endometriosis. Aftertelling him of the pain she experiences inthe affected area, Bengtson explains heroptions, including surgery to remove thegrowth or to forgo removal and follow-upwith a CT scan in another six months,since the growth is benign or non-cancer-ous. She agrees to follow-up in six monthswith the scan.

8:25 a.m. — A man shows Bengtson agrowth he has had on his elbow for thepast year. After examination, Bengtsonoffers to have the lump removed in theoffice. “Whack ‘er off there,” the managrees. Led to one of two procedurerooms in the surgical area of BMC,Bengtson shaves the man’s elbow aroundthe spot to be removed, cleans the areaand injects Lidocaine into the growth. Heexplains he won’t feel any pain, but rathera tugging sensation as it is cut from hisarm. Nurse Jan Lambert assists Bengtson,handing him gauze as Bengtson snips outwhat he explains is a sebaceous cyst or agland that gets clogged and is unable tosecrete therefore causing an enlargementunder the skin. The man passes up theopportunity to look at the growth once it’sremoved and jokes with Bengtson aboutpassing out at the sight of his own bloodonce. “That’s why I hate cleaning fish,”Bengtson jokes back. “The blood and gutsget me.”

8:50 a.m. — Bengtson is assisted in theprocedure room by nurse JackieWeinhandl for a female patient sufferingfrom hemorrhoids. Back at the nurse’s sta-tion, nurse Lambert explains howBengtson will soon be doing gastricbypass surgeries as well as varicose vein

procedures at SJMC. “We do a lot now,”she says, “but we’ll be doing even more inthe future.”

9 a.m. — Bengtson makes phone callsto follow up on patients, giving themresults from lab work and X-rays as well ascatches up on paperwork before seeinghis next patient.

9:20 a.m. — A woman with leg and footswelling visits with Bengtson. She explainsshe has had the swelling for the past threeyears but it has gotten progressivelyworse. After reviewing her medical histo-ry, previous surgeries and examining bothlegs and feet, Bengtson explains the possi-ble causes and treatments for the swelling.He suggests a pair of good compressionstockings as well ascoming back for anultrasound of the legsto rule out anychance of blood clots.

9:30 a.m. — Afterreturning to thenurse’s station,Bengtson dictates hispatient’s informationand findings from hisvisit into a taperecorder, a regularpractice he does afterseeing each patientthroughout the day.

9:40 a.m. —Bengtson follows-upwith a gentlemanwho first experiencedan abscess by his analarea. The area hadbeen drained but did-n’t completely reme-dy itself resulting inyet another proce-dure three weeksago. But at this exam,Bengtson says theman is doing “asexpected.”

9:50 a.m. — Anolder couple visitswith Bengtson follow-ing the husband’scarotid endarterecto-my, a procedure doneto open an artery inthe neck and allowblood flow followingsevere narrowing orblockage. The arteryhad become cloggedand led to the manhaving a small stroke.

Now following up on the procedure, theman is in good spirits and said he hasresumed life as normal for the most part.A small mass has collected at the incisionsite during the recovery process, which isoften typical following this type of proce-dure. Bengtson gives the man the optionto attempt to drain out some of the fluidwith a syringe or to simply wait for thebody to reabsorb it. After consideration,the man agrees to let Bengtson drain thefluid. But after attempting, Bengtsondetermines the fluid gathered beneaththe skin is still too thick to be removed atthis time. He tells the man to come back inthree weeks if the growth is still apparent.

10:05 a.m. — A woman, experiencing

Thirty-two year old surgeon Ross Bengtson scrubs in before surgery atSt. Joseph's Medical Center in Brainerd. Bengtson, a Brainerd resident,has been with SJMC and Brainerd Medical Center for nearly one year.

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similar blockage in the carotid artery is seen byBengtson. He explains her blockage consumesabout 80 percent of this essential artery, asdetermined by an ultrasound. Without surgery,Bengtson says she runs an 11 percent risk of astroke. Once operated on, that risk drops to 5percent over five years, he tells her. But the eld-erly woman refuses to have surgical interven-tion. Bengtson accepts her decision andrequests she return in a year to have anotherultrasound. “I’ll see you in a year,” he tells herwhen leaving the room. “You better be here in ayear,” she tells him. “Oh, I will be,” he laughsback.

10:14 a.m. — A gentleman with skin cancer isback in Bengtson’s office to have his incisionchecked where cancerous spots were removed.“Everything looks pretty good from my stand-point,” he tells the man and his wife. The wifeasks Bengtson about any lifting restrictions forher husband, to which Bengtson tells her he isfree to lift. “Oh good,”she says with a twinkle inher eye, noting some furniture at home shewants moved. But that’s obviously not the newsthis man wants his wife to hear as he grimacesand tries to convincingly tell her how he canalready tell that bending and lifting won’t begood.

10:30 a.m. — Bengtson is called to the proce-dure room where he meets an older man whohad an amputation of his leg below the kneedue to diabetes. The man also has skin cancer,with an additional growth on his neck to beremoved today. “All I hear about you, youngman, is good,” the man says to Bengtson. “Well,wait till I get to tell my side of the story,”Bengtson shoots back. Bengtson examines the

ed by fellow surgeon Dr. Jim Dehen and Registered Nurse Marysma, Dr. Ross Bengtson performed a carotid endarterectomy, an opera- unblock his patient's carotid artery, one of two main arteries which run

from the heart to the brain down either side of the neck.

With a needle smaller than the surgical suturesthemselves, it’s easy to see why magnifyingglasses and a steady hand are a surgeon’s alliesin the operating room.

Dr. James Tuorila, psychologist at the St.Cloud VA Medical Center, leads a post-traumatic stress disorder support grouponce a week at Brainerd Regional HumanServices Center. About 30 people fromOperation Desert Storm, Vietnam andWorld War II meet to discuss differenttopics related to PTSD.

“We discuss how traumatic experiencesduring war have affected our lives today,”Tuorila said. “Front line units have higherrates of problems depending on whatthey experienced during their tour ofduty.”

Tuorila, himself a Korean War veteran,currently has a son serving in Iraq. Tuorilaexpects him to come back a changed man.

“I don’t think anyone can go away towar for a year and come back the sameperson,” he said.

For many veterans, war has changedthem for the better, becoming moremature and in touch with their feelings,Tuorila said, but others struggle to ridthemselves of the tragedy of war.

“The number one issue (dealt with atthe PTSD support group) is the transitionfrom being on guard 24 hours a day to nothaving a rifle or machine gun by yourside,” Tuorila said.

PTSD is triggered after being involved in

or witnessing a traumatic act, such asbeing wounded, seeing someone killed orbeing a prisoner of war. Symptoms ofPTSD include having nightmares,responding to loud or unexpected noises,drinking problems or having anger man-agement issues.

Tuorila said no one from OperationEnduring Freedom in Afghanistan orOperation Iraqi Freedom have joined thePTSD support group yet.

Col. Vern Anderson, Minnesota statechaplain for the joint forces, said soldiersare well prepared for the transition ofreturning home after being at war in Iraq.

“Reunion (with family members) ismore difficult than mobilization,”Anderson said.

Before soldiers are sent home, they arebriefed about what to expect when reunit-ing with their families and returning tocivilian employment.

Many people have trouble reconnect-ing with their spouses or significant othersafter being at war for a long period of time.Local church leaders and mental healthcounselors as well as military support canhelp ease the transition, Anderson said.

“Things might feel awkward, but this isvery normal,” he said. “The key is don’trush things.”

Josh Cameron had no trouble reunitingwith his family. The day he returned hewas greeted by friends and family at a sur-prise party, welcoming him home.

Hayden Cameron was 10 months oldwhen Josh left and was on the verge of theterrible 2s when he returned. Josh’sfiancee, Dawn Statly, showed Hayden apicture of Josh daily to remind her who hewas.

“Dawn would show (Hayden) a pictureand she’d kiss it,” Josh said. “She wouldn’tlet her forget who I was.”

The ritual must have worked. Althougha little shy at first, Hayden welcomed herdad with open arms when he returnedhome in March.

“Hayden is probably the one thing thathas changed the most while I was gone,”Josh said.

Josh has been on leave from the Armyfor the last four weeks, spending time withhis family, reconnecting with his “regular”life. He soon plans to go back to work atCrosslake Sheetmetal, something he saidhe’s definitely ready to do.

Sue Cameron is just happy to have herfamily back together.

“If he goes back (to war), we’re all goingback with him,” Sue said.

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Life after warNow the mental, emotional battle starts

After spending nearly a year in Iraq, Spc. Josh Cameron was welcomed home by his family, includ-ing his daughter, Hayden, who was only 10 months old when he left. For many soldiers, reunitingwith their families after being at war is harder than leaving them.

Josh Cameron didn’t see his daughter, Hayden, walk forthe first time or hear her speak her first word. He evenmissed her first birthday.

On active duty with the Minnesota National Guard’sCompany C, 142nd Engineer Battalion, Spc. Cameron, whohad never been away from his family for more than a fewmonths at a time during training, found himself stationed atCamp Anaconda near Balad, Iraq, for nearly a year.

“We’re a very close-knit family,” said Sue Cameron, Josh’smother. “I can’t handle the separation.”

Sue found herself reading war updates on the Internetthree or four times a day while her son was gone, trying tokeep up on the latest news from Iraq. E-mails or letters fromJosh were few and far between the first few months in Iraq,while camp was still getting set up.

“I’d have to wait in line four or five hours to use thephone,” Josh said.

