One of the Core Values at Orange City Area Health System – Integrity, “do the right thing” – includes “be good stewards of the resources entrusted to you. One of the ways we attempt to do that is through our “green” initiatives, coordinated and promoted by our Green Team. Just as we care for you and your family, we care for the environment, and have launched many programs and practices over the past several years. Some of those practices include: • Recycling – Paper recycling bins are located throughout each of our campuses, and employees are encouraged to recycle everything from magazines to non-confidential documents. – Since beginning our cardboard recycling program, we have saved approximately $40 per month in sanitation fees, and have delivered about 100 tons of cardboard to the recycling facility. – Other regular recycling initiatives include batteries, cell phones, computers, and other electronics. • Styrofoam and other paper products in dietary have been significantly reduced. Our cafeteria only offers Styrofoam containers upon request, and for a fee. To demonstrate the fact that Styrofoam does not decompose for hundreds of years under any normal circumstances, our Green Team created a meal worm aquarium. Meal worms are the only way to break down Styrofoam. Ask our maintenance team to see it sometime! • Between 2007 and 2012 … we eliminated all mercury from our facility … started using coreless toilet paper … switched to “cling” garbage bags in waste- baskets so they can be reused … donated used mattresses to missions … and became a Soles for Souls drop-off location. • Many of our cleaning products are environmentally safe, and we use Grow Green organic fertilizer on our main campus and senior care campus lawns.

Research shows that between 10 and 20 percent of individuals who experience loss also experience more disabling reactions, including Complicated Grief or other conditions triggered by the loss such as PTSD, Major Depressive Disorder, Separation Anxiety Disorder, or substance abuse. Complicated Grief reactions may also be a factor in physical illness. The Hospice Foundation of America’s annual Living with Grief program, “When Grief is Complicated,” looks at how to identify disabling grief reactions and when referrals to trained clinicians or professionals may be indicated. Orange City Area Home Health & Hospice is hosting this free two-hour live webcast on April 27 from 1-3:30pm at the Orange City Area Health System Downtown Campus located at 400 Central Avenue NE in Orange City, in the lower level conference rooms. CE credits are available for professionals for a small fee. To register or for more information call 712-737-5279. We’re excited to announce that Sanford Health’s board-certified cardiologist, Dr. Chris Stanton, is now seeing patients at Orange City Area Health System. Dr. Stanton is a cardiac electrophysiologist who specializes in complex arrhythmia evaluation and management, including SVT, VT, and Atrial Fibrillation Ablation, Pacemaker, ICD implants, and Biventricular Pacing. To schedule an appointment with Dr. Stanton in Orange City, talk to your family doctor or call 877-220-2929. Orange City Area Health System now offers paperless billing statements. To receive paperless statements, you simply need to sign up for MyChart personal health records. Once logged in to your MyChart account, sign up for paperless statements on the home screen. You will receive an email alert monthly when your statement is ready to view in MyChart. You can also pay your bill online through MyChart. When cancer strikes close to home, it’s nice to know you can receive care and therapy at Orange City Area Health System. Our Infusion Center provides chemotherapy/biotherapy so you don’t have to travel far for compassionate, quality, personalized care. The Infusion Center is open M-F 8am-4pm, offering treatments for Cancer, Rheumatoid arthritis, Osteoporosis, Crohn’s Disease, IV antibiotics, and much more! Being open five days a week has expanded our ability to monitor outpatient schedules and get to know our patients on a more personal level. Our infusion center staff work closely with physicians from all area hospitals to take care of our local patients’ outpatient needs. Oncologists Dr. Rhada Rao and Dr. Stephen Kahanic from the June E. Nylen Cancer Center / Siouxland Hematology-Oncology are on-site three times a month to consult with patients. It is been a cloudy spring so far. But that doesn’t mean the dog days of summer aren’t around the corner. Hopefully it means more outside time for all of us. And with that comes sun exposure. Time outside in the sun with loved ones, pursuing a hobby, or even your everyday work can be very enjoyable. But it also involves risk. Sun exposure is the major risk factor for skin cancers including the fastest growing skin cancer in the United States – melanoma. Sun exposure is additive or cumulative. That means those sunburns we get when we are young, contribute to skin problems when we are older. Each sun exposure, even if it only results in tanning, increases the risk for skin cancer and skin damage. Protection from the harmful rays of the sun is important whether you are young or old. So what can you do? Consider your skin type: If you have fair skin, red or blonde hair, or light -colored eyes, you are likely to sunburn than a dark skin toned person. If he you have already had sunburns in your lifetime, you already have a higher