“The worst part was not hearing from him,” Sue added.As part of an engineering company, Josh didn’t feel like

he was in much danger while in Iraq. Except for the occa-sional mortar, or incoming rounds of enemy fire, Josh saidhe didn’t see any devastating effects of the war.

“We weren’t running through the towns busting downdoors or anything like that,” he said. “I never saw any directfire. If mortar was falling and your tent didn’t move, thendon’t worry about it.”

A bit of reality set in when Josh Cameron got word arocket propelled grenade went through a Bradley FightingVehicle, killing a fellow Minnesotan and acquaintance ofhis.

Story/Heidi LakePhoto/Nels Norquist

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1:09 p.m. — Wearing special glasses to magnify images,Bengtson makes the first incision into his patient’s neck.Cutting through layers of tissue, he makes his way to thecarotid artery being careful of nerves while en route.

1:16 p.m. — Dehen scrubs in and joins Bengtson in theoperating room. As a nurse monitors the patient’s vital signs,Bengtson orders medications to be administered throughhis IV. Once the carotid artery is located, an incision is madeinto its wall and a shunt, or artificial artery, is placed withinthat artery. Blood flow will be rerouted through that shunt asBengtson cleans away the plaque inside the artery’s walls.Once cleaned out, a patch is placed over the incision madein the artery and the shunt is removed.

2:27 p.m. — A small tube is placed near the incision siteto allow excess fluids to drain out the neck. With anothersuccessful procedure under his belt, Bengtson sews the lay-ers of tissue and skin back together. He estimates he per-forms about three carotid endarterectomy procedures amonth. He says if all goes as planned, this man will be goinghome tomorrow.

2:41 p.m. — Nurse Patty Fortier removes the breathingapparatus in place during the surgery and calls the man’sname to help him come out of the anesthesia. “Open youreyes,” she tells him. “You’re just waking up.” Bengtson sayswith this type of procedure he usually stays in the OR untilthe patient is conscious to ensure he or she didn’t suffer astroke during surgery, which can be a risk.

2:44 p.m. — The man begins to wake up as he opens hiseyes and coughs from the remaining airway tube in histhroat. Bengtson asks the man to squeeze his hand and wig-gle his toes, which he does successfully, assuring a strokedid not occur.

2:46 p.m. — Bengtson walks to the surgery waiting area,where the man’s wife awaits word on her husband’s condi-tion, and tells her the good news.

2:49 p.m. — A middle-aged woman waits in a room in thesame-day surgery area, prepped for a laparoscopic proce-dure on a hernia. He talks with her briefly answering a fewquestions, then returns to the staff lounge for a quick breakbefore returning to the OR. Laparoscopy is a surgical tech-nique when a lighted viewing instrument is inserted into thelower abdomen through a small incision allowing for a min-imally invasive procedure.

2:55 p.m. — Bengtson is excited for things to come, heexplains, as he will soon be doing laparoscopic gastricbypass surgeries at SJMC. He said the hospital is still gettingthe program set up from pre-operative psychiatric evalua-tion and nutritionists to support groups following the sur-gery. “We want to make it as good a program as possible,”heexplains, adding the services will be most likely availablewithin the next few months. He said the hospital also offersvaricose vein removal procedures which are minimally inva-sive and growing in popularity amongst those who sufferfrom the vascular disorder.

3:23 p.m. — Bengtson has just been informed, due to anumber of surgeries scheduled, his laparoscopic procedurewill be pushed back a couple hours. And with two gallblad-der surgeries still scheduled later in the day, Bengtson notesit’s going to be a long day for him. But through it all, heshows his true passion for his career and concedes it’s all ina day’s work in this day in the life of a surgeon.

n site on the man’s amputation anddages the area before helping him

to the exam table where he is laid on his side so Bengtson can accessck. Injecting a needle of Lidocainee growth area, Bengtson likens the

” to a mosquito bite. The man gri- on the table and when asked if he’s all right he replies, “That’s an awfulosquito.” Bengtson tells him the

h being removed will be sent in toiopsy. He also examines two moles man’s neck but tells him they arebenign but to continue to watchor any changes. 7 a.m. — An elderly man partiallyzed and confined to a wheelchair isson’s next patient. The man’s tightly shoes had rubbed sores on histoe, forcing an earlier amputation.er sore had formed on that foot’se as well which had also been treat-

ed. Today’s visit was for his re-evaluation.Noting that the sores had improved,Bengtson also offered to write the man aprescription for support socks. Beforeleaving the room, Bengtson helps theman put his sock and shoe back on,attributing his “expertise”to his work as anursing assistant in a nursing home whileattending college.

11:30 a.m. — Done for the day withappointments at the clinic, Bengtson fin-ishes his paperwork and makes a fewcalls before heading to SJMC where he isscheduled for four surgeries this after-noon.

12:30 p.m. — Bengtson grabs a quicklunch from the SJMC cafeteria and eats inthe surgical staff lounge, visiting with Dr.Hal Leland and other surgical staff. Due tothe full schedule of surgeries this after-noon at the hospital, Bengtson explainshis first procedure has been pushed

back. 12:55 p.m. — Bengtson arrives in

Operating Room 6 with his MP3 playerand a set of small speakers, explainingthat everything is better with music. Theanesthesiologist and several nurses pre-pare for the surgery, starting IVs on thepatient and unfolding blue sheets filledwith sterile silver surgical tools. Bengtsonuses a black marker to visibly mark theincision site on the now unconscious 53-year-old man’s neck. He will be undergo-ing a carotid endarterectomy, an opera-tion to unblock his carotid artery, one oftwo main arteries which run blood fromthe heart to the brain down either side ofthe neck.

1:02 p.m. — Scrubbed in and ready tobegin this delicate surgery, Bengtsonhelps the operating room staff drape thepatient’s body, leaving only an opening atthe surgical site.

g a successful proce-r. Ross Bengtson shared

news with his patient’s

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1:09 p.m. — Wearing special glasses to magnify images,Bengtson makes the first incision into his patient’s neck.Cutting through layers of tissue, he makes his way to thecarotid artery being careful of nerves while en route.

1:16 p.m. — Dehen scrubs in and joins Bengtson in theoperating room. As a nurse monitors the patient’s vital signs,Bengtson orders medications to be administered throughhis IV. Once the carotid artery is located, an incision is madeinto its wall and a shunt, or artificial artery, is placed withinthat artery. Blood flow will be rerouted through that shunt asBengtson cleans away the plaque inside the artery’s walls.Once cleaned out, a patch is placed over the incision madein the artery and the shunt is removed.

2:27 p.m. — A small tube is placed near the incision siteto allow excess fluids to drain out the neck. With anothersuccessful procedure under his belt, Bengtson sews the lay-ers of tissue and skin back together. He estimates he per-forms about three carotid endarterectomy procedures amonth. He says if all goes as planned, this man will be goinghome tomorrow.

2:41 p.m. — Nurse Patty Fortier removes the breathingapparatus in place during the surgery and calls the man’sname to help him come out of the anesthesia. “Open youreyes,” she tells him. “You’re just waking up.” Bengtson sayswith this type of procedure he usually stays in the OR untilthe patient is conscious to ensure he or she didn’t suffer astroke during surgery, which can be a risk.

2:44 p.m. — The man begins to wake up as he opens hiseyes and coughs from the remaining airway tube in histhroat. Bengtson asks the man to squeeze his hand and wig-gle his toes, which he does successfully, assuring a strokedid not occur.

2:46 p.m. — Bengtson walks to the surgery waiting area,where the man’s wife awaits word on her husband’s condi-tion, and tells her the good news.

2:49 p.m. — A middle-aged woman waits in a room in thesame-day surgery area, prepped for a laparoscopic proce-dure on a hernia. He talks with her briefly answering a fewquestions, then returns to the staff lounge for a quick breakbefore returning to the OR. Laparoscopy is a surgical tech-nique when a lighted viewing instrument is inserted into thelower abdomen through a small incision allowing for a min-imally invasive procedure.

2:55 p.m. — Bengtson is excited for things to come, heexplains, as he will soon be doing laparoscopic gastricbypass surgeries at SJMC. He said the hospital is still gettingthe program set up from pre-operative psychiatric evalua-tion and nutritionists to support groups following the sur-gery. “We want to make it as good a program as possible,”heexplains, adding the services will be most likely availablewithin the next few months. He said the hospital also offersvaricose vein removal procedures which are minimally inva-sive and growing in popularity amongst those who sufferfrom the vascular disorder.

3:23 p.m. — Bengtson has just been informed, due to anumber of surgeries scheduled, his laparoscopic procedurewill be pushed back a couple hours. And with two gallblad-der surgeries still scheduled later in the day, Bengtson notesit’s going to be a long day for him. But through it all, heshows his true passion for his career and concedes it’s all ina day’s work in this day in the life of a surgeon.

incision site on the man’s amputation andre-bandages the area before helping himmove to the exam table where he is laiddown on his side so Bengtson can accesshis neck. Injecting a needle of Lidocaineinto the growth area, Bengtson likens the“sting” to a mosquito bite. The man gri-maces on the table and when asked if he’sdoing all right he replies, “That’s an awfulbig mosquito.” Bengtson tells him thegrowth being removed will be sent in toget a biopsy. He also examines two moleson the man’s neck but tells him they arelikely benign but to continue to watchboth for any changes.

10:57 a.m. — An elderly man partiallyparalyzed and confined to a wheelchair isBengtson’s next patient. The man’s tightlyfitting shoes had rubbed sores on hissmall toe, forcing an earlier amputation.Another sore had formed on that foot’sbig toe as well which had also been treat-

ed. Today’s visit was for his re-evaluation.Noting that the sores had improved,Bengtson also offered to write the man aprescription for support socks. Beforeleaving the room, Bengtson helps theman put his sock and shoe back on,attributing his “expertise”to his work as anursing assistant in a nursing home whileattending college.

11:30 a.m. — Done for the day withappointments at the clinic, Bengtson fin-ishes his paperwork and makes a fewcalls before heading to SJMC where he isscheduled for four surgeries this after-noon.

12:30 p.m. — Bengtson grabs a quicklunch from the SJMC cafeteria and eats inthe surgical staff lounge, visiting with Dr.Hal Leland and other surgical staff. Due tothe full schedule of surgeries this after-noon at the hospital, Bengtson explainshis first procedure has been pushed

back. 12:55 p.m. — Bengtson arrives in

Operating Room 6 with his MP3 playerand a set of small speakers, explainingthat everything is better with music. Theanesthesiologist and several nurses pre-pare for the surgery, starting IVs on thepatient and unfolding blue sheets filledwith sterile silver surgical tools. Bengtsonuses a black marker to visibly mark theincision site on the now unconscious 53-year-old man’s neck. He will be undergo-ing a carotid endarterectomy, an opera-tion to unblock his carotid artery, one oftwo main arteries which run blood fromthe heart to the brain down either side ofthe neck.

1:02 p.m. — Scrubbed in and ready tobegin this delicate surgery, Bengtsonhelps the operating room staff drape thepatient’s body, leaving only an opening atthe surgical site.

Following a successful proce-dure, Dr. Ross Bengtson sharedthe good news with his patient’swife.

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Life after warNow the mental, emotional battle starts

After spending nearly a year in Iraq, Spc. Josh Cameron was welcomed home by his family, includ-ing his daughter, Hayden, who was only 10 months old when he left. For many soldiers, reunitingwith their families after being at war is harder than leaving them.

Josh Cameron didn’t see his daughter, Hayden, walk forthe first time or hear her speak her first word. He evenmissed her first birthday.

On active duty with the Minnesota National Guard’sCompany C, 142nd Engineer Battalion, Spc. Cameron, whohad never been away from his family for more than a fewmonths at a time during training, found himself stationed atCamp Anaconda near Balad, Iraq, for nearly a year.

“We’re a very close-knit family,” said Sue Cameron, Josh’smother. “I can’t handle the separation.”

Sue found herself reading war updates on the Internetthree or four times a day while her son was gone, trying tokeep up on the latest news from Iraq. E-mails or letters fromJosh were few and far between the first few months in Iraq,while camp was still getting set up.

“I’d have to wait in line four or five hours to use thephone,” Josh said.

“The worst part was not hearing from him,” Sue added.As part of an engineering company, Josh didn’t feel like

he was in much danger while in Iraq. Except for the occa-sional mortar, or incoming rounds of enemy fire, Josh saidhe didn’t see any devastating effects of the war.

“We weren’t running through the towns busting downdoors or anything like that,” he said. “I never saw any directfire. If mortar was falling and your tent didn’t move, thendon’t worry about it.”

A bit of reality set in when Josh Cameron got word arocket propelled grenade went through a Bradley FightingVehicle, killing a fellow Minnesotan and acquaintance ofhis.

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similar blockage in the carotid artery is seen byBengtson. He explains her blockage consumesabout 80 percent of this essential artery, asdetermined by an ultrasound. Without surgery,Bengtson says she runs an 11 percent risk of astroke. Once operated on, that risk drops to 5percent over five years, he tells her. But the eld-erly woman refuses to have surgical interven-tion. Bengtson accepts her decision andrequests she return in a year to have anotherultrasound. “I’ll see you in a year,” he tells herwhen leaving the room. “You better be here in ayear,” she tells him. “Oh, I will be,” he laughsback.

10:14 a.m. — A gentleman with skin cancer isback in Bengtson’s office to have his incisionchecked where cancerous spots were removed.“Everything looks pretty good from my stand-point,” he tells the man and his wife. The wifeasks Bengtson about any lifting restrictions forher husband, to which Bengtson tells her he isfree to lift. “Oh good,”she says with a twinkle inher eye, noting some furniture at home shewants moved. But that’s obviously not the newsthis man wants his wife to hear as he grimacesand tries to convincingly tell her how he canalready tell that bending and lifting won’t begood.

10:30 a.m. — Bengtson is called to the proce-dure room where he meets an older man whohad an amputation of his leg below the kneedue to diabetes. The man also has skin cancer,with an additional growth on his neck to beremoved today. “All I hear about you, youngman, is good,” the man says to Bengtson. “Well,wait till I get to tell my side of the story,”Bengtson shoots back. Bengtson examines the

Assisted by fellow surgeon Dr. Jim Dehen and Registered Nurse MaryDroogsma, Dr. Ross Bengtson performed a carotid endarterectomy, an opera-tion to unblock his patient's carotid artery, one of two main arteries which runblood from the heart to the brain down either side of the neck.

With a needle smaller than the surgical suturesthemselves, it’s easy to see why magnifyingglasses and a steady hand are a surgeon’s alliesin the operating room.

Dr. James Tuorila, psychologist at the St.Cloud VA Medical Center, leads a post-traumatic stress disorder support grouponce a week at Brainerd Regional HumanServices Center. About 30 people fromOperation Desert Storm, Vietnam andWorld War II meet to discuss differenttopics related to PTSD.

“We discuss how traumatic experiencesduring war have affected our lives today,”Tuorila said. “Front line units have higherrates of problems depending on whatthey experienced during their tour ofduty.”

Tuorila, himself a Korean War veteran,currently has a son serving in Iraq. Tuorilaexpects him to come back a changed man.

“I don’t think anyone can go away towar for a year and come back the sameperson,” he said.

For many veterans, war has changedthem for the better, becoming moremature and in touch with their feelings,Tuorila said, but others struggle to ridthemselves of the tragedy of war.

“The number one issue (dealt with atthe PTSD support group) is the transitionfrom being on guard 24 hours a day to nothaving a rifle or machine gun by yourside,” Tuorila said.

PTSD is triggered after being involved in

or witnessing a traumatic act, such asbeing wounded, seeing someone killed orbeing a prisoner of war. Symptoms ofPTSD include having nightmares,responding to loud or unexpected noises,drinking problems or having anger man-agement issues.

Tuorila said no one from OperationEnduring Freedom in Afghanistan orOperation Iraqi Freedom have joined thePTSD support group yet.

Col. Vern Anderson, Minnesota statechaplain for the joint forces, said soldiersare well prepared for the transition ofreturning home after being at war in Iraq.

“Reunion (with family members) ismore difficult than mobilization,”Anderson said.

Before soldiers are sent home, they arebriefed about what to expect when reunit-ing with their families and returning tocivilian employment.

Many people have trouble reconnect-ing with their spouses or significant othersafter being at war for a long period of time.Local church leaders and mental healthcounselors as well as military support canhelp ease the transition, Anderson said.

“Things might feel awkward, but this isvery normal,” he said. “The key is don’trush things.”

Josh Cameron had no trouble reunitingwith his family. The day he returned hewas greeted by friends and family at a sur-prise party, welcoming him home.

Hayden Cameron was 10 months oldwhen Josh left and was on the verge of theterrible 2s when he returned. Josh’sfiancee, Dawn Statly, showed Hayden apicture of Josh daily to remind her who hewas.

“Dawn would show (Hayden) a pictureand she’d kiss it,” Josh said. “She wouldn’tlet her forget who I was.”

The ritual must have worked. Althougha little shy at first, Hayden welcomed herdad with open arms when he returnedhome in March.

“Hayden is probably the one thing thathas changed the most while I was gone,”Josh said.

Josh has been on leave from the Armyfor the last four weeks, spending time withhis family, reconnecting with his “regular”life. He soon plans to go back to work atCrosslake Sheetmetal, something he saidhe’s definitely ready to do.

Sue Cameron is just happy to have herfamily back together.

“If he goes back (to war), we’re all goingback with him,” Sue said.

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8 a.m. — While many are just arrivingfor a day’s work, Dr. Ross Bengtson hasbeen at his job for more than an houralready. Bengtson, 32, a physician and sur-geon who splits his time betweenBrainerd Medical Center and St. Joseph’sMedical Center, says he made his first stopof the day at 6:45 a.m. to visit his post-oper-ative patients at SJMC. Now at BMC for amorning of office visits, Bengtson pre-pares for the full day that lies ahead.Bengtson, a Brainerd resident, has beenwith BMC/SJMC for nearly one year. Heand Dr. Jim Dehen work together at boththe clinic and hospital, conferring withone another and assisting when neededon surgical procedures. Much like Dehen,Bengtson is a general surgeon with carelevels ranging from vascular and laparo-scopic to thoracic and more.

8:15 a.m. — A middle-aged womanmeets with Bengtson as a follow-up to arecent diagnosis of endometriosis. Aftertelling him of the pain she experiences inthe affected area, Bengtson explains heroptions, including surgery to remove thegrowth or to forgo removal and follow-upwith a CT scan in another six months,since the growth is benign or non-cancer-ous. She agrees to follow-up in six monthswith the scan.

8:25 a.m. — A man shows Bengtson agrowth he has had on his elbow for thepast year. After examination, Bengtsonoffers to have the lump removed in theoffice. “Whack ‘er off there,” the managrees. Led to one of two procedurerooms in the surgical area of BMC,Bengtson shaves the man’s elbow aroundthe spot to be removed, cleans the areaand injects Lidocaine into the growth. Heexplains he won’t feel any pain, but rathera tugging sensation as it is cut from hisarm. Nurse Jan Lambert assists Bengtson,handing him gauze as Bengtson snips outwhat he explains is a sebaceous cyst or agland that gets clogged and is unable tosecrete therefore causing an enlargementunder the skin. The man passes up theopportunity to look at the growth once it’sremoved and jokes with Bengtson aboutpassing out at the sight of his own bloodonce. “That’s why I hate cleaning fish,”Bengtson jokes back. “The blood and gutsget me.”