risk of skin cancer. It is even more important to protect your skin from further sun damage. Consider your surroundings: Would working or visiting in the shade be equally as enjoyable as sitting in the sun? Are you on the water? Water reflects some of the rays back to you; so you are getting more exposure than if you were on grass. Concrete or pavement has the same effect as water. Elevation makes a difference. The higher the elevation the less atmosphere to filter out those harmful rays. And latitude also makes a difference. Protecting yourself on vacation in Florida during January is important. If you are in the sun what can you do? Wear protective clothing. A long sleeve shirt will provide more protection than a T-shirt. Long pants obviously cover more than shorts do. And don’t forget about those parts you can’t see – the back of your neck and the tops of your head and ears. A wide brim hat will cover those, where a baseball cap may not. For those areas that are sun exposed and cannot be covered up, use a sunscreen. This is especially important for children and adolescents. Use sunscreen with SPF 30 or higher. Try to avoid the peak sun hours of 10 AM to 2 PM. If you are sweating a lot or swimming, reapply frequently. And yes fishermen rinse your hands, apply your bait, and then REAPPLY the sunscreen. Lastly, what should we watch for to see if we do contract skin cancer? Most skin cancers occur as a new growth that is continuing to enlarge. Often these act like sores that won’t heal or keep coming back. For the most dreaded type of skin cancer, melanoma, think about the ABCDEFs: • Asymmetry – irregular or “funny” shape. • Border irregularity – an outgrowth or “feeler” projecting from the skin spot. • Color variability – several different shades or changing color of the spot. • Diameter – larger than 6 mm or larger than the size of a pencil eraser. • Evolution – a progressive change in the size, color or border. • Feeling – a change in the way the spot feels like roughening or itching. If you have a skin spot that concerns you, be sure to talk to your family health care provider about it. Proper skin protection can help to keep all your “mole problems” in the garden and not in the doctor’s office. Enjoy the sunny days, but don’t let them harm you. Medical laboratory professionals provide vital information about patients’ health. Up to 85% of decisions about diagnosis and treatment are based on laboratory test results. Our staff of lab professionals at Orange City Area Health System perform over 200,000 tests each year. We salute this team and thank them for their 24/7 dedication to our patients and providers! Learn more here. Injury and disease can influence the way we use our bodies. From a lingering limp after an ankle sprain, to avoiding a handshake following an arm injury, to missing out on water skiing from fear of reinjuring a knee …getting back to the important, fun, and necessary parts of our lives is often benefited from evaluation and treatment by a therapist in the Physical/ Occupational Therapy Department at Orange City Area Health System. A physical therapist or occupational therapist will give you guidance and confidence to get moving within the boundaries that are safe, which will optimize your ability to meet your goals. Stacy Wernimont-Diehl, OTR/L, recalls a patient,“Ann,” who was recovering from a fracture near her wrist. Ann expressed great appreciation in the specific techniques and exercises she was taught. These, in addition to the treatment Stacy provided in the clinic, helped her to meet her goal of “getting rid of swelling.” Ann also recalled sharing with her husband the new knowledge she had gained on the importance of preventing scar adhesions to her tendons. Ann and Stacy collaborated throughout rehabilitation to develop goals as Stacy shared knowledge about timelines and milestones for getting back to more activity. This is but one strong story of being empowered to reach goals. Getting a new knee is an undertaking that is benefited by preparation and teamwork. Working with a physical therapist before and after surgery is critical to returning to activities that you enjoy. Rosemary Schilmoeller, who recently had a knee replacement said, “Everyone I’ve worked with here is very good and have been very helpful to help me reach my goals of dancing at my granddaughter’s wedding this summer and getting back to walking wherever I want.” Sue Blankers, DPT, Rosemary’s physical therapist, explains: “We’ve taken into consideration Rosemary’s previous hip replacement in how we’ve developed a rehabilitation plan which helped her set expectations for activity, and helped her set and meet her goals.” The therapists consider patients’ expectations for returning to activities when guiding people through the rehab process. Often therapists get to influence people’s assumptions about the rehab process to help achieve an optimal outcome. Assumptions about pain are a significant area where a therapist’s instruction can help patients understand their pain more accurately, assisting in goal attainment. An expectation of progress is always assumed, and the therapists promote confidence that progress is being made by celebrating milestones reached, reviewing the patient’s progress and history of improvement, and explaining the different sensations a patient experiences throughout the rehab process. Physical and Occupational Therapy: Empowering people through knowledge.