8:50 a.m. — Bengtson is assisted in theprocedure room by nurse JackieWeinhandl for a female patient sufferingfrom hemorrhoids. Back at the nurse’s sta-tion, nurse Lambert explains howBengtson will soon be doing gastricbypass surgeries as well as varicose vein

procedures at SJMC. “We do a lot now,”she says, “but we’ll be doing even more inthe future.”

9 a.m. — Bengtson makes phone callsto follow up on patients, giving themresults from lab work and X-rays as well ascatches up on paperwork before seeinghis next patient.

9:20 a.m. — A woman with leg and footswelling visits with Bengtson. She explainsshe has had the swelling for the past threeyears but it has gotten progressivelyworse. After reviewing her medical histo-ry, previous surgeries and examining bothlegs and feet, Bengtson explains the possi-ble causes and treatments for the swelling.He suggests a pair of good compressionstockings as well ascoming back for anultrasound of the legsto rule out anychance of blood clots.

9:30 a.m. — Afterreturning to thenurse’s station,Bengtson dictates hispatient’s informationand findings from hisvisit into a taperecorder, a regularpractice he does afterseeing each patientthroughout the day.

9:40 a.m. —Bengtson follows-upwith a gentlemanwho first experiencedan abscess by his analarea. The area hadbeen drained but did-n’t completely reme-dy itself resulting inyet another proce-dure three weeksago. But at this exam,Bengtson says theman is doing “asexpected.”

9:50 a.m. — Anolder couple visitswith Bengtson follow-ing the husband’scarotid endarterecto-my, a procedure doneto open an artery inthe neck and allowblood flow followingsevere narrowing orblockage. The arteryhad become cloggedand led to the manhaving a small stroke.

Now following up on the procedure, theman is in good spirits and said he hasresumed life as normal for the most part.A small mass has collected at the incisionsite during the recovery process, which isoften typical following this type of proce-dure. Bengtson gives the man the optionto attempt to drain out some of the fluidwith a syringe or to simply wait for thebody to reabsorb it. After consideration,the man agrees to let Bengtson drain thefluid. But after attempting, Bengtsondetermines the fluid gathered beneaththe skin is still too thick to be removed atthis time. He tells the man to come back inthree weeks if the growth is still apparent.

10:05 a.m. — A woman, experiencing

Thirty-two year old surgeon Ross Bengtson scrubs in before surgery atSt. Joseph's Medical Center in Brainerd. Bengtson, a Brainerd resident,has been with SJMC and Brainerd Medical Center for nearly one year.

AMARILLO, Texas — No hospital roomcompares to your own bedroom — espe-cially when your room has red, orange,yellow and green walls.

That’s 12-year-old Wendy Weatherly’sroom, and she was glad to return to it.

“It was so great,” Wendy said. “There’snothing like home.”

Wendy, a seventh-grader, returned toAmarillo on March 27 after undergoing 13hours of surgery in Philadelphia tostraighten her spine curved by scoliosis.

Surgeons removed staples from a previ-ous procedure, then inserted rods intoher spine to straighten it.

Doctors had hoped that fall’s pioneer-ing procedure would straighten Wendy’sspine without the traditional rods, but X-rays earlier this year showed that hercurve was getting worse and she’d needthe rods.

For now, Wendy is continuing her stud-ies at home as her spine fuses perfectly

straight.“Every day is a little bit better, but every

day has its challenges,” Wendy said.She doesn’t remember much about the

first few days after surgery. But that didn’tstop her from communicating with family— her fingers remembered sign language,even when a tube in her throat wouldn’tlet her talk.

“I guess God just provided a way to talkto my parents through sign language,”Wendy said.

Family members back in Amarillo alsocontributed to her recovery, said hermother, Karla Weatherly. When Wendy’sblood count was low, a local blood bankshipped blood that her grandfathers haddonated.

Four hours after the transfusion started,the 12-year-old felt much better and wasready to watch some television.

“She got some very powerful grandfa-ther blood,” Karla Weatherly said.

But Wendy also gets strength from ahigher source, the family said.

“It comes from God — really it does,”Wendy said.

She doesn’t know why all this has hap-pened to her, but Wendy trusts that she’llfind out someday.

“(God) has a reason, and he’ll tell mewhen I get to heaven,” she said.

Wendy has also been comforted by thephone calls and cards from people literal-ly around the globe — even from perfectstrangers.

“It’s such a nice feeling to know thatpeople care,” she said.

Wendy will wear her brace — now apsychedelic pink and purple one — forthree more months, she said.

Her dad, Brent Weatherly, said he’s gladhis daughter is home.

He is grateful for all of Wendy’s doctors.“I’m glad there’s people like that

around,” he said.

Story/Jennifer Wilson Morris News Service

Life after spinal surgery: A 12-year-old’s recovery

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A day in the life of a surgeon

Wearing special glasses to magnify images, Dr. Ross Bengtson cut through layers of tissue while he made his way to the carotid arteryof his patient’s neck, being careful of nerves en route.

Story/Jenny Kringen-HolmesPhotos/Nels Norquist

With a John Mayer CD playing in the back-ground, Dr. Ross Bengtson makes his first inci-sion along a 53-year-old man’s neck, workinghis way through the layers of tissue to thecarotid artery.

It’s the first of four surgeries on Bengtson'sschedule at St. Joseph’s Medical Center inBrainerd on this Thursday afternoon.

The 32-year-old surgeon may look young at

first glance, but Bengtson’s knowledge and tal-ent far exceed his age.

With the consent of Brainerd MedicalCenter, St. Joseph’s Medical Center and sever-al patients, this reporter followed a local gen-eral surgeon during a typical Thursday shift inMarch.

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Inside the stressed outStory/Jane E. AllenLos Angeles Times

As a high-level executive for a large computer manufac-turer, Dan Bishop was a self-described workaholic whothought he was ably juggling daily demands and corporatepressures. Then he woke up one night with tightness in hischest, barely able to breathe. At first he suspected a heartattack. The tightness quickly passed, but he was frightenedenough to see his doctor.

The doctor diagnosed an anxiety attack — caused bystress — and told him to “stop being so driven.”

“I didn’t know what stress was; I didn’t think I had stress,”said Bishop, now 52, referring to the 1990 diagnosis.

As Bishop found, stress can be insidious.The pressures of daily life — jobs, relationships, money,

raising children and now, war and terrorism — havebecome such constant companions that many of us oper-ate with ever-present feelings of pressure, anxiety orburnout.

The stress can become so unflagging that many peoplehave accepted it as a standard part of life. Although we maytry to ignore its presence, stress doesn’t go away. It justgoes to work inside the body.

Prolonged stress contributes to many physical and psy-chological ills. It overrides natural defenses against virusesthat cause AIDS, chickenpox and the common cold;encourages the production of inflammatory hormonesthat drive heart disease, obesity and diabetes; sparks flare-ups of rheumatoid arthritis and digestive disorders; createsdepression and ages the brain.

“Numerous studies show that psychological stress canlead to illness, or even death,”said Dr. Michael Irwin, direc-tor of the Norman Cousins Center forPsychoneuroimmunology at the University of California,Los Angeles’ Neuropsychiatric Institute. “How we copewith stress and whether or not we get depressed is crucialfor our health.”

Unchecked stress sends out complex signals thatunleash a cascade of activity throughout the body.

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But chronic stress opens the floodgates to epinephrineand norepinephrine, regardless of whether there’s a threat,allowing bacteria, viruses or tumors to flourish and makingblood more prone to clotting.

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The brain’s other reaction comes through the pituitarygland, which sends signals through the bloodstreaminstructing the adrenal glands to release the stress hor-mone cortisol and other steroids. In the right amounts,cortisol helps the body recharge, enhances disease resist-ance, fights inflammation and improves memory.

In excess, however, cortisol promotes the accumulationof abdominal fat, suppresses immunity, shrinks brain cellsand impairs memory.

Over time, cells become less sensitive to the protectiveeffects of cortisol, and inflammation goes unchecked.

Scientists are only now beginning to understand whathappens when stress disrupts the delicate interplaybetween the brain, the endocrine system — the glands andorgans that make and release hormones — and theimmune system, stimulating the release of compoundsthat cause inflammation.

They’re also beginning to identify ways to stop thisinflammation and other stress-related biological effects.

“New treatments that teach us ways to relax and copewith daily stress offer great promise in decreasing the riskfor many preventable illnesses,” Irwin said.

Recent research has identified some of the followingways in which stress influences the course of illnesseslinked to viruses, aging or the body’s misguided attack onits own tissues.

Physical or mental stress can take an enormous andsometimes deadly toll on the heart. It increases bloodpressure, narrows blood vessels and causes blood tobecome stickier and more likely to clot, increasing the like-lihood of a heart attack or stroke.

In February, Irwin published a study in the AmericanJournal of Psychiatry showing that stress and depression inheart attack patients increase amounts of chemicals thatmake certain immune cells sticky and help them travel toartery linings, where they produce inflammation and pro-mote coronary artery disease.

A study published last week in the journal Circulationfound that mental stress also triggers irregular heartbeats,which can be deadly.

Stress can certainly give you butterflies or a stom-achache, but chronic stress can trigger flare-ups of irritablebowel syndrome, an intestinal condition that includescramping, gas, diarrhea and constipation.

Women with the condition (who vastly outnumber men)not only have elevated levels of cortisol, but also haveexaggerated differences between the higher morning andlower evening levels found in healthy people, Italianresearchers reported in 2001.

Although stress is no longer believed to cause ulcers(they’re sparked by an infection of the bacterium H. pylori),it can worsen symptoms.

HIV-infected gay men who keep their sexual orientationsecret get sicker and have shorter life spans than gay menwho are more open about their sexuality, a 1996 studyfound. Closeted gay men tend to be shyer and their nerv-ous systems overreact to stress; as a result, their bodiespump out more stress hormones, which encourage thevirus to multiply.

severity of a patient’s sleep apnea. If acertain criteria is met, technicians quiet-ly enter the patient’s room, and wakethem up just enough to slip on a contin-uous positive airway pressure mask orCPAP.

CPAP is a machine that delivers airinto the airway through a mask wornover the nose. The mask’s airflow createsenough pressure that when a patientinhales their airway stays open, allowingthem to breathe easily, without snoring.

CPAP is considered the most com-mon and most effective non-surgicaltreatment for the alleviation of snoringand sleep apnea. Even Greatens andWills wear CPAP at night.

“I used to wake up with bruises frommy wife elbowing me,”Wills joked abouthis loud snoring that accompanied hissleep apnea. “Now it’s a whole newlifestyle. It can change people’s lives.”

Tousignant agreed.“It was just like a different me,” she

said following her night at the sleep cen-ter where she used CPAP for the firsttime. “I felt very refreshed.”

After looking over the test results anddiscussing options with Greatens themorning after the study, Tousignant wassold on CPAP. She got one the very next

day.“I was almost anxious to go to bed just

to put it on,” she said.Other sleep apnea treatment options

include surgery and oral applianceswhich pull the lower jaw forward, keep-ing the airway open. Greatens said othersleep disorders can be treated withmedication.

Sleep apnea affects 14 percent of menand more than 2 percent of women.Obesity, smoking and drinking alcoholcan contribute to sleep apnea, whichcan affect cardiovascular health by caus-ing high blood pressure, heart diseaseand stroke. Greatens said anyone withsleeping problems is prone to depres-sion as well.

“Education is a big part of what wedo,” Wills said, encouraging people tolearn about and get treated for theirsleep disorder early.

Tousignant said getting treated forsleep apnea has changed her life.

“Don’t drag your feet — if you thinkyou have a (sleeping disorder), getchecked,” she said.

Other sleep labs are located inDuluth, St. Cloud and the Twin Cities.

Continuous positive airway pressure mask, orCPAP, is considered the most common and mosteffective non-surgical treatment for the alleviationof snoring and sleep apnea.

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When Paul M. Ribisl needed his secre-tary to photocopy exams at Wake ForestUniversity 30 years ago, she had to typethe questions, walk them to a mimeo-graph machine, then manually crank outcopies. When he needed a letter typed,she would walk to his desk, take short-hand, return to her desk to type the letter,walk it back to him to proofread, then walkback to retype it if there were corrections.

Today, however, a copy machine col-lates, staples and bundles exams in min-utes, and Ribisl can type letters and e-mailthem to colleagues, saving his secretary allthose steps.

“You can look at every part of some-one’s life and see that the physical drudg-ery has been taken out of it,” said Ribisl,who now chairs the health and exercisescience department at the university inNorth Carolina. “People are stuck at theirdesks more.”

Along with super-size fries and the TVremote, the workplace has become a cul-

prit in the great American weight gain. Arecent study released in the Journal of theAmerican Medical Association concludedthat poor diet and lack of exercise couldsoon surpass tobacco as the leading pre-ventable cause of premature death in theUnited States.

The economy has become dominatedby sedentary office work. Technologyallows — even requires — workers toremain in a chair all day, staring at a screen.Ever pressed for time, workers seem con-stantly to be scarfing down junk food onthe run or grazing at their desks. Improvedtechnology — from conference calling toinstant messaging to Internet-cams —makes communication ever more possi-ble without leaving one’s seat.

The result: Gaining weight has becomethe latest occupational hazard.

Americans on average expend about200 to 300 fewer calories a day than theydid 25 years ago — or about 7,000 fewercalories a month, he said. The change

years ago from manual typewriters tocomputers, by one estimate, caused theaverage full-time secretary to gain 5 to 10pounds a year.

“There’s a huge decrease in metabolismthat you get when you’re just sitting atyour desk all the time,” said Scott Collier,an adviser and instructor in SyracuseUniversity’s exercise science departmentwho directs an exercise program for theuniversity’s staff.

Stress from work, many experts say, isalso greater, fueled by such things as thepush for greater productivity and thethreat of outsourcing and downsizing.Stress lowers metabolism, making ittougher to burn calories. And cell phonesand e-mail at home and on the road canmake work seem omnipresent.

“Our work force has become more andmore sedentary every single year as tech-nology advances. I think at this point we’revery chair-bound, between the phone andthe computer,”said Chris Corcoran, senior

Sitting is a spreading occupational hazardStory/Stacey HirshBaltimore Sun

out what the underlying problem may be.Overnight sleep studies are done three

nights per week at the center. Overnightstudies are recommended for most sleepdisorder sufferers in order to find out theextent of their problem and how it can befixed.

“We try to know what the problem isbefore the sleep study,” Greatens said.

Of the more than 80 sleep disordersout there, including insomnia, narcolep-sy, sleep walking and recurring night-mares, obstructive sleep apnea syn-drome is the most common disordertreated at BMC’s sleep clinic.

“That’s probably the bread and butterof the lab,” John Wills, sleep lab managersaid.

Extremely loud snoring, pauses inbreathing and falling asleep at inappro-priate times are signs of sleep apnea, apotentially life-threatening disorder.

Snoring occurs when the muscles in aperson’s throat relax too much, narrow-ing the airway. When air is forcedthrough the narrowed passageway, itresults in a snoring sound. For most peo-ple the narrowing is not a problem, but

for people with sleep apnea it makesbreathing difficult, causing them to stopbreathing for a period of time whilesleeping. When the brain senses theincreased difficulty to breathe, it wakesup just enough to tighten the throat mus-cles, allowing air to get through effort-lessly.

Tousignant’s brain had to remind her tobreathe 112 times per hour during hersleep study, Greatens said, resulting inher never feeling like she got a goodnight’s sleep.

Before being diagnosed with sleepapnea, Tousignant took a nighttime coldmedication to help her sleep at night.

“It helped some, but not with the toss-ing and turning,” she said. “I’d have todrag myself out of bed in the morning. Ihad no energy whatsoever.”

Tousignant admitted when she andGreatens decided a sleep study neededto be done she was nervous, but anxiousby the mere thought of sleeping well.

Patients arrive at the sleep clinic at 8:30p.m., change into their pajamas and relax.A sleep technician places sensors on thepatient’s head, temple, jaw, neck, chin,

nose, chest and legs to monitor the bodyand its sleeping habits, such as heart rate,breathing, snoring and leg movement.The sensors transmit information into acontrol room, manned by sleep techni-cians all night long.

“I thought I would fight with the wiresall night, but I couldn’t even tell I hadthem on,” Tousignant said.

The sleep center, part of BMC’s newlycompleted $9 million expansion project,has a hotel-like feel, with a lounging area,kitchen and four private bedrooms withtelevisions and attached private bath-rooms. The comfortable beds and casualdecor gives the sleep center a homeyfeel, except for the microphone abovethe bed and the infrared camera attachedto the bedroom wall. Although the hard-ware looks discreet, it plays a major partin the sleep study’s success.

For two hours technicians closely mon-itor each patient, watching them on asmall TV screen, listening to their breath-ing, snoring and studying the informationthe sensors reveal.

When two hours is up, enough infor-mation is gathered to determine the

John Wills, sleep lab manager, studied the information gatheredduring an overnight sleep study. A video camera and microphoneare in each sleeping room, allowing sleep technicians to carefullymonitor the patient’s sleeping and snoring habits.

Patient rooms at Brainerd Lakes Sleep Health Center resemble a hotel roomwith a private bathroom and television.

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thru June 30th, 2004

Ahh, the feeling of utter exhaustion. Whenyou’re so tired it takes all your might to even pull

the bed sheets back. After sliding into the comfortzone, your head gets lost in your pillow and you

can’t help but let out a sigh. We’ve all been there.

Suddenly a permeating noise comes out of the lumpon the other side of the bed. In and out. In and out. With

each breath you lose a little more of that comfort and relax-ation you felt when you first climbed into bed.We’ve all been there too.

Snoring. About 10 to 30 percent of adults do it, and for somesnoring is more serious than just being an annoyance to their bed

partner.When Ann Tousignant and her family vacationed together they’d sleep

in separate hotel rooms.For as long as she could remember, Tousignant said her family and friends

would tease her about snoring so loudly no one within an earshot could sleep.But it wasn’t until about a year and a half ago that Tousignant realized some-

thing was wrong.She’d toss and turn all night. She’d go to bed at 8:30 p.m. and have to drag

herself to get up at 7 in the morning, never feeling the least bitrefreshed.

The 49-year-old daycare provider had no energy and was so worn-out it was starting to affect her personal and professional life.

“Finally, I just got tired of being tired,” she said.So Tousignant met with Dr. Todd Greatens who specializes in sleep and

pulmonary medicine at Brainerd Medical Center. Greatens rec-ommended Tousignant undergo a sleep study at BrainerdLakes Sleep Health Center, BMC’s new sleep center.