Chances are, if you or a loved one has had an orthopedic procedure done at Orange City Area Health System – including ACL repairs, shoulder surgeries, or total knee replacements – you were in the good hands of Dr. Thomas Jacobson. “Jake” has been part of our team, coming to Orange City for over 20 years from CNOS in Dakota Dunes. Good news! Dr. Jacobson is now seeing patients and doing surgical procedures every week! He schedules surgeries on Tuesdays, and sees patients for evaluation and follow-up in our specialty/outreach clinic on Thursdays. Dr. Jacobson works closely with your family physician, our sports medicine doctors, and our physical therapists to offer you skilled and experienced solutions right here, close to home. If you need a certain procedure just ask, “Can I have it here?” To see Dr. Jacobson, you can get a referral from your family medicine provider or call 712-737-5276.Note: Deb is an RN in our sports medicine clinic, working closely with Dr. Mark Muilenburg and Dr. Philip Van De Griend. She is also the honorable Mayor of Orange City. My oldest grandson, Kade, turned nine on March 11, 2017. When he was three and his brother, Grayson turned one, I realized the constant pain in both of my knees was preventing me from being the grandparent they deserved – and the grandparent I wanted to be at the age of 54. Getting up off the floor after playing cars was extremely difficult … playing ball outside was too painful … and I could barely move after our weekends together. I told Dr. Muilenburg, “I am not going to live like this,” and I requested a referral to Dr. Jacobson, orthopedic surgeon. He agreed and reassured me they were doing knee replacements in 50-year-olds quite frequently. Dr. Jacobson performed my first knee replacement on my left knee on 10/04/11 at Orange City Area Health System. The surgery was a gift – and I never looked back. Was the physical therapy and rehabilitation and recovery tough? You bet it was. But I had my grandsons as my goal and I pushed hard to recover quickly. Physical therapist Sue Blankers and her team at our health system made all the difference. I am very fortunate to work at Orange City Area Health System (OCAHS) with Dr. Muilenburg and have the perfect job for rehab, so I was back at work two weeks post-op because walking the hallways of the clinic was perfect therapy – and provided great motivation for me. Everyone’s recovery is different but with the team at OCAHS you can not help but be successful. So when May of 2012 rolled around I was excited to get my right knee replacement scheduled with Dr. Jacobson. In my opinion he is a rockstar! I am now six years out from my knee replacements, and grandson number three, Bennett, has joined the clan. I don’t even think about my knees anymore! I am forever grateful to Dr. Jacobson, the physical therapy/rehab team, and Orange City Area Health System for giving me life without pain.

Most of us who were young in the 1980s would answer that question with, “Ghostbusters!” But there is a growing question about who you are going to be able to “call” (more accurately “see”) when you need medical care. In a recent report prepared for the Association of American Medical Colleges, the projected shortfall for all physicians by 2025 is 46,000 to 94,000; for primary care it is 14,900 to 35,600.* So insurance or not, access may be an issue.

How then do we answer the pressures of growing medical needs? One of the answers has been the rise of the non-physician practitioner. There have been many names to describe this group of providers: physician extender, mid-level provider, advance-level practitioner, advance-practice provider … to name a few. I know I have displeased some, mentioning those names. The fact of the matter is, there is no single term to call this group of professionals that everyone is happy with. So my apologies to any offended parties if I am using a term you are uncomfortable with. There are many professions that fall into this grouping, and each has its own education requirements. The list can be extensive, but for purposes of this article I will refer to the two groups we work with at Orange City Area Health System on the clinic side: Nurse Practitioners (NPs) and Physician Assistants (PAs). These are not the only non-physician practitioners we work with at the health system, but they are the two types that work hand-in-hand with our physicians to provide care at our clinics. It takes significant work, study, and training to become one of these professionals. Both professions require a college degree, medical care- giving experience, and training after college. The post-bachelor degree (NP or PA) requires classroom as well as clinical experience (hands-on training) for at least two years (and usually more). After graduating from an approved post-collegiate program, both professions require passing a certification examination before they can start practicing. Additionally, just like physicians, both professions require ongoing continuing medical education and periodic recertification. So while both PAs and NPs follow a path not dissimilar to physicians in medical school, most do not incorporate a residency program as physicians do. I believe this is because most are anticipating practicing alongside physicians who are available for consultation and guidance in patient care. This has worked very well at Orange City Area Health System. The doubling of medical knowledge was 3.5 years in 2010 – and by 2020 it is expected to be 0.2 years (73 days).** No one can know it all. And I have been blessed to practice at OCAHS where I have colleagues I can call on in their areas of expertise. Working together as a team, we provide far better care than any of us could individually. So let me return to my earlier quandary about what to call this group of professionals. There is no single term that captures what this group does and is capable of doing. Perhaps one day, someone will coin the correct term. But for now, I am blessed to call each and every one of them a colleague. And even better than that, I get to call them a friend. And that is part of what makes Orange City Area Health System a great place to work.