Before a patient such as Tousignant visits Greatens,a 10-question survey regarding sleeping habits mustbe done. A patient also has to complete a sleep log,

stating when they go to bed and wake up and how many hoursthey thought they actually slept. At the initial consultation, Greatens

goes over the questionnaire and talks with the patient, trying to figure

marketing manager for WeightWatchers International Inc.

A study last year of the Amish, a ruralpeople whose culture forgoes the luxu-ries of modern technology, showedthey are far leaner than mostAmericans as a result of the lifestyle. Astudy published by the AmericanCollege of Sports Medicine inIndianapolis concluded that only 4 per-cent of Amish were obese and 26 per-cent were overweight, compared to thegeneral population, in which 31 per-cent registered as obese and 65 percentas overweight. Some of the Amish, whoagreed to wear pedometers for thestudy, walked as many as 18,000 steps —the equivalent of nine miles a day.

The work-weight connection is notmerely about lack of physical activity.Many workers are spending more timeat the office. A survey by the Web clas-sified site Monster.com of more than17,500 people concluded that 46 per-cent work about 40 to 50 hours perweek and 25 percent said they work 50hours or more.

“We certainly have more stressed

lives, longer work hours for many of us,and less opportunity for being physi-cally active,” said Lawrence J. Cheskin,associate professor at the JohnsHopkins Bloomberg School of Healthand director of the Johns HopkinsWeight Management Center inBaltimore.

Poor eating habits at work com-pound the problem. About two-thirdsof Americans eat lunch at their desk,while more than 60 percent of workerssnack throughout the day, according toa survey last year by the AmericanDietetic Association and ConAgraFoods, the Omaha, Neb., food con-glomerate.

Moreover, with a preponderance ofboth sexes working outside the home,people turn more to prepared foodsfrom groceries or restaurants. Carryoutfoods in general contain more fat andsugar than home-cooked meals, andoften come in larger portions. Theoffice itself is laden with opportunitiesfor eating, from birthday cakes togoing-away celebrations.

A desk can even become a psycho-

logical cue for food cravings — likepopcorn at the movies, said ThomasWadden, director of the weight andeating disorders program at theUniversity of Pennsylvania School ofMedicine.

While businesses frequently requesthealthier foods in their vendingmachines, those snacks often costmore and don’t sell as well as thecheaper, more caloric items.

“They’re still big candy eaters. Theystill drink a lot of soda,” said GaryDesenberg, a sales and service manag-er at A. Kovens Vending, a Pennsylvaniacompany that supplies and stocksvending machines.

Some workplaces are trying tobecome part of the solution.Offices,factories — even sawmills — are host-ing aerobics workouts or contractingwith groups like Weight Watchers toconduct weight-loss classes. Someemployers now distribute pedometersto motivate workers to walk, even if itmeans taking a bathroom break onanother floor to squeeze in some extrasteps.

Story and photos/Heidi Lake

CPAP provides restful nightsfor sleep apnea sufferers

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Residents of the lakes area will soonhave another choice when making healthcare decisions.

The Brainerd Lakes Surgery Center isslated to open this fall in Baxter, providingoutpatient, or same day, surgery servicesto the community.

The surgery center, currently being con-structed, is located off Highway 371 nearthe bypass. It will house four operatingrooms as well as one procedure room.

Dr. Kurt Waters, a physician and facialplastics surgeon at Brainerd MedicalCenter, is a surgical partner in the facility.W

ture between the surgical community andSt. Joseph’s Medical Center in Brainerd.

Waters said the facility will offer state-of-the-science technologies in a conven-ient location.

“From a convenience standpoint, it’ll begreat for patients,” he said. “It’s ourresponse to the growing needs of ourmedical staff and our community.”

The services to be offered at the surgi-cal center mirror many of those currentlyoffered on a same day surgery level atSJMC, including general surgeries, oph-thalmology, ear nose and throat, orthope-

Waters said he hopes the center willexpand in the near future to also includepain management and various women’sservices.

All minimally invasive and outpatientsurgical procedures will be done at thesurgical center. All invasive proceduresthat require a hospital stay will remain atSJMC where inpatient and outpatientcare, as well as additional technology andsupport services are available to ensurethe patient receives the best possible care.One thing that will be a constant at bothsites is that a board-certified anesthesiolo-

Local doctors team up to openoutpatient surgical center

The Brainerd Lakes Surgery Center will open this fall in Baxter, providing outpatient surgery services to the communi-ty. The surgery center will be located off Highway 371 near the bypass. The facility is a joint venture between the sur-gical community and St. Joseph’s Medical Center in Brainerd and will offer state-of-the-science technologies.

Story/Jenny Kringen-Holmes

8aters explained the facility is a joint ven- dics, podiatry, plastics, and urology. gist will oversee each case.

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A job well doneThe fact that Botox injections are now

the No. 1 non-surgical cosmetic proce-dure in the United States proves the drugis getting and giving not only the aesthet-ic, but also the medical results people areseeking.

Carissa Peterson’s story has especiallyreinforced Elieff’s confidence in this oftencontroversial drug. Elieff said he treatsseveral patients with conditions similar toPeterson’s, but says her case was one ofhis first and remains one of his favoritesuccess stories.

“It’s something people need to knowabout,” Peterson added. “Had I not dis-covered (Botox) I’d be miserable. If some-thing can help you, you don’t really haveto be ashamed of it.”

Not only is Peterson free of shame,she’s also ready to show off what has beenhidden under bulky shirts for too long,noting she will be wearing a straplessblack dress to prom this spring.

“It has changed my self-esteem andconfidence,”Peterson said. “Getting stuckfor 15 minutes can change the rest of yourlife.”

What is Botox?Botulinium Toxin, or Botox, was dis-

covered by accident at a Belgian picnicin 1895 when 34 people ate sausagescontaminated with a lethal substance(later known as Botulism) and, subse-quently, three died. Botulism isdefined as an anaerobic, spore-form-ing bacteria that, under the right con-ditions, can germinate and create tox-ins. After being isolated, purified andexperimented with by scientists, thefirst batch of toxin for human use wasprepared in 1979. The Botox procedurehas been widely used and is consid-ered a safe, effective way of treatingaging skin. Previously approved for thetreatment of lazy eye and eye spasms,Botox was approved by the Food andDrug Administration for the treatmentof frown lines between the eyes, alsoknown as glabellar lines, in 2002.

How does it work?The Botox procedure works by

weakening facial muscles related to

expression lines. The constant contrac-tions of those muscles result in wrin-kles. Botox blocks the impulses fromthe nerves to the facial muscles there-by relaxing them, resulting in asmooth, unwrinkled look.

What does it cost?Each treatment can cost anywhere

between $100 and $800, or more,depending on the affected area to betreated and the units of Botox used.

Where is Botox available?Any authorized health care profes-

sional can administer Botox, includingdermatologists, plastic surgeons andother cosmetic physicians. Localproviders include Dr. Kurt Waters atFacial Plastics at Brainerd MedicalCenter; Dr. Daniel Elieff of MidwestClinic of Dermatology, Laser andCosmetic Surgery in St. Cloud; andMidsota Plastic and ReconstructiveSurgeons with physician servicesoffered at St. Joseph’s Medical Center.

Centers of excellenceThe decision to open an ambulatory

surgery center has been a long time in themaking. Waters said he and several othersurgeons decided to pursue the opportu-nity with the support of SJMC.

“Obviously there are communitieswhere hospitals and doctors compete,but that’s not the case here,” Waters said.

Thomas K. Prusak, SJMC president,said, “SJMC and the physicians are veryexcited about the future of the ambulato-ry surgery center and the development ofa medical park to meet the current andfuture needs of the community.”

Prusak said the development of thesurgical center will enable SJMC and thephysicians to develop two centers ofexcellence for the area.

“It was more patient driven than any-thing,” Waters explained. “This center willprovide convenient, easy access and willcontinue to uphold patient privacy.”

Along with the operating and proce-dure rooms, the center will providepatient care suites where the patient andtheir family will begin the process and pre-pare for surgery. The family will also beallowed to wait in that suite until theirloved one is returned from recovery.

There will also be a refreshment center forfamilies to utilize and a children’s playarea. Waters also noted a separate recov-ery area for pediatric patients where fami-lies will be allowed to rejoin their childrenfollowing surgery.

Minimally invasive proceduresWaters said the surgical center will give

surgeons the opportunity to perform min-imally invasive procedures, making small-er incisions and performing surgeries tele-scopically. That means less discomfort anda quicker healing time.

“We’re all trying to reduce health carecosts,” Waters noted. “Surgical centers

have the ability to reduce those coststhrough copays and deductibles. So thatwill also be nice for our community.”

But the bottom line is continuing toprovide quality services in a timely man-ner to the entire community, Waters

emphasized.“This center coincides with what’s

going on in other communities. Wehave the same quality surgeons as inother cities. We just want the same facil-ities to offer those services in.”

And the medical community’s growthwon’t necessarily stop with the comple-tion of the surgical center. Prusak out-lined SJMC’s plans for a medical park inBaxter.

“The lakes area is growing and so isthe demand for medical services,” hesaid. “To meet the long-term needs ofthe community, we are developing a

medical park located close to the majorhighways and retail outlets so that we canprovide services that are convenient andeasily accessible.”

Examples of future services at the med-ical park, Prusak said, include a clinic,physician offices and other outpatientmedical services.

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The other side of BotoxWhile Botox has provided relief to

those suffering with chronic disorders,the drug has gained popularity mostly forits cosmetic contributions.

Hollywood stars have helped launchthis drug into superstardom. Accordingto the Cosmetic Surgery Times publica-tion, more than 2 million Botox proce-dures were done in the United Statesduring 2003 alone. And Elieff predicts thatnumber will double after the turn of 2004.

Elieff explained Botox temporarily par-alyzes muscles at the injection site dis-abling the individual to create the linescaused when raising their eyebrows,squinting or frowning. Botox is used bymany newscasters, actors and politicians“to eliminate those facial miscues peoplecan see,” he added.

Tracy Blumberg, a 28-year-old St. Cloudwoman, began having regular Botoxinjections about two years ago after beingtold she had hyperanimation of her facialmuscles. Without being consciouslyaware, Blumberg would excessivelysquint or frown, giving those around hermiscues about her temperament.

“People would think I was mad when Iwasn’t,” she said.

Elieff suggested Blumberg try Botox to

prevent her facial muscles from contract-ing.

“I’d heard a lot of good things about it,”Blumberg said. “So, I tried it. And I lovedit.”

And now, she admits, she’s hooked.Results, which typically take about 72hours to appear, last between two tothree months before another treatment isnecessary.

“It doesn’t hurt at all,” Blumberg said.“The first sensation, when the needlegoes in, feels like a pin prick. And you canfeel the Botox being injected into themuscles. But it’s just so quick. I loveBotox. It’s my best friend.”

An admitted Botox user himself for thepast 10 years, Elieff said the three mostpopular areas where Botox is injectedinto the face include the forehead; theglabellar, or area between the eyes; andon the outside of either eye where lines,nicknamed crow’s feet, develop. Thenumber of necessary injections per ses-sion to treat lines depends on the mus-cles and areas being treated as well as theindividual, but usually range from five toseven.

“It’s just super, super dramatic stuff,”Elieff said, adding each Botox session inthe facial area is done in a matter of min-

utes with affects to be seen for months.Other areas that can be injected for

cosmetic purposes include the tip of thenose, drooped lower lips, in aging neckmuscles and, believe it or not, to saggingbreasts to provide more lift.

When opening his practice eight yearsago, Elieff said only a couple viles of Botoxwere kept in stock. Now, his clinic keepsa couple dozen in the refrigerator fortheir continually growing client base.

While approximately 90 percent of hisBotox clients are female, Elieff said moremen are catching on to the craze. Theaverage Botox users at this St. Cloud clin-ic are women in their mid-30s to mid-40swho are concerned with reducing thesigns of aging.

“One thing we see a lot of is the peoplewho come in for Botox don’t want to cre-ate a stroked-out, paralyzed face,” Elieffsaid. “They want to retain some motion ofthe facial muscles, but soften the wrinklesand lines.”

Elieff stressed the importance of agood overall familiarity with the anatomywhen administering Botox. If injectedinto the wrong place, Botox can causestroke-like affects, including paralysis oflimbs and facial muscles as well as droop-ing eyelids.

Before . . .

. . . and after

After getting Botox injected in her forehead, Tracy Blumberg was unableto use the muscles that move her eyebrows. The Botox procedure weak-ens facial muscles that are related to expression lines. Botox works byblocking the impulses from the nerves to the facial muscles, relaxingthem. The result is a smooth, unwrinkled look.

Midwifery

Brian and Shelly Crenna ofRoyalton welcomed thenewest addition to their fam-ily, Levi Thomas Crenna, atCentraCare clinic in LongPrairie. The Crenna’s used themidwifery program duringtheir pregnancy, but when aCesarean Section was need-ed, a doctor was called in toperform the procedure.

A parent’s alternative to hospital birthing

S

LONG PRAIRIE — With teary eyes you clutchyour coach’s hand. Sweat beads gather on yourbrow and you can’t help but smile at the thoughtof your child being born.

Having a baby is the happiest day of many peo-ple’s lives. Although known for being ratherpainful, giving birth in a calm and relaxing atmos-phere could help ease the stress of the laboring

0tory and photos/Heidi Lake situation.

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ST. CLOUD — All Carissa Petersonwanted to do was live a normal life — a lifewhere this bubbly 17-year-old could befree to wear clothes of her choice withouta constant feeling of self-consciousness.Instead, the Sartell High School studentwas forced to wear sweatshirts and darktops to hide an embarrassing excessivesweating condition, also known as hyper-hydrosis. That is, until she learned aboutthe medical uses for the increasingly pop-ular drug, Botox.

It was the eighth grade when CarissaPeterson realized her excessive sweatingwasn’t normal.

“It’s not something you really talk toyour friends about,” the blond-haired,blue-eyed girl said. But after literally beingdrenched in sweat during stationary activ-ities from watching movies to sitting inclass, Peterson said she’d had enough. “AllI wanted to do was be able to wear a littleblue T-shirt,” she commented, adding thesweating condition forced her to hideunder bulky sweatshirts and dark colors.

Her involvement in the Sartell SabresDance Team was even affected as hersweat glands were kicked into an evenhigher gear when active and sweat was vis-

ibly obvious on costumes.“Literally, every shirt she bought before

this was based on the excess sweating,”said mom Cindy Peterson. “I started wor-rying about her wearing sweatshirts all thetime. And I knew (the sweating) wasn’tcaused by her being hot.”

Cindy contacted Carissa’s pediatricianwho diagnosed the hyperhydrosis andprescribed her a heavy duty antiperspi-rant. Carissa even tried an electronicdevice that, when applied, would send aseries of painful shocks into her arm. Butnothing seemed to help.

Until one day, paging through aSeventeen magazine, Carissa says shecame across an article regarding the use ofBotox to treat conditions like hers. Afterconsulting her pediatrician on the infor-mation she read, Peterson was referred tothe Midwest Clinic of Dermatology Laserand Cosmetic Surgery in St. Cloud.

Dr. Daniel Elieff, owner of the eight-year-old private practice with offices in St.Cloud and Alexandria, gave this young girlhope that with the use of Botox, the sweatproduction could be controlled.

For the last two years Peterson hasundergone Botox injections every three to

four months. Each session entails approxi-mately 20 to 30 punctures into eacharmpit. Once injected, the Botox partiallyparalyzes the muscle that is to blame forputting pressure on the sweat glands andcausing them to contract. Each injection isdone with a 30 gauge needle, smaller indiameter than an insulin syringe, to mini-mize invasion and discomfort.

Lying flat on an exam table while eachinjection is made, Peterson takes eachpoke and prod in stride.

“You just have to tell yourself that it’snot that bad,” she said, likening it torepeated pricks with a safety pin. “But it’stotally worth it.”

Each injection is superficial, Elieff said,explaining the small needle penetrates thedermis, or second layer of the skin.

Because the treatments have provenclinical benefits, each of Peterson’s visitsare covered under her family’s healthinsurance policy.

Other medical purposes for Botox haveincluded treating lazy or crossed eyes,headaches, club foot disorder and evenfor Peterson’s cousin who has cerebralpalsy and finds relief from chronic muscletension with help from the powerful drug.

Dr. Daniel Elieff of MidwestClinic of Dermatology Laser andCosmetic Surgery in St. Cloud,administered Botox injections inCarissa Peterson’s underarmarea. Peterson, 17, suffers fromhyperhydrosis, or excessivesweating, and found Botox helpscontrol the condition.

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Previous page photo: TracyBlumberg, 28, has received Botoxtreatments in her forehead andbetween her eyes for the pasttwo years. The St. Cloud residentsaid the procedure has become“addictive.”

The nurse-midwifery program atCentraCare clinic in Long Prairie pridesitself at putting the comfort and well-being of moms and their families first.

“I want to help people be healthy andhave healthy babies,” said Ruth Wingeier,Long Prairie’s certified nurse-midwife.

Two large birthing suites resemble hotelrooms, complete with a couch and nightstand. Medical equipment is hiddenbehind pictures on the wall, making therooms feel inviting.

“We try to keep moms from beingafraid (of giving birth) because it tends tomake labor take longer,” Wingeier said.“The rooms are calm, relaxed and com-fortable.”

Wingeier said she averages 11 or 12deliveries per month, and the interest inmidwife-aided births seems to be on therise, with more than 20 babies born underWingeier’s care in the month of March.

Long Prairie’s clinic will soon be hiring asecond midwife and will possibly addanother birthing suite, due to the contin-ued popularity of midwife-assisted births.

The birthing suites have private bath-rooms with whirlpool bathtubs allowingexpectant mothers to labor, or actuallygive birth in the water.

Wingeier said about one-third of herexpecting patients choose to give birthunder water, an option first offered atLong Prairie three years ago.

“(The water) helps moms relax and ismore calming for the baby,” she said.

Babies are in water while in the womb,and to be born under water eases theirtransition of entering the world andbreathing on their own, Wingeier said.

CentraCare clinic in Long Prairie, havingone of the oldest midwifery programs inMinnesota, even makes house calls.

Wingeier said women who have had nocomplications during their pregnancy, orhave many children and are prone to hav-ing quick, easy labors often opt to givebirth at home, with the assistance of amidwife.

“Some people just don’t like all theintervention they get at a hospital,”Wingeier said.

Others just like the feeling of gettingpersonalized health care.

Debbie Sauer, 42, on the verge of havingher eighth baby, used a midwife while hav-ing all but two of her children.

“(Midwives) are less routine than doc-tors,” Sauer said. “They give you optionsand respect your wishes. I feel more con-

fident in their care.”Wingeier said she educates women and

encourages them to make their own deci-sions during pregnancy, often times usingalternative methods such as herbs andnutrition instead of medication.

“Midwives attract people who wantalternative methods,” Wingeier said.

Shelly Crenna wanted to give birth toher second child at home, but her hus-band, Brian, wasn’t comfortable with theidea. So the Royalton couple decided tocompromise and use Long Prairie’s mid-wifery program.

“I wanted a home birth because hospi-tals scare me,” Shelly Crenna said. “I want-ed something more personable (than adoctor’s office).”

Fifteen days overdue, weighing in at 10pounds, 6 ounces, Levi Thomas Crennaentered the world via Cesarean Section.

Each mom under midwives care has aconsulting physician in case of complica-tions.

If a C-section is required, if pregnantwith multiples, or if there are other riskfactors, the doctor is called in and the mid-wife assists during the birthing process.

“Sometimes you just need two sets ofhands,” Wingeier said.

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Appointments with a midwife atCentraCare clinic are 20-30 minuteslong, giving Wingeier and her patientsplenty of time to talk and get to knowone another, something both Wingeierand her patients enjoy.

“Right now I’m delivering the daugh-ters I delivered,” Wingeier said with asmile.

With a bachelor’s degree in nursingand a master’s in nurse-midwifery,Wingeier spends much of her day pro-viding prenatal, postpartum and new-born care, and also provides routinegynecological care.

Wingeier is on call 24-hours a day andrarely has time to catch her breathbetween laboring and birthing patientsas well as doing regular patient check-ups. She gets calls in the middle of thenight, regardless of weekends or holi-days. But with more than 20 years expe-rience as a midwife, Wingeier said help-ing women stay comfortable while giv-ing birth to healthy babies makes it allworth while.

Ruth Wingeier, cer-tified nurse-mid-wife at CentraCareclinic in LongPrairie, checkedSheila McCoy’sbaby for problemsfollowing a car acci-dent the previousnight.

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From the editorThe medical field never ceases to

amaze me. Even right here in theBrainerd lakes area, medical profes-sionals perform what I call miraclesevery single day.

To go to work and cure someone ofa plaguing disease or illness or to savelives through emergency surgery, issomething my mind can hardly grasp.For many in the medical profession,this is everyday life.

This issue of HealthWatch followsthe amazing acts performed at local

hospitals and clinics, from the heroicsof a surgeon, to delivering babies, tocuring sleep disorders.

To the doctors, nurses, paramedicsand everyone who has a hand in med-ically improving the lives of others,don’t take your job for granted. Youtruly are miracle workers.

Publisher — Terry McColloughAdvertising Director — Mary PanzerEditor — Heidi LakeCopy Editor — DeLynn Howard

HealthWatch is a quarterly publica-tion of the Brainerd Dispatch.

Read HealthWatch online atwww.upnorthhealthwatch.com.

For advertising opportunities callMary Panzer at (218) 855-5844.

E-mail your comments toheidi.lake@brainerddispatch.com orwrite to:

Heidi LakeBrainerd DispatchPO Box 974Brainerd, MN 56401

Who we are

Cover photo/Nels Norquist

Any first-grader can tell you that if youdon’t brush your teeth, creepy sugar“bugs” will take over and cause cavities.

But not all of the bugs, or microbes, inthe mouth actually affect oral health. Andnot all of them are bad.

A vast and diverse community of micro-scopic organisms — including viruses,bacteria, fungi and protozoa — thrive inthe mouth, scientists are learning. Someof them may play important roles in pre-serving health and causing diseases, saysDr. David Relman, an associate professorof microbiology at Stanford University.

“We already know so much about somany disease-causing agents that it tendsto give you the feeling that there is no rea-son to be going out and trying to find oth-ers,” he says.

But the causes of many diseases remainunknown — and the mouth appears to bea good place to look for clues.

“We are increasingly becoming awareof the connection between the oral cavityand the body,” says Donna Mager, aresearcher at the Forsyth Institute, an

independent research center in Boston.“Whatever grows in the oral cavity couldhave an impact on what happens to thebody.”

Research by Relman and Mager is help-ing to advance this notion.

In his lab, Relman samples the region inthe mouth called the subgingival crevice,the deep space between the gum andtooth. So far, scientists have found morethan 500 bacterial strains or microbes inthis area, and Relman has identified 37others. Other mouth microbes have yet tobe identified, he believes.

Ultimately, researchers want to betterunderstand the patterns and prevalenceof particular microbes and what those pat-terns suggest about a person’s health.

“I think it’s fair to say that the vast major-ity of members of the oral microbial floraare not disease-causing agents. They maybe necessary or important for maintaininghealth,” he says. “Some small subset maybe involved in disease.”

Gum disease, in which gums becomeinflamed, red and swollen because of

plaque deposits on teeth, is probablycaused by several organisms, but no onehas identified all the microbes responsiblefor this common disorder.

Some microbes found in the mouthmay even contribute to disease in otherparts of the body, such as the heart,although those links are still tenuous.

Mager is trying to identify possibly pre-cancerous changes in the mouth’s bacte-ria colony. About half of all people diag-nosed with oral cancer die within fiveyears because the disease is detected atadvanced stages. But if scientists couldfind clues that disease could develop —based on changes in bacteria — theymight be able to intervene earlier, shesays.

“We are tracking the changes in thosecolonization patterns,” says Mager, whoseresearch is in collaboration with the DanaFarber Cancer Institute. “Hopefully, wewill be able to predict which people willdevelop cancer.”

What lives in your mouth Story/Shari RoanLos Angeles Times

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Parkinson’s disease can lock up WilliamStanziano’s muscles so quickly, he says itfeels like a crowbar thrust into a gearbox.

“Sometimes I walk into a Dunkin’Donuts and can’t walk out,” saidStanziano, who may have to wait patientlyfor hours until medication kicks in andloosens his limbs enough to get home.

Four months ago, the 51-year-oldWolcott man went to the University ofConnecticut Health Center, where doc-tors implanted a “brain pacemaker” —electrodes placed deepinside his brain that aredesigned to short-circuitthe errant signals that canimmobilize him.

The procedure, knownas deep brain stimulation,is one of many promisingtreatments that uses elec-tricity to treat ailing minds.

For Stanziano, deepbrain stimulation isdesigned to compensatefor the death of brain cellsthat produce the neuro-transmitter dopamine,essential for many musclemovements. The death ofdopamine-producing cellsis caused by Parkinson’sdisease.

Stanziano’s medicationhad stopped preventingthe muscular lockup thathis doctors call the “off”state, a period when mus-cles are not functioning.The advanced stage of hisdisease and his relativegood health made Stanziano eligible toreceive a brain pacemaker. People withmilder forms of Parkinson’s, dementiapatients and those in ill health are not eli-gible for the procedure, which carries aslight risk of internal bleeding or infection.

After more than a decade of successfultrials, deep brain stimulation has nowentered the mainstream of Parkinson’streatment. Deep brain stimulationrequires two separate operations — oneto implant electrodes deep into thepatient’s brain, and a second to implanttwo hockey-puck-size pulse generators onboth sides of the chest. A hand-held pulse

programmer controls the high-frequencyelectrical signals, which in Stanziano’s caseare sent to each side of the subthalamus,an area of the brain involved in move-ment.

The hardware costs $25,000. The tech-nology is similar to cardiac pacemakers,used to regulate the heart, and vagusnerve stimulation, used to control epilep-sy.

Although deep brain stimulation has ledto a few spectacular successes in unlock-

ing the frozen gaits and ending the debili-tating tremors of Parkinson’s patients, itdoes not cure the disease, said Dr. J.Antonelle “Toni” de Marcaida, director ofthe movement disorders program atUConn.

“There is no real evidence that it isneuro-protective,” she said.

And it doesn’t work for everyone,although in trials eight of 10 Parkinson’spatients have shown improvement thathas lasted more than five years, deMarcaida said.

Stanziano also now realizes that deepbrain stimulation does not work

overnight. Doctors must tinker, some-times for months, with the strength of theelectric pulses and the dosages ofdopamine-replacing medicine to get thebest results. Although doctors can adjustthe strength of the pulse with the hand-held programmer, patients can only turnthe pulse generators on or off.

For Stanziano, the results have beenmixed since he received his brain pace-maker last November. He no longer hasthe residual Parkinson’s symptoms when

he is in his “on,” or morefunctional, state.However, when he is inthe “off” state, his condi-tion is as bad as beforethe operation, he said.

Doctors can’t explainwhy the technologysometimes doesn’t work,because they don’t fullyunderstand why it worksat all.

Some researchers sug-gest electrical stimulationaffects the release of spe-cific neurotransmittersthat compensate for thelack of dopamine, whileothers have argued thatelectrical pulses resetabnormal electrical sig-nals in the brain.

Scientists have knownfor more than 70 yearsthat modifying electricalimpulses in the brain canhave therapeutic bene-fits, said Dr. Sara H.Lisanby, associate profes-

sor of clinical psychiatry and medicaldirector of Columbia University’s depres-sion center.

Deep brain stimulation is an indirectdescendant of some of those early treat-ments, she said.

The earliest use, in electric shock thera-py, has been condemned for the pain andside effects such as memory loss that itafflicted upon patients with mental illness.However, in the past two decades, scien-tists have rehabilitated the procedure, andtoday, targeted electrical convulsive thera-py “remains the most effective treatmentfor depression, period,” Lisanby said.

’Brain pacemaker’ helps Parkinson’s patients’ muscle controlStory/William HathawayHartford Courant

Bill Stanziano wears a "brain pacemaker" and pulse generators in his chest, which helpprovide deep brain stimulation to help his muscles stay loose, thereby counteractingthe effects of Parkinson's disease. Dr. J. Antonelle de Marcaida, at right, adjusts theelectrical signals to the pulse generators.

Photo/Tom Brown